Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 12.074
Filtrar
1.
J Ment Health Policy Econ ; 22(3): 95-108, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31811753

RESUMO

BACKGROUND: Psychosis onset commonly occurs at ages 16-30 when individuals are typically developing their education, employment and career trajectories. Coordinated specialty care (CSC) programs provide access to team-based early invention services for psychosis, including supported education and employment (SEE) services. AIMS OF STUDY: We examine factors associated with the use of SEE services and whether use of SEE services (for supported education, supported employment, or both) is associated with education and employment participation within New York's CSC program, OnTrackNY. METHODS: Participants (n=779) enrolled in OnTrackNY from October 2013-September 2017. Assessments were collected by clinical staff at admission, quarterly, and at discharge. Logistic regression models were specified to identify factors associated with the probability of use of SEE specialist services during the first year of program participation, using generalized estimating equations with an autoregressive covariance structure to account for within-subject correlations over time. Logistic models were also used to predict whether use of SEE services in the prior quarter predict the probability of work and school participation in the subsequent quarter, respectively; these were analyzed cross-sectionally for each time period. Models controlled for other factors associated with work/school outcomes for young people with early psychosis. RESULTS: Participants who were younger, and who had lower rates of work/school participation had greater odds of SEE service use. Use of SEE services for education support in the first quarter among clients under age 23 is significantly associated with school enrollment in the second quarter and this continued through the first year. Use of SEE services for employment support in the first quarter is significantly associated with employment in the second quarter, but significant associations for employment were not found at later periods of participation. Use of SEE services for both education and employment support was inconsistently associated with subsequent school enrollment or employment in the subsequent quarter. Results were upheld when limiting the sample to those not receiving other SEE services. DISCUSSION: Rates of school and work participation increased over the duration of OnTrackNY participation. Clients with lower work/school participation were more likely to use SEE services. Supported education services are associated with greater school participation during the first year for clients under age 23. However, this association is only significant in the first quarter for supported employment services, and is inconsistent when examining those who used both simultaneously. It is possible that we may find significant associations for employment as the program continues. It is also possible that clients may end supported employment services after obtaining employment, while those in school may require ongoing services (e.g. to renew educational accommodations). Additionally, it is possible that OnTrackNY's supported education model, designed to adhere to Individual Placenment and Support (IPS) principles, may be helping clients stay in school. However, as this is an observational study with no control condition, we cannot say that OnTrackNY, or SEE services participation, caused the observed outcomes. IMPLICATIONS FOR FURTHER RESEARCH: Future research should continue to develop the evidence base for supported education services.


Assuntos
Pessoas com Deficiência/psicologia , Intervenção Médica Precoce/métodos , Educação Especial/métodos , Readaptação ao Emprego/métodos , Transtornos Psicóticos/reabilitação , Adolescente , Adulto , Serviços Comunitários de Saúde Mental , Readaptação ao Emprego/estatística & dados numéricos , Hospitalização , Humanos , New York , Desenvolvimento de Programas , Transtornos Psicóticos/complicações , Transtornos Psicóticos/psicologia , Transtornos Psicóticos/terapia , Adulto Jovem
2.
Epidemiol Psychiatr Sci ; 29: e78, 2019 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-31839014

RESUMO

AIMS: Associations between childhood abuse and various psychotic illnesses in adulthood are commonly reported. We aim to examine associations between several reported childhood adverse events (sexual abuse, physical abuse, emotional abuse, neglect and interpersonal loss) among adults with diagnosed psychotic disorders and clinical and psychosocial outcomes. METHODS: Within a large epidemiological study, the 2010 Australian National Survey of Psychosis (Survey of High Impact Psychosis, SHIP), we used logistic regression to model childhood adverse events (any and specific types) on 18 clinical and psychosocial outcomes. RESULTS: Eighty percent of SHIP participants (1466/1825) reported experiencing adverse events in childhood (sexual abuse, other types of abuse and interpersonal loss). Participants reporting any form of childhood adversity had higher odds for 12/18 outcomes we examined. Significant associations were observed with all psychosocial outcomes (social dysfunction, victimisation, offending and homelessness within the previous 12 months, and definite psychosocial stressor within 12 months of illness onset), with the strongest association for homelessness (odds ratio (OR) = 2.82). Common across all adverse event types was an association with lifetime depression, anxiety and a definite psychosocial stressor within 12 months of illness onset. When adverse event types were non-hierarchically coded, sexual abuse was associated with 11/18 outcomes, other types of abuse 13/18 and, interpersonal loss occurring in the absence of other forms of abuse was associated with fewer of the clinical and psychosocial outcomes, 4/18. When adverse events types were coded hierarchically (to isolate the effect of interpersonal loss in the absence of abuse), interpersonal loss was associated with lower odds of self-reproach (OR = 0.70), negative syndrome (OR = 0.75) and victimisation (OR = 0.82). CONCLUSIONS: Adverse childhood experiences among people with psychosis are common, as are subsequent psychosocial stressors. Mental health professionals should routinely enquire about all types of adversities in this group and provide effective service responses. Childhood abuse, including sexual abuse, may contribute to subsequent adversity, poor psychosocial functioning and complex needs among people with psychosis. Longitudinal research to better understand these relationships is needed, as are studies which evaluate the effectiveness of preventative interventions in high-risk groups.


