RESUMEN
OBJECTIVE: Practitioner attitudes regarding the nature of psychosis and prospects of recovery are important targets in supervision and training of practitioners who work therapeutically with this population. The 19-item Psychosis Attitudes Scale (PAS) was developed as a way to monitor changes in psychosis-related attitudes among practitioners being trained in an Evidence Based Treatment (EBT) for psychosis. This study reports the development and underlying factor structure of the PAS. METHOD: Three hundred twenty-five community mental health clinicians completed the PAS following a Cognitive Behavioral Therapy for psychosis (CBTp) multiday workshop training. We conducted an exploratory factor analysis to investigate the underlying structure of the initial set of items. RESULTS: Our analyses suggest that the PAS taps into four attitude groupings, which can be conceptualized as perceived confidence in working with individuals with psychosis (Factor 1), a recovery orientation (Factor 2), expectations of fulfillment (Factor 3), and a stress-vulnerability orientation (Factor 4). CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Factors 1 and 3 appear to tap into general themes relevant to training practitioners in an evidence-based psychotherapeutic intervention for psychosis. Factors 2 and 4 are consistent with guiding principles of high-fidelity CBTp. At the individual level, practitioner attitudes have implications for training retention and treatment delivery. At the organizational level, the collective attitudes of staff in a given setting may serve as an indicator of readiness for EBT for psychosis implementation. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
Asunto(s)
Terapia Cognitivo-Conductual , Trastornos Psicóticos , Actitud del Personal de Salud , Análisis Factorial , Conocimientos, Actitudes y Práctica en Salud , Humanos , Trastornos Psicóticos/psicologíaRESUMEN
Attitudes of mental health providers are an important consideration in training and delivering evidence-based practices. Treatment approaches for individuals who experience schizophrenia consistently endorse the importance of a recovery perspective. At the same time, a review of the literature suggests that the attitudes of many providers and many policies of community health care settings serving individuals who experience schizophrenia, may not align with the recovery perspective. This brief report provides a summary of the program evaluation outcomes of a wide range of mental health providers who participated in a 2-day intensive training to learn strategies informed by Cognitive Behavioral Therapy for Psychosis (CBT-p). This intensive training emphasizes engagement strategies and person-centered approaches inherent in the recovery perspective. Consistent with the aims of the training, participants' attitudes about working with people who experience psychosis appeared to be positively influenced by training.
Asunto(s)
Terapia Cognitivo-Conductual , Trastornos Psicóticos , Servicios de Salud Comunitaria , Conocimientos, Actitudes y Práctica en Salud , Humanos , Evaluación de Resultado en la Atención de Salud , Trastornos Psicóticos/terapiaRESUMEN
Assertive community treatment (ACT) has the potential to serve as a medical home for adults with serious mental illness, a population that experiences some of the most significant health disparities in the United States. Using site visit methodology, the authors describe partnerships that were created between five ACT programs and federally qualified health centers (FQHCs) to provide integrated behavioral health and primary care. The authors examined rates of screening for common chronic conditions. The programs used three distinct approaches: two programs colocated ACT teams at an FQHC, two programs employed primary care providers who split their time between the FQHC and the ACT program, and one program embedded a primary care provider within the ACT team. Effective communication between staffs may be more important than type of partnership in determining integration success.
Asunto(s)
Servicios Comunitarios de Salud Mental/métodos , Prestación Integrada de Atención de Salud/métodos , Trastornos Mentales/terapia , Atención Primaria de Salud/métodos , Adulto , Humanos , Comunicación Interdisciplinaria , Estados UnidosRESUMEN
The Center for Evidence-Based Practices (CEBP), a multidisciplinary center located at the Mandel School of Applied Social Sciences (MSASS), has been in operation for the past 17 years. It is a joint project of MSASS and the Department of Psychiatry, School of Medicine, Case Western Reserve University, and funded primarily through the Ohio Department of Mental Health and Addiction Services, as well as a variety of contractual agreements with agencies throughout the state and the country. The CEBP provides technical assistance for service innovations that improve quality of life and other outcomes for people with mental illness or co-occurring mental illness and substance use disorders. Clinical and programmatic consultation, as well as training, are provided to both public and private agencies to help them build capacity to implement and sustain research-supported interventions practices. CEBP staff also provide instruction to students in the classroom and field experiences.
Asunto(s)
Trastornos Mentales/terapia , Psiquiatría/educación , Calidad de Vida , Ciencias Sociales/educación , Universidades/organización & administración , Práctica Clínica Basada en la Evidencia , Humanos , Derivación y Consulta , Trastornos Relacionados con Sustancias/terapiaRESUMEN
OBJECTIVE: Assertive community treatment (ACT) is one of the few evidence-based practices for adults with severe mental illness. Interest has slowly waned for ACT implementation. Yet ACT remains an appealing services platform to achieve the triple aim of health care reform (improved health outcomes, reduced cost, and improved satisfaction) through integration of primary care and behavioral health services. This review highlights the evidence for ACT to improve general medical outcomes, reduce treatment costs, and increase access to treatment. METHODS: Using a comprehensive list of relevant search terms, the authors performed a systematic literature database search for articles published through November 2015, resulting in ten articles for inclusion. RESULTS: No studies reported on clinical outcomes of general medical comorbidities or on mortality of ACT clients. Half of the studies reporting utilization (three of six) found a decrease in emergency room usage, and three of four studies identified an increase in outpatient primary care visits. Most studies found no increase in overall medical care costs. Of the few studies reporting on quality of life, most found mild to moderate improvements. CONCLUSIONS: To date, rigorous scientific examination of the effect of ACT on the general health of the populations it serves has not been undertaken. Given ACT's similarity to emerging chronic illness medical management models, the approach seems like a natural fit for improving general medical outcomes of persons with severe mental illnesses. More research is needed that investigates the current effect of ACT teams on general medical outcomes, treatment costs, and access to care.
Asunto(s)
Servicios Comunitarios de Salud Mental/métodos , Estado de Salud , Trastornos Mentales/terapia , Evaluación de Procesos y Resultados en Atención de Salud , Atención Primaria de Salud/métodos , HumanosRESUMEN
Forensic hospital records of 39 severely mentally ill mothers adjudicated Not Guilty by Reason of Insanity for filicide (child murder by parents) were analyzed to describe characteristics preceding this tragedy and to suggest prevention strategies. Almost three-quarters of the mothers (72%) had previous mental health treatment. Over two thirds (69%) of the mothers were experiencing auditory hallucinations, most frequently command hallucinations, and half (49%) were depressed at the time of the offense. Over one third (38%) of the filicides occurred during pregnancy or the postpartum period, and many had a history of postpartum psychosis. Almost three-quarters (72%) of the mothers had experienced considerable developmental stressors, such as death of their own mother or incest. Maternal motives for filicide were predominantly "altruistic" (meaning murder out of love) or "acutely psychotic" (occurring in the throes of psychosis, without rational motive). Psychiatrists should perform careful risk assessments for filicide in mothers with mental illnesses.
Asunto(s)
Psiquiatría Forense , Homicidio , Defensa por Insania , Enfermos Mentales/psicología , Madres/psicología , Adolescente , Adulto , Niño , Maltrato a los Niños/estadística & datos numéricos , Custodia del Niño , Preescolar , Depresión/psicología , Depresión Posparto/psicología , Femenino , Alucinaciones/psicología , Humanos , Lactante , Recién Nacido , Acontecimientos que Cambian la Vida , Métodos , Michigan/epidemiología , Persona de Mediana Edad , Motivación , Ohio/epidemiología , Trastornos de la Personalidad/epidemiología , Embarazo , Estudios Retrospectivos , Estrés Psicológico/psicología , Trastornos Relacionados con Sustancias/epidemiologíaRESUMEN
The purpose of this phenomenological study was to identify commonly occurring factors in filicide-suicide offenders, to describe this phenomenon better, and ultimately to enhance prevention of child murder. Thirty families' files from a county coroner's office were reviewed for commonly occurring factors in cases of filicide-suicide. Parental motives for filicide-suicide included altruistic and acutely psychotic motives. Twice as many fathers as mothers committed filicide-suicide during the study period, and older children were more often victims than infants. Records indicated that parents frequently showed evidence of depression or psychosis and had prior mental health care. The data support the hypothesis that traditional risk factors for violence appear different from commonly occurring factors in filicide-suicide. This descriptive study represents a step toward understanding filicide-suicide risk.
