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1.
Artigo em Inglês | MEDLINE | ID: mdl-32942345

RESUMO

Background: There is a paucity of studies on treatment of childhood-onset bipolar disorder and its associated comorbidities, which leads to a wide diversity of opinion on choice and sequencing of treatment options. Methods: From December 2018 to January 2019, a graphic depiction of medications and weekly ratings of symptoms of mania, depression, anxiety, attention-deficit/hyperactivity disorder (ADHD), and oppositional behavior that parents had rated on their 9-year-old child over a period of several years was sent to experts in child and adult bipolar disorder. These responding medical doctors (MDs, 8 child and 18 adult psychiatrists) rated a comprehensive list of medications that they would choose (and with what priority) to treat the child's now improved mood (mania and depression) but continued mild to moderate symptoms of anxiety, ADHD, and oppositional behavior. Results: In the whole group, the drugs most highly endorsed were lamotrigine: 69%, lithium: 62%, lurasidone: 62%, quetiapine: 54%, aripiprazole: 46%, and valproate: 42%. Among the antidepressants, 38% endorsed a selective serotonin reuptake inhibitor, 12% a serotonin-norepinephrine reuptake inhibitor, and 27% bupropion. Of the child MDs, 75% suggested increasing the 1-mg dose of risperidone, while few adult MDs suggested this. Conversely, 56% of the adult MDs suggested using valproate, while only 1 child MD did so. There was little consensus on how to manage ADHD symptoms unresponsive to methylphenidate 36 mg/d. How these treatment options were sequenced also varied widely. Conclusions: There was wide variation in suggestions on to how to treat persistent symptoms of anxiety, ADHD, and oppositional behavior in a child whose mania and depression had been brought under good control. We surmise that this great diversity in recommendations among experts in child and adult bipolar disorder stems at least partially from inadequate literature on treatment and that a new emphasis on funding and conducting studies on efficacy and effectiveness is needed.


Assuntos
Transtornos de Ansiedade/tratamento farmacológico , Transtornos de Deficit da Atenção e do Comportamento Disruptivo/tratamento farmacológico , Transtorno Bipolar/tratamento farmacológico , Psicotrópicos/uso terapêutico , Transtorno do Deficit de Atenção com Hiperatividade/tratamento farmacológico , Transtorno Bipolar/terapia , Criança , Consenso , Feminino , Humanos , Prevenção Primária , Indução de Remissão
2.
Adv Mind Body Med ; 34(3): 4-10, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32931456

RESUMO

Background: This case report illustrates that the use of a series of lifestyle interventions delivered via the "Vital Mind Reset" online program led to the resolution of disabling psychiatric symptoms. Summary: A 40-year-old, married, Caucasian female, with onset of suicidal ideation as a teenager, was treated with antidepressants and was later formally diagnosed with dissociative identity disorder (DID), borderline personality traits, and bipolar disorder (BD). In the ensuing years, the patient was treated with 35 psychiatric medications. Additionally, she experienced numerous hospitalizations and received over 30 electroconvulsive therapy (ECT) treatments. Despite this extensive conventional treatment, she reported limited gains. In October 2017, the patient committed to the Vital Mind Reset (VMR) online program and implemented a series of lifestyle changes over 44 days, starting with 30 days of dietary, meditation, and lifestyle protocols, followed by supplementation. Notably, the patient has since resolved both physical and psychiatric symptoms including fatigue, acne, migraines, cold sweats, dizziness, nausea, blood sugar crashes, resting tremors, brain fog, anxiety, depression, suicidal ideation, auditory hallucinations, and delusions. In this patient's case, hypertension, bradycardia, headaches, increased frequency of mania, tremors, insomnia, and weight gain accompanied her medications. This case exemplifies the dramatic resolution of disabling psychiatric symptoms after engagement in the lifestyle interventions outlined in the VMR program, medication taper, and supplementation. When medication demonstrates limited clinical yield and a plethora of side effects, tapering combined with lifestyle interventions and supplementation should be considered as first-line therapy. This case is evidence of the potential for healing and resolution of severe and persistent psychiatric illness with dietary and lifestyle changes.


