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1.
J Korean Med Sci ; 35(49): e429, 2020 Dec 21.
Artigo em Inglês | MEDLINE | ID: mdl-33350187

RESUMO

With the rapid spread of coronavirus disease 2019 (COVID-19), a particularly sharp increase in the number of confirmed cases in Daegu and Gyeongbuk regions at the end of February, Korea faced an unprecedented shortage of medical resources, including hospital beds. To cope with this shortage, the government introduced a severity scoring system for patients with COVID-19 and designed a new type of quarantine facility for treating and isolating patients with mild symptoms out of the hospital, namely, the Residential Treatment Center (RTC). A patient with mild symptoms was immediately isolated in the RTC and continuously monitored to detect changes in symptoms. If the symptoms aggravate, the patient was transferred to a hospital. RTCs were designed by creating a quarantine environment in existing lodging facilities capable of accommodating > 100 individuals. The facilities were entirely divided into a clean zone (working area) and contaminated zone (patient zone), separating the space, air, and movement routes, and the staff wore level D personal protective equipment (PPE) in the contaminated zone. The staffs consisted of medical personnel, police officers, soldiers, and operation personnel, and worked in two or three shifts per day. Their duty was mainly to monitor the health conditions of quarantined patients, provide accommodations, and regularly collect specimens to determine if they can be released. For the past two months, RTCs secured approximately 4,000 isolation rooms and treated approximately 3,000 patients with mild symptoms and operated stably without additional spread of the disease in and out of the centers. Based on these experience, we would like to suggest the utilization of RTCs as strategic quarantine facilities in pandemic situations.


Assuntos
/diagnóstico , Isolamento de Pacientes/organização & administração , Quarentena/organização & administração , /epidemiologia , Planejamento em Desastres/métodos , Pessoal de Saúde , Humanos , Pandemias , Vigilância da População , República da Coreia/epidemiologia , Tratamento Domiciliar , Índice de Gravidade de Doença
2.
Psychiatr Serv ; 71(10): 1070-1074, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-32781926

RESUMO

The global experience of the COVID-19 pandemic is unprecedented. The magnitude, pace, and uncertainty of the pandemic have taxed systems and catalyzed innovation in many fields, including behavioral health. Behavioral health leaders have absorbed changing information about regulations and laws, proper use of personal protective equipment, isolation and quarantine, telepsychiatry practices (broadly defined here as the use of virtual and telephonic means to provide behavioral health care), and financial opportunities and challenges while attending to the mental health needs of local populations. This Open Forum reviews many of the adaptations of the behavioral health system in response to COVID-19 on the basis of a point-in-time snapshot and describes needed multidimensional policy and practice considerations for the future.


Assuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Assistência à Saúde/métodos , Transtornos Mentais/terapia , Serviços de Saúde Mental , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Serviços Comunitários de Saúde Mental/métodos , Hospitais Estaduais , Humanos , Tratamento Domiciliar , Telemedicina/métodos
3.
Brasília, D.F.; OPAS; 2020-08-26. (OPAS-W/BRA/COVID-19/20-102).
Não convencional em Português | PAHO-IRIS | ID: phr2-52615

RESUMO

Objetivo da orientação: Este breve informe se destina a orientar os profissionais de saúde pública e de prevenção e controle de infecção (PCI), os gerentes de unidades de saúde, os profissionais de saúde a e outros provedores comunitários treinados ao abordarem questões relacionadas ao atendimento domiciliar para pacientes com suspeita ou confirmação de COVID-19, referindo-se, portanto, a um paciente com suspeita ou confirmação de COVID-19 ao longo de todo o documento. Em muitos contextos, os serviços de saúde são prestados em nível comunitário e em casa por profissionais de saúde comunitários, médicos tradicionais, assistentes sociais ou uma variedade de provedores de atendimento formais e informais da comunidade, incluindo cuidadores. Para os fins deste documento, o termo “cuidadores” se refere aos pais, cônjuges e outros membros da família ou amigos que prestam cuidados informais, em oposição aos cuidados prestados por prestadores de atendimento de saúde formais.


