RESUMEN
UNLABELLED: The provision of psycho-educational groups for people diagnosed with schizophrenia is an important part of successful treatment. The value of such interventions is less clearly established in secure settings with no reports on women. Gender differences in the manifestation of schizophrenia highlight the importance of a gender-specific intervention. A 'Living with Mental Illness' group programme for women in a secure psychiatric setting is described and evaluated. Those who completed group treatments (n = 20; 63%) showed improved knowledge of schizophrenia, decreased fear of schizophrenia, greater insight and increased optimism and perceived control of the illness. They also showed increased hope and greater self-compassion. Pre-post group findings reflected improved ratings of compliance with drug treatments, appropriate behaviour and insight into risk. This was reflected in a decrease in risk behaviours, improved attendance at treatment sessions and a reduction in symptomatology. Group members also reported a positive group therapeutic alliance. Findings are discussed in the context of gender-specific treatment, research, methodological issues characteristic of a real-world evaluations and the need to assess the long-term benefits of such treatment. Copyright © 2015 John Wiley & Sons, Ltd. KEY PRACTITIONER MESSAGE: Psycho-educational groups for secure inpatients with schizophrenia need to address gender-specific differences in the manifestation of the condition. Such interventions as part of a broader treatment initiative can be associated with clinical improvement that is both illness specific and leads to improved engagement with care initiatives. The needs of patients who do not complete treatments needs to be regularly reassessed.
Asunto(s)
Terapia Cognitivo-Conductual/métodos , Educación en Salud/métodos , Pacientes Internos/psicología , Evaluación de Programas y Proyectos de Salud/métodos , Psicoterapia de Grupo/métodos , Esquizofrenia/terapia , Adulto , Femenino , Humanos , Resultado del TratamientoRESUMEN
In secure psychiatric services where the potential for 'burnout' by nurses is high, clinical supervision is viewed as a key to reflective practice to support staff in stressful working environments. Barriers to the uptake of clinical supervision in such service settings are personal and organizational. The study was prompted by the need to evaluate the effectiveness of supervision for registered nurses and health-care assistants (HCAs) and a desire to use survey findings to improve the quality and uptake of supervision. The study examined the perceived benefits, the best practice elements and the practical aspects of clinical supervision including how to improve practice. An approximate uptake of clinical supervision by 50% of staff confirmed previous findings; that HCAs were significantly less likely to engage in supervision and less likely to perceive benefit from it. Initiatives to address the training and managerial obstacles to the provision of formal supervision are described.
Asunto(s)
Enfermeras y Enfermeros/psicología , Supervisión de Enfermería/organización & administración , Auxiliares de Psiquiatría/psicología , Servicio de Psiquiatría en Hospital/organización & administración , Adulto , Femenino , Humanos , Enfermeras y Enfermeros/organización & administración , Supervisión de Enfermería/normas , Auxiliares de Psiquiatría/organización & administraciónRESUMEN
People with mental disorder account for a disproportionately large amount of smokers, and the problem is greatest in inpatient settings. 'Stop smoking' services should be tailored to the needs of individual patient groups. It is important therefore to investigate factors relevant to different groups in order to inform future quit smoking interventions. We compared 50 patients and 50 staff in a secure mental health hospital on measures of smoking and smoking motives, nicotine dependence, craving, previous cessation attempts, motivation to quit and quit smoking-related self-efficacy. Patients were significantly more dependent on nicotine with higher levels of craving; were more likely to smoke to cope with stress, for something to do when bored, for enjoyment and pleasure; and reported significantly less readiness to quit smoking. Staff were more likely to cite health concerns as reasons for quitting. Future pre-intervention work with inpatients should focus on increasing their readiness to quit smoking. Once motivation is increased, interventions should include advice on reducing cravings, finding alternative methods for coping with stress and boredom and achieving enjoyment and pleasure from alternative sources.