Assuntos
Transtorno Bipolar , Transtorno da Personalidade Borderline , Transtorno Dissociativo de Identidade , Eletroconvulsoterapia , Adulto , Transtorno Bipolar/terapia , Transtorno da Personalidade Borderline/terapia , Feminino , Humanos , Estilo de Vida
3.
BMJ Case Rep ; 13(9)2020 Sep 17.
Artigo em Inglês | MEDLINE | ID: mdl-32943446

RESUMO

The global threat posed by the COVID-19 pandemic has highlighted the need to accurately identify the immediate and long-term postdisaster impacts on disaster-relief workers. We examined the case of a local government employee suffering from post-traumatic stress disorder (PTSD) and bipolar II disorder following the Great East Japan Earthquake. The complex and harsh experience provoked a hypomanic response such as elated feelings with increased energy, decreased need for sleep and an increase in goal-directed activity, which allowed him to continue working, even though he was adversely affected by the disaster. However, 3.5 years later, when he suffered further psychological damage, his PTSD symptoms became evident. In addition to treating mood disorders, trauma-focused psychotherapy was required for his recovery. Thereafter, we considered the characteristics of mental health problems that emerge in disaster-relief workers, a long time after the disaster, and the conditions and treatments necessary for recovery.


Assuntos
Transtorno Bipolar/psicologia , Terremotos , Acidente Nuclear de Fukushima , Socorro em Desastres , Transtornos de Estresse Pós-Traumáticos/psicologia , Tsunamis , Adulto , Betacoronavirus , Transtorno Bipolar/terapia , Infecções por Coronavirus , Desastres , Humanos , Terapia Implosiva , Masculino , Pandemias , Pneumonia Viral , Transtornos de Estresse Pós-Traumáticos/terapia
5.
PLoS One ; 15(7): e0235409, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32726314

RESUMO

OBJECTIVES: To identify inequalities in cancer survival rates for patients with a history of severe psychiatric illness (SPI) compared to those with no history of mental illness and explore differences in the provision of recommended cancer treatment as a potential explanation. DESIGN: Population-based retrospective cohort study using linked cancer registry and administrative data at ICES. SETTING: The universal healthcare system in Ontario, Canada. PARTICIPANTS: Colorectal cancer (CRC) patients diagnosed between April 1st, 2007 and December 31st, 2012. SPI history (schizophrenia, schizoaffective disorders, other psychotic disorders, bipolar disorders or major depressive disorders) was determined using hospitalization, emergency department, and psychiatrist visit data and categorized as 'no history of mental illness, 'outpatient SPI history', and 'inpatient SPI history'. MAIN OUTCOME MEASURES: Cancer-specific survival, non-receipt of surgical resection, and non-receipt of adjuvant chemotherapy or radiation. RESULTS: 24,507 CRC patients were included; 482 (2.0%) had an outpatient SPI history and 258 (1.0%) had an inpatient SPI history. Individuals with an SPI history had significantly lower survival rates and were significantly less likely to receive guideline recommended treatment than CRC patients with no history of mental illness. The adjusted HR for cancer-specific death was 1.69 times higher for individuals with an inpatient SPI (95% CI 1.36-2.09) and 1.24 times higher for individuals with an outpatient SPI history (95% CI 1.04-1.48). Stage II and III CRC patients with an inpatient SPI history were 2.15 times less likely (95% CI 1.07-4.33) to receive potentially curative surgical resection and 2.07 times less likely (95% CI 1.72-2.50) to receive adjuvant radiation or chemotherapy. These findings were consistent across multiple sensitivity analyses. CONCLUSIONS: Individuals with an SPI history experience inequalities in colorectal cancer care and survival within a universal healthcare system. Increasing advocacy and the availability of resources to support individuals with an SPI within the cancer system are warranted to reduce the potential for unnecessary harm.