Assuntos
Adultos Sobreviventes de Eventos Adversos na Infância/psicologia , Abuso Sexual na Infância/psicologia , Maus-Tratos Infantis/psicologia , Transtornos Psicóticos/epidemiologia , Adolescente , Adulto , Adultos Sobreviventes de Eventos Adversos na Infância/estatística & dados numéricos , Idoso , Ansiedade/epidemiologia , Ansiedade/psicologia , Austrália/epidemiologia , Criança , Maus-Tratos Infantis/estatística & dados numéricos , Abuso Sexual na Infância/estatística & dados numéricos , Depressão/epidemiologia , Depressão/psicologia , Feminino , Humanos , Acontecimentos que Mudam a Vida , Masculino , Pessoa de Meia-Idade , Prevalência , Transtornos Psicóticos/psicologia , Classe Social , Estresse Psicológico , Adulto Jovem
3.
Psychiatr Danub ; 31(3): 355-357, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31596829

RESUMO

We aimed to compare processing speed (PS) and its subcomponents in schizophrenia (SC) and schizoaffective disorder (SA). Thirty-five patients were divided into two groups (SC=18; SA=17). PS tasks from the MATRICS Consensus Cognitive Battery Central/South America version were used. Additional PS subcomponents were analyzed (i.e., behavioral execution, response processing, and accuracy). SA obtained significant higher scores than SC in response processing, verbal fluency and the PS general domain. Our results indicate that PS is a potential cognitive marker to differentiate between SC and SA. Further research with larger samples must be conducted.


Assuntos
Transtornos Cognitivos/fisiopatologia , Transtornos Cognitivos/psicologia , Transtornos Psicóticos/fisiopatologia , Transtornos Psicóticos/psicologia , Esquizofrenia/fisiopatologia , Psicologia do Esquizofrênico , Transtornos Cognitivos/complicações , Humanos , Testes Neuropsicológicos , Projetos Piloto , Transtornos Psicóticos/complicações , Esquizofrenia/complicações
4.
Psychopathology ; 52(4): 221-231, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31610542

RESUMO

Recently, there has been renewed interest in Schneider's first-rank symptoms (FRS) of schizophrenia, thanks in part to a meta-analysis of their diagnostic accuracy, which deserves much credit for its methodological rigor. Conceptualising FRS as a diagnostic test whose performance can be measured in terms of sensitivity and specificity involves some issues that require reflection. First, the full adequacy of sensitivity as a measure of diagnostic accuracy for FRS might be questioned. However, it is conceptually acceptable, though FRS are at a disadvantage as compared with many other psychiatric "diagnostic tests" that should have perfect sensitivity under ideal conditions. Also, from a psychopathological perspective it may well be argued that FRS cannot be conceptualised as a simple, inexpensive diagnostic test suitable for screening purposes; however, the history of the concept reveals some reasons why it may be legitimate to view them this way. While no other relevant study has appeared after the publication of the meta-analysis, data on a further 166 patients from a study that could not be included due to incompletely reported data were located. This brought the total to 4,236 patients from 17 studies on the ability of FRS to differentiate schizophrenia from other psychoses. The resulting summary estimates of sensitivity, specificity and positive and negative likelihood ratios are 60.2%, 75.9%, 2.50, and 0.52, respectively. FRS have a kind of double nature, as they can be legitimately considered as belonging to both a sophisticated framework grounded in phenomenological psychopathology and an eminently pragmatic framework grounded in clinical epidemiology. When FRS are conceptualised as simple clinical indicators that require low levels of inference, the available estimates of their diagnostic accuracy are a fairly valid appraisal of their performance and usefulness, and suggest that FRS have some value in differential diagnosis. However, when FRS are conceptualised as profoundly anomalous experiences that can be properly identified and evaluated only by using a phenomenological approach, these estimates can hardly be seen as a valid evaluation of their diagnostic significance. Phenomenologically informed studies are needed to address this research gap.