Asunto(s)
Trastornos Mentales , Autoeficacia , Cese del Hábito de Fumar/psicología , Fumar/psicología , Tabaquismo/psicología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Comorbilidad , Femenino , Humanos , Masculino , Trastornos Mentales/epidemiología , Persona de Mediana Edad , Motivación , Personal de Hospital , Servicio de Psiquiatría en Hospital , Fumar/epidemiología , Tabaquismo/epidemiología , Adulto JovenRESUMEN
BACKGROUND: For young people, the transition from adolescent to adult services is particularly problematic. This may be particularly difficult for female service users. AIMS: The aim of this study is to gain a fuller account of the experience of young people during transition from adolescent services to adult services and to add to the knowledge around the transitional process. METHOD: This study used a qualitative analysis of female adolescents' experience of transition to adult secure services. A four-layer coding structure grouped responses by time frame. RESULTS: The results were consistent with previous research indicating that adolescents are sensitive to the behaviour of others throughout the transition process. Particularly, strong themes were the negative impact of aggression from other patients, the importance of relationships with staff and other patients, and the need for informed involvement in all aspects of the transition process. CONCLUSIONS: An increase in positive statements regarding the post-transition experience suggests that moves have been positive although this could be explained by admission to settings of lower security. The discussion highlights the importance of moving beyond procedural issues of transition to a focus on the social and culture gaps that appear to divide CAMHS and AMHS.
Asunto(s)
Pase de Guardia , Servicios de Salud para Mujeres , Adolescente , Servicios de Salud del Adolescente , Adulto , Femenino , Humanos , Servicios de Salud Mental , Proyectos PilotoRESUMEN
BACKGROUND: Women in secure setting represent a group for whom gender sensitive treatments are only emergent. Service users are viewed as participants in treatment developments. However, the opinions of forensic patients have, in contrast to other service users, been under researched. AIMS: To identify service users' views of the constituents of an effective therapeutic milieu for women in secure settings and to help identify the extent to which services need to be specifically tailored for women. METHOD: A qualitative service user-led participatory research approach was used. Two focus groups with service users from low and medium secure settings discussed the ingredients of an effective therapeutic milieu based on their experience of gender-specific treatment. Group transcripts were subjected to thematic analysis. RESULTS: Themes identified covered interpersonal relationships; treatment programming; service user empowerment; the ward as a place of safety; and hope for the future. Participants did not highlight gender-specific issues despite this being implicit in focus group questions. CONCLUSIONS: Findings echo themes from other psychiatric settings and provide a much needed consensus between service providers and users on which to base healthcare planning. The elucidation of gender-specific factors in effective therapeutic milieus requires more focussed research.
Asunto(s)
Actitud Frente a la Salud , Trastorno de Personalidad Limítrofe/terapia , Psiquiatría Forense/métodos , Pacientes Internos/psicología , Satisfacción del Paciente/estadística & datos numéricos , Psicoterapia/métodos , Adulto , Trastorno de Personalidad Limítrofe/psicología , Femenino , Grupos Focales , Psiquiatría Forense/estadística & datos numéricos , Hospitales Psiquiátricos , Humanos , Pacientes Internos/estadística & datos numéricos , Relaciones Interpersonales , Servicios de Salud Mental , Persona de Mediana Edad , Participación del Paciente/métodos , Participación del Paciente/psicología , Participación del Paciente/estadística & datos numéricos , Seguridad del Paciente , Poder Psicológico , Psicoterapia/estadística & datos numéricos , Resultado del Tratamiento , Reino Unido , Salud de la Mujer/estadística & datos numéricosRESUMEN
Attempts to understand determinates of length of stay in secure settings has been given increased impetus by minimum standard setting and payment by results initiatives. Factors predictive of length of stay in the extant literature include, index offence, previous engagement in therapy, symptomatology, personality pathology and need. These factors were assessed for their predictive validity in a sample of 70 consecutive admissions to a women's medium secure service. Patients were divided into short- and long-stay groups A loglinear analysis of intake variables indicated that the highest order interaction (duration of stay × diagnosis × index offence/previous engagement in therapy) was significant. Analysis of dynamic variables indicated that longer stays were associated with total symptomatology, paranoid pathological personality scale scores and Camberwell Assessment of Need Forensic Version need items of psychotic symptoms and psychological distress. Short-stay patients showed higher levels of therapy engagement. Findings are confirmatory of some of the key variables to be considered when estimating length of stay and when planning treatment.