Assuntos
Infecções por Coronavirus , Coronavirus , Pandemias , Pacientes Domiciliares , Tratamento Domiciliar , Serviços de Assistência Domiciliar
5.
J Addict Med ; 14(5): e261-e263, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32530889

RESUMO

OBJECTIVES: The global pandemic of coronavirus disease 2019 (Covid-19) may disproportionately affect persons in congregate settings, including those in residential substance use treatment facilities. To limit the spread of SARS-CoV-2 through congregate settings, universal testing may be necessary. We aimed to determine the point prevalence of SARS-CoV-2 in a residential treatment program setting and to understand the unique challenges of Covid-19 transmission in this setting. METHODS: We performed a case series of SARS-CoV-2 rT-PCR testing via nasopharyngeal in a residential substance use treatment program for women in Boston. Staff and residents of the treatment program were tested for SARS-CoV-2. The primary outcome was SARS-CoV-2 test result. RESULTS: A total of 31 residents and staff were tested. Twenty-seven percent (6/22) of the residents and 44% (4/9) of staff tested positive for SARS-CoV-2. All of the SARS-CoV-2 positive residents resided in the same residential unit. Two positive cases resided together with 2 negative cases in a 4-person room. Two other positive cases resided together in a 2-person room. One positive case resided with 2 negative cases in a 3-person room. One positive case resided with a negative case in a 2-person room. Based on test results, residents were cohorted by infection status and continued to participate in addiction treatment on-site. CONCLUSIONS: SARS-CoV-2 infection was common among staff and residents within a residential substance use treatment program for women in Boston. Universal SARS-CoV-2 testing in residential substance use programs can be instituted to reduce the risk of further transmission and continue addiction treatment programming when accompanied by adequate space, supplies, and staffing.


Assuntos
Infecções por Coronavirus/epidemiologia , Pessoal de Saúde/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Tratamento Domiciliar/estatística & dados numéricos , Centros de Tratamento de Abuso de Substâncias/estatística & dados numéricos , Adulto , Betacoronavirus/genética , Boston/epidemiologia , Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/genética , Feminino , Humanos , Pandemias , Prevalência , Adulto Jovem
6.
Behav Ther ; 51(4): 559-571, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32586430

RESUMO

Delays in behavioral and biological circadian rhythms (e.g., sleep timing, melatonin secretion) are found more frequently in individuals with severe and treatment-resistant obsessive-compulsive disorder (OCD). In recent years, it has been documented that these delays in behavioral and biological circadian rhythms are associated with more severe OCD symptoms and poorer response to some OCD treatments. This study examined self-reported sleep behaviors in individuals taking part in an intensive treatment for OCD and the relations between these and OCD symptoms (both at admission to and discharge from the treatment program). Replicating previous findings in less severe populations, delayed sleep phases were relatively common in this group and later bedtimes were associated with more severe OCD symptoms at admission. Sleep onset latency and sleep duration were not associated with OCD symptom severity at admission. Later bedtimes were not associated with self-reported depression or worry symptom severity. There was no evidence of sleep behaviors affecting change in OCD symptoms from admission to discharge from treatment-however, later bedtimes at admission were associated with more severe OCD symptoms at admission and discharge from treatment. There was no evidence of sleep onset latency or sleep duration having a similar predictive effect. More severe OCD symptoms at admission were also associated with later bedtimes at admission and discharge from treatment. These bidirectional predictive relations between late bedtimes and OCD symptoms were of small effect size but support the potential value of evaluating sleep timing in individuals with severe and/or treatment-resistant OCD.