Assuntos
Transtorno Bipolar/terapia , Neoplasias Colorretais/terapia , Transtorno Depressivo Maior/terapia , Esquizofrenia/terapia , Adulto , Transtorno Bipolar/complicações , Transtorno Bipolar/epidemiologia , Transtorno Bipolar/patologia , Sobreviventes de Câncer/psicologia , Quimioterapia Adjuvante , Estudos de Coortes , Neoplasias Colorretais/complicações , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/patologia , Transtorno Depressivo Maior/complicações , Transtorno Depressivo Maior/epidemiologia , Transtorno Depressivo Maior/patologia , Serviço Hospitalar de Emergência , Feminino , Hospitalização , Humanos , Pacientes Internados/psicologia , Masculino , Pessoa de Meia-Idade , Ontário/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Esquizofrenia/complicações , Esquizofrenia/epidemiologia , Esquizofrenia/patologia
8.
Am J Public Health ; 110(9): 1308-1314, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32673109

RESUMO

Objectives. To examine whether growing use of telemental health (TMH) has reduced the rural-urban gap in specialty mental health care use in the United States.Methods. Using 2010-2017 Medicare data, we analyzed trends in the rural-urban difference in rates of specialty visits (in-person and TMH).Results. Among rural beneficiaries diagnosed with schizophrenia or bipolar disorder, TMH use grew by 425% over the 8 years and, in higher-use rural areas, accounted for one quarter of all specialty mental health visits in 2017. Among patients with schizophrenia or bipolar disorder, TMH visits differentially grew in rural areas by 0.14 visits from 2010 to 2017. This growth partially offset the 0.42-visit differential decline in in-person visits in rural areas. In net, the gap between rural and urban patients in specialty visits was larger by 2017.Conclusions. TMH has improved access to specialty care in rural areas, particularly for individuals diagnosed with schizophrenia or bipolar disorder. While growth in TMH use has been insufficient to eliminate the overall rural-urban difference in specialty care use, this difference may have been larger if not for TMH.Public Health Implications. Targeted policy to extend TMH to underserved areas may help offset declines in in-person specialty care.


Assuntos
Transtorno Bipolar/terapia , População Rural/estatística & dados numéricos , Esquizofrenia/terapia , Telemedicina/tendências , População Urbana/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Medicare/estatística & dados numéricos , Pessoa de Meia-Idade , Estados Unidos
10.
Cien Saude Colet ; 25(suppl 1): 2457-2460, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32520289

RESUMO

Mental disorders (MD) are commonly comorbid with cardiovascular, metabolic, and some infectious diseases. Since the current SARS-CoV-2 epidemic is affecting the most multimorbid individuals, we might expect that the epidemic will be particularly problematic for people with MD. Understanding the burden of an outbreak on mental health is fundamental to effective action towards containing the spread of the disease, as psychopathology might reduce endurance during the lockdown. This can potentially reduce adhesion to ongoing treatment resulting in avoidable recurrence of a disorder. Additionally, there is the stress caused by the eminent risk of infection or economic uncertainty, especially in low-middle income settings. This is an overview on the expected influence of the COVID-19 on mental health from a research group that has not long ago been involved in the Zika epidemic. It aims to discuss the effects of the pandemic on a Low and Middle-Income country (LMIC), Brazil.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/psicologia , Países em Desenvolvimento , Saúde Mental , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/psicologia , Transtorno Bipolar/psicologia , Transtorno Bipolar/terapia , Brasil , Cuidadores , Demência/enfermagem , Família , Acesso aos Serviços de Saúde , Humanos , Transtornos Mentais/tratamento farmacológico , Transtornos Mentais/epidemiologia , Transtornos Mentais/psicologia , Multimorbidade , Sensação , Isolamento Social
11.
Encephale ; 46(3S): S40-S42, 2020 Jun.
Artigo em Francês | MEDLINE | ID: mdl-32370981