Assuntos
Psicopatologia/métodos , Transtornos Psicóticos/psicologia , Esquizofrenia/diagnóstico , Feminino , Humanos , Masculino
6.
Psychiatr Danub ; 31(Suppl 3): 338-344, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31488750

RESUMO

INTRODUCTION: Mental difficulties are common in the postpartum period. They can manifest in a mild form, but also as serious disorders which need to be treated in a timely manner. The most common psychological problem is "Baby blues" characterized by relatively short duration without consequences and treatment is largely unnecessary. Postpartum depression is characterized by a sense of sadness, loss of interest, insomnia, discomfort, loss of energy, reduced concentration. Postpartum psychosis is the most serious disorder but is also rare and may have serious consequences for the mother and child. Important factors in the postpartum mental problems/difficulties are genetic factors, situation of unwanted pregnancy, a feeling of discomfort with the role of motherhood and sudden hormonal changes. AIM: to investigate the frequency and type of mental problems in postpartum period, as well as possible type of help needed by the women in postpartum period. SUBJECTS AND METHODS: One hundred (112) respondents participated in the survey. The survey was conducted from November to December 2017 through a "google docs" application. The survey was placed on different social networks, and the participation in the survey was voluntary and anonymous. A series of 14 questions with the offered answers was used in the survey. RESULTS: The results of the survey have shown that psychological difficulties and disturbances in the postpartum period to be common problems encountered by almost 50% of women (44.46%). The most common difficulty is Baby blues, followed by postpartum depression and anxiety disorders. Age and the mode of birth did not affect the emergence of changes, while social factors such as family support had a great impact. CONCLUSION: The provision of information to the mothers can help, but inaccurate information can do the opposite. Thus, the role of health care professionals is important for helping mothers in that period to prevent certain difficulties as well as in identifying and referring mothers to seek help in a timely fashion.


Assuntos
Ansiedade/epidemiologia , Depressão Pós-Parto/epidemiologia , Depressão Pós-Parto/psicologia , Mães/psicologia , Período Pós-Parto/psicologia , Transtornos Psicóticos/epidemiologia , Ansiedade/psicologia , Criança , Feminino , Humanos , Recém-Nascido , Mães/educação , Gravidez , Gravidez não Desejada/psicologia , Transtornos Psicóticos/psicologia , Inquéritos e Questionários
7.
Ned Tijdschr Geneeskd ; 1632019 08 19.
Artigo em Holandês | MEDLINE | ID: mdl-31433145

RESUMO

Physical and emotional pain are signalling and protective functions. In this clinical lesson, we describe the case of a patient with a psychotic disorder who had an episode of seriously disturbed pain awareness and experience, which caused severe delays in care and resulted in severe permanent damage. Due to his psychosis and lack of pain, the patient refused medical treatment and his leg henceforth developed mummification necrosis. Once admitted to a medical psychiatric unit, he was declared incompetent by his doctor and curator and his leg could be amputated. His psychosis adapted to the new situation, which he could then accept. This clinical lesson underlines the importance of awareness on disturbed pain and pain experience when it concerns a patient with a psychotic disorder, and that adequate medical treatment should not be ignored due to incompetence of the patient.


Assuntos
Saúde Mental , Transtornos Psicóticos/psicologia , Humanos , Masculino , Transtornos Psicóticos/tratamento farmacológico
8.
Riv Psichiatr ; 54(4): 150-159, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31379380

RESUMO

Scopo. Nell'ultimo ventennio l'interesse di ricercatori e clinici nella prevenzione di disturbi psicotici è cresciuto notevolmente. Gli studi internazionali su strategie a favore di giovani "ad alto rischio di un primo episodio di psicosi" sono ancora in numero ridotto, mentre in Italia risultano del tutto assenti. Oltre a manifestare sintomi psicotici sotto-soglia, questa popolazione di frequente riporta un compromesso funzionamento. La terapia cognitivo-comportamentale (TCC) è la strategia di prima linea, ma si rileva in letteratura l'importanza di studi su ulteriori misure di esito, quali il funzionamento. Il presente studio ha valutato se un protocollo di TCC modulare riducesse il rischio di un primo episodio psicotico in un gruppo di giovani ad alto rischio a post-trattamento e follow-up rispettivamente di 6 e 14 mesi a confronto con trattamento di supporto psicologico di routine ( treatment as usual). Metodi. Cinquantotto partecipanti (età media=25,51, 67,20% maschi) che soddisfacevano criteri per stati mentali a rischio alla Comprehensive Assessment of At-Risk-Mental States sono stati randomizzati a TCC o treatment as usual. Il protocollo di TCC ha incluso 30 sedute settimanali. Risultati. Nel gruppo TCC, il numero di giovani che ha sviluppato un primo episodio psicotico a follow-up è stato inferiore (n=4, 10,30%) a quello del gruppo di controllo (n=8, 27,60%), sebbene tale differenza sia risultata di significatività marginale [Log rank test χ2(1)= 3,66, p=0,05]. I giovani con funzionamento baseline più alto hanno ottenuto maggiori benefici al di là del tipo di percorso. Conclusioni. Anche nel contesto italiano, la TCC sembra efficace e promettente nel prevenire un primo episodio psicotico in giovani con stato mentale a rischio.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Transtornos Psicóticos/prevenção & controle , Adolescente , Adulto , Fatores Etários , Análise de Variância , Feminino , Humanos , Itália , Masculino , Pacientes Desistentes do Tratamento , Transtornos Psicóticos/psicologia , Risco , Método Simples-Cego , Adulto Jovem
9.
Psychopathology ; 52(4): 240-247, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31454823

