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Dubey S, Biswas P, Ghosh R, Chatterjee S, Dubey MJ, Chatterjee S, Lahiri D, Lavie CJ. Psychosocial impact of COVID-19. Diabetes Metab Syndr 2020; 14:779-788. [PMID: 32526627 PMCID: PMC7255207 DOI: 10.1016/j.dsx.2020.05.035] [Citation(s) in RCA: 917] [Impact Index Per Article: 183.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 05/21/2020] [Accepted: 05/22/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Along with its high infectivity and fatality rates, the 2019 Corona Virus Disease (COVID-19) has caused universal psychosocial impact by causing mass hysteria, economic burden and financial losses. Mass fear of COVID-19, termed as "coronaphobia", has generated a plethora of psychiatric manifestations across the different strata of the society. So, this review has been undertaken to define psychosocial impact of COVID-19. METHODS Pubmed and GoogleScholar are searched with the following key terms- "COVID-19", "SARS-CoV2", "Pandemic", "Psychology", "Psychosocial", "Psychitry", "marginalized", "telemedicine", "mental health", "quarantine", "infodemic", "social media" and" "internet". Few news paper reports related to COVID-19 and psychosocial impacts have also been added as per context. RESULTS Disease itself multiplied by forced quarantine to combat COVID-19 applied by nationwide lockdowns can produce acute panic, anxiety, obsessive behaviors, hoarding, paranoia, and depression, and post-traumatic stress disorder (PTSD) in the long run. These have been fueled by an "infodemic" spread via different platforms of social media. Outbursts of racism, stigmatization, and xenophobia against particular communities are also being widely reported. Nevertheless, frontline healthcare workers are at higher-risk of contracting the disease as well as experiencing adverse psychological outcomes in form of burnout, anxiety, fear of transmitting infection, feeling of incompatibility, depression, increased substance-dependence, and PTSD. Community-based mitigation programs to combat COVID-19 will disrupt children's usual lifestyle and may cause florid mental distress. The psychosocial aspects of older people, their caregivers, psychiatric patients and marginalized communities are affected by this pandemic in different ways and need special attention. CONCLUSION For better dealing with these psychosocial issues of different strata of the society, psychosocial crisis prevention and intervention models should be urgently developed by the government, health care personnel and other stakeholders. Apt application of internet services, technology and social media to curb both pandemic and infodemic needs to be instigated. Psychosocial preparedness by setting up mental organizations specific for future pandemics is certainly necessary.
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917 |
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Abstract
Over the past decade the approaches adopted towards the mental health care of refugees by a range of national and international healthcare organisations have been the subject of a sustained and growing critique. Much of this critique has focused on the way in which Western psychiatric categories have been ascribed to refugee populations in ways which, critics argue, pay scant attention to the social, political and economic factors that play a pivotal role in refugees' experience. Rather than portraying refugees as "passive victims" suffering mental health problems, critics have argued that attention should be given to the resistance of refugees and the ways in which they interpret and respond to experiences, challenging the external forces bearing upon them. In this paper a range of issues concerning the mental health care of refugees will be examined. These include the role of psychiatric diagnosis in relation to refugees' own perceptions of their need and within the context of general health and social care provision. In examining services the emergence of new paradigms in mental health care is identified. These include the growth of holistic approaches that take account of refugees' own experiences and expressed needs and which address the broader social policy contexts in which refugees are placed. A three-dimensional model for the analysis of the interrelationship between "macro" level institutional factors in the mental health of refugees and the individual treatment of refugees within mental health services is proposed.
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Abstract
This article, which seeks to sketch a coherent conceptual and philosophical framework for psychiatry, confronts two major questions: how do mind and brain interrelate, and how can we integrate the multiple explanatory perspectives of psychiatric illness? Eight propositions are proposed and defended: 1) psychiatry is irrevocably grounded in mental, first-person experiences; 2) Cartesian substance dualism is false; 3) epiphenomenalism is false; 4) both brain-->mind and mind-->brain causality are real; 5) psychiatric disorders are etiologically complex, and no more "spirochete-like" discoveries will be made that explain their origins in simple terms; 6) explanatory pluralism is preferable to monistic explanatory approaches, especially biological reductionism; 7) psychiatry must move beyond a prescientific "battle of paradigms" to embrace complexity and support empirically rigorous and pluralistic explanatory models; 8) psychiatry should strive for "patchy reductionism" with the goal of "piecemeal integration" in trying to explain complex etiological pathways to illness bit by bit.
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Wisner KL, Zarin DA, Holmboe ES, Appelbaum PS, Gelenberg AJ, Leonard HL, Frank E. Risk-benefit decision making for treatment of depression during pregnancy. Am J Psychiatry 2000; 157:1933-40. [PMID: 11097953 DOI: 10.1176/appi.ajp.157.12.1933] [Citation(s) in RCA: 130] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The Committee on Research on Psychiatric Treatments of the American Psychiatric Association identified treatment of major depression during pregnancy as a priority area for improvement in clinical management. The goal of this article was to assist physicians in optimizing treatment plans for childbearing women. METHOD The authors' work group developed a decision-making model designed to structure the information delivered to pregnant women in the context of the risk-benefit discussion. Perspectives of forensic and decision-making experts were incorporated. RESULTS The model directs the psychiatrist to structure the problem through diagnostic formulation and identification of treatment options for depression. Reproductive toxicity in five domains (intrauterine fetal death, physical malformations, growth impairment, behavioral teratogenicity, and neonatal toxicity) is reviewed for the potential somatic treatments. The illness (depression) also is characterized by symptoms of somatic dysregulation that compromise health during pregnancy. The patient actively participates and provides her evaluation of the acceptability of the various treatments and outcomes. Her capacity to participate in this process provides evidence of competence to consent. Included in the decision-making process are the patient's significant others and obstetrical physician. The process is ongoing, with the need for incorporation of additional data as the pregnancy and treatment response progress. CONCLUSIONS The conceptual model provides structure to a process that is frequently stressful for both patients and psychiatrists. By applying the model, clinicians will ensure that critical aspects of the risk-benefit discussion are included in their care of pregnant women.
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Hedrick SC, Chaney EF, Felker B, Liu CF, Hasenberg N, Heagerty P, Buchanan J, Bagala R, Greenberg D, Paden G, Fihn SD, Katon W. Effectiveness of collaborative care depression treatment in Veterans' Affairs primary care. J Gen Intern Med 2003; 18:9-16. [PMID: 12534758 PMCID: PMC1494801 DOI: 10.1046/j.1525-1497.2003.11109.x] [Citation(s) in RCA: 130] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To compare collaborative care for treatment of depression in primary care with consult-liaison (CL) care. In collaborative care, a mental health team provided a treatment plan to the primary care provider, telephoned patients to support adherence to the plan, reviewed treatment results, and suggested modifications to the provider. In CL care, study clinicians informed the primary care provider of the diagnosis and facilitated referrals to psychiatry residents practicing in the primary care clinic. DESIGN Patients were randomly assigned to treatment model by clinic firm. SETTING VA primary care clinic. PARTICIPANTS One hundred sixty-eight collaborative care and 186 CL patients who met criteria for major depression and/or dysthymia. MEASUREMENTS Hopkins Symptom Checklist (SCL-20), Short Form (SF)-36, Sheehan Disability Scale. MAIN RESULTS Collaborative care produced greater improvement than CL in depressive symptomatology from baseline to 3 months (SCL-20 change scores), but at 9 months there was no significant difference. The intervention increased the proportion of patients receiving prescriptions and cognitive behavioral therapy. Collaborative care produced significantly greater improvement on the Sheehan at 3 months. A greater proportion of collaborative care patients exhibited an improvement in SF-36 Mental Component Score of 5 points or more from baseline to 9 months. CONCLUSIONS Collaborative care resulted in more rapid improvement in depression symptomatology, and a more rapid and sustained improvement in mental health status compared to the more standard model. Mounting evidence indicates that collaboration between primary care providers and mental health specialists can improve depression treatment and supports the necessary changes in clinic structure and incentives.
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Clinical Trial |
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Vieta E, Pérez V, Arango C. Psychiatry in the aftermath of COVID-19. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2020; 13:105-110. [PMID: 38620300 PMCID: PMC7177054 DOI: 10.1016/j.rpsm.2020.04.004] [Citation(s) in RCA: 120] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 04/15/2020] [Accepted: 04/16/2020] [Indexed: 02/07/2023]
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Abstract
Social capital is an umbrella term used to describe aspects of social networks, relations, trust, and power, as a function of either the individual or a geographical entity (e.g., a city neighborhood). Increased attention is being paid to the role that social capital can play in determining a variety of physical health outcomes, though less attention has been paid to its role in determining mental health outcomes. This relative inattention continues despite a long historical tradition in psychiatry of exploring the role that socio-environmental factors can play in the etiology and course of mental illness. In this review, we begin by tracing the historical development of the concept of social capital, describing and analyzing competing definitions. We then proceed to review the published studies that examine the relationship between social capital and mental health-looking first at studies that focus on depression and anxiety, and second at studies that focus on psychoses. After briefly exploring whether social capital can have a detrimental effect on mental health, we discuss how knowledge regarding social capital may aid the clinician and mental health services. We go on to make a number of suggestions relevant to methodological, theoretical, and empirical advancement. These suggestions include refining the definitions of social capital, paying attention to communities without propinquity, and constructing contextual indicators of social capital. We conclude by remarking that social capital may be a promising heuristic for studies in community psychiatry and may even help individual clinicians in designing treatment plans. Despite all this promise, however, there is a lack of strong evidence supporting the hypothesis that social capital protects mental health.