RESUMO

The recent COVID-19 pandemic has led to major organisational changes in health care settings, especially in psychiatric hospitals. We conducted a national online survey to assess the evolution of electroconvulsive therapy (ECT) in the different centres practicing this treatment. 65 responses from all over France were analysed. More than 90 % of the centres practising ECT experienced a decrease in their activity. Half of the centres experienced a total cessation of activity and 25 % of the centres experienced a decrease of more than half of their usual activity. Post-pandemic COVID-19 psychiatric care is expected to be difficult. It is essential not to add to this difficulty the complications, often serious, that will be associated with delaying or stopping the practice of ECT. It will also be necessary to remain vigilant with regard to the specific neuropsychiatric consequences that will follow the pandemic.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Eletroconvulsoterapia/tendências , Hospitais Psiquiátricos/organização & administração , Pandemias , Pneumonia Viral , Transtorno Bipolar/terapia , Controle de Doenças Transmissíveis , Continuidade da Assistência ao Paciente , Assistência à Saúde , Transtorno Depressivo/terapia , Eletroconvulsoterapia/estatística & dados numéricos , França , Humanos , Utilização de Procedimentos e Técnicas
12.
Behav Cogn Psychother ; 48(5): 615-620, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32372734

RESUMO

BACKGROUND: Alcohol misuse is common in bipolar disorder and is associated with worse outcomes. A recent study evaluated integrated motivational interviewing and cognitive behavioural therapy for bipolar disorder and alcohol misuse with promising results in terms of the feasibility of delivering the therapy and the acceptability to participants. AIMS: Here we present the experiences of the therapists and supervisors from the trial to identify the key challenges in working with this client group and how these might be overcome. METHOD: Four therapists and two supervisors participated in a focus group. Topic guides for the group were informed by a summary of challenges and obstacles that each therapist had completed at the end of therapy for each individual client. The audio recording of the focus group was transcribed and data were analysed using thematic analysis. RESULTS: We identified five themes: addressing alcohol use versus other problems; impact of bipolar disorder on therapy; importance of avoidance and overcoming it; fine balance in relation to shame and normalising use; and 'talking the talk' versus 'walking the walk'. CONCLUSIONS: Findings suggest that clients may be willing to explore motivations for using alcohol even if they are not ready to change their drinking, and they may want help with a range of mental health problems. Emotional and behavioural avoidance may be a key factor in maintaining alcohol use in this client group and therapists should be aware of a possible discrepancy between clients' intentions to reduce misuse and their actual behaviour.


Assuntos
Transtorno Bipolar , Terapia Cognitivo-Comportamental , Entrevista Motivacional , Consumo de Bebidas Alcoólicas , Transtorno Bipolar/terapia , Humanos , Relações Profissional-Paciente
13.
Psychiatry Res Neuroimaging ; 301: 111086, 2020 07 30.
Artigo em Inglês | MEDLINE | ID: mdl-32464340

RESUMO

Electroconvulsive therapy (ECT) is an effective treatment for major depression. Previous studies suggested that dopaminergic neurotransmission plays a crucial role in the mechanism of the action of ECT. Since dopamine transporters (DAT) regulate extracellular dopamine concentration, DAT represents an interesting target for the study of the mechanism of action of ECT. Eight inpatients (7 patients with major depressive disorder and 1 patient with bipolar disorder with a DSM-IV diagnosis) received a series of 7-15(11.3±5.2) bilateral ECT sessions.The severity of symptoms was assessed using the 21-item Hamilton Depression Rating Scale (HDRS) and Clinical Global Impression-Severity (CGI-S). All patients were examined with [18F]FE-PE2I positron emission tomography (PET) at pre-ECT, after the 10th ECT, and at post-ECT. Striatal DAT-binding potential (BPND) of all patients was reduced, with an average change ratio of DAT-BPND of -13.1±5.6%. In the 2 cases with 15 ECT sessions, the ratio change of DAT-BPND after the 15th ECT was larger than that after the 10th ECT. Also, HDRS and CGI-S were reduced. These results indicate that the dopamine nervous system is part of themechanism of action of ECT.