RESUMO

INTRODUCTION: The notion of a full psychosis continuum in which psychosis is seen on a continuum with normal experience rests heavily on studies showing that psychotic symptoms are common in the general population. However, the methods of assessment in the studies have been criticized. OBJECTIVES: (1) to investigate how many from the general population who answered positively on a psychotic-like symptoms questionnaire and (2) to clinically assess a subset of those with psychotic-like experiences (PLE). METHODS: A self-rating questionnaire concerning PLEs was given to individuals from the general population. A subsample of those, who scored positively for PLEs, was clinically assessed for psychosis. RESULTS: Totally, 5.7% of the participants rated positive for PLEs according to the self-rating questionnaire. Forty of these were clinically assessed and 7 (17.5%) of them were found to have had a psychotic experience, 4 of them were already in psychiatric treatment. CONCLUSION: The self-reported psychotic-like phenomena were more common in the general population than psychotic disorders. However, when assessed clinically, the experienced phenomena did correspond to psychotic phenomena except in a few patients, who were found to suffer from a psychotic disorder. Overall, we did not find support for the full psychosis continuum model.


Assuntos
Transtornos Psicóticos/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Autorrelato , Inquéritos e Questionários , Adulto Jovem
10.
Actas esp. psiquiatr ; 47(4): 149-157, jul.-ago. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-185165

RESUMO

Introducción. El manejo clínico de los pacientes con trastornos psicóticos (TPs) es particularmente complejo si se lleva a cabo en el contexto de los servicios de psiquiatría de enlace e interconsulta (PEI) de un hospital general. Sin embargo, disponemos de pocos estudios que hayan investigado de forma específica los procedimientos asistenciales de tratamiento agudo para estos pacientes en entornos PEI. Objetivos. Examinar las características de una muestra de pacientes hospitalizados que presentan un TPs primario, que son remitidos a un servicio de PEI durante un período de 10 años y comparar las características clínicas de este subgrupo con respecto a los pacientes con otros diagnósticos (OD). Material y métodos. Estudio observacional y descriptivo llevado a cabo durante un período de 10 años (2005-2014), evaluando prospectivamente pacientes adultos ingresados en unidades no psiquiátricas del Hospital Clínico Universitario de Barcelona, que fueron remitidos de forma consecutiva a nuestro servicio de PEI. Realizamos un análisis post-hocpara comparar las características clínicas entre el subgrupo de pacientes con TPs y el resto de pacientes que cumplían los criterios para OD. Resultados. Se recibieron 393 interconsultas referentes a pacientes que presentaban un diagnóstico de TPs primario y 9.415 derivaciones de pacientes con OD. Nuestros resulta-dos mostraron que los pacientes con TPs eran más jóvenes que los pacientes con OD, tenían una mayor prevalencia de enfermedades somáticas relacionadas con un estilo de poco saludable (como enfermedades infecciosas, endocrinas o metabólicas), una menor frecuencia de cáncer y una necesidad de recibir asistencia psiquiátrica de forma más intensiva. Conclusiones. Los pacientes hospitalizados con TPs que son remitidos a los servicios de PEI tienen diferentes características clínicas en comparación con aquellos que cumplen con los criterios para OD. Se trata de un grupo complejo, con necesidades específicas en cuanto a la atención psiquiátrica


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 post-hoc 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
Humanos , Transtornos Psicóticos/diagnóstico , Transtornos Mentais/diagnóstico , Encaminhamento e Consulta , Transtornos Psicóticos/psicologia , Estudos Prospectivos , Psicofarmacologia
11.
Psicothema (Oviedo) ; 31(3): 263-270, ago. 2019. tab
Artigo em Inglês | IBECS | ID: ibc-185352

