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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.
Cad Saude Publica ; 35(4): e00108018, 2019 05 02.
Artigo em Inglês | MEDLINE | ID: mdl-31066775

RESUMO

Several Latin American countries have made remarkable strides towards offering community mental health care for people with psychoses. Nonetheless, mental health clinics generally have a very limited outreach in the community, tending to have weaker links to primary health care; rarely engaging patients in providing care; and usually not providing recovery-oriented services. This paper describes a pilot randomized controlled trial (RCT) of Critical Time Intervention-Task Shifting (CTI-TS) aimed at addressing such limitations. The pilot RCT was conducted in Santiago (Chile) and Rio de Janeiro (Brazil). We included 110 people with psychosis in the study, who were recruited at the time of entry into community mental health clinics. Trial participants were randomly divided into CTI-TS intervention and usual care. Those allocated to the intervention group received usual care and, in addition, CTI-TS services over a 9-month period. Primary outcomes include quality of life (WHO Quality of Life Scale - Brief Version) and unmet needs (Camberwell Assessment of Needs) at the 18-month follow-up. Primary outcomes at 18 months will be analyzed by Generalized Estimating Equations (GEE), with observations clustered within sites. We will use three-level multilevel models to examine time trends on the primary outcomes. Similar procedures will be used for analyzing secondary outcomes. Our hope is that this trial provides a foundation for planning a large-scale multi-site RCT to establish the efficacy of recovery-oriented interventions such as CTI-TS in Latin America.


Assuntos
Serviços Comunitários de Saúde Mental , Transtornos Psicóticos/reabilitação , Adulto , Idoso , Brasil , Chile , Protocolos Clínicos , Humanos , Pessoa de Meia-Idade , Projetos Piloto , Qualidade de Vida , Adulto Jovem
3.
PLoS One ; 14(5): e0216929, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31095611

RESUMO

INTRODUCTION: Volunteer befriending can be used to address social isolation in patients with psychosis. Traditionally this involves face-to-face encounters between a volunteer and a patient, but modern digital technology also makes it possible to have these interactions remotely. This study aimed to explore the views and interests of patients with psychosis about different formats of volunteering, face-to-face or digitally. METHODS: A survey was conducted with patients with psychotic disorders in community mental health teams in London. Questions covered socio-demographic characteristics, quality of life, loneliness, views on the different formats of volunteering and types of volunteers, and their interest in getting volunteering support, face-to-face or digitally. Binary logistic regressions were used to investigate potential predictors of interest in getting volunteering support face-to-face or digitally. RESULTS: A total of 151 patients with psychotic disorders were included in this study. More than half of the patients (n = 87, 57.6%) had not heard about these volunteering programs. Many were interested in getting face-to-face (n = 87, 57.6%) and digital (n = 56, 37.1%) volunteering. For the face-to-face encounters, most preferred them to be weekly (n = 36, 41.4%), for one-hour (n = 32, 36.8%), and with an open-ended relationship (n = 45, 51.7%). For the digital contacts, most preferred them to be weekly (n = 17, 30.9%) and through text messages (n = 26, 46.4%). A minority of patients (n = 20, 13.2%) did not use digital technology. Patients with lower quality of life were significantly more likely to prefer face-to-face volunteering (p < .05). Younger patients and with fewer years of diagnosis were significantly more likely to prefer digital volunteering (p < .05). CONCLUSIONS: The variability in patients' interests suggests that different formats of volunteer support should be offered. Digital volunteering may become more important in the future, since many younger patients are interested in it.


Assuntos
Preferência do Paciente , Transtornos Psicóticos/reabilitação , Comportamento Social , Isolamento Social/psicologia , Mensagem de Texto , Voluntários , Adulto , Idoso , Feminino , Amigos , Humanos , Internet , Londres , Solidão , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Análise de Regressão , Classe Social , Inquéritos e Questionários , Resultado do Tratamento , Adulto Jovem
4.
Asian J Psychiatr ; 42: 48-54, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30953884

