Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.563
Filtrar
2.
Res Dev Disabil ; 110: 103856, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33497856

RESUMO

During the COVID-19 pandemic, the Oasi Research Institute of Troina (Italy) became an important hotbed for infection; in fact, 109 patients with different levels of Intellectual Disability (ID) tested positive for COVID-19. The procedures and interventions put in place at the Oasi Research Institute due to the COVID-19 pandemic are exhaustively reported in this paper. The description of the clinical procedures as well as remote/in person psychological support services provided to people with ID and their families are here divided into three different sections: Phase I (or Acute phase), Phase II (or Activity planning), and Phase III (or Activity consolidation). In each section, the main psycho-pathological characteristics of patients, the reactions of family members and the multidisciplinary interventions put in place are also described.


Assuntos
/epidemiologia , Deficiências do Desenvolvimento/reabilitação , Deficiência Intelectual/reabilitação , Sistemas de Apoio Psicossocial , Telemedicina , Academias e Institutos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Transtorno do Espectro Autista/epidemiologia , Transtorno do Espectro Autista/psicologia , Transtorno do Espectro Autista/reabilitação , /fisiopatologia , Criança , Pré-Escolar , Comorbidade , Deficiências do Desenvolvimento/epidemiologia , Deficiências do Desenvolvimento/psicologia , Surtos de Doenças , Epilepsia/epidemiologia , Feminino , Hospitais Especializados , Humanos , Hipotireoidismo/epidemiologia , Lactente , Deficiência Intelectual/epidemiologia , Deficiência Intelectual/psicologia , Itália , Masculino , Pessoa de Meia-Idade , Transtornos do Humor/epidemiologia , Transtornos do Humor/psicologia , Transtornos do Humor/reabilitação , Obesidade/epidemiologia , Sobrepeso/epidemiologia , Transtornos da Personalidade/epidemiologia , Transtornos da Personalidade/psicologia , Transtornos da Personalidade/reabilitação , Transtornos Psicóticos/epidemiologia , Transtornos Psicóticos/psicologia , Transtornos Psicóticos/reabilitação , Índice de Gravidade de Doença , Adulto Jovem
3.
Artigo em Inglês | MEDLINE | ID: mdl-33166098

RESUMO

Objective: To report the clinical characteristics and transmission rate of coronavirus disease 2019 (COVID-19) in a community inpatient long-term care psychiatric rehabilitation facility designed for persons with serious mental illness to provide insight into transmission and symptom patterns and emerging testing protocols, as well as medical complications and prognosis. Methods: This study examined a cohort of 54 residents of a long-term care psychiatric rehabilitation program from March to April 2020. Baseline demographics, clinical diagnoses, and vital signs were examined to look for statistical differences between positive versus negative severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) groups. During the early phase of the pandemic, the facility closely followed the local shelter-in-place order (starting March 19, 2020) and symptom-based testing. Results: Of the residents, the primary psychiatric diagnoses were schizoaffective disorder: 28 (51.9%), schizophrenia: 21 (38.9%), bipolar I disorder: 3 (5.5%), and unspecified psychotic disorder: 2 (3.7%). Forty (74%) of 54 residents tested positive for SARS-COV-2, with a doubling time of 3.9 days. There were no statistical differences between the positive SARS-COV-2 versus negative groups for age or race/ethnicity. Psychiatric and medical conditions were not significantly associated with contracting SARS-COV-2, with the exception of obesity (n = 17 [43%] positive vs n = 12 [86%] negative, P = .01). Medical monitoring of vital signs and symptoms did not lead to earlier detection. All of the residents completely recovered, with the last resident no longer showing any symptoms 24 days from the index case. Conclusion: Research is needed to determine optimal strategies for long-term care mental health settings that incorporate frequent testing and personal protective equipment use to prevent rapid transmission of SARS-COV-2.