Assuntos
Transtorno Obsessivo-Compulsivo , Humanos , Transtorno Obsessivo-Compulsivo/terapia , Tratamento Domiciliar , Sono , Transtornos do Sono-Vigília
7.
Artigo em Inglês | MEDLINE | ID: mdl-32218385

RESUMO

Background: Professional caregivers are exposed to multiple stressors and have high burnout rates; however, not all individuals are equally susceptible. We investigated the association between resilience and burnout in a Swiss population of professional caregivers working in youth residential care. Methods: Using a prospective longitudinal study design, participants (n = 159; 57.9% women) reported on burnout symptoms and sense of coherence (SOC), self-efficacy and self-care at four annual sampling points. The associations of individual resilience measures and sociodemographic variables, work-related and personal stressors, and burnout symptoms were assessed. Cox proportional hazards regressions were calculated to compute hazard ratios over the course of three years. Results: Higher SOC, self-efficacy and self-care were related to lower burnout symptoms in work-related and personal domains. Higher SOC and self-efficacy were reported by older caregivers and by those with children. All three resilience measures were highly correlated. A combined model analysis weakened the protective effect of self-efficacy, leaving only SOC and self-care negatively associated with burnout. Conclusion: This longitudinal analysis suggests that SOC and self-caring behaviour in particular protect against burnout. Our findings could have implications for promoting self-care practices, as well as cultivating a meaningful, comprehensible and manageable professional climate in all facets of institutional care.


Assuntos
Esgotamento Profissional/prevenção & controle , Cuidadores , Adolescente , Criança , Estudos Transversais , Feminino , Humanos , Estudos Longitudinais , Masculino , Estudos Prospectivos , Tratamento Domiciliar , Suíça
8.
Eur Eat Disord Rev ; 28(3): 246-259, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32196843

RESUMO

OBJECTIVE: Residential centres for the treatment of eating disorders are becoming increasingly common, yet data following residential care are scarce. We reviewed outcomes of residential treatment for eating disorders across all diagnoses, age groups and genders. A secondary goal was to identify treatment elements and patient characteristics that predicted a greater response to treatment. METHOD: Peer-reviewed studies published in the last 20 years were identified through a systematic search of the electronic databases PubMed and Cochrane Library. RESULTS: Nineteen open-label studies reporting changes between admission and discharge were included in this review. Most took an eclectic approach to treatment, integrating elements from several different techniques without a unifying theoretical framework. All studies reported improvements in most outcomes at discharge, including changes in eating disorders psychopathology, weight, depression, anxiety and quality of life. Eight studies reported outcomes at some interval after discharge, with largely positive outcomes. CONCLUSIONS: While residential care was associated with consistently positive outcomes, the variability in program characteristics and poor quality of research designs prevent firm conclusions from being drawn about their efficacy. Future research should include controlled studies that evaluate specific theoretical approaches and program elements, include long-term follow-up, and compare residential care to other treatment settings.


Assuntos
Transtornos da Alimentação e da Ingestão de Alimentos/terapia , Tratamento Domiciliar , Ensaios Clínicos como Assunto , Humanos , Resultado do Tratamento
9.
Epidemiol Psychiatr Sci ; 29: e109, 2020 Mar 11.
Artigo em Inglês | MEDLINE | ID: mdl-32157987

RESUMO

AIMS: Community care units (CCUs) are a model of residential psychiatric rehabilitation aiming to improve the independence and community functioning of people with severe and persistent mental illness. This study examined factors predicting improvement in outcomes among CCU consumers. METHODS: Hierarchical regression using data from a retrospective cohort (N = 501) of all consumers admitted to five CCUs in Queensland, Australia between 2005 and 2014. The primary outcome was changed in mental health and social functioning (Health of the Nation Outcome Scale). Secondary outcomes were disability (Life Skills Profile-16), service use, accommodation instability, and involuntary treatment. Potential predictors covered service, consumer, and treatment characteristics. Group-level and individualised change were assessed between the year pre-admission and post-discharge. Where relevant and available, the reliable and clinically significant (RCS) change was assessed by comparison with a normative sample. RESULTS: Group-level analyses showed statistically significant improvements in mental health and social functioning, and reductions in psychiatry-related bed-days, emergency department (ED) presentations and involuntary treatment. There were no significant changes in disability or accommodation instability. A total of 54.7% of consumers demonstrated reliable improvement in mental health and social functioning, and 43.0% showed RCS improvement. The majority (60.6%) showed a reliable improvement in psychiatry-related bed-use; a minority demonstrated reliable improvement in ED presentations (12.5%). Significant predictors of improvement included variables related to the CCU care (e.g. episode duration), consumer characteristics (e.g. primary diagnosis) and treatment variables (e.g. psychiatry-related bed-days pre-admission). Higher baseline impairment in mental health and social functioning (ß = 1.12) and longer episodes of CCU care (ß = 1.03) increased the likelihood of RCS improvement in mental health and social functioning. CONCLUSIONS: CCU care was followed by reliable improvements in relevant outcomes for many consumers. Consumers with poorer mental health and social functioning, and a longer episode of CCU care were more likely to make RCS improvements in mental health and social functioning.