RESUMO

BACKGROUND: Employment is a significant stepping stone towards recovery for persons with severe mental illness. In the last two decades there has been increasing focus on obtaining professional courses and degrees for employment in India. AIM: To understand the challenges faced by persons with severe mental illness with professional degrees in obtaining and maintaining employment. METHODS: We interviewed 31 individuals with severe mental illness, who had professional degrees, using qualitative interviews. These interviews explored factors that facilitated as well as those that hindered the process of obtaining and sustaining jobs. RESULTS: Factors that were identified as facilitators for obtaining and maintaining employment included personal strengths, social support, accommodative work environment, disclosure, support from mental health professionals and services. Factors that were identified as hindering for obtaining and maintaining employment included symptoms of the illness, side effects of medications, stigma, poor social support, academic underachievement, disjointed work history, poor workplace environment and specific cultural, gender issues. CONCLUSION: Factors such as workplace accommodations, creating an environment that is permissive of disclosure, using family support and support from mental health professionals will facilitate employment. Addressing factors that hinder such as stigma, academic under-achievement, improving workplace environments, social support will also be important in vocational recovery.


Assuntos
Transtorno Bipolar , Escolaridade , Emprego/psicologia , Transtornos Psicóticos , Esquizofrenia , Logro , Adulto , Transtorno Bipolar/psicologia , Transtorno Bipolar/reabilitação , Feminino , Humanos , Índia , Masculino , Pessoa de Meia-Idade , Transtornos Psicóticos/psicologia , Transtornos Psicóticos/reabilitação , Pesquisa Qualitativa , Esquizofrenia/reabilitação , Estigma Social , Apoio Social , Adulto Jovem
6.
PLoS One ; 14(1): e0210816, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30682067

RESUMO

INTRODUCTION: Emotion recognition (ER) deficits have been extensively demonstrated in schizophrenia. These deficiencies are not only restricted to facial emotion recognition but also include emotional prosody (tone of the voice) recognition deficits. They have been significantly associated with symptom severity and poor social functioning. The aim of this study was to test the efficacy, in real clinical conditions, of an online self-training prosodic game included in the Social Cognition rehabilitation program e-Motional Training. METHOD: A randomized, single-blind multicenter clinical trial was conducted with 50 outpatients with schizophrenia or schizoaffective disorder. The control group was treated with Treatment-as-usual (TAU), based on drug therapy, case management and individual and group psychotherapy (not focused on Social Cognition). The intervention group was treated with TAU plus the employment of Voices, an online self-training program devised for prosodic rehabilitation. STATISTICAL ANALYSIS: Linear regression was used to evaluate the effectiveness of the intervention in emotion recognition measured with the Reading the Mind in the Voice-Spanish Version (RMV-SV). RESULTS: There were statistically significant differences between the intervention and control group measured with RMV-SV (ß = 3,6[IC 95%], p<0.001), with a response variable in RMV post R2 = 0,617. DISCUSSION: Voices, a prosodic rehabilitation game included in e-Motional Training, seems to be a promising tool for improving emotional voice recognition deficits in schizophrenia, filling the need for such interventions.


Assuntos
Emoções , Esquizofrenia/terapia , Voz , Adulto , Percepção Auditiva , Cognição , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Psicóticos/psicologia , Transtornos Psicóticos/reabilitação , Transtornos Psicóticos/terapia , Esquizofrenia/reabilitação , Psicologia do Esquizofrênico , Método Simples-Cego , Ajustamento Social , Comportamento Social , Percepção Social , Software , Espanha , Jogos de Vídeo/psicologia
7.
Early Interv Psychiatry ; 13(4): 859-866, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-29888528

RESUMO

AIM: Individual placement and support (IPS) for first episode psychosis (FEP) has proven effective for employment and education, but yields differing results across geographical regions. Local adaptations may be necessary for various reasons, such as regional differences in employment- and welfare services; in educational opportunities and job markets. The aim of this study was to investigate the efficacy of an adapted Norwegian intervention offering early IPS for education and employment to persons with FEP. METHOD: Matched control (N = 66) study with a 1-year early IPS intervention and a 2-year follow up. A rating of fidelity to the IPS model was conducted. RESULTS: Fidelity was "good." Adaptations to the model included the use of internships and flexible combinations of education and employment. Thirty out of 33 participants completed the intervention. Fourteen were in competitive employment >20 h/wk post intervention, compared to 2 in the control group. Fifteen participants were enrolled in education >20 h/wk, 10 of whom also had employment >20 h/wk and 3 < 20 h/wk, compared to 5 in the control group, with 2 having employment <20 h/wk on the side. Symptom levels did not predict outcome. CONCLUSION: The School- and JobPrescription adaptation of IPS, allowing for temporary internships as a step towards obtaining the goal of paid competitive employment and facilitating flexible combinations of employment and education, showed encouraging results. These were however not sustained after closure of the intervention. At the 2-year follow up, Job- and SchoolPrescription advantages had waned, underscoring the point in IPS that support should be time-unlimited.