Assuntos
Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Transtornos Psicóticos/reabilitação , Centros de Reabilitação , Esquizofrenia/reabilitação , Adulto , Afro-Americanos , Americanos Asiáticos , Betacoronavirus , Transtorno Bipolar/epidemiologia , Transtorno Bipolar/reabilitação , California/epidemiologia , Técnicas de Laboratório Clínico , Comorbidade , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/transmissão , Diabetes Mellitus/epidemiologia , Grupo com Ancestrais do Continente Europeu , Refluxo Gastroesofágico/epidemiologia , Hispano-Americanos , Humanos , Hiperlipidemias/epidemiologia , Hipertensão/epidemiologia , Hipotireoidismo/epidemiologia , Controle de Infecções , Assistência de Longa Duração , Programas de Rastreamento , Pessoa de Meia-Idade , Obesidade/epidemiologia , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/fisiopatologia , Pneumonia Viral/transmissão , Reabilitação Psiquiátrica , Psicoterapia de Grupo , Transtornos Psicóticos/epidemiologia , Recreação , Reabilitação Vocacional , Esquizofrenia/epidemiologia , Fumar/epidemiologia , Visitas a Pacientes
5.
J Psychiatr Ment Health Nurs ; 27(2): 194-202, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31610067

RESUMO

WHAT IS KNOWN ON THE SUBJECT: The intersection of sexuality and psychosis has a long history, yet research in this area has been minimal over the past few decades. Mental health clinicians practice from within the confines of a mental health system that is founded on a conflict between containment and care and that positions the consumer as an object of care. At the same time, mental health services often have a Recovery approach to care. This presents a difficulty and tension in mental health clinical work because the Recovery approach is opposed to positioning the consumer as an object. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE: The findings suggest that sexuality and sexual needs are common to both clinicians and consumers, and via identification, make the two groups more similar than different. Sexuality can problematize and so open up questions about the objectification of consumers. Consideration of consumers' sexuality and sexual needs can therefore work as a resistance to the dominant mental health approach and, in doing so, produce a more Recovery-oriented approach to treatment in terms of how the consumer is positioned. Other aspects of living that escape capture by the diagnostic system may also operate as organizing factors for a more subject-to-subject approach to treatment. THE IMPLICATIONS FOR PRACTICE: Focusing on sexuality and other aspects of living that escape capture by the diagnostic system can bring into question the way consumers are objectified by the psychiatric model of care. Abstract Introduction The Recovery approach introduced a radical shift in the positioning of consumers as subjects rather than objects of mental health treatment. While this approach has been internationally adopted, the practice of Recovery has been under-researched and a knowledge gap exists regarding the intersection of sexuality and psychosis. Aim The study aim was to investigate how sexuality was governed in a long-stay mental health rehabilitation facility that was Recovery-oriented. Method A case study methodology with a conceptual framework using Foucault's work on disciplinary power was used. Results The findings illustrated how mental health clinicians were caught between two main and incompatible models of care: a psychiatric one and a Recovery one. Discussion While the policy framework authorized a Recovery approach, clinicians practised surveillance, hierarchical observation and normalization, which are tenants of a psychiatric model of care. However, the study found that sexuality was an area that opened questions about the psychiatric model for clinicians. Consideration of consumers' sexual needs allowed the clinicians to think of consumers more as subjects like themselves than as objects to be treated. Implications for practice Consideration of consumers' sexuality opens up possibilities for questioning the objectification of the consumer via the psychiatric model.


Assuntos
Atitude do Pessoal de Saúde , Serviços de Saúde Mental , Pessoas Mentalmente Doentes , Enfermagem Psiquiátrica , Reabilitação Psiquiátrica , Transtornos Psicóticos/reabilitação , Instituições Residenciais , Esquizofrenia/reabilitação , Sexualidade , Adulto , Humanos , Enfermagem Psiquiátrica/métodos , Reabilitação Psiquiátrica/métodos , Pesquisa Qualitativa
6.
Am J Orthopsychiatry ; 90(2): 181-192, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31021133