Assuntos
Serviços Comunitários de Saúde Mental/estatística & dados numéricos , Transtornos Mentais/reabilitação , Transtornos Mentais/terapia , Reabilitação Psiquiátrica/organização & administração , Centros Comunitários de Saúde Mental , Humanos , Transtornos Mentais/psicologia , Tratamento Domiciliar , Estudos Retrospectivos
10.
JAMA Netw Open ; 3(2): e1920843, 2020 02 05.
Artigo em Inglês | MEDLINE | ID: mdl-32031650

RESUMO

Importance: While many individuals with opioid use disorder seek treatment at residential facilities to initiate long-term recovery, the availability and use of medications for opioid use disorder (MOUDs) in these facilities is unclear. Objective: To examine differences in MOUD availability and use in residential facilities as a function of Medicaid policy, facility-level factors associated with MOUD availability, and admissions-level factors associated with MOUD use. Design, Setting, and Participants: This cross-sectional study used deidentified facility-level and admissions-level data from 2863 residential treatment facilities and 232 414 admissions in the United States in 2017. Facility-level data were extracted from the 2017 National Survey of Substance Abuse Treatment Services, and admissions-level data were extracted from the 2017 Treatment Episode Data Set-Admissions. Statistical analyses were conducted from June to November 2019. Exposures: Admissions for opioid use disorder at residential treatment facilities in the United States that identified opioids as the patient's primary drug of choice. Main Outcomes and Measures: Availability and use of 3 MOUDs (ie, extended-release naltrexone, buprenorphine, and methadone). Results: Of 232 414 admissions, 205 612 (88.5%) contained complete demographic data (166 213 [80.8%] aged 25-54 years; 136 854 [66.6%] men; 151 867 [73.9%] white). Among all admissions, MOUDs were used in only 34 058 of 192 336 (17.7%) in states that expanded Medicaid and 775 of 40 078 (1.9%) in states that did not expand Medicaid (P < .001). A relatively low percentage of the 2863 residential treatment facilities in this study offered extended-release naltrexone (854 [29.8%]), buprenorphine (953 [33.3%]), or methadone (60 [2.1%]). Compared with residential facilities that offered at least 1 MOUD, those that offered no MOUDs had lower odds of also offering psychiatric medications (odds ratio [OR], 0.06; 95% CI, 0.05-0.08; Wald χ21 = 542.09; P < .001), being licensed by a state or hospital authority (OR, 0.39; 95% CI, 0.27-0.57; Wald χ21 = 24.28; P < .001), or being accredited by a health organization (OR, 0.28; 95% CI, 0.23-0.33; Wald χ21 = 180.91; P < .001). Residential facilities that did not offer any MOUDs had higher odds of accepting cash-only payments than those that offered at least 1 MOUD (OR, 4.80; 95% CI, 3.47-6.64; Wald χ21 = 89.65; P < .001). Conclusions and Relevance: In this cross-sectional study of residential addiction treatment facilities in the United States, MOUD availability and use were sparse. Public health and policy efforts to improve access to and use of MOUDs in residential treatment facilities could improve treatment outcomes for individuals with opioid use disorder who are initiating recovery.