Asunto(s)
Criminales/psicología , Hospitales Psiquiátricos/normas , Tiempo de Internación , Trastornos Mentales/terapia , Psicoterapia/normas , Adulto , Femenino , Hospitales Psiquiátricos/organización & administración , Humanos , Trastornos Mentales/psicología , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Adulto JovenRESUMEN
Problem-solving interventions are a feature of overall medium secure treatment programmes. However, despite the relevance of such treatment to personality disorder there are few descriptions of such interventions for women. Beneficial effects for women who completed social problem-solving group treatment were evident on a number of psychometric assessments. A treatment non-completion rate of one-third raises questions of both acceptability and timing of cognitive behavioural interventions.
Asunto(s)
Trastornos Mentales/terapia , Solución de Problemas , Psicoterapia de Grupo , Adulto , Internamiento Obligatorio del Enfermo Mental , Femenino , Humanos , Persona de Mediana Edad , Evaluación de Programas y Proyectos de Salud , Adulto JovenRESUMEN
BACKGROUND: Social climate has been measured in a variety of therapeutic settings, but there is little information about it in secure mental health services, or how it may vary along a gender specific care pathway. AIM: To assess social climate in women's secure wards and its variation by level of security and ward type, therapeutic alliance, patient motivation, treatment engagement and disturbed behaviour. METHOD: Three-quarters (80, 76%) of staff and nearly all (65, 92%) of patients in the two medium-security wards and two low-security wards that comprised the unit completed the Essen Climate Evaluation Schema (EssenCES) and the California Psychotherapy Alliance Scale (CALPAS); patients also completed the Patient Motivation Inventory (PMI). Pre-assessment levels of disturbed behaviour and treatment engagement were recorded. RESULTS: Social climate varied according to ward type and level of security. EssenCES ratings indicative of positive social climate were associated with lower levels of security; such ratings were also associated with lower behavioural disturbance and with higher levels of motivation, treatment engagement and therapeutic alliance. CONCLUSION: This serial cross-sectional survey indicated that use of the EssenCES alone might be a good practical measure of treatment progress/responsivity. A longitudinal study would be an important next step in establishing the extent to which it would be useful in this regard.
Asunto(s)
Prisioneros/psicología , Conducta Social , Medio Social , Adolescente , Adulto , Agresión , Estudios Transversales , Femenino , Personal de Salud/psicología , Hospitales Psiquiátricos , Humanos , Servicios de Salud Mental , Persona de Mediana Edad , Motivación , Escalas de Valoración Psiquiátrica , Adulto JovenRESUMEN
The treatment and risk management programmes in a women's medium secure service are described. Changes in risk profiles and its relationship to treatment engagement are examined in a cohort of women during their stay in a medium secure service. Findings show that clinically significant reductions in risk behaviours were paralleled by increases in treatment engagement. The clinical healthcare implications of these findings are discussed along with the need for further research.
Asunto(s)
Agresión/psicología , Internamiento Obligatorio del Enfermo Mental , Trastornos Mentales/enfermería , Cooperación del Paciente/psicología , Prisioneros/psicología , Gestión de Riesgos , Medidas de Seguridad , Adulto , Vías Clínicas , Inglaterra , Femenino , Humanos , Tiempo de Internación , Trastornos Mentales/psicología , Trastornos Mentales/rehabilitación , Persona de Mediana Edad , Trastornos del Humor/enfermería , Trastornos del Humor/psicología , Trastornos del Humor/rehabilitación , Relaciones Enfermero-Paciente , Grupo de Atención al Paciente , Trastornos de la Personalidad/enfermería , Trastornos de la Personalidad/psicología , Trastornos de la Personalidad/rehabilitación , Trastornos Psicóticos/enfermería , Trastornos Psicóticos/psicología , Trastornos Psicóticos/rehabilitación , Asunción de Riesgos , Esquizofrenia/enfermería , Esquizofrenia/rehabilitación , Autocuidado/psicología , Violencia/legislación & jurisprudencia , Violencia/prevención & control , Violencia/psicología , Adulto JovenRESUMEN
The relationship between a variety of within-treatment factors and the outcome of treatment for alcoholism was examined. One hundred and twenty-eight male and 68 female participants (consecutive referrals with an ICD-10 diagnosis of alcohol dependence syndrome) were followed at 12 months following in- and day-patient cognitive behavioral treatment on an addiction unit. Within-treatment factors (of self-efficacy, psychological symptoms, expectations for treatment, treatment satisfaction, treatment climate, therapeutic alliance, and treatment evaluation), were assessed to determine their relationship to global outcome categorization into abstinent, nonproblem drinker, drinking but improved, and unimproved participant groups. A logistic regression analysis identified five variables that were predictive of a more favorable outcome: higher self-efficacy in positive social situations, greater treatment program involvement, a lower perception of staff control, a greater perception of treatment as helpful, and a reduction in psychological symptoms during treatment. Findings confirm previous research that pinpoints the importance of self-efficacy as a treatment variable of significance in treatment planning and delivery. It also highlights the prognostic significance of a reduction in psychological distress and, thus, the value of dynamic predictors of treatment outcome. The failure of the therapeutic alliance to predict outcome is discussed. It is concluded that time-limited alcoholism treatment programs need to give equal emphasis to within-treatment change via the promotion of patient confidence and the perception of helpfulness, as well as to skill-based relapse prevention strategies.
Asunto(s)
Alcoholismo/rehabilitación , Terapia Cognitivo-Conductual , Individualidad , Adulto , Femenino , Humanos , Masculino , Evaluación de Resultado en la Atención de Salud , Determinación de la Personalidad , Relaciones Profesional-Paciente , Pronóstico , AutoeficaciaRESUMEN
The usefulness of distinguishing between alcoholic patients' expectations and their fantasies about treatment outcome was examined. Results at 6 and 12 months follow-up did not support the results of research with nonalcoholic participants which related better outcomes to a combination of positive expectations and negative fantasies about future drink-related situations. Higher self-efficacy expectancy at intake, however, was associated with better clinical outcome. Findings supported Bandura's (1986) contention that outcome expectations add little information on prediction beyond that explained by self-efficacy expectancy. The clinical implications of these results are discussed.
Asunto(s)
Alcoholismo/psicología , Alcoholismo/terapia , Actitud Frente a la Salud , Fantasía , Autoeficacia , Adulto , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Recurrencia , Factores de Riesgo , Encuestas y Cuestionarios , Resultado del TratamientoRESUMEN
AIMS: To compare effectiveness and cost-effectiveness of a 5-week inpatient and a two week in- and day-patient regime. DESIGN: Pre-post assessment of consecutive treatment referrals with follow-up at 6 and 12 months. In a sequential study design, 112 patients underwent a 5-week residential programme while a subsequent 100 patients underwent a 2-week in- and day-patient programme. To investigate the effect of changing programme delivery, patient groups from before and after the programme changes were compared. SETTING: Addiction treatment unit in an independent hospital. PARTICIPANTS: One hundred and thirty-six males and 76 female patients with an ICD-10 diagnosis of Alcohol Dependence Syndrome. MEASUREMENTS: Self-report (Comprehensive Drinkers Profile: Follow-Up Drinkers Profile: SADQ), collateral report (Collateral Interview Form) and blood test (MCV & GGT) data were used to categorize patients into abstinent, non-problem drinker, drinking but improved and unimproved groups. Percentage of days abstinent, intensity of drinking, length of time in treatment, treatment cost and use of aftercare were also measured. FINDINGS: Abstinence or non-problem drinking was achieved by 55.6% of all patients at 1 year. Change in programme delivery did not affect outcome but treatment costs and mean length of stay for the revised programme were significantly reduced. CONCLUSIONS: A two week in- and day-patient treatment was more cost effective than a 5-week inpatient treatment. Design limitations make these conclusions tentative pending a randomized controlled trial.