Assuntos
Educação não Profissionalizante/métodos , Readaptação ao Emprego/métodos , Transtornos Psicóticos/reabilitação , Reabilitação Vocacional/métodos , Apoio ao Desenvolvimento de Recursos Humanos/métodos , Adolescente , Adulto , Idoso , Estudos de Casos e Controles , Educação não Profissionalizante/estatística & dados numéricos , Readaptação ao Emprego/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Noruega , Apoio ao Desenvolvimento de Recursos Humanos/estatística & dados numéricos , Adulto Jovem
8.
Appl Neuropsychol Child ; 8(1): 93-99, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-29185868

RESUMO

Limbic encephalitis (LE) is a rare neurological disorder characterized by inflammation of the brain caused by autoimmunity or infection. LE has been a difficult to define and diagnose disorder due to the insidious and nonspecific (e.g., irritability, low mood, short-term memory complaints) presentation of early symptoms, as well as inconsistent findings on neuroimaging, lumbar puncture serum analysis, and electroencephalogram. Seizures, memory problems, and psychiatric disturbance are among the earliest and most prominent clinical features. This manuscript describes three adolescent males who developed LE and became psychotic, needed inpatient care, were trialed on various psychotropic medications, and exhibited lingering cognitive and psychiatric issues, though generally had very positive recoveries and return to community activities. There was no history of psychiatric disturbance, developmental disorder, or learning difficulties in any of these three young men. Two of the three cases exhibited a long, insidious symptom onset. None of the adolescents benefitted from antipsychotic medications and did not begin to experience improvement and eventual recovery until intravenous immunoglobulin (IVIG) was added to their treatment regimen. Neuropsychological consultation and team education was helpful in each of these cases. Neuropsychological findings for each individual are presented.


Assuntos
Disfunção Cognitiva , Encefalite Límbica , Transtornos Psicóticos , Adolescente , Antipsicóticos/farmacologia , Disfunção Cognitiva/tratamento farmacológico , Disfunção Cognitiva/etiologia , Disfunção Cognitiva/fisiopatologia , Disfunção Cognitiva/reabilitação , Humanos , Imunoglobulinas Intravenosas/farmacologia , Fatores Imunológicos/farmacologia , Encefalite Límbica/complicações , Encefalite Límbica/tratamento farmacológico , Encefalite Límbica/fisiopatologia , Encefalite Límbica/reabilitação , Masculino , Transtornos Psicóticos/tratamento farmacológico , Transtornos Psicóticos/etiologia , Transtornos Psicóticos/fisiopatologia , Transtornos Psicóticos/reabilitação
9.
Epidemiol Psychiatr Sci ; 28(1): 9-14, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30043719

RESUMO

In many European countries, deinstitutionalisation has been an ongoing process over the last few decades. Mental health organisations were transformed to provide support in a more integrated and comprehensive manner, preferably in their own homes in the community. Yet, despite the welcome aspiration of community integration for all, people with complex mental health problems (also termed severe mental illness) have continued to require high levels of support, in inpatient settings and in the community. This group's needs make them highly dependent on their caregivers. The attitudes, knowledge and skills of the staff providing treatment and support is crucial to their recovery. Rehabilitation programmes provide a much-needed framework to guide practitioners and help them organise and focus their recovery-oriented approach. In this editorial, we will provide a non-exhaustive overview of such rehabilitation programmes and interventions to illuminate the wide scope and practical usability of these interventions for this group of people with complex mental health problems.