RESUMO

Homelessness is a major public health problem, and serious mental illness (SMI) is highly prevalent in the homeless population. Although supported housing services-which provide permanent housing in the community along with case management-improve housing outcomes, community integration typically remains poor, and little is known about the underlying determinants of poor community integration postresidential placement. The general SMI literature has indicated that motivational and cognitive ability factors are key determinants of successful community integration, which provides a foundation for examining this issue. This study evaluated whether interview- and performance-based assessments of motivation, nonsocial and social-cognitive ability, and psychiatric symptoms were associated with community integration indices in 2 samples of homeless veterans either with (N = 96) or without (N = 80) a psychotic disorder who had recently been admitted to a supported housing program but who had not yet attained housing. Motivation indices, including experiential negative symptoms and defeatist performance attitudes, stood out as the most robust correlates (rs = -.30 to -.69) of community integration across both samples, particularly for social role participation. Demographics, general psychiatric symptoms, and nonsocial cognition showed generally weak relations with community integration, though social cognition showed a few relations. The consistent findings across samples point to the importance of motivational factors for understanding the determinants of poor community integration in this complex population. Further, interventions that target motivational challenges may have widespread usefulness for enhancing community integration outcomes beyond obtaining housing. (PsycINFO Database Record (c) 2020 APA, all rights reserved).


Assuntos
Integração Comunitária , Pessoas em Situação de Rua , Pessoas Mentalmente Doentes , Motivação/fisiologia , Transtornos Psicóticos/fisiopatologia , Transtornos Psicóticos/reabilitação , Habitação Popular , Veteranos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos
7.
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 , Avaliação de Resultados em Cuidados de Saúde , Desenvolvimento de Programas , Transtornos Psicóticos/complicações , Transtornos Psicóticos/psicologia , Transtornos Psicóticos/terapia , Adulto Jovem
8.
Acta Psychiatr Scand ; 140(6): 498-507, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31565796

RESUMO

OBJECTIVE: To evaluate the feasibility and effects of integrating aerobic interval training (AIT) in standard care of out-patients with schizophrenia on aerobic capacity and conventional cardiovascular disease (CVD) risk factors. METHODS: Out-patients with schizophrenia spectrum disorder were randomized to the following: 1) a training group (TG), performing AIT 2 day/week at the clinic with adherence support from municipal services; or 2) a control group (CG), given two AIT sessions and encouraged to exercise on their own. Feasibility was assessed through retention/adherence. V ˙ O 2 peak was measured directly along with conventional CVD risk factors before and after 12 weeks. RESULTS: Of 48 out-patients, 16/25 and 18/23 completed the TG and CG respectively. After 12 weeks, V ˙ O 2 peak was higher (2.7 ± 4.8 ml/kg/min, P < 0.01) in the TG compared with the CG. The TG improved V ˙ O 2 peak by 3.1 ± 3.7 ml/kg/min (P < 0.01), while no change in the CG was observed. No intergroup difference in weight, body mass index (BMI), waist circumference, blood pressure, lipids, or glucose at posttest was observed. Weight (1.9 ± 4.0 kg, P < 0.05) and BMI (0.5 ± 1.1 kg/m2 , P < 0.05) increased in the CG, with no change in the TG. CONCLUSION: AIT, combined with adherence support, of out-patients with schizophrenia was feasible, improved V ˙ O 2 peak , and may be integrated in standard care. (ClinicalTrials.gov identifier: NCT02743143).


Assuntos
Terapia por Exercício/métodos , Avaliação de Processos em Cuidados de Saúde , Transtornos Psicóticos/reabilitação , Esquizofrenia/reabilitação , Adulto , Estudos de Viabilidade , Feminino , Treinamento Intervalado de Alta Intensidade , Humanos , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais , Testes de Função Respiratória , Adulto Jovem
9.
Psychiatr Serv ; 70(11): 1027-1033, 2019 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-31480928

RESUMO

OBJECTIVE: Since 2010, the Affordable Care Act has required private health plans to extend dependent coverage to adults up to age 26. Because psychosis often begins in young adulthood, expanded private insurance benefits may affect early psychosis treatment. The authors examined changes in insurance coverage and hospital-based service use among young adults with psychosis before and after this change. METHODS: The study included a national sample (2006-2013) of discharges and emergency department visits. Using a difference-in-differences study design, the authors compared changes in insurance coverage (measured as payer source), per capita admissions, and 30-day readmissions for psychosis before and after ACA dependent coverage expansion among targeted individuals (ages 20-25) and a comparison group (ages 27-29). RESULTS: After dependent coverage expansion, hospitalization for psychosis among young adults was 5.8 percentage points more likely to be reimbursed by private insurance among the targeted age group (ages 20-25), compared with the slightly older age group (ages 27-29). Dependent coverage expansion was not associated with changes in overall insurance coverage, per capita admissions, or 30-day readmission for psychosis. CONCLUSIONS: Although dependent coverage expansion was unrelated to changes in use of hospital-based treatments for psychosis among young adults, care was more likely to be covered by private insurance, and coverage of these hospitalizations by public insurance decreased. This shift from public to private insurance may reduce public spending on young-adult treatments for early-episode psychosis but may leave young adults without coverage for rehabilitation services.