RESUMO

Background: Despite the recent popularity of the classification for maladaptive traits proposed by the DSM-5, little is known about the implications of these traits in adolescent populations. This study examines the relationship between the five broad maladaptive traits included in the DSM-5 (Negative Affect, Detachment, Antagonism, Disinhibition and Psychoticism) and a wide range of criteria of adolescent functioning: behavioural (bullying, cyberbullying, victimization, cybervictimization, problematic Internet use, substance use), emotional (negative and positive emotions, life satisfaction, self-esteem, loneliness) and motivational (extrinsic and intrinsic aspirations). Methods: Data were collected from 921 community adolescents, who were administered the brief form of the Personality Inventory for the DSM-5 (PID-5-BF) as well as self-reported measures of the behavioural, emotional and motivational criteria. Results: Antagonism and Disinhibition were the most important traits for behaviour problems, with face-to-face bullying being more associated with maladaptative traits than cyberbullying; Negative Affect, Detachment and Psychoticism were more closely related to emotional dissatisfaction, and adolescents’ goals were associated with most of the maladaptative traits. Conclusions: This study supports the relevance of the PID-5 traits for adolescents, and extends the nomological net of pathological personality traits to multiple facets of emotions, motivations and social behaviour in young people


Antecedentes: a pesar de la reciente popularidad de los rasgos desadaptativos de la personalidad propuestos por el DSM-5, se sabe poco sobre sus implicaciones en la adolescencia. Este estudio examina la relación entre los cinco grandes rasgos desadaptativos incluidos en el DSM-5 (Afecto Negativo, Desapego, Antagonismo, Desinhibición y Psicoticismo) y múltiples criterios de funcionamiento adolescente: conductuales (acoso, ciberacoso, victimización, cibervictimización, uso problemático de Internet, uso de sustancias), emocionales (emociones negativas y positivas, satisfacción con la vida, autoestima, soledad) y motivacionales (aspiraciones extrínsecas e intrínsecas). Método: se recogieron datos en 921 adolescentes de la población general, a quienes se les administró el PID-5-BF, así como medidas autoinformadas de los criterios a analizar. Resultados: Antagonismo y Desinhibición fueron los rasgos más asociados con los problemas de conducta, y el bullying se vio más relacionado con los rasgos PID que el ciberbullying; Afecto Negativo, Desapego y Psicoticismo se relacionaron más estrechamente con la insatisfacción emocional, y los rasgos desadaptativos contribuyeron también a predecir las metas de los jóvenes. Conclusiones: este estudio apoya la relevancia de los rasgos del PID-5 en la adolescencia, y extiende su red nomológica a múltiples facetas de las emociones, motivaciones y conducta social de los adolescentes


Assuntos
Humanos , Masculino , Feminino , Adolescente , Comportamento do Adolescente , Bullying/psicologia , Manual Diagnóstico e Estatístico de Transtornos Mentais , Emoções , Motivação , Transtornos da Personalidade/psicologia , Afeto , Anedonia , Vítimas de Crime/psicologia , Comportamento Impulsivo , Internet , Satisfação Pessoal , Inventário de Personalidade , Assunção de Riscos , Transtornos Psicóticos/psicologia , Autorrelato , Fatores Sexuais , Isolamento Social , Transtornos Relacionados ao Uso de Substâncias/psicologia
12.
Psicothema ; 31(3): 263-270, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31292040

RESUMO

BACKGROUND: Despite the recent popularity of the classification for maladaptive traits proposed by the DSM-5, little is known about the implications of these traits in adolescent populations. This study examines the relationship between the five broad maladaptive traits included in the DSM-5 (Negative Affect, Detachment, Antagonism, Disinhibition and Psychoticism) and a wide range of criteria of adolescent functioning: behavioural (bullying, cyberbullying, victimization, cybervictimization, problematic Internet use, substance use), emotional (negative and positive emotions, life satisfaction, self-esteem, loneliness) and motivational (extrinsic and intrinsic aspirations). METHODS: Data were collected from 921 community adolescents, who were administered the brief form of the Personality Inventory for the DSM-5 (PID-5-BF) as well as self-reported measures of the behavioural, emotional and motivational criteria. RESULTS: Antagonism and Disinhibition were the most important traits for behaviour problems, with face-to-face bullying being more associated with maladaptative traits than cyberbullying; Negative Affect, Detachment and Psychoticism were more closely related to emotional dissatisfaction, and adolescents’ goals were associated with most of the maladaptative traits. CONCLUSIONS: This study supports the relevance of the PID-5 traits for adolescents, and extends the nomological net of pathological personality traits to multiple facets of emotions, motivations and social behaviour in young people.