Assuntos
Transtornos Mentais/reabilitação , Serviços de Saúde Mental/organização & administração , Reabilitação Psiquiátrica/organização & administração , Transtornos Psicóticos/reabilitação , Esquizofrenia/reabilitação , Medicina Baseada em Evidências , Humanos , Transtornos Mentais/psicologia , Transtornos Psicóticos/psicologia , Psicologia do Esquizofrênico
10.
Early Interv Psychiatry ; 13(4): 961-968, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30019851

RESUMO

AIM: Most mental disorders have their onset by age 25, disrupting normative vocational engagement. Factors associated with vocational disengagement at first contact with specialist treatment are important for service planning. The aim of this paper was to investigate the association between theoretically important factors and vocational disengagement for youth entering mental health treatment. METHODS: A file audit was used to extract vocational data of 145 young people aged 15 to 25 years entering treatment in 2011 at a public youth mental health service in Melbourne, Australia. Comparisons were made across three specialist programs for: psychosis (n = 50), mood disorders (n = 52) and borderline personality pathology (n = 43). Individual characteristics were entered into univariate and multivariate logistic regressions to investigate their associations with vocational disengagement. RESULTS: Educational disengagement was associated with being older (OR = 4.38, P = 0.004) and not living with parents (OR = 2.87, P = 0.038). Unemployment and being NEET (Not in Education, Employment or Training) were both associated with not having commenced tertiary education (OR = 0.23, P = 0.022; OR = 0.05, P = 0.002; respectively). Being NEET was also associated with being older (OR = 6.18, P = 0.004). Primary diagnostic grouping was not associated with vocational disengagement, once accounting for other factors. CONCLUSIONS: The likelihood of vocational disengagement did not differ across disorder groups, implying that intervention should be "transdiagnostic" and might best target education first, specifically post-secondary qualifications. Other domains or variables not measured in this study are also likely to be important, and this might include young people's support systems and symptom severity. Qualitative studies may be useful for exploring further factors relevant to vocational engagement.


Assuntos
Transtorno da Personalidade Borderline/reabilitação , Escolha da Profissão , Serviços de Saúde Mental , Transtornos do Humor/reabilitação , Transtornos Psicóticos/reabilitação , Reabilitação Vocacional , Adolescente , Adulto , Atitude , Transtorno da Personalidade Borderline/diagnóstico , Transtorno da Personalidade Borderline/psicologia , Estudos Transversais , Escolaridade , Emprego/psicologia , Feminino , Humanos , Masculino , Transtornos do Humor/diagnóstico , Transtornos do Humor/psicologia , Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/psicologia , Vitória , Adulto Jovem
11.
Early Interv Psychiatry ; 13(3): 525-531, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-29278295

RESUMO

AIM: There is lack of research on the study of clinical personality traits in recent onset of psychosis (ROP) patients. The aims of this research were to study the relations among psychosocial, personality and clinical characteristics in ROP patients and also the effect that significant variables had on the different domains of Quality of Life (QoL). METHODS: Data for these analyses were obtained from 81 ROP patients. The Millon Clinical Multiaxial Inventory, the Positive and Negative Syndrome Scale and the World Health Organization Quality of Life Brief Scale were used to assess personality, symptoms and QoL. RESULTS: Correlations between the negative symptoms and the physical, psychological and social domains of QoL, and the disorganized symptoms and physical domain, were found. Furthermore, the physical, psychological and social relationship domains of QoL were lower in patients with schizoid traits and the psychological domain was lower in patients with depressive traits. In contrast, the psychological and social domains were higher in patients with histrionic traits, while the physical domain was higher for patients with narcissistic traits. Multiple linear regressions demonstrated that negative symptoms and narcissistic and depressive traits explained 16.9% of the physical domain. Narcissistic and depressive traits explained 15% of the psychological domain. Finally, the negative symptoms and histrionic traits explained 13.7% of the social domain. CONCLUSIONS: QoL seems to be better explained by negative psychotic symptoms and some clinical personality traits. Our results support the importance of integrated intervention approaches that consider personality.