Asunto(s)
Alcoholismo/rehabilitación , Análisis Costo-Beneficio , Femenino , Costos de la Atención en Salud , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Evaluación de Programas y Proyectos de Salud , Resultado del TratamientoRESUMEN
The triple-helical domains of type IV collagen chains have more than 20 sites at which the repeating (Gly-X-Y)n pattern is interrupted. Analysis of alpha 1 (IV) and alpha 2 (IV) chains indicates the residues in the three Gly-X-Y triplets preceding or following interruptions differ statistically from the rest of the chain. Unusually high frequencies of charged residues are seen at a number of X and Y sites, with the charge density being particularly high C-terminal to the interruption site. Analyses were carried out on individual categories of interruptions, classified as insertions or deletions in the Y position. All of the residues in the X and Y positions of the triplets flanking insertion sites are atypical, with a high concentration of charged residues. Triplets flanking sites where there has been a deletion in the Y position show unusually high frequencies of charged residues at some sites, hydrophobic residues at other sites, and an invariant imino acid N-terminal to the interruption. The presence of atypical sequences surrounding interruptions could be important at a molecular level, related to triple-helix stability, or at a supramolecular level, related to the association of molecules to form networks in basement membranes.
Asunto(s)
Colágeno/química , Oligopéptidos/química , Conformación Proteica , Animales , Membrana Basal/metabolismo , Variación Genética , Humanos , Ratones , Mutación Puntual , Eliminación de SecuenciaRESUMEN
The Work Environment Scale was used to assess staff perceptions of a change in a treatment programme for problem drinkers. A more cost-effective 2-week research-based day-patient programme, which included the concept of matching, replaced a 5-week cognitive behavioural in-patient programme. The maintenance of a positive work environment was attributed to the meeting of staff expectations, a cognitive behavioural ideology, and the establishment of a research culture. The study highlights the importance of the thorough preparation of staff for change, and their active involvement in the process in settings where work satisfaction is already above the average level for mental health facilities.
Asunto(s)
Alcoholismo/rehabilitación , Actitud del Personal de Salud , Servicio de Enfermería en Hospital/organización & administración , Personal de Enfermería/psicología , Alcoholismo/enfermería , Inglaterra , Humanos , Satisfacción en el Trabajo , Innovación Organizacional , Medio SocialRESUMEN
The specificity of the retardation effect on the Stroop Naming task with eating disorder clients was examined by comparing anorexic patients and normal weight controls with obese restrained eaters. Although the expected differences between normal weight controls and anorexics were found for color naming of food and body size words, obese restrained eaters were not differentiated from the clinical sample. It is suggested, therefore, that the Stroop phenomena do not have a precise relationship to the extent of psychopathology and that factors such as the ability to "fake" the test and poor concentration leading to general slowing, may explain the results.
Asunto(s)
Anorexia Nerviosa/psicología , Atención , Constitución Corporal , Dieta Reductora/psicología , Alimentos , Obesidad/psicología , Lectura , Semántica , Adolescente , Adulto , Imagen Corporal , Índice de Masa Corporal , Peso Corporal , Femenino , Humanos , Obesidad/dietoterapia , Inventario de Personalidad , Tiempo de Reacción , Valores de ReferenciaRESUMEN
Glycine is found as every third residue along the entire length of triple helices in fibrillar collagens, but the triple-helix regions of nonfibrillar collagens and other proteins usually contain one or more interruptions in this repeating pattern. A set of four peptides was designed to model the effect of interruptions in the (Gly-X-Y)n repeating pattern on triple-helix formation, stability, and folding. Into the middle of the stable triple-helical peptide (Pro-Hyp-Gly)10, an interruption was introduced representing one of the four possible categories: a glycine deletion, a deletion of a hydroxyproline (Y position), an alanine insertion, or a glycine to alanine substitution. As shown by sedimentation equilibrium, NMR, and CD studies, the introduction of an interruption still allowed formation of trimers in solution, but with marked decrease in stability. The degree of destabilization and the thermodynamic basis for the loss of stability depended on the type of interruption. The glycine substitution and alanine insertion were the least disruptive, followed by the hydroxyproline deletion, with the glycine deletion being the most destabilizing. Our results suggest that the breaks in these peptides affect both the triple-helical conformation and the monomer conformation. These studies provide a basis for considering the structural and functional consequences of different kinds of interruptions in collagen.