Assuntos
Comportamento do Adolescente , Manual Diagnóstico e Estatístico de Transtornos Mentais , Emoções , Motivação , Transtornos da Personalidade/psicologia , Adolescente , Afeto , Anedonia , Bullying/psicologia , Vítimas de Crime/psicologia , Feminino , Humanos , Comportamento Impulsivo , Internet , Masculino , Satisfação Pessoal , Inventário de Personalidade , Transtornos Psicóticos/psicologia , Assunção de Riscos , Autorrelato , Fatores Sexuais , Isolamento Social , Transtornos Relacionados ao Uso de Substâncias/psicologia
13.
Crim Behav Ment Health ; 29(3): 157-167, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31274230

RESUMO

BACKGROUND: Current Japanese forensic mental health legislation (Medical Treatment and Supervision Act [MTSA]) was enacted in 2003. Little is known, however, about the actual outcomes for the offender patients detained within hospitals under this provision. AIM: This study aimed to quantify reoffending and readmission following patients' discharge from forensic psychiatric hospital units across Japan and explore related risk factors. METHODS: We followed up 526 offenders with mental disorder who had been detained under the MTSA and who were subsequently discharged from any of the 28 hospitals nationwide between 2007 and 2015. RESULTS: The total cumulative reoffence rate was found to be 2.5% (1.1-3.9%) after 1 year and 7.5% (4.6-10.4%) after 3 years. The rate of serious reoffending was 0.4% (-0.18% to 0.99%) after 1 year and 2.0% (0.4-3.6%) after 3 years. The cumulative admission rate to local psychiatric hospitals following a discharge was 21.8% after 6 months and 37.6% after 1 year. Patients who had been discharged from their MTSA order but transferred to a general psychiatric hospital before open community residence-because it was necessary to build community supports-were more likely to reoffend than those discharged directly to the community. Patients who had been diagnosed with a substance use disorder (F10-F19) and had one subsequent admission were at higher risk of further readmissions. CONCLUSIONS: The low reoffending rates could be attributed to the intensive treatment and care plans required by the MTSA. The high rate of readmission to psychiatric hospitals may indicate shortcomings in community mental health services in Japan.


Assuntos
Criminosos , Hospitais Psiquiátricos/estatística & dados numéricos , Alta do Paciente , Readmissão do Paciente/estatística & dados numéricos , Transtornos Psicóticos/psicologia , Adulto , Serviços Comunitários de Saúde Mental , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Substâncias/psicologia
14.
Nord J Psychiatry ; 73(6): 349-356, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31271338

RESUMO

Background: Treatment satisfaction predicts treatment adherence and long-term outcome for patients with psychosis. It is therefore important to understand the underpinnings of patient satisfaction in psychosis treatment for optimal treatment delivery. Aims: To examine the associations between satisfaction and level and change in positive symptoms, insight, depression and side effects of antipsychotics in previously medicated and antipsychotic-naïve patients. Method: Data derive from a randomised trial, with 226 respondents at baseline and 104 at follow-up. The measures were the positive subscale and insight item from the Positive and Negative Syndrome Scale, Calgary Depression Scale, the UKU Consumer Satisfaction Rating Scale, and the UKU side effects scale. Structural equation modelling was used to test the model. The full information maximum likelihood estimator used all available data. Results: In the sample of 226 patients, 67.3% were male and 44.2% were antipsychotic-naïve. The mean age was 34.1 years. For previously medicated patients, satisfaction was predicted by level of insight (b = -2.21, ß = -0.42) and reduction in positive symptoms (b = -0.56, ß = -0.39). For antipsychotic-naïve patients, satisfaction was predicted by level and change of insight (b = -2.21, ß = -0.46), change in depression (b = -0.37, ß = -0.26) and side effects (b = -0.15, ß = -0.30). All predictors were significant at the 0.05 level. Conclusion: Reducing positive symptoms and side effects are important to enhance patient satisfaction. However, improving insight and reducing depression are more important in antipsychotic-naïve patients.


Assuntos
Antipsicóticos/uso terapêutico , Satisfação do Paciente , Transtornos Psicóticos/tratamento farmacológico , Transtornos Psicóticos/psicologia , Doença Aguda/psicologia , Doença Aguda/terapia , Adulto , Feminino , Humanos , Masculino , Escalas de Graduação Psiquiátrica , Ensaios Clínicos Controlados Aleatórios como Assunto
15.
Neurology ; 93(6): 259-266, 2019 08 06.
Artigo em Inglês | MEDLINE | ID: mdl-31289146