Assuntos
Hospitalização/economia , Cobertura do Seguro/estatística & dados numéricos , Patient Protection and Affordable Care Act , Transtornos Psicóticos/economia , Transtornos Psicóticos/reabilitação , Adulto , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Hospitalização/tendências , Humanos , Seguro de Hospitalização , Modelos Lineares , Masculino , Pessoas sem Cobertura de Seguro de Saúde/estatística & dados numéricos , Avaliação de Resultados em Cuidados de Saúde , Estados Unidos , Adulto Jovem
10.
Asian J Psychiatr ; 44: 138-142, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31376797

RESUMO

In India, expenditure incurred to access mental health services often drives families to economic crisis. Families of Persons with mental illness (PMI) incur 'out-of-pocket' (OOP) expenditure for medicines, psychiatrist fee and travel in addition to losing wages on the day of visiting psychiatrist. AIM: To describe impact of Community Based Rehabilitation (CBR) on OOP expenditure incurred by families of persons with severe mental illness (PSMI). METHODS: The sample comprised 95 PSMI who switched from treatment from other mental health facilities to CBR at Jagaluru, India. RESULTS: The PSMI were predominantly male (52%) with mean age 41 years and diagnosed with psychosis (75%). Most of them (84%) were earlier taking treatment from private sector and spent on an average Rs. 15,074 (US $ 215) per PSMI per annum in availing treatment. After availing CBR, the annual expenditure reduced to Rs 492 (US $ 7) on an average per PSMI. OOP expenditure on medicines (largest head of expenditure) and psychiatrist consultation fee dropped to zero. DISCUSSION: After excluding costs incurred to run the CBR, the net savings for the system for 95 PSMI included in study alone was Rs 3,83,755 (US $ 5,482) per annum. The amount would be much higher on including savings for PSMI initiated on treatment for the first time and PMI on regular follow-up in CBR. CONCLUSIONS: Provision of CBR in partnership with public health system and NGO's leads to dramatic fall in OOP health expenditure of families of PSMI. It is also cost-effective to the system.


Assuntos
Serviços Comunitários de Saúde Mental/economia , Gastos em Saúde/estatística & dados numéricos , Transtornos Mentais/economia , Transtornos Mentais/reabilitação , Reabilitação Psiquiátrica/economia , População Rural/estatística & dados numéricos , Adulto , Feminino , Humanos , Índia , Masculino , Pessoa de Meia-Idade , Transtornos Psicóticos/economia , Transtornos Psicóticos/reabilitação
11.
Schizophr Res ; 212: 72-78, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31420200

RESUMO

BACKGROUND: Recovery is the ultimate goal of psychosis treatment. Basic self-disturbances (BSDs) are non-psychotic phenomena associated with clinical outcome, present in prodromal, psychotic and residual phases of psychotic disorders. AIM: To investigate the relationship between BSDs and recovery seven years after first treatment in patients with psychotic disorders. METHOD: Prospective longitudinal study of 56 patients recruited during first adequate treatment for schizophrenia (n = 35) and other psychotic disorders (n = 21) (psychotic bipolar disorder, delusional disorder, psychotic disorder NOS). At baseline and follow-up BSDs were assessed using the Examination of Anomalous Self-Experience (EASE) manual, while standard clinical instruments were used to ascertained diagnosis, clinical symptom severity, and functioning. Recovery was defined as absence of psychotic symptoms and regaining of functioning that persisted the last two years before follow-up. RESULTS: At follow up, 34% achieved recovery (5 (14%) with schizophrenia and 14 (67%) with other psychoses at baseline). Recovery was predicted by an absence of a schizophrenia diagnosis, low baseline level of BSDs and further reductions in BSDs from baseline to follow-up. Change in BSDs was the strongest predictor, also after adjusting for premorbid adjustment and duration of untreated psychosis, and was not confounded by diagnosis. CONCLUSION: Low baseline levels of basic self-disturbances and further reductions over time independently predict recovery seven years later in first treated psychosis patients.