Assuntos
Analgésicos Opioides/provisão & distribução , Acesso aos Serviços de Saúde/estatística & dados numéricos , Tratamento de Substituição de Opiáceos/estatística & dados numéricos , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Tratamento Domiciliar/estatística & dados numéricos , Centros de Tratamento de Abuso de Substâncias/estatística & dados numéricos , Buprenorfina/provisão & distribução , Estudos Transversais , Humanos , Medicaid , Metadona/provisão & distribução , Naltrexona/provisão & distribução , Estados Unidos
11.
J Autism Dev Disord ; 50(8): 2987-3004, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32056114

RESUMO

Self-injurious behavior (SIB) occurs in up to 50% of individuals with autism. As one of the most serious conditions in individuals with developmental disabilities, SIB affects the individual and his or her family in multiple contexts. A systematic analysis of factors most commonly associated with SIB could inform the development of individualized intervention strategies. The current study examined factors related to SIB in an analysis of client records of 145 children with autism in a comprehensive care center. Predictor variables included age, gender, the Adaptive Behavior Composite, sensory processing, aggression, stereotypies, irritability, adaptive skills, and medical conditions. Age, irritability, and the Adaptive Behavior Composite were found to significantly predict SIB.


Assuntos
Transtorno do Espectro Autista/complicações , Comportamento Autodestrutivo/etiologia , Adolescente , Agressão , Transtorno Autístico/complicações , Criança , Feminino , Humanos , Humor Irritável , Masculino , Tratamento Domiciliar , Transtorno de Movimento Estereotipado
12.
Psychiatry Res ; 284: 112778, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-32004894

RESUMO

Adverse childhood experiences (ACEs) lead to devastating long-term health consequences that are associated with a dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis. Children and adolescents living in institutional care have an increased risk to experience ACEs, particularly linked to missing continuity of care, and a higher risk for consequences of ACEs such as mental disorders. In order to improve the overall quality of care, it is important to better understand the stress-physiology of this high-risk sample and to identify specific stressors linked to adverse outcomes. Therefore, we assessed ACEs due to missing continuity of care and their association with hair cortisol and DHEA levels in children, adolescents and young adults in institutional care. Results show that ACEs resulting from the family of origin, in detail maternal mental illness, and ACEs due to out-of-home placement, namely frequent change of caregivers, are associated with HPA axis over-activation. HPA axis activation is associated with enhanced mental health problems. These results point towards an association between continuity of care and the stress system of children and adolescents in this high-risk sample. Care concepts that focus on continuity of care might help to reduce these physiological alterations and devastating long-term consequences following ACEs.


Assuntos
Experiências Adversas da Infância/tendências , Relações Familiares/psicologia , Sistema Hipotálamo-Hipofisário/metabolismo , Transtornos Mentais/psicologia , Sistema Hipófise-Suprarrenal/metabolismo , Tratamento Domiciliar/tendências , Adolescente , Adulto , Criança , Feminino , Humanos , Hidrocortisona/sangue , Masculino , Transtornos Mentais/sangue , Transtornos Mentais/diagnóstico , Saúde Mental/tendências , Projetos Piloto , Fatores de Risco , Adulto Jovem
13.
Riv Psichiatr ; 55(1): 31-36, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32051623