RESUMO

OBJECTIVE: Psychosis is one of the most debilitating complications of Parkinson disease (PD). Although research on PD psychosis has been focused on the study of well-structured visual hallucinations (VH), currently accepted National Institute of Neurological Disorders and Stroke-National Institute of Mental Health diagnostic criteria emphasize minor hallucinations (MH) as the most common psychotic phenomena in PD. The objective of this review is to comprehensively describe the clinical and research advances on the understanding of MH and to provide future directions for obtaining further insights into their potential major implications for PD management and prognosis. METHODS: A PubMed search was done in November 2018 to identify articles on minor psychotic phenomena in PD. RESULTS: MH often precede the onset of well-structured VH and are associated with other nonmotor symptoms such as REM sleep behavior disorder and depression. The pattern of functional brain connectivity changes associated with MH involve visual-processing areas and attention control networks, which overlap with abnormalities described in patients with well-structured VH. The dysfunction of cortical networks in patients with MH may be an early indicator of a more widespread form of the disease. CONCLUSION: Although called "minor," MH may have major clinical and prognostic implications. Further research is needed to establish whether MH are associated with a higher risk of disabling psychotic complications, cognitive deterioration, or a more accelerated disease progression. Understanding the early neurobiological underpinnings of MH may provide the background for future studies to identify the progressive dysfunction of neural circuits leading to more severe forms of psychosis in PD.


Assuntos
Alucinações/etiologia , Doença de Parkinson/complicações , Alucinações/psicologia , Alucinações/terapia , Humanos , Doença de Parkinson/psicologia , Doença de Parkinson/terapia , Transtornos Psicóticos/etiologia , Transtornos Psicóticos/psicologia
16.
Psychopathology ; 52(2): 143-150, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31362287

RESUMO

Phenomenology often looks at psychosis as a defined pathological state. In this paper, psychosis is not seen as a (pathological) state but as a way to respond in extreme stress. It is psychological functioning of the embodied and relational mind, and psychotic experience can be seen as one form of affective arousal among any other affects. Taken the point of views of Emmanuel Levinas and Mikhail Bakhtin about the primacy of living in responsive relationships, psychotic behavior is seen as emerging in relationships that do not guarantee adequate responses and thus the subject is imposed to isolate from social relationships and developing odd behavior. If dialogical responses are guaranteed, recovery from psychotic behavior can occur. Some guidelines for such dialogues are given.


Assuntos
Transtornos Psicóticos/psicologia , Estresse Psicológico/psicologia , Humanos
17.
Rev Med Suisse ; 15(654): 1204, 2019 Jun 05.
Artigo em Francês | MEDLINE | ID: mdl-31166678
18.
J Wound Care ; 28(6): 317-322, 2019 Jun 02.
Artigo em Inglês | MEDLINE | ID: mdl-31166860

RESUMO

OBJECTIVE: Self-inflicted burns typically result in extensive injuries requiring intensive care and attention in a specialised burn unit. Burn units should be familiar with the optimal management of self-inflicted burns, including the psychological and psychiatric treatment. This paper describes the experiences of managing these challenging injuries in a German burn centre. METHODS: A retrospective review of patients with self-inflicted burns admitted to the burn centre between 2000 and 2017. Demographics, details of injury, presence of psychiatric disorder, clinical course, operative management and patient outcomes were recorded and compared with a control group without self-inflicted burns. Outcome measures included graft take rate, complications and need for further surgery. RESULTS: There were a total of 2055 burn patient admissions, with 17 cases (0.8%) of self-inflicted burns. The mean age was 36±11 years with an mean percentage total body surface area (%TBSA) burned of 43.5±22.5% which was not significantly different from the control group (p=0.184). Schizophrenia and personality disorder were the most common diagnoses in the self-inflicted burns patients (n=11; 65%). Of these, four had sustained previous self-inflicted burns. Length of hospital stay was significantly longer in the self-inflicted burn group than in the control group (49.0±16.7 days, respectively, p=0.002). CONCLUSION: Attempted suicide by self-inflicted burns represents <1% of burn admissions. This population demonstrates a high incidence of prior psychiatric disorders. Successful treatment includes multidisciplinary management of acute medical, surgical, and psychiatric care.


Assuntos
Queimaduras/terapia , Hidratação , Transtornos Mentais/psicologia , Transplante de Pele , Tentativa de Suicídio , Escala Resumida de Ferimentos , Adolescente , Adulto , Idoso , Asfixia/mortalidade , Unidades de Queimados , Queimaduras/mortalidade , Queimaduras/psicologia , Estudos de Casos e Controles , Causas de Morte , Cuidados Críticos , Transtorno Depressivo Maior/psicologia , Feminino , Alemanha , Insuficiência Cardíaca/mortalidade , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Mortalidade , Insuficiência de Múltiplos Órgãos/mortalidade , Traumatismo Múltiplo/mortalidade , Transtornos da Personalidade/psicologia , Transtornos Psicóticos/psicologia , Estudos Retrospectivos , Esquizofrenia , Comportamento Autodestrutivo/terapia , Choque/mortalidade , Adulto Jovem
19.
Trials ; 20(1): 331, 2019 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-31174586