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Abstract
This paper examines the potential effects of using video-conferencing within the field of mental health in the UK. In order to assess the usefulness of telepsychiatric services, an electronic search was conducted for articles published between August 1998 and July 2006 using the MEDLINE, EMBASE, PsychINFO and Telemedicine and Information Exchange (TIE) databases. The search was carried out using the following terms: telepsychiatry, videoconferencing and telepsychology. A total of 178 articles were identified and based on review of the abstracts 72 were identified as being specific to efficacy, cost-effectiveness and satisfaction with psychiatric services delivered via videoconferencing. This paper concludes that the use of video conferencing can enhance psychiatric services within the UK especially for those patients who live in rural areas. Current advances in technology make this an increasingly more reliable and cost-effective method for assessing patients. The limitations of telemedicine are discussed and it is clear that this type of care is not suitable for all patients. Further research is required to assess the types of patients that telepsychiatry is most suitable for.
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Abstract
The concept of recovery in psychosis has gained much momentum in recent years in the UK. Current government policy describes its underpinning philosophy as the way forward for mental health services. Many mental health professionals now claim to embrace this concept yet fail to make the desired impact upon the care and treatment of individuals with schizophrenia. This article reviews some of the literature and explores what the concept of recovery means. The formal evidence will be augmented with personal accounts about recovery written by individuals who have schizophrenia. In doing so the main components that appear to have influenced the recovery process will be highlighted, and the implications for mental health nurses and practitioners will be discussed.
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Review |
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83 |
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Shore JH, Hilty DM, Yellowlees P. Emergency management guidelines for telepsychiatry. Gen Hosp Psychiatry 2007; 29:199-206. [PMID: 17484936 PMCID: PMC1986661 DOI: 10.1016/j.genhosppsych.2007.01.013] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2006] [Revised: 01/24/2007] [Accepted: 01/24/2007] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Telepsychiatry, in the form of live interactive videoconferencing, is an emerging application for emergency psychiatric assessment and treatment and can improve the quality and quantity of mental health services, particularly for rural, remote and isolated populations. Despite the potential of emergency telepsychiatry, the literature has been fairly limited in this area. METHOD Drawing on the combined clinical and administrative experiences of its authors, this article reviews the common administrative, legal/ethical and clinical issues that arise in emergency telepsychiatry. RESULTS An initial set of guidelines for emergency telepsychiatry is presented to generate further discussion to assist those who are considering establishing general telepsychiatry and/or emergency telepsychiatry services. CONCLUSION The practices and techniques of emergency telepsychiatry are relatively new and require further examination, modification and refinement so that they may be fully utilized within comprehensive mental health service systems.
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Abstract
Telepsychiatry may involve working with clinicians, patients and systems of care that are both geographically and culturally distinct. In this context, culturally appropriate care is an important component of telepsychiatry. The outline for cultural formulation from the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) provides general principles for addressing these issues. Two components of the outline are particularly relevant in telepsychiatry: (1) how the cultural background of patients (i.e. their cultural identity) influences their comfort with technology; and (2) the effect of cultural differences on the patient-provider relationship. Cultural differences between patient and provider are often highlighted in telepsychiatry by the patient and provider location (e.g. rural versus urban differences). Familiarity with the rural community and regular contact and feedback are important. Future research should examine the effect of telepsychiatry on patient-provider relationships, patient attitudes towards care and, most importantly, patient outcomes.
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Research Support, N.I.H., Extramural |
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OBJECTIVE To provide a framework of mental health care reform across Europe. METHOD On the basis of summary quantitative indices and expert ratings of broad aspects of mental health care structure, the process and outcome of psychiatric reform common trends and differences are outlined. RESULTS There has been a broad trend away from an institutional model of care with the mental hospital as the dominant institution, and community- and general hospital-based mental health services of varying comprehensiveness are in place in most countries. The social and broad community aspects of psychiatric reform have generally been somewhat less successful than changes in service set-up. Assessment of reform outcomes proves particularly difficult. CONCLUSION Psychiatric reform processes have achieved some of their aims, and there are broadly similar trends. Regional variation is substantial and may be as important as cross-national differences. Mental health care reform is ongoing across the European region.
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Abstract
Nursing has always struggled for recognition and status, and there has always been exploitation and shortages, and no more so than in psychiatric settings. Today, however, nursing is in truly dire straits and, as a consequence, psychiatric nursing is more precariously positioned than ever. In order to think constructively about psychiatric nursing's future, it is crucial that this wider context in which it operates is fully appreciated, and this paper begins by summarizing the key features of this context from an international perspective. It is argued that dramatic changes occurring in 'Western' societies call for radical changes in public and professional thinking, and in their vision for health care in the future. Beginning with the general nursing context, this paper depicts the perilous state of psychiatric nursing and mental health care in Australia and elsewhere, and suggests some of the causal factors. It concludes by arguing that the future mental health workforce should be a graduate specialist who stands outside existing disciplinary identities.
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Review |
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Pincus HA, Page AEK, Druss B, Appelbaum PS, Gottlieb G, England MJ. Can psychiatry cross the quality chasm? Improving the quality of health care for mental and substance use conditions. Am J Psychiatry 2007; 164:712-9. [PMID: 17475728 DOI: 10.1176/ajp.2007.164.5.712] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
In 2001, a seminal Institute of Medicine report, Crossing the Quality Chasm: A New Health System for the 21st Century, put forth a comprehensive strategy for improving the quality of U.S. health care. This strategy attained considerable traction within the overall U.S. health care system and subsequent attention in the mental health community as well. A new Institute of Medicine report, Improving the Quality of Health Care for Mental and Substance Use Conditions, examines the quality chasm strategy in light of the distinctive features of mental and substance use health care, including concerns about patient decision-making abilities and coercion into care, a less developed quality measurement and improvement infrastructure, lagging use of information technology and participation in the development of the National Health Information Infrastructure, greater separations in care delivery accompanied by more restrictions on sharing clinical information, a larger number of provider types licensed to diagnose and treat, more solo practice, and a differently structured marketplace. This article summarizes the Institute of Medicine's analysis of these issues and recommendations for improving mental and substance use health care and discusses the implications for psychiatric practice and related advocacy efforts of psychiatrists, psychiatric organizations, and other leaders in mental and substance use health care.
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Research Support, N.I.H., Extramural |
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70 |
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Hilty D, Yellowlees PM, Parrish MB, Chan S. Telepsychiatry: Effective, Evidence-Based, and at a Tipping Point in Health Care Delivery? Psychiatr Clin North Am 2015; 38:559-92. [PMID: 26300039 DOI: 10.1016/j.psc.2015.05.006] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Patient-centered health care questions how to deliver quality, affordable, and timely care in a variety of settings. Telemedicine empowers patients, increases administrative efficiency, and ensures expertise gets to the place it is most needed--the patient. Telepsychiatry or telemental health is effective, well accepted, and comparable to in-person care. E-models of care offer variety, flexibility, and positive outcomes in most settings, and clinicians are increasingly interested in using technology for care, so much so that telepsychiatry is now being widely introduced around the world.
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66 |
16
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Abstract
India, the second most populated country of the world with a population of 1.027 billion, is a country of contrasts. It is characterized as one of the world's largest industrial nations, yet most of the negative characteristics of poor and developing countries define India too. The population is predominantly rural, and 36% of people still live below poverty line. There is a continuous migration of rural people into urban slums creating major health and economic problems. India is one of the pioneer countries in health services planning with a focus on primary health care. Improvement in the health status of the population has been one of the major thrust areas for social development programmes in the country. However, only a small percentage of the total annual budget is spent on health. Mental health is part of the general health services, and carries no separate budget. The National Mental Health Programme serves practically as the mental health policy. Recently, there was an eight-fold increase in budget allocation for the National Mental Health Programme for the Tenth Five-Year Plan (2002-2007). India is a multicultural traditional society where people visit religious and traditional healers for general and mental health related problems. However, wherever modern health services are available, people do come forward. India has a number of public policy and judicial enactments, which may impact on mental health. These have tried to address the issues of stigma attached to the mental illnesses and the rights of mentally ill people in society. A large number of epidemiological surveys done in India on mental disorders have demonstrated the prevalence of mental morbidity in rural and urban areas of the country; these rates are comparable to global rates. Although India is well placed as far as trained manpower in general health services is concerned, the mental health trained personnel are quite limited, and these are mostly based in urban areas. Considering this, development of mental health services has been linked with general health services and primary health care. Training opportunities for various kinds of mental health personnel are gradually increasing in various academic institutions in the country and recently, there has been a major initiative in the growth of private psychiatric services to fill a vacuum that the public mental health services have been slow to address. A number of non-governmental organizations have also initiated activities related to rehabilitation programmes, human rights of mentally ill people, and school mental health programmes. Despite all these efforts and progress, a lot has still to be done towards all aspects of mental health care in India in respect of training, research, and provision of clinical services to promote mental health in all sections of society.
