An overview of the biological and psychosocial context surrounding neurocognition in HIV.

The presence of a psychiatric illness increases the risk of exposure to HIV and disease complications; however, effective treatments have substantially reduced mortality in adults with HIV. Despite such effective treatments, nearly half of adults with HIV experience neurocognitive deficits that can affect job-related and everyday tasks, thus reducing their quality of life. This article provides an overview of the context in which neurocognitive deficits occur in adults with HIV; it also includes implications for treatment and mitigation of such neurocognitive deficits. Understanding the underlying neurocognitive changes related to HIV can help psychiatric nurses provide better care to patients that may improve medication compliance and everyday functioning.

Does caregiver well-being predict stroke survivor depressive symptoms? A mediation analysis.

BACKGROUND AND PURPOSE: Studies suggest that family caregiver well-being (ie, depressive symptoms and life satisfaction) may affect stroke survivor depressive symptoms. We used mediation analysis to assess whether caregiver well-being might be a factor explaining stroke survivor depressive symptoms, after controlling for demographic factors and stroke survivor impairments and problems. METHODS: Caregiver/stroke participant dyads (N = 146) completed measures of stroke survivor impairments and problems and depressive symptoms and caregiver depressive symptoms and life satisfaction. Mediation analysis was used to examine whether caregiver well-being mediated the relationship between stroke survivor impairments and problems and stroke survivor depressive symptoms. RESULTS: As expected, more stroke survivor problems and impairments were associated with higher levels of stroke survivor depressive symptoms (P < .0001). After controlling for demographic factors, we found that this relationship was partially mediated by caregiver life satisfaction (29.29%) and caregiver depressive symptoms (32.95%). Although these measures combined to account for 40.50% of the relationship between survivor problems and impairments and depressive symptoms, the direct effect remained significant. CONCLUSIONS: Findings indicate that stroke survivor impairments and problems may affect family caregivers and stroke survivors and a high level of caregiver distress may result in poorer outcomes for stroke survivors. Results highlight the likely importance of intervening with both stroke survivors and family caregivers to optimize recovery after stroke.

Use of actors as standardized psychiatric patients.

Using actors in simulation provides opportunities for immersive, interactive, and reflective experiences to improve health care professionals' clinical expertise and practice. These experiences facilitate the development of enhanced critical thinking, problem-solving, and communication skills without risks to patients. This article discusses how to integrate actors and students into simulated experiences. Examples are provided using mental health simulations with actors as standardized psychiatric patients.

Simulation to enhance care of patients with psychiatric and behavioral issues: use in clinical settings.

Nurses with a medical-surgical clinical focus often care for patients with psychiatric and behavioral issues in acute care hospitals. This article describes how hospital staff and nursing and theater department faculty joined forces to develop realistic simulated psychiatric scenarios for use by practicing nurses.

The future of cognitive remediation training in older adults.

With the growing population of older adults, nurses will need to address age-related cognitive declines. Evidence demonstrates that cognitive remediation training is effective in improving neuropsychological abilities in older adults, which can translate into improved functioning in instrumental activities of daily living. The future of cognitive remediation training will incorporate health promoting factors (e.g., sleep hygiene, physical exercise), which supports neuroplasticity and cognitive reserve. By approaching cognitive health holistically, the patient will be primed to receive the maximum benefit from cognitive remediation training. A model emphasizing this approach is provided as adidactic for nurses and other health professionals providing care to their older patients.

Practical implications of Procedural and Emotional Religion Activity Therapy for nursing.

Procedural and Emotional Religious Activity Therapy encapsulates an approach to engaging older adults with Alzheimer's disease in meaningful activities that can be performed within the parameters of their cognitive functioning. Alzheimer's disease disrupts some brain structures more than others, resulting in a disproportionate loss of certain cognitive abilities. Explicit (conscious) memory skills are disrupted first, followed by implicit (unconscious) memory skills, and lastly emotional memory. Activities relying more on implicit and emotional memory, such as specially selected religious activities, are more likely to be used by patients. Steps and caveats of using this approach are provided.

Family relationships in people living with HIV in a city in the USA.

The purpose of this study was to identify relationships of individuals that people living with human immunodeficiency virus/acquired immune deficiency syndrome (PLWH) in a city in the USA include in their family of choice, or chosen family. The convenience sample in this cross-sectional, exploratory study consisted of 150, mostly male and African American PLWH. Participants included partners/lovers most frequently, followed by children, mother, and siblings, and grandparents in their chosen family. Family structures of PLWH in this study are consistent with the diverse nature of families within society.

Relationships among functional social support, HIV-related stigma, social problem solving, and depressive symptoms in people living with HIV: a pilot study.

This cross-sectional exploratory study examined relationships among functional social support, HIV-related stigma, social problem solving, and depressive symptoms in a convenience sample of 30 men and nonpregnant women who sought care at two HIV outpatient clinics in the southeastern United States. Participants completed a set of self-report questionnaires at these clinics during scheduled regular visits. Data were analyzed using descriptive statistics. Consistent with other HIV studies, participants in this sample were at high risk for depression. Depressive symptoms were associated with more perceived HIV-related stigma, less social support provided by others, and dysfunctional social problem solving. These results are preliminary but important in identifying potential components for effective interventions to reduce the risk of depressive symptoms in persons with HIV.

Biological Perspectives: Anti-NMDA Receptor Encephalitis.

PURPOSE: This article explores the recently recognized anti-NMDA receptor encephalitis, which may produce psychiatric symptoms. CONCLUSIONS: Historically, some patients presenting for psychiatric care may have actually been suffering from anti-NMDA encephalitis; thus, awareness of this disorder may facilitate appropriate treatment. TREATMENT IMPLICATIONS: Early diagnosis and aggressive treatment promote better outcomes. First-line treatment includes immunotherapy.

Biological perspectives. Aripiprazole: a third generation of antipsychotics begins?

Schizophrenia places an incredible burden on patients, families, communities, and governments, therefore intense efforts to find therapeutic responses to this illness continue. The traditional antipsychotics were discovered by chance, the atypical antipsychotics were configured to preserve "what worked" while adding and eliminating important effects, and the next generation continues to evolve in an attempt to improve on previous generations. Aripiprazole is extoled as a new generation of antipsychotic drugs. Information to date suggests it is an effective antipsychotic with a remarkable side effect profile. We are hopeful this drug will provide a relief for the suffering associated with schizophrenia.

The ABCs of psychopharmacology.

The forgoing represents an attempt to reduce psychopharmacology to a presynaptic neuron-synapse-post-synaptic neuron event. Obviously other strategies might be employed resulting in equal or perhaps greater clarity. Limitations of this approach include the lack of discussion about neuronal modulation, second messenger systems (which most NTs discussed here use), expansion of the ion channel discussion, and the implications of excitatory vs. inhibitory physiological effects. Nonetheless, we find this template for understanding psychotropic drug mechanism of action a fruitful lens through which to guide further study of these drugs. We feel like we are moving toward a silver dollar-size circle.

The case for atypical antipsychotics in bipolar disorder.

As the opening scenario illustrates about Mary and Bob, bipolar disorder can be devastating to individuals and families. Managing symptoms through psychotropic medications can help people with mental illness better manage their lives. Our brief review of the current research supports the effectiveness of atypical antipsychotic medications and, therefore, supports their use in treating bipolar disorder.

Mechanisms and treatments of SSRI-induced sexual dysfunction.

SSRI-induced sexual dysfunction affects 30% to 50% or more of individuals who take these drugs for depression. Biochemical mechanisms suggested as causative include increased serotonin, particularly affecting 5HT2 and 5HT3 receptors; decreased dopamine; blockade of cholinergic and alpha-1 adrenergic receptors; inhibition of nitric oxide synthetase; and elevation of prolactin levels. Five approaches to treatment include conservative approaches such as wait and see, decrease dosage, and drug holidays. More aggressive strategy for treating SSRI-induced sexual dysfunction are changing antidepressants and augmentation.

Biological perspectives: pain: it's not all in your head.

Neuroanatomy correlates with the psychological changes of pain. Neuroplastic transformation appears in the reduction of gray matter volume, or shrinkage in the top-down cortical areas vital for working memory, problem solving, sequencing and discrimination of different information and cognitive modulation of pain via the descending pain modulatory tracts and control over other cortical areas involved in the emotional perception of pain. These latter areas become more active,thereby intensifying the susceptibility to negative affect associated with pain (Geha & Apkarian, 2006).An animal model of chronic neuropathic pain was associated with impairment in the firing activity of the locus coeruleus and its expression of noradrenaline in ascending and descending pathways, which plays roles in not only pain perception, but mood, anxiety,attention and concentration, the sympathetic nervous system,and the activity of the hypothalamic-pituitary-adrenal axis,which serves to mobilize an organism's survival by the expression of cortisol in an immediate survival circumstance.

Comparing the effectiveness of video-assisted oral debriefing and oral debriefing alone on behaviors by undergraduate nursing students during high-fidelity simulation.

Complex healthcare, less resources, high-level medical equipment, and fewer available clinical settings have led many health professionals to use simulation as a method to further augment educational experiences for nursing students. While debriefing is recommended in the literature as a key component of simulation, the optimal format in which to conduct debriefing is unknown. This pre- and posttest two-group randomized quasi-experimental design compared the effectiveness of video-assisted oral debriefing (VAOD) and oral debriefing alone (ODA) on behaviors of 48 undergraduate nursing students during high-fidelity simulation. Further, this study examined whether roles (e.g., team leader, medication nurse), type of scenarios (i.e., pulmonary and cardiac scenarios), and student simulation team membership (i.e., VAOD and ODA groups) influenced these behaviors. Behaviors observed in this study related to patient safety, communication among team members, basic- and problem-focused assessment, prioritization of care, appropriate interventions, and delegation to healthcare team members. Both human patient simulator practice and guidance using video-assisted oral debriefing and oral debriefing alone appeared to be comparable regarding behaviors, regardless of roles, type of scenarios, and student simulation team membership. These findings suggest that nurse educators may use either video-assisted oral debriefing or oral debriefing alone to debrief undergraduate nursing students during high-fidelity simulation.