RESUMO

BACKGROUND: Evidence is conflicting about a causal role of inflammation in psychosis and, specifically, regarding antibodies binding to neuronal membrane targets, especially N-methyl-D-aspartate receptors. NMDAR, LGI1 and GABA-A antibodies were found more prevalent in people with psychosis than in healthy controls. We aim to test whether these antibodies are pathogenic and may cause isolated psychosis. The SINAPPS2 phase IIa double-blinded randomised controlled trial will test the efficacy and safety of immunoglobulin and rituximab treatment versus placebo for patients with acute psychosis symptoms as added to psychiatric standard of care. METHODS: We will screen approximately 2500 adult patients with acute psychosis to identify 160 with antibody-positive psychosis without co-existing neurological disease and recruit about 80 eligible participants to the trial in the period from September 2017 to September 2021 across the UK. Eligible patients will be randomised 1:1 either to intravenous immunoglobulin (IVIG) followed by rituximab or to placebo infusions of 1% albumin followed by 0.9% sodium chloride, respectively. To detect a time-to-symptomatic-recovery hazard ratio of 0.322 with a power of 80%, 56 participants are needed to complete the trial, allowing for up to 12 participants to drop out of each group. Eligible patients will be randomised and assessed at baseline within 4 weeks of their eligibility confirmation. The treatment will start with IVIG or 1% albumin placebo infusions over 2-4 consecutive days no later than 7 days from baseline. It will continue 4-5 weeks later with a rituximab or sodium chloride placebo infusion and will end 2-3 weeks after this with another rituximab or placebo infusion. The primary outcome is the time to symptomatic recovery defined as symptomatic remission sustained for at least 6 months on the following Positive and Negative Syndrome Scale items: P1, P2, P3, N1, N4, N6, G5 and G9. Participants will be followed for 12 months from the first day of treatment or, where sustained remission begins after the first 6 months, for an additional minimum of 6 months to assess later response. DISCUSSION: The SINAPPS2 trial aims to test whether immunotherapy is efficacious and safe in psychosis associated with anti-neuronal membrane antibodies. TRIAL REGISTRATION: ISRCTN, 11177045. Registered on 2 May 2017. EudraCT, 2016-000118-31. Registered on 22 November 2016. ClinicalTrials.gov, NCT03194815. Registered on 21 June 2017.


Assuntos
Antipsicóticos/administração & dosagem , Imunoglobulinas Intravenosas/administração & dosagem , Transtornos Psicóticos/tratamento farmacológico , Rituximab/administração & dosagem , Adolescente , Adulto , Idoso , Antipsicóticos/efeitos adversos , Ensaios Clínicos Fase II como Assunto , Método Duplo-Cego , Feminino , Humanos , Imunoglobulinas Intravenosas/efeitos adversos , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Estudos Multicêntricos como Assunto , Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/imunologia , Transtornos Psicóticos/psicologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , Rituximab/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Reino Unido , Adulto Jovem
20.
Soc Psychiatry Psychiatr Epidemiol ; 54(9): 1023-1044, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31236631

RESUMO

PURPOSE: Higher rates of psychosis have been reported in minority groups. Since individuals belonging to such groups are vulnerable to the experiences of discrimination, and in line with models proposing that social and life adversity may play a causal role in development and maintenance of psychotic experiences, it has been proposed that perceived discrimination may represent an important determinant of psychotic experiences. This paper reviews the literature examining the relationship between perceived discrimination and psychosis, examining whether discrimination is associated with an increased risk of psychosis, the severity of psychotic symptoms and whether there is an association with specific psychotic symptoms. METHODS: A systematic database search of PsycINFO, Embase and PubMed was conducted to identify quantitative cross-sectional and prospective studies that examined the association between discrimination and psychosis. RESULTS: Twenty-four studies met the inclusion criteria, four of which used prospective designs and twenty used cross-sectional designs. The main findings indicated that discrimination may be associated with an increased risk of psychosis (too few studies to determine whether discrimination is associated with severity). Some studies found associations between discrimination and positive psychotic experiences and/or specific psychotic experiences such as paranoia. A small number of studies found that greater exposure to discrimination was associated with a greater likelihood of reporting psychotic experiences, tentatively indicating a dose-response relationship. CONCLUSIONS: This review indicates that discrimination plays an important role in the experience of psychosis; however, future research is required to clarify the nature of this relationship. Avenues for further research and clinical implications are proposed.


Assuntos
Transtornos Psicóticos/psicologia , Discriminação Social/psicologia , Estudos Transversais , Humanos , Grupos Minoritários/psicologia , Transtornos Paranoides/psicologia , Percepção , Estudos Prospectivos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA