Mitchell Byrne

RESUMO - Introdução: Consideradas como um problema crónico de saúde, as perturbações psiquiátricas apresentam uma elevada prevalência em termos de não-adesão ao tratamento. Métodos: Revisão narrativa, não sistemática, da literatura relevante. Resultados: A maioria dos trabalhos de investigação tem incidido sobre os fatores relacionados com o doente que interferem na adesão ao tratamento. No entanto, existem estudos que indicam que a responsabilidade para aumentar a adesão está mais relacionada com o profissional de saúde do que com o doente. Conclusões: Através da identificação de fatores relacionados com os clínicos, pretendemos possibilitar o desenvolvimento de competências que poderão ter um papel importante na adesão ao tratamento dos doentes com perturbações psiquiátricas.ABSTRACT - Introduction: Among the chronic health diseases are psychiatric disorders and it is well established that within this population there is a particularly high prevalence of non-adherence to treatment...

Having to intervene in severe crises or bearing witness to human tragedy, can take its toll on the individual (Erickson, Vande Kemp, Gorsuch, Hoke & Foy, 2001; Lind, 2000; Lugris, 2000). These effects can include severe, debilitating anxiety that persists for months and sometimes even years following the event. Because these people are not directly involved in the event, their distress often goes undetected (Brady, Guy, Poelstra & Brokaw, 1999; Motta, Joseph, Rose, Suozzi & Leiderman, 1997). Support resources for people who are indirectly affected by a traumatic event are limited. To date, a history of previous trauma, previous psychological well‐being, social support, age, gender, educational achievement, socio‐economic status and styles of coping have been highlighted as mediating the effects of indirect exposure to a traumatic incident. Understanding this phenomenon and the mechanisms precipitating such distress is an important step in providing appropriate help for a large numbe...

ABSTRACT Post-traumatic stress through indirect exposure to trauma can mimic the psychological experiences of direct victims. This is referred to as vicarious traumatization, an impairing condition that largely goes undetected in the general population. This study sought to describe this condition and predict those who may be at risk of developing this type of post-traumatic stress. One hundred and fifteen participants from south-east New South Wales (NSW) in Australia who had not experienced any direct exposure, loss or injury from the 2001–2002 NSW bushfires were interviewed using the Vicarious Traumatization Questionnaire, Impact of Events Scale and Coping Strategies Indicator. Results indicated that specific peri-event, post-event and pre-event characteristics were able to predict at least 75 per cent of those who experienced vicarious traumatization resulting from the 2001–2002 NSW bushfires. This study was able to identify and describe vicarious traumatization in a sample of the general population. The importance of these results and the issues for further research are discussed. Copyright © 2006 John Wiley & Sons, Ltd.

Nonadherence to antipsychotic medications remains a major factor in poor clinical outcomes. This study sought to identify clinician beliefs about patients who do not adhere to treatment, the clinicians' own beliefs about medicines, and the impact of beliefs on efforts to enhance patient adherence. In total, 292 clinicians responded to an anonymous questionnaire that included questions about their beliefs and their efforts to enhance adherence. Results indicated that clinicians' beliefs about their own adequacy to enhance adherence significantly predicted actual efforts to enhance adherence. Both pessimism about outcomes and empathy for the patient predicted outcome expectancy. It was concluded that enhancing clinicians' beliefs about working with nonadherent patients is a potentially important ingredient in efforts to improve patient adherence.

Objective: Patient nonadherence to psychiatric medication is a key cause of relapse but clinicians do not appear to possess specific adherence skills. We sought to demonstrate that a brief training program on medication adherence strategies could improve the adherence skills, attitudes and knowledge of mental health clinicians. Methods: Twenty-three Tasmanian mental health workers were provided a 3 day training workshop on strategies to enhance patient adherence to medications (Medication Alliance). Pre- and post-training measures were taken of clinician knowledge about adherence strategies, ability to identify predictors of nonadherence, attitudes toward working with nonadherent patients, and optimism about treatment outcomes for patients. Videotapes of clinicians demonstrating key adherence therapy skills were also collected before and after training and blind-rated by two experienced therapists. Results: A series of paired samples t-tests indicated significant improvements in skills, knowledge and attitudes. Conclusions: Compared with similar studies in the UK, Medication Alliance was found to be an effective and efficient training program. However, there is a need for further research to assess maintenance of training effects over time and patient outcomes.