RESUMO

BACKGROUND: The present paper aims at studying the efficacy of the Integrated Neurocognitive Therapy (INT), according to Roder's model, in a group of chronic schizophrenics in a long term residential condition. This kind of treatment is particularly interesting because, according to the most recent studies concerning schizophrenia as a neurodevelopmental disorder, allows to act on the neuro- and socio- cognitions areas, which are the most deteriorated ones. Moreover the INT program includes also computer aided activities (Cog PacK), which largely proved their efficacy on neurocognition. MATERIALS AND METHODS: The study sample consists of 10 inpatients suffering of Schizophrenia (according to DSM-5), 5 Male and 5 Female, average age 52, disorder average length 24,9 years, with IQ not <80. The sample took part in the 18 months INT program and has been evaluated through the neurocognitive set RBANS and MCST (modified version of WCST for the survey of the executive functions: abstraction, categorization, set shifting at the beginning of the treatment (T0), after 12 months (T1), and at its end, after 18 months (T2). RESULTS: As regards neurocognition, starting from the preliminary result analysis, the only statistical significance refers to time factor concerning the immediate memory measured by RBANS at T2. We can also point out an improvement trend in T1 evaluations for the single cognitive functions and for the general cognitive profile. Concerning the executive functions (MCST), even without any statistical significance, a general improvement trend is present (completed categories, persisting and not persisting mistakes). CONCLUSIONS: The data presented, even in a numerically reduced sample, encourage however an optimistic perspective concerning the INT rehabilitation use in schizophrenic inpatients, substantially confirming the data already present in literature. We have to pay specific attention even in the evaluation of computerized programs, whose use can aid the general sociocognitive functioning. We hope that later and wider studies will support what we have herein preliminarly presented and discussed.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Dados Preliminares , Tratamento Domiciliar/métodos , Esquizofrenia/terapia , Doença Crônica , Cognição , Função Executiva , Feminino , Humanos , Pacientes Internados/psicologia , Idioma , Masculino , Memória de Curto Prazo , Pessoa de Meia-Idade , Esquizofrenia/reabilitação , Fatores de Tempo
14.
Depress Anxiety ; 37(3): 273-284, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31951318

RESUMO

BACKGROUND: Suicidal thoughts are common among veterans with posttraumatic stress disorder (PTSD). The aim of this study was to examine the prevalence and correlates of four courses of suicidal (SI) among veterans receiving residential PTSD treatment. METHODS: A total of 1,807 veterans receiving residential PTSD treatment at Department of Veterans Affairs medical facilities who completed self-report measures at admission and discharge were included. RESULTS: The prevalence of SI courses were No SI (33.6%), Remitted SI (23.0%), SI onset (6.0%), and Chronic SI (37.4%). There were group differences between the four SI courses in PTSD symptoms at baseline, magnitude of PTSD symptom change during treatment, race/ethnicity and baseline depression, substance use, physical functioning, and pain. Chronic SI was associated with highest baseline PTSD, depression, substance use, pain and worse physical functioning. Remitted SI course was associated with greatest pre-posttreatment PTSD improvement, followed by No SI, Chronic SI, and SI Onset. Multinomial logistic regressions revealed that PTSD symptom improvement and baseline PTSD symptoms most consistently related to symptomatic SI courses compared to less symptomatic or No SI courses. Receipt of trauma-focused psychotherapy (none, some, or adequate) and length of stay were not related to SI courses and did not differ between groups. CONCLUSIONS: Findings indicate that treating PTSD symptoms could be impactful for reducing suicidal thoughts. Although many veterans had remitted or reduced severity of SI at discharge, a significant proportion of veterans reported SI at discharge (43.4%), potentially highlighting the need for suicide specific treatment interventions within the context of PTSD treatment.


Assuntos
Militares , Transtornos de Estresse Pós-Traumáticos , Veteranos , Humanos , Tratamento Domiciliar , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/terapia , Ideação Suicida
15.
BMC Public Health ; 20(1): 107, 2020 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-31992258

RESUMO

BACKGROUND: A priority area in the field of substance dependence treatment is reducing the rates of relapse. Previous research has demonstrated that telephone delivered continuing care interventions are both clinically and cost effective when delivered as a component of outpatient treatment. This protocol describes a NSW Health funded study that assesses the effectiveness of delivering a telephone delivered continuing care intervention for people leaving residential substance treatment in Australia. METHODS/DESIGN: All participants will be attending residential alcohol and other drug treatment provided by The Salvation Army or We Help Ourselves. The study will be conducted as a randomised controlled trial, where participants will be randomised to one of three treatment arms. The treatment arms will be: (i) 12-session continuing care telephone intervention; (ii) 4-session continuing care telephone intervention, or (iii) continuing care plan only. Baseline assessment batteries and development of the participants' continuing care plan will be completed prior to participants being randomised to a treatment condition. Research staff blind to the treatment condition will complete follow-up assessments with participants at 3-months and 6-months after they have been discharged from their residential service. DISCUSSION: This study will provide comprehensive data on the effect of delivering the continuing care intervention for people exiting residential alcohol and other drug treatment. If shown to be effective, this intervention can be disseminated to improve the rates of relapse among people leaving residential alcohol and other drug treatment. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry, ACTRN12618001231235. Registered on 23rd July 2018. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375621&isReview=true.