Asunto(s)
Colágeno/química , Péptidos/química , Secuencia de Aminoácidos , Dicroismo Circular , Espectroscopía de Resonancia Magnética , Datos de Secuencia Molecular , Conformación Proteica , UltracentrifugaciónRESUMEN
The successful treatment by behavioral methods of self-starvation and self-injury in a 35-year-old psychiatric in-patient, with a diagnosis of borderline personality disorder, is described. An individualized program using positive and negative reinforcers to increase food and fluid intake was used, while a token economy therapeutic milieu with time out was used to decrease acts of self-injury and aggression. Progress in treatment generalized to a non-secure treatment environment, and was maintained at an 8-month follow-up. The study illustrates the differential response of active and passive self injurious behaviors to group-based and individual treatments, respectively.
Asunto(s)
Terapia Conductista/métodos , Trastorno de Personalidad Limítrofe/terapia , Conducta Autodestructiva/prevención & control , Inanición/terapia , Adulto , Agresión/psicología , Trastorno de Personalidad Limítrofe/psicología , Terapia Combinada , Femenino , Humanos , Admisión del Paciente , Psicotrópicos/uso terapéutico , Conducta Autodestructiva/psicología , Inanición/psicología , Régimen de RecompensaRESUMEN
The triple-helical conformation has the stringent amino acid sequence constraint that every third residue must be a glycine, (X-Y-Gly)n. We use nuclear magnetic resonance and circular dichroism to quantify the consequences of a substitution in the glycine position of a triple-helical peptide, and to enhance our understanding of interactions in this basic structural motif. A 30-residue peptide with a Gly----Ala change forms a stable trimer at a folding rate somewhat less than that of the unsubstituted peptide, and the substitution results in a marked decrease in thermal stability and a conformational perturbation of about 30% of the triple-helical structure. Two models were generated for this peptide, one with the alanine residues packed inside the triple helix and one with a looping out of the chain at the substitution site. Studies on the Gly----Ala peptide are useful in understanding connective tissue diseases which result from the substitution of one glycine residue in the triple-helix of fibrillar collagens.
Asunto(s)
Glicina/química , Péptidos/química , Dicroismo Circular , Cinética , Espectroscopía de Resonancia Magnética , Conformación Proteica , TemperaturaRESUMEN
Triple-helix formation of the peptide (Pro-Hyp-Gly)10 was monitored by nmr and CD spectroscopy. The two-dimensional nmr spectra indicated that the Gly C alpha H and Pro C delta H proton resonances shift upfield in going from the nonhelical to helical form, while hydroxy-proline resonances are unchanged. The integrated areas of the helical and nonhelical resonances could be monitored in the one-dimensional nmr spectrum, and indicate that in the (Pro-Hyp-Gly)10 about 90% of the residues are in a defined triple-helical conformation. The introduction of a glycine to alanine substitution or the deletion of a single hydroxyproline residue in the stable triple-helical peptide (Pro-Hyp-Gly)10 still allows trimers to be formed, but the trimers show a substantial loss of triple helix and decreased thermal stability compared with (Pro-Hyp-Gly)10. Two computer models were generated for the Gly----Ala peptide, one with the Ala side chains packed inside the helix and the other with the region containing the alanines forming a beta-bend that loops out from the helix. The nmr data is more consistent with the latter model.
Asunto(s)
Conformación Proteica , Secuencia de Aminoácidos , Dicroismo Circular , Espectroscopía de Resonancia Magnética , Datos de Secuencia MolecularRESUMEN
This study reports a comparison of a single ward versus a two-ward system of acute in-patient care in a general hospital psychiatric unit. It focuses on staff and patient perceptions and attitudes towards the two types of ward. A continuous care ward system was preferred by the majority of staff who described an improvement in 'ward atmosphere'. Patients who had experienced both ward systems also preferred the continuous care system. Both patients and staff felt that the continuous care system still needed to place greater emphasis on 'ward atmosphere' dimensions of involvement, support and spontaneity. The implications of these findings for improving the functioning of the preferred ward are discussed.