Assuntos
Caráter , Transtornos Psicóticos/psicologia , Qualidade de Vida/psicologia , Adulto , Transtorno Depressivo/diagnóstico , Transtorno Depressivo/psicologia , Transtorno Depressivo/reabilitação , Feminino , Humanos , Masculino , Determinação da Personalidade , Escalas de Graduação Psiquiátrica/estatística & dados numéricos , Psicometria , Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/reabilitação , Transtorno da Personalidade Esquizoide/diagnóstico , Transtorno da Personalidade Esquizoide/psicologia , Transtorno da Personalidade Esquizoide/reabilitação , Esquizofrenia/diagnóstico , Psicologia do Esquizofrênico , Ajustamento Social , Fatores Socioeconômicos , Adulto Jovem
12.
Br J Psychiatry ; 214(2): 76-82, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30251616

RESUMO

BACKGROUND: High unemployment is a hallmark of psychotic illness. Individual placement and support (IPS) may be effective at assisting the vocational recoveries of young people with first-episode psychosis (FEP).AimsTo examine the effectiveness of IPS at assisting young people with FEP to gain employment (Australian and Clinical Trials Registry ACTRN12608000094370). METHOD: Young people with FEP (n = 146) who were interested in vocational recovery were randomised using computer-generated random permuted blocks on a 1:1 ratio to: (a) 6 months of IPS in addition to treatment as usual (TAU) or (b) TAU alone. Assessments were conducted at baseline, 6 months (end of intervention), 12 months and 18 months post-baseline by research assistants who were masked to the treatment allocations. RESULTS: At the end of the intervention the IPS group had a significantly higher rate of having been employed (71.2%) than the TAU group (48.0%), odds ratio 3.40 (95% CI 1.17-9.91, z = 2.25, P = 0.025). However, this difference was not seen at 12- and 18-month follow-up points. There was no difference at any time point on educational outcomes. CONCLUSIONS: This is the largest trial to our knowledge on the effectiveness of IPS in FEP. The IPS group achieved a very high employment rate during the 6 months of the intervention. However, the advantage of IPS was not maintained in the long term. This seems to be related more to an unusually high rate of employment being achieved in the control group rather than a gross reduction in employment among the IPS group.Declaration of interestNone.


Assuntos
Readaptação ao Emprego , Transtornos Psicóticos/reabilitação , Reabilitação Vocacional , Feminino , Humanos , Masculino , Método Simples-Cego , Fatores de Tempo , Adulto Jovem
13.
Schizophr Res ; 203: 99-104, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-29070442

RESUMO

BACKGROUND: Social Recovery Therapy (SRT) is a cognitive behavioural therapy which targets young people with early psychosis who have complex problems associated with severe social disability. This paper provides a narrative overview of current evidence for SRT and reports new data on a 2year follow-up of participants recruited into the Improving Social Recovery in Early Psychosis (ISREP) trial. METHOD: In the ISREP study 50 participants (86%) were followed up at 2years, 15months post treatment. The primary outcome was engagement in paid work, assessed using the Time Use Survey. Engagement in education and voluntary work were also assessed. In addition, the Positive and Negative Syndrome Scales (PANSS) and the Beck Hopelessness Scale (BHS) were administered. RESULTS: 25% of individuals with non-affective psychosis in the treatment group had engaged in paid work at some point in the year following the end of therapy, compared with none of the control group. Data from the PANSS and BHS suggested no worsening of symptoms and an indication that gains in hope were maintained over the 15month period following the end of therapy. CONCLUSION: Social Recovery Therapy is a promising psychological intervention which may improve social recovery in individuals with early psychosis. The new data reported in this paper shows evidence of gains in engagement in paid employment outcomes that persisted 15months beyond the period of active intervention.


Assuntos
Transtornos Psicóticos Afetivos/reabilitação , Terapia Cognitivo-Comportamental , Emprego , Transtornos Psicóticos/reabilitação , Comportamento Social , Adulto , Seguimentos , Humanos , Método Simples-Cego , Resultado do Tratamento
14.
Schizophr Res ; 203: 49-54, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-28768601

RESUMO

Cognitive remediation (CR) research typically addresses internal validity, and few studies consider CR in a real-world context. This study evaluated the fit between the program conditions and treatment model in research and clinical settings, with the goal of informing future research on the contextual challenges associated with the implementation of CR. Data was drawn from an initiative by New York State's Office of Mental Health (OMH), to implement CR programs for adults with Serious Mental Illness (SMI) in 16 state operated outpatient clinics. One of these clinics first became a research site for a CR randomized clinical trial, which allowed for a comparison of the feasibility and acceptability of CR in a research as compared to a clinical setting. RESULTS: The research site averaged almost triple the number of referrals as the clinical sites. Over nine months 46.51% of clinic referrals were enrolled in the CR program whereas 64.29% of research referrals were enrolled. Clinical site utilization averaged 70.53% while research site utilization averaged 90.47%. At the clinical sites, 97% of respondents reported CR was an excellent or good experience. There was high treatment fidelity for program structure and content across sites. CONCLUSIONS: This comparison of CR in clinical and research sites highlights the decrease in referrals, enrollment and utilization that occurs when a program moves from a highly controlled setting to the real world. Still, the acceptability, fill rates and utilization indicated that CR can be successfully implemented in large scale, geographically diverse, publically funded clinic settings.