Assuntos
Transtorno Bipolar/metabolismo , Corpo Estriado/metabolismo , Transtorno Depressivo Maior/terapia , Proteínas da Membrana Plasmática de Transporte de Dopamina/metabolismo , Eletroconvulsoterapia/métodos , Adulto , Idoso , Transtorno Bipolar/terapia , Corpo Estriado/diagnóstico por imagem , Transtorno Depressivo Maior/metabolismo , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons/métodos , Resultado do Tratamento , Adulto Jovem
14.
PLoS One ; 15(5): e0232798, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32437356

RESUMO

The treatment of depressive symptoms of bipolar disorder (BD) has received increasing attention. Recently, some studies have shown that bright light therapy (BLT) seems to be useful for BD depression. This meta-analysis is intended to further elucidate the role of BLT in depressive symptoms in patients with BD. Register of Systematic Reviews PROSPERO: CRD 420191 33642.Randomized controlled trials and cohort studies were retrieved in PubMed, Cochrane Library, EMbase, Web of Science, CINHAL, CBM, CNKI, VIP, and Wanfang from their foundation to March 2020, and other sources as supplement was also retrieved. Data were extracted after strict evaluation of literature quality by two researchers, and Meta-analysis was conducted on literatures that met the inclusion criteria. Meta-analysis was performed using Revman 5.3 software. In total, 12 studies including 847 patients with BD depression were included in our meta-analysis. A meta-analysis found significant differences between BLT and placebo for the following outcomes: (1) depression severity before and after BLT [SMD = -0.43, 95% CI (-0.73,-0.13), P<0.05] in RCT and [SMD = -2.12, 95% CI (-2.3,-1.94), P<0.05] in cohort studies.; (2) the efficacy of duration/timing of light therapy for depressive symptoms in BD [I2 = 85%, SMD = -1.88, 95% CI (-2.04, -1.71),P<0.05] and [I2 = 71%, SMD = -2.1,95% CI(-2.24, -1.96), P<0.05]; (3) the efficacy of different color/color temperatures for depressive symptoms in BD [I2 = 0%, SMD = -0.56, 95% CI (-0.92, -0.19), P<0.05] and [I2 = 97%, SMD = -1.74, 95% CI (-1.99, -1.49), P<0.05].We performed a subgroup meta-analysis of studies that used different light intensities. The results showed that light intensity≥5000 lux significantly reduced the severity of depression. And patients without psychotropic drugs revealed significantly decreased disease severity [I2 = 0%, SMD = -0.6, 95% CI (-1.06,-0.13), P<0.05]. Limitations of the study include studies only assessed short-term effects, and insufficient duration may underestimate adverse reactions and efficacy. Our results highlight the significant efficiency of BLT in the treatment of bipolar depression. Prospective studies with more rigorous design and consistent follow-up.


Assuntos
Transtorno Bipolar/terapia , Depressão/terapia , Fototerapia , Transtorno Bipolar/complicações , Transtorno Bipolar/epidemiologia , Transtorno Bipolar/patologia , Depressão/complicações , Depressão/epidemiologia , Depressão/patologia , Feminino , Humanos , Masculino , Ensaios Clínicos Controlados Aleatórios como Assunto
15.
Obstet Gynecol Surv ; 75(3): 199-203, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32232498

RESUMO

Importance: Approximately 10% to 16% of women meet diagnostic criteria for depression during pregnancy. Untreated maternal depression is associated with adverse pregnancy outcomes including premature birth, low birth weight, and fetal growth restriction. objective: The aim of this study is to review the current safety data on electroconvulsive therapy (ECT) in pregnancy and provide guidance to clinicians on the role of ECT in pregnancy and the special considerations for its use in our population. Evidence Acquisition: We reviewed 4 meta-analyses on the use of ECT in pregnancy as well as the source material (case series, etc) for these meta-analyses. We reviewed the official position statements on ECT in pregnancy from obstetric and psychiatric governing bodies as well as clinical best practice information from practitioners of ECT in pregnancy. Results: Electroconvulsive therapy may be underutilized due to stigma and lack of access for these women. Rates of ECT use in pregnancy are difficult to determine. There are physiologic differences in pregnancy that merit additional attention during ECT, including increased risk of aspiration, concern for aortocaval compression, and the possibility of fetal heart rate changes associated with prolonged seizure activity. Serious adverse outcomes associated with ECT use in pregnancy are rare. Conclusions and Relevance: Electroconvulsive therapy is a highly effective and safe treatment modality for unipolar depression, bipolar disorder, schizophrenia, and other psychiatric illnesses. Electroconvulsive therapy treatment in pregnancy requires a multidisciplinary team approach with obstetrics, maternal-fetal medicine, psychiatry, and anesthesiology, but is overall felt to be safe and effective.