Assuntos
Transtornos Psicóticos Afetivos/fisiopatologia , Ego , Transtornos Psicóticos/fisiopatologia , Esquizofrenia/fisiopatologia , Adolescente , Adulto , Transtornos Psicóticos Afetivos/diagnóstico , Transtornos Psicóticos Afetivos/reabilitação , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/reabilitação , Esquizofrenia/diagnóstico , Esquizofrenia/reabilitação , Adulto Jovem
12.
Schizophr Res ; 211: 56-62, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31351829

RESUMO

BACKGROUND: Internalized stigma (IS) is a key factor in the recovery, quality of life and functioning of people with severe mental illness (SMI), and effective intervention programs are needed to reduce IS in all its dimensions. The aim of this report was to design and evaluate the effectiveness of a new psychological intervention group program for the reduction of IS in people with SMI. METHODS: A 9-session hands-on intervention program was designed with a group format in which different therapeutic techniques were combined. To evaluate the effectiveness of the program, 80 people with SMI and high levels of IS were selected and randomly assigned to one of two groups: program (n = 41, experimental group) or conventional treatment (n = 39, control group). RESULTS: Mixed analysis of variance showed improvements in total IS and all of its dimensions (cognitive, emotional and behavioral) (p ≤ 0.01) and in depressive symptomatology (p = 0.01) in the experimental group after the treatment phase. CONCLUSION: The results indicate that the program effectively reduces IS and its dimensions as well as other relevant associated variables in a sample of people with SMI.


Assuntos
Recuperação da Saúde Mental , Transtornos do Humor/psicologia , Transtornos da Personalidade/psicologia , Psicoterapia de Grupo , Transtornos Psicóticos/psicologia , Autoimagem , Estigma Social , Adulto , Ansiedade , Depressão , Feminino , Humanos , Masculino , Transtornos Mentais/psicologia , Transtornos Mentais/reabilitação , Pessoa de Meia-Idade , Transtornos do Humor/reabilitação , Transtornos da Personalidade/reabilitação , Transtornos Psicóticos/reabilitação , Qualidade de Vida , Participação Social
14.
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
15.
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 , Envio de Mensagens 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
17.
Ann Glob Health ; 85(1)2019 04 05.
Artigo em Inglês | MEDLINE | ID: mdl-30951270

RESUMO

BACKGROUND: Peers are people with lived experience of mental illness. Peer support is an established intervention in which peers offer support to others with mental illness. A large proportion of people living with severe mental illness receive no care. The care gap is largest in low- and middle-income countries, with detrimental effects on individuals and societies. The global shortage of human resources for mental health is an important driver of the care gap. Peers are an under-used resource in global mental health. OBJECTIVES: To describe rationale and methodology of an international multicentre study which will scale-up peer support for people with severe mental illness in high-, middle-, and low-income countries through mixed-methods implementation research. METHODS: UPSIDES is an international community of research and practice for peer support, including peer support workers, mental health researchers, and other relevant stakeholders in eight study sites across six countries in Europe, Africa, and Asia. During the first two years of UPSIDES, a series of qualitative studies and systematic reviews will explore stakeholders' perceptions and the current state of peer support at each site. Findings will be incorporated into a conceptual framework to guide the development of a culturally appropriate peer support intervention to be piloted across all study sites. All intervention and study materials will be translated according to internationally recognised guidelines.Expected Impact: UPSIDES: will leverage the unique expertise of people with lived experience of mental illness to strengthen mental health systems in high-, middle- and low-income countries. UPSIDES will actively involve and empower service users and embed patient-centeredness, recovery orientation, human rights approaches, and community participation into services. The focus on capacity-building of peers may prove particularly valuable in low-resource settings in which shortages of human capital are most severe.