Assuntos
Instituições de Assistência Ambulatorial/estatística & dados numéricos , Remediação Cognitiva/estatística & dados numéricos , Serviços de Saúde Mental/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Transtornos Psicóticos/reabilitação , Encaminhamento e Consulta/estatística & dados numéricos , Esquizofrenia/reabilitação , Pesquisa Biomédica/estatística & dados numéricos , Terapia Cognitivo-Comportamental/estatística & dados numéricos , Estudos de Viabilidade , Órgãos Governamentais/estatística & dados numéricos , Humanos , New York , Satisfação do Paciente , Desenvolvimento de Programas , Ensaios Clínicos Controlados Aleatórios como Assunto , Governo Estadual
15.
Schizophr Res ; 203: 41-48, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-28823720

RESUMO

Treatments for cognitive and functional impairments associated with severe mental illnesses are urgently needed. We tested a 12-week, manualized, Compensatory Cognitive Training (CCT) intervention targeting prospective memory, attention, learning/memory, and executive functioning in the context of supported employment for people with severe mental illnesses who were seeking work. 153 unemployed, work-seeking outpatients with schizophrenia/schizoaffective disorder (n=58), bipolar disorder (n=37), or major depression (n=58) were randomized to receive supported employment plus CCT or enhanced supported employment, a robust control group. Assessments of neuropsychological performance, functional capacity, psychiatric symptom severity, and self-reported functioning and quality of life were administered at baseline and multiple follow-up assessments over two years; work outcomes were collected for two years. Forty-seven percent of the participants obtained competitive work, but there were no differences in work attainment, weeks worked, or wages earned between the CCT and the enhanced supported employment group. ANCOVAs assessing immediate post-treatment effects demonstrated significant, medium to large, CCT-associated improvements on measures of working memory (p=0.038), depressive symptom severity (p=0.023), and quality of life (p=0.003). Longer-term results revealed no statistically significant CCT-associated improvements, but a trend (p=0.058) toward a small to medium CCT-associated improvement in learning. Diagnostic group (schizophrenia-spectrum vs. mood disorder) did not affect outcomes. We conclude that CCT has the potential to improve cognitive performance, psychiatric symptom severity, and quality of life in people with severe mental illnesses. Receiving CCT did not result in better work outcomes, suggesting that supported employment can result in competitive work regardless of cognitive status.


Assuntos
Transtorno Bipolar/reabilitação , Disfunção Cognitiva/reabilitação , Remediação Cognitiva/métodos , Transtorno Depressivo Maior/reabilitação , Readaptação ao Emprego , Reabilitação Psiquiátrica/métodos , Transtornos Psicóticos/reabilitação , Esquizofrenia/reabilitação , Adulto , Transtorno Bipolar/complicações , Disfunção Cognitiva/etiologia , Transtorno Depressivo Maior/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Psicóticos/complicações , Esquizofrenia/complicações
16.
Psychiatr Rehabil J ; 42(1): 48-56, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30407035

RESUMO

OBJECTIVE: Evidence concerning the effectiveness of yoga in partial hospital programs is limited. Yet, partial hospitals provide treatment at a critical juncture by bridging inpatient and outpatient care. The present study tested the effectiveness of a single-session group yoga intervention for short-term mood and psychiatric symptom change in participants attending a 1- to 2-week partial hospital program. METHOD: Participants included 104 partial hospital patients who participated in the single-session yoga intervention and completed a measure of positive/negative affect before and after the group. Participants, as well as partial hospital patients who did not attend the yoga intervention (n = 438), completed measures of depression and anxiety symptoms at admission and discharge from the program. At discharge, they also rated their perceived improvement and the overall quality of the care they received. RESULTS: Participants who attended the yoga intervention experienced significant improvements in positive and negative affect during the group. They did not show greater improvements in symptoms of anxiety or depression over the course of treatment compared to individuals who did not attend the group. Yoga intervention participants nonetheless gave higher ratings to the quality of the care they received. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Findings demonstrated that attending a single yoga session during partial hospitalization was associated with short-term mood benefits, and with enhanced overall perceptions of treatment. Further research is needed to determine the conditions under which participation in yoga during partial hospitalization could contribute to symptom change in this context. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Transtornos de Ansiedade/reabilitação , Hospital Dia/métodos , Hospitais Psiquiátricos , Transtornos do Humor/reabilitação , Transtornos da Personalidade/reabilitação , Reabilitação Psiquiátrica/métodos , Transtornos Psicóticos/reabilitação , Ioga , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
17.
Psychiatr Rehabil J ; 42(2): 139-146, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30556725