Asunto(s)
Homicidio/estadística & datos numéricos , Relaciones Padres-Hijo , Suicidio/estadística & datos numéricos , Adulto , Niño , Violencia Doméstica/legislación & jurisprudencia , Violencia Doméstica/estadística & datos numéricos , Familia/psicología , Composición Familiar , Padre/estadística & datos numéricos , Femenino , Humanos , Masculino , Trastornos Mentales/epidemiología , Trastornos Mentales/psicología , Persona de Mediana Edad , Madres/estadística & datos numéricos , Estudios RetrospectivosRESUMEN
OBJECTIVE: Lack of insight affects the management of schizophrenia. The interrelationship between lack of insight and illness attributes in patients with schizophrenia who commit violent acts is important and underresearched. METHOD: One hundred fifteen violent patients with schizophrenia in a jail or court psychiatric clinic were evaluated on measures of symptoms, illness severity, insight into illness, and the legal consequences of their illness ("forensic insight"). A sample of nonviolent patients served as a comparison group. RESULTS: Compared with the nonviolent cohort, violent patients were more symptomatic, had poorer functioning, and had a more prominent lack of insight. Deficits of insight into illness coexisted with a lack of forensic insight, which was also associated with psychosis. CONCLUSIONS: Patients with schizophrenia who commit violent acts have insight deficits, including lack of awareness of the legal implications of their behavior. Targeted interventions to improve insight and treatment compliance in this population are warranted.
Asunto(s)
Concienciación , Esquizofrenia/diagnóstico , Psicología del Esquizofrénico , Violencia/psicología , Adulto , Síntomas Conductuales/diagnóstico , Síntomas Conductuales/psicología , Trastornos del Conocimiento/diagnóstico , Trastornos del Conocimiento/psicología , Estudios de Cohortes , Crimen/legislación & jurisprudencia , Femenino , Psiquiatría Forense/legislación & jurisprudencia , Estado de Salud , Humanos , Masculino , Ohio/epidemiología , Escalas de Valoración Psiquiátrica/estadística & datos numéricos , Calidad de Vida , Índice de Severidad de la Enfermedad , Prueba de Secuencia AlfanuméricaRESUMEN
OBJECTIVE: Because about one-third of persons with bipolar illness take less than 30 percent of their medication and because nonadherence is associated with rehospitalization and suicide, the literature was searched to identify controlled studies of enhancement of treatment adherence among persons with bipolar disorder. METHODS: Studies published up to October 2003 were evaluated. Those selected for review were controlled trials that used samples of adults with a diagnosis of bipolar disorder and that measured adherence to either mood-stabilizing medication or psychotherapy. Information was extracted on the diagnostic composition and size of the study group, the type and duration of the intervention, the method of measuring adherence, and outcomes. RESULTS: Eleven studies met inclusion criteria. Although the literature on enhancing treatment adherence among persons with bipolar disorder is limited, the existing data are promising and demonstrate development over time in our understanding of how best to manage this illness. Interventions that have been shown to be effective include interpersonal group therapy, cognitive-behavioral therapy, group sessions for partners of persons with bipolar disorder, and patient and family psychoeducation. Effective therapies occur in the context of long-term management of illness that incorporates a good understanding of medications and their risks and benefits as well as education about illness awareness and self-management. The majority of effective therapies feature an interactional component between patients and their care providers or therapists. CONCLUSIONS: Adherence to treatment for bipolar disorder may be enhanced by interventions that address issues of appropriately taking medications to manage illness. For optimum outcomes, promotion of adherence must be integrated into the medication management of bipolar illness.
Asunto(s)
Trastorno Bipolar/tratamiento farmacológico , Cooperación del Paciente , Investigación sobre Servicios de Salud , Humanos , Ensayos Clínicos Controlados Aleatorios como Asunto , Estados UnidosRESUMEN
Aggression among patients with serious mental illness occurs relatively infrequently, but it is a significant concern for patients, relatives, mental health professionals, and the public. Recognition of this risk and providing access and continuity of appropriate psychiatric care should be major clinical and administrative objectives in the management of violence in psychotic patients. To date, pharmacologic approaches have been unclear and inconsistent. At present, typical antipsychotics continue to have a primary role in acute management and in long-term management, in which noncompliance necessitates the use of long-acting depot neuroleptic preparations. Atypical antipsychotics in acute and long-acting intramuscular forms doubtless will influence and expand the choice for acute management of hostile psychotic patients and the long-term management of poorly compliant patients who are at risk to become violent on relapse. Persistent aggression should be managed by atypical antipsychotics with a preferential indication for clozapine, for which the most data on efficacy are available. The role of adjunctive medications is presently unclear. A major focus of care should be to refine legal processes and to conduct intervention studies aimed at enhancing treatment compliance. Violence risk reduction is not only crucial from a societal perspective, but also it is a humanitarian necessity to alleviate the burden and stigma for patients with serious mental illness.