Assuntos
Continuidade da Assistência ao Paciente , Tratamento Domiciliar , Transtornos Relacionados ao Uso de Substâncias/terapia , Telefone , Adulto , Austrália , Feminino , Humanos , Masculino , Estudos Prospectivos , Prevenção Secundária/estatística & dados numéricos , Resultado do Tratamento
16.
Am J Orthopsychiatry ; 90(3): 324-327, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31916801

RESUMO

Oxford Houses (OH) are democratically run, self-funded, substance-use recovery homes that operate across the United States and internationally. Previous research shows the OHs are present in diverse neighborhoods. The current study examined the neighborhoods of 42 OHs located in Oregon, Texas, and North Carolina to better quantify and understand house and neighborhood characteristics that are related to relapse rates. Independent variables were participants' length of stay in OH, wages earned from employment, and income/education neighborhood characteristics. Neighborhood characteristics were related to relapse rates, with higher relapse rates occurring in neighborhoods with lower income and education levels. This finding supports the OH organization's premise that while OHs may work across community settings, they perform better in neighborhoods with higher average income and education levels. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


Assuntos
Características de Residência/estatística & dados numéricos , Tratamento Domiciliar , Fatores Socioeconômicos , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Emprego/estatística & dados numéricos , Feminino , Humanos , Masculino , North Carolina , Oregon , Recidiva , Texas
17.
Psychol Serv ; 17(1): 46-53, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30265069

RESUMO

This study examined the role of attitudes toward evidence-based psychotherapies (EBPs) in predicting use of prolonged exposure (PE) and cognitive processing therapy (CPT), two EBPs for posttraumatic stress disorder (PTSD) among PTSD treatment providers within the Department of Veterans Affairs. Providers' general attitudes toward EBPs, as well as their specific perceptions of PE and CPT, were examined as potential predictors of use. One hundred fifty-nine providers from 38 Department of Veterans Affairs' residential PTSD programs across the United States completed an online survey that included the predictors listed as well as self-reported use of PE on an individual basis and CPT on an individual and on a group basis. Although general attitudes toward EBPs were related to use of individually administered CPT, they were not related to use of PE or group-administered CPT. For each of the 3 treatments, however, specific positive perceptions were related to use. In examination of other training, skill, and delivery-related variables, general attitudes appear more in line with perceptions and delivery of CPT than PE. Perhaps this is because of the unique exposure component of PE. Assessing provider perceptions of specific EBPs may help providers in guiding their own practice as well as aid treatment developers, trainers, and administrators to more effectively tailor dissemination and implementation efforts. (PsycINFO Database Record (c) 2020 APA, all rights reserved).


Assuntos
Atitude do Pessoal de Saúde , Terapia Cognitivo-Comportamental , Conhecimentos, Atitudes e Prática em Saúde , Terapia Implosiva , Psicoterapia de Grupo , Tratamento Domiciliar , Transtornos de Estresse Pós-Traumáticos/terapia , Adulto , Prática Clínica Baseada em Evidências , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos , United States Department of Veterans Affairs
18.
Psychol Serv ; 17(1): 84-92, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30284867