RESUMO

OBJECTIVE: Hope is a key component of personal recovery. There is limited evidence regarding the association of hope with the level of functioning in individuals with psychosis. It is also not clear which dimensions of hope are most strongly related to clinical recovery. Thus, this study aims to explore the relationships of hope and its dimensions with various indicators of clinical recovery such as overall psychopathology, depression and global functioning among people with psychotic disorders. METHOD: The Integrative Hope Scale (IHS; Schrank, Woppmann, Sibitz, & Lauber, 2011) was administered to 110 people with psychotic disorders. Multiple regression analysis was used to investigate the associations of the IHS total score and its four subscales (i.e., Trust and Confidence, Lack of Perspective, Positive Future Orientation, and Social Relations and Personal Value) with overall psychiatric symptoms, depression, and general functioning. RESULTS: A total level of Hope was not associated with overall psychopathology or global functioning; however, it showed a significant negative relationship with severity of depression. A stronger feeling of a Lack of Perspective turned out to be associated with more severe depression and a greater intensity of psychopathological symptoms. The relationships of the remaining dimensions of Hope with the indicators of clinical recovery were found to be nonsignificant. CONCLUSION AND IMPLICATIONS FOR PRACTICE: The findings suggest that combining Hope-enhancement strategies with interventions targeting symptoms may increase the effectiveness of rehabilitation programs for people with psychosis. They also point to the sense of a Lack of Perspective as the aspect of Hope most strongly related to clinical recovery. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Depressão/psicologia , Esperança , Transtornos Psicóticos/psicologia , Transtornos Psicóticos/reabilitação , Adulto , Estudos Transversais , Depressão/fisiopatologia , Feminino , Esperança/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Psicóticos/fisiopatologia , Índice de Gravidade de Doença
18.
Neuropsychol Rehabil ; 29(3): 361-375, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28316273

RESUMO

Cognitive remediation (CR) is an intensive intervention targeting cognitive impairment with the aim of improving functioning in people with psychotic disorders. Shorter forms of CR based on metacognition and targeting awareness of cognitive problems may be more appropriate for acute inpatient settings where time is limited. The objective of the study was to evaluate the feasibility and acceptability of a new brief course of CR targeting cognitive and metacognitive difficulties within an acute inpatient psychiatric setting. Thirteen male service users with psychosis received a three-week course of CR. Participants were assessed at baseline and post-treatment on cognitive measures, subjective cognitive complaints, functional impairment, and symptom severity. Feasibility was assessed based on engagement, attendance, and attrition. Acceptability was evaluated through treatment satisfaction. Eight participants completed therapy, with 81% session attendance. Therapy was considered acceptable, with the majority of participants considering it satisfactory. Potential benefit analysis showed a significant post-treatment improvement in global cognition and memory. Subjective cognitive complaints did not change over time. It was concluded that it is feasible to deliver brief CR in an acute inpatient setting. Context of delivery and engagement are challenges for optimal therapy implementation. CR protocol adaptations made to promote metacognitive competencies may compensate for lack of intensive practice.