Assuntos
Transtorno Depressivo/terapia , Eletroconvulsoterapia/métodos , Transtornos Mentais/terapia , Complicações na Gravidez/terapia , Cuidado Pré-Natal/métodos , Transtorno Bipolar/terapia , Feminino , Acesso aos Serviços de Saúde , Humanos , Equipe de Assistência ao Paciente , Gravidez , Complicações na Gravidez/psicologia , Resultado da Gravidez , Esquizofrenia/terapia , Resultado do Tratamento
16.
Behav Cogn Psychother ; 48(5): 515-529, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32317034

RESUMO

BACKGROUND AND AIM: This study investigated the effects of group cognitive behavioural therapy (CBT) for patients with bipolar disorder. The development of CBT for this disorder is relatively under-explored. METHOD: Participants with bipolar I or II disorder were treated with group CBT in addition to treatment as usual. The effectiveness of the protocol was explored through sequence analysis of daily mood monitoring prior to, during and after the intervention. Also, a repeated measures design was used assessing symptomatology, dysfunctional attitudes, sense of mastery, psychosocial functioning, and quality of life at start and end of intervention, and at follow-up 2 and 12 months later. RESULTS: The results indicate that variation in mood states diminished over the course of the intervention. Also, there was a change from depressive states to more euthymic states. Greater number of reported lifetime depressive episodes was associated with greater diversity of mood states. There was an increase in overall psychosocial functioning and self-reported psychological health following the intervention. Improvement continued after treatment ended until follow-up at 2 months, and measured 1 year later, for outcomes representing depression, general psychosocial functioning and self-reported psychological health. Due to small sample size and the lack of a control group the results are preliminary. CONCLUSIONS: The results of this pilot study suggest that both offering CBT in group interventions and sequence analysis of time series data are helpful routes to further explore when improving standard CBT interventions for patients suffering from bipolar disorder.


Assuntos
Transtorno Bipolar , Terapia Cognitivo-Comportamental , Psicoterapia de Grupo , Transtorno Bipolar/terapia , Cognição , Humanos , Projetos Piloto , Qualidade de Vida
17.
Am J Psychother ; 73(3): 107-114, 2020 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-32306747

RESUMO

OBJECTIVE: This study compared relapse rates at 18 months among patients with bipolar disorder who, after discharge from publicly funded mental health services, received either adjunctive interpersonal and social rhythm therapy (IPSRT) or treatment as usual (general practice medical care). METHODS: Patients diagnosed as having a bipolar I or II disorder who had been discharged from publicly funded mental health services in New Zealand during the previous 3 months were randomly assigned to 18 months of IPSRT or to treatment as usual. The primary outcome measure was the Life Interval Follow-Up Evaluation (LIFE) completed at weeks 26, 52, and 78 of treatment. Secondary measures were scores on the Social Adjustment Scale (SAS) and the Quality of Life-Bipolar Disorder Scale (QoL-BD) and readmission to mental health services. RESULTS: The sample consisted of 88 patients. In this intention-to-treat analysis, no significant differences were observed in rates of mood episodes between the groups (odds ratio=0.93, 95% confidence interval=0.37-2.17, p=0.86). A statistically significant difference was seen between the intervention and treatment-as-usual groups in scores on the SAS (effect size=0.5) but not on the QoL-BD. A significantly lower readmission rate was observed among the intervention group. CONCLUSIONS: This pragmatic clinical effectiveness trial found that a combination of IPSRT and medication management over 18 months did not significantly improve mood relapse but did improve patient functioning.