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Abstract
Psychiatric research and practice involves the colonization of the personal experience of problems of human living. From a Western perspective, this process shares many similarities with the subjugation of women, people of colour and people embracing non-Christian faiths and cultures. The Tidal Model is a mental health recovery and reclamation model, developed to provide the framework for discrete alternatives to the colonizing approach of mainstream psychiatric practice. The Model asserts the intrinsic value of personal experience and the centrality of narrative in the development of contextually bound, personally appropriate, mental health care. This paper summarizes the features of the Model, which attempt to address the foci of the more significant critiques of psychiatric practice (and psychiatric nursing), against a background sketch of psychiatric colonization.
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Marshall M, Lockwood A, Lewis S, Fiander M. Essential elements of an early intervention service for psychosis: the opinions of expert clinicians. BMC Psychiatry 2004; 4:17. [PMID: 15230978 PMCID: PMC455683 DOI: 10.1186/1471-244x-4-17] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2004] [Accepted: 07/01/2004] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Early intervention teams attempt to improve outcome in schizophrenia through earlier detection and the provision of phase-specific treatments. Whilst the number of early intervention teams is growing, there is a lack of clarity over their essential structural and functional elements. METHODS A 'Delphi' exercise was carried out to identify how far there was consensus on the essential elements of early intervention teams in a group of 21 UK expert clinicians. Using published guidelines, an initial list was constructed containing 151 elements from ten categories of team structure and function. RESULTS Overall there was expert consensus on the importance of 136 (90%) of these elements. Of the items on which there was consensus, 106 (70.2%) were rated essential, meaning that in their absence the functioning of the team would be severely impaired. CONCLUSION This degree of consensus over essential elements suggests that it is reasonable to define a model for UK early intervention teams, from which a measure of fidelity could be derived.
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McClelland R, Trimble P, Fox ML, Stevenson MR, Bell B. Validation of an outcome scale for use in adult psychiatric practice. Qual Health Care 2000; 9:98-105. [PMID: 11067258 PMCID: PMC1743512 DOI: 10.1136/qhc.9.2.98] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To clarify the usefulness, acceptability, sensitivity, and validity of version 4 of the Health of the Nation Outcome Scale (HoNOS), a scale developed to meet the requirement for a clinically acceptable outcome scale for routine use in mental illness services. DESIGN Patients with a range of mental illnesses were rated on the HoNOS at the beginning and end of an episode by interviews with mental health professionals. SUBJECTS 934 patients from eight diagnostic categories were rated by 129 mental health professionals at 17 sites; 250 were also rated on a range of comparison scales. OUTCOME MEASURES Comparison of patients' scores at the beginning and end of an episode using individual item scores, dimensional subscores, and the total score. RESULTS HoNOS scores decreased by almost 50% between the beginning and end of episodes. They varied with the severity of the setting and discriminant analysis showed that the HoNOS had a moderate level of discriminatory power. Correlation analysis showed acceptable levels of agreement with independent scales, although the accuracy of ratings of some items at the beginning of an episode was affected by information deficits. CONCLUSION The findings indicate that HoNOS is sensitive to change across time and to differences in illness type and severity, and has a sufficient degree of both construct and criterion related validity to fulfil the requirements of a mental health outcome scale for routine use in clinical settings.
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Abstract
OBJECTIVE To describe the current situation of mental health care in Italy and implementation of mental health reform legislation. METHOD The current mental health care system and studies of the implementation of psychiatric reform are described. RESULTS The 1978 reform law inaugurated fundamental changes in the care system (prohibiting admissions to state mental hospitals, stipulating community-based services, allowing hospitalization only in small general-hospital units). Uneven reform implementation was reported initially. However, in 1984 in- and out-patient services in the community were available to >80% of the population. There is a comprehensive network of in- and out-patient, residential and semi-residential facilities. Recently, services have been jeopardized by the managed-care revolution, and non-profit organizations supplement the public system (especially residential care, employment and self/mutual help). CONCLUSION Implementation of the psychiatric reform law has been accomplished, and the year 1998 marked the very end of the state mental hospital system in Italy.
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Review |
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Abstract
OBJECTIVE The no-suicide