Assuntos
Saúde Global , Transtornos Mentais/reabilitação , Recuperação da Saúde Mental , Serviços de Saúde Mental , Grupo Associado , Apoio Social , Transtorno Bipolar/reabilitação , Assistência à Saúde Culturalmente Competente , Transtorno Depressivo Maior/reabilitação , Alemanha , Humanos , Ciência da Implementação , Índia , Israel , Participação do Paciente , Transtornos Psicóticos/reabilitação , Esquizofrenia/reabilitação , Participação dos Interessados , Tanzânia , Uganda , Reino Unido
18.
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
19.
J Behav Ther Exp Psychiatry ; 64: 80-86, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-30875541

RESUMO

OBJECTIVE: The HospitalitY (HY) intervention is a novel recovery oriented intervention for people with psychotic disorders in which peer support and home-based skill training are combined in an eating club. A feasibility study was conducted to inform a subsequent randomised trial. METHODS: This study evaluated three eating clubs consisting of nine participants and three nurses. Semi-structured interviews and pre- and post-intervention measures (18 weeks) of personal recovery, quality of life and functioning were used to evaluate the intervention. Participants received individual skills training, guided by self-identified goals, while organising a dinner at their home. During each dinner, participants engaged in peer support, led by a nurse. RESULTS: In personal interviews participants reported positive effects on social support, loneliness, and self-esteem. Nurses reported that participants became more independent during the intervention. Participants were satisfied with the HY-intervention (attendance rate = 93%). All were able to organise a dinner for their peers with practical support from a nurse. Pre- and post -intervention measures did not show important improvements. LIMITATIONS: Outcome measures were not sensitive to change, likely due to a short intervention period (5 months) and a limited number of participants (N = 9). Using Goal Attainment Scaling to evaluate personal goals turned out to be unfeasible. CONCLUSIONS: The HY-intervention is feasible for participants with psychotic disorders. This study refined intervention and research design for the upcoming multicentre randomised controlled trial. We expect that the Experience Sampling Method will be more sensitive to changes in recovery outcomes than regular pre-post intervention measures.


Assuntos
Relações Interpessoais , Grupo Associado , Reabilitação Psiquiátrica/métodos , Transtornos Psicóticos/reabilitação , Esquizofrenia/reabilitação , Apoio Social , Adulto , Estudos de Viabilidade , Feminino , Humanos , Solidão , Masculino , Refeições , Pessoa de Meia-Idade , Autoimagem , Resultado do Tratamento
20.
Psychiatr Serv ; 70(4): 302-308, 2019 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-30717644

RESUMO

OBJECTIVE: Given the benefits of early intervention for psychosis and the social disengagement of youths not in education, employment, or training (NEET), this study sought to examine how being vocationally inactive (NEET) affects engagement in early intervention services. Both baseline vocational status and vocational trajectory in the first year of treatment were analyzed. METHODS: Data from 394 patients of a Canadian early intervention service were analyzed using time-to-event and Cox proportional hazards regression analyses. Two-year disengagement rates were compared between patients who were vocationally inactive and active at baseline and between those who remained vocationally inactive until month 12 and those who were vocationally inactive only at baseline. Pertinent sociodemographic (age, sex, visible minority status, social and material deprivation indices, and family involvement), and clinical (duration of untreated psychosis, substance use disorder, medication nonadherence, and baseline positive and negative symptoms) factors were considered. RESULTS: There was no statistically significant difference between the disengagement rates of those who were vocationally inactive (N=154) and those who were vocationally active (N=240) at baseline. Those who remained vocationally inactive at month 12 (N=77) were likelier to disengage in the second year than those who were vocationally inactive only at baseline (N=48) (χ2=5.44, df=1, p<0.05). This comparison remained significant in the regression analysis (hazard ratio [HR]=8.52, 95% confidence interval [95% CI]=1.54-47.1). The association of disengagement from services with lack of family contact with the treatment team (HR=3.91, 95% CI=0.98-15.6) and with greater material deprivation (HR=1.03, 95% CI=1.00-1.07) trended toward significance. CONCLUSIONS: The functional recovery of youths who are vocationally inactive when they enter services can affect their long-term service engagement and merits targeting by evidence-based interventions.


Assuntos
Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Cooperação do Paciente/estatística & dados numéricos , Transtornos Psicóticos/psicologia , Transtornos Psicóticos/reabilitação , Desemprego , Adolescente , Adulto , Canadá , Intervenção Médica Precoce/métodos , Feminino , Humanos , Masculino , Modelos de Riscos Proporcionais , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...