Assuntos
Transtorno Bipolar/terapia , Psicoterapia , Adulto , Afeto , Feminino , Humanos , Relações Interpessoais , Masculino , Qualidade de Vida , Resultado do Tratamento
18.
Behav Cogn Psychother ; 48(4): 395-407, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32157985

RESUMO

BACKGROUND: Sleep and mood are known to be linked and this is particularly evident in people with a diagnosis of bipolar disorder (BD). It has been proposed that psychological interventions improving sleep can be a pathway for improving mood. In order for a psychological sleep intervention to be appropriate, the common cognitive processes maintaining the range of sleep disturbances need to be investigated. AIM: This study aimed to explore and identify expert consensus on positive and negative sleep appraisals in the context of low and high mood states, using the Integrative Cognitive Model as a theoretical guide. METHOD: A Delphi approach was utilized to allow clinical and research professionals, with experience in the field of BD, to be anonymously consulted about their views on sleep appraisals. These experts were invited to participate in up to three rounds of producing and rating statements that represented positive and negative sleep appraisals. RESULTS: A total of 38 statements were developed and rated, resulting in a final list of 19 statements that were rated as 'essential' or 'important' by >80% of the participants. These statements represent the full range of extreme sleep appraisals this study had set out to explore, confirming the importance of better understanding and identifying positive and negative sleep cognitions in the context of high and low mood. CONCLUSION: The statements reviewed in this study will be used to inform the development of a sleep cognition measure that may be useful in cognitive therapy addressing sleep disturbances experienced along the bipolar spectrum.


Assuntos
Transtorno Bipolar , Afeto , Transtorno Bipolar/terapia , Cognição , Técnica Delfos , Depressão , Humanos
19.
BMC Health Serv Res ; 20(1): 219, 2020 Mar 17.
Artigo em Inglês | MEDLINE | ID: mdl-32183787

RESUMO

BACKGROUND: Despite the potential of digital health interventions to improve the delivery of psychoeducation to people with mental health problems and their relatives, and substantial investment in their development, there is little evidence of successful implementation into clinical practice. We report the first implementation study of a digital health intervention: Relatives Education And Coping Toolkit (REACT), into routine mental healthcare. Our main aim was to identify critical factors affecting staff uptake and use of this online self-management tool for relatives of people with psychosis or bipolar. METHODS: A mixed-methods, theory-driven (Normalisation Process Theory), iterative multiple case study approach using qualitative analysis of interviews with staff and quantitative reporting of uptake. Carer researchers were part of the research team. RESULTS: In all, 281 staff and 159 relatives from Early Intervention teams across six catchment areas (cases) in England registered on REACT; 129 staff took part in qualitative interviews. Staff were positive about REACT helping services improve support and meet clinical targets. Implementation was hindered by: high staff caseloads and difficulties prioritising carers; perception of REACT implementation as research; technical difficulties using REACT; poor interoperability with trust computer systems and care pathways; lack of access to mobile technology and training; restricted forum populations; staff fears of risk, online trolling, and replacement by technology; and uncertainty around REACT's long-term availability. CONCLUSIONS: Digital health interventions, such as REACT, should be iteratively developed, evaluated, adapted and implemented, in partnership with the services they aim to support, and as part of a long term national strategy to co-develop integrated technology-enabled mental healthcare. Implementation strategies must instil a sense of ownership for staff and ensure they have adequate IT training, appropriate governance protocols for online working, and adequate mobile technologies. Wider contextual factors including adequate funding for mental health services and prioritisation of carer support, also need to be addressed for successful implementation of carer focussed digital interventions. TRIAL REGISTRATION: Study registration: ISCTRN 16267685.


Assuntos
Atitude do Pessoal de Saúde , Transtorno Bipolar/terapia , Cuidadores , Instrução por Computador , Educação a Distância , Educação em Saúde/métodos , Serviços de Saúde Mental , Transtornos Psicóticos/terapia , Adaptação Psicológica , Atitude Frente aos Computadores , Inglaterra , Família , Humanos , Internet , Autogestão
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