RESUMEN
BACKGROUND: A proportion of people with mental health problems require longer term care in a psychiatric or social care institution. However, there are no internationally agreed quality standards for institutional care and no method to assess common care standards across countries. We aimed to identify the key components of institutional care for people with longer term mental health problems and the effectiveness of these components. METHODS: We undertook a systematic review of the literature using comprehensive search terms in 11 electronic databases and identified 12,182 titles. We viewed 550 abstracts, reviewed 223 papers and included 110 of these. A "critical interpretative synthesis" of the evidence was used to identify domains of institutional care that are key to service users' recovery. RESULTS: We identified eight domains of institutional care that were key to service users' recovery: living conditions; interventions for schizophrenia; physical health; restraint and seclusion; staff training and support; therapeutic relationship; autonomy and service user involvement; and clinical governance. Evidence was strongest for specific interventions for the treatment of schizophrenia (family psychoeducation, cognitive behavioural therapy (CBT) and vocational rehabilitation). CONCLUSION: Institutions should, ideally, be community based, operate a flexible regime, maintain a low density of residents and maximise residents' privacy. For service users with a diagnosis of schizophrenia, specific interventions (CBT, family interventions involving psychoeducation, and supported employment) should be provided through integrated programmes. Restraint and seclusion should be avoided wherever possible and staff should have adequate training in de-escalation techniques. Regular staff supervision should be provided and this should support service user involvement in decision making and positive therapeutic relationships between staff and service users. There should be clear lines of clinical governance that ensure adherence to evidence-based guidelines and attention should be paid to service users' physical health through regular screening.
Asunto(s)
Institucionalización/normas , Trastornos Mentales/terapia , Calidad de la Atención de Salud , Gestión Clínica , Servicios Comunitarios de Salud Mental/organización & administración , Servicios Comunitarios de Salud Mental/normas , Adhesión a Directriz , Encuestas de Atención de la Salud , Humanos , Cuidados a Largo Plazo/normas , Trastornos Mentales/rehabilitación , Metaanálisis como Asunto , Evaluación de Resultado en la Atención de Salud , Garantía de la Calidad de Atención de Salud , Calidad de la Atención de Salud/estadística & datos numéricos , Rehabilitación Vocacional , Esquizofrenia/rehabilitación , Esquizofrenia/terapia , Asistencia Social en PsiquiatríaRESUMEN
It is an established fact that idiomatic expressions are fast to process. However, the explanation of the phenomenon is controversial. Using a semantic judgment paradigm, where people decide whether a string is meaningful or not, the present experiment tested the predictions deriving from the three main theories of idiom recognition-the lexical representation hypothesis, the idiom decomposition hypothesis, and the configuration hypothesis. Participants were faster at judging decomposable idioms, nondecomposable idioms, and clichés than at judging their matched controls. The effect was comparable for all conventional expressions. The results were interpreted as suggesting that, as posited by the configuration hypothesis, the fact that they are known expressions, rather than idiomaticity, explains their fast recognition.
Asunto(s)
Comprensión , Juicio , Tiempo de Reacción , Lectura , Reconocimiento en Psicología , Semántica , Atención , Toma de Decisiones , Humanos , PsicolingüísticaRESUMEN
Three experiments tested the main claims of the idiom decomposition hypothesis: People have clear intuitions on the semantic compositionality of idiomatic expressions, which determines the syntactic behavior of these expressions and how they are recognized. Experiment 1 showed that intuitions are clear only for a very restricted number of expressions, but for the majority of idioms, they are not consistent across speakers. Experiment 2 failed to support the claim that semantic compositionality influences the syntactic flexibility of idioms. Finally, Experiment 3 showed that idioms are more quickly recognized than their literal counterparts, regardless of compositionality and syntactic flexibility. All of the findings were at odds with the tenets of the idiom decomposition hypothesis. The theoretical implications of the results with respect to idiom processing and the notion of compositionality are discussed.
Asunto(s)
Comprensión , Psicolingüística , Lectura , Semántica , Adulto , Femenino , Humanos , Juicio , Lenguaje , MasculinoRESUMEN
This study investigates recognition of spoken idioms occurring in neutral contexts. Experiment 1 showed that both predictable and non-predictable idiom meanings are available at string offset. Yet, only predictable idiom meanings are active halfway through a string and remain active after the string's literal conclusion. Experiment 2 showed that the initial fragment of a predictable idiom inhibits recognition of a word providing a congruous, but literal, conclusion to the expression. No comparable effects were obtained with non-predictable idioms. These findings are consistent with the view that spoken idiom identification differs from word recognition and occurs word-by-word, just as with other familiar, multi-lexical phrases.