Assuntos
Remediação Cognitiva , Metacognição , Transtornos Psicóticos/psicologia , Transtornos Psicóticos/reabilitação , Adulto , Remediação Cognitiva/métodos , Estudos de Viabilidade , Hospitalização , Humanos , Pacientes Internados/psicologia , Masculino , Memória , Aceitação pelo Paciente de Cuidados de Saúde , Estudos Prospectivos , Resultado do Tratamento
19.
Gac. sanit. (Barc., Ed. impr.) ; 32(6): 513-518, nov.-dic. 2018. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-174283

RESUMO

Objetivo: Valorar la efectividad de una estrategia de apoyo individualizado al empleo (IPS) en personas con enfermedad mental grave en la isla de Tenerife (España). Método: Pacientes de los Servicios de Salud Mental Comunitaria con trastornos mentales graves fueron asignados a dos grupos de forma aleatorizada. En uno de ellos se aplicó el método IPS (n=124) y en el grupo control (n=75) se asesoró en la manera habitual de búsqueda de empleo. Los pacientes fueron seguidos una media de 3,4 años y se analizó cuántos trabajaron al menos un día, el tiempo trabajado, los salarios, el número de contratos y el número de admisiones hospitalarias. Se usaron métodos estadísticos no paramétricos en la comparación de resultados (U de Mann-Whitney). Resultados: Los pacientes asignados al grupo IPS trabajaron al menos un día el 99%, frente al 75% del grupo control; trabajaron de media 30,1 semanas/año vs. 7,4; el salario mensual fue de 777,9 euros vs. 599,9 euros; el número de contratos por persona fue de 3,89 vs. 4,85, y los ingresos hospitalarios fueron 0,19 vs. 2,1. Conclusión: La estrategia IPS es efectiva en la integración laboral de personas con enfermedad mental grave, logrando que trabajen más tiempo, tengan mayor salario y menos ingresos hospitalarios, en un contexto social de alto desempleo


Objective: To assess the effectiveness of an individual placement and support (IPS) strategy in people with severe mental disorders in Tenerife Island (Spain). Methods: Patients of Community Mental Health Services with severe mental disorders were randomly assigned to two groups. One of them received IPS (n=124), and the control group (n=75) was advised in the usual job search. Patients were followed up for an average of 3.4 years and an analysis was made of how many patients worked at least one day, working hours, wages, the number of contracts and the number of hospital admissions. Non-parametric methods were used to compare the results (Mann-Whitney U test). Results: The percentage of patients who worked at least one day was 99% in the IPS group compared with 75% in the control group; they worked on average 30.1 weeks per year vs 7.4; the monthly salary was Euros 777.9 vs Euros 599.9; the number of contracts per person was 3.89 vs 4.85, and hospital admissions were 0.19 vs 2.1. Conclusions: The IPS strategy is effective for the labour integration of people with severe mental illness getting them to work longer, have higher wages and fewer hospital admissions


Assuntos
Humanos , Transtornos Mentais/epidemiologia , Readaptação ao Emprego/estatística & dados numéricos , Transtornos Psicóticos/epidemiologia , Avaliação de Eficácia-Efetividade de Intervenções , Apoio Social , Integração Comunitária/tendências , Transtornos Psicóticos/reabilitação , Transtornos Mentais/reabilitação
20.
Artigo em Inglês | MEDLINE | ID: mdl-30297637

RESUMO

Mental health is reportedly influenced by the presence of green and blue space in residential areas, but scientific evidence of a relation to psychotic disorders is scant. We put two hypotheses to the test: first, compared to the general population, psychiatric patients live in neighborhoods with less green and blue space; second, the amount of green and blue space is negatively associated with the duration of hospital admission. The study population consisted of 623 patients with psychotic disorders who had been admitted to the psychiatric ward of an academic hospital in Utrecht, The Netherlands from 2008 to 2016. Recovery was measured by length of stay. Structured patient data was linked to socio-economic status and the amount of green and blue space in the residential area. Associations were assessed by means of regression models controlling for confounding factors. Compared to the general population, psychiatric patients had a significantly lower amount of green space in their neighborhood. This result was not confirmed for blue space. Furthermore, no significant associations were found between green and blue space and the duration of hospital stay. In conclusion, previous studies focusing on other mental disorders, like anxiety or depression, found positive mental health effects of green and blue space in the neighborhood. We were not able to confirm significant effects among our study population on duration of admission, however. Future research focusing on psychotic patients could investigate the influence of exposure to green and blue space on other influences and outcomes on mental health.


Assuntos
Parques Recreativos/estatística & dados numéricos , Transtornos Psicóticos/reabilitação , Características de Residência/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos , Fatores Socioeconômicos , Adulto Jovem
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