RESUMO

Although most veterans in the Department of Veterans Affairs (VA) health system are treated for posttraumatic stress disorder (PTSD) in the outpatient setting, the VA has approximately 40 residential PTSD treatment facilities across the country for those requiring more intensive care. The symptom profiles of these veterans are poorly understood. Thus, the current study was designed to characterize classes of PTSD symptoms in a national sample of veterans undergoing residential treatment. We analyzed latent classes of PTSD symptoms among 2,452 veterans entering VA PTSD residential treatment in fiscal year 2013. The model with the best fit was a 4-class model comprising a low symptom class, moderate symptom class with high reexperiencing symptoms, a moderate symptom class with high emotional numbing, and a high symptom class. Compared to classes identified in outpatient samples, these classes were similar in type but greater in severity. Classes differed by age, race/ethnicity, trauma type, co-occurring medical conditions, co-occurring psychiatric conditions, and social functioning. Compared to the moderate class with high emotional numbing, those in the moderate class with high reexperiencing symptoms were more likely to be non-White, have greater pain severity, greater sleep problems, and were less likely to be depressed. Our findings suggest that veterans in residential treatment who have more severe PTSD symptoms also experience other medical and psychosocial stressors. A better understanding of symptom profiles may help to create more individualized treatment planning and thus potentially improve care for these veterans. (PsycINFO Database Record (c) 2020 APA, all rights reserved).


Assuntos
Tratamento Domiciliar , Transtornos de Estresse Pós-Traumáticos/classificação , Transtornos de Estresse Pós-Traumáticos/fisiopatologia , Transtornos de Estresse Pós-Traumáticos/terapia , Veteranos , Adulto , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Estados Unidos/epidemiologia , United States Department of Veterans Affairs
19.
J Gambl Stud ; 36(2): 669-683, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31562578

RESUMO

Gambling-related cognitive distortions are associated with gambling disorder severity, but few studies have provided an in-depth examination of the interrelationship between cognitive distortions, gambling severity, psychiatric comorbidity and treatment outcomes. The present study sought to identify factors associated with elevated cognitive distortions among problem gamblers entering residential treatment, examine changes in cognitive distortions through treatment, and explore the association between cognitive distortions and treatment outcomes. Pre- and post-treatment data were extracted from the charts of 125 individuals who participated in a 21-day residential treatment program for gambling disorder. Assessments included measures of demographics, gambling disorder severity, psychiatric symptoms and gambling-related cognitive distortions. Several significant associations were found between baseline cognitive distortions and psychiatric symptoms. Cognitive distortions decreased significantly from pre- to post-treatment. Pre- to post-treatment changes on several cognitive distortion scales were positively associated with greater baseline psychiatric symptomology. Treatment drop-out was associated with higher scores on measures reflecting greater impulsivity/addiction and greater perceived predictive control. Gambling-related cognitive distortions represent an important mechanism of gambling disorder and its treatment and provide a target for the development and refinement of treatment for gambling disorder.


Assuntos
Comportamento Aditivo/reabilitação , Transtornos Cognitivos/psicologia , Jogo de Azar/reabilitação , Tratamento Domiciliar/métodos , Adulto , Comportamento Aditivo/psicologia , Cognição/fisiologia , Feminino , Jogo de Azar/psicologia , Humanos , Comportamento Impulsivo , Masculino
20.
Cult Med Psychiatry ; 44(1): 135-157, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31297717

RESUMO

Unpaid work is now a central therapy in Puerto Rican therapeutic communities, where substance users reside and seek to rehabilitate each other, often for years at a time. Once a leading treatment for addiction in mainland United States, therapeutic communities were scaled back in the 1970s after they lost federal endorsement. They continue to flourish in Puerto Rico for reasons that have less to do with their curative powers than with their malleability as multi-purpose social enterprises and their historical co-option by state, market and family actors who have deployed them for a variety of purposes. Their endurance from the 1960s to the neoliberal present obliges us to recognize their capacities as what Mizruchi calls abeyance mechanisms whereby 'surplus' populations, otherwise excluded from labor and home, are absorbed into substitute livelihoods. Having initially emerged as a low-cost treatment, in a context of mass unemployment and prison-overcrowding they now thrive as institutions of containment and informal enterprise.


Assuntos
Tratamento Domiciliar , Transtornos Relacionados ao Uso de Substâncias/etnologia , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Comunidade Terapêutica , Adulto , Humanos , Porto Rico/etnologia , Tratamento Domiciliar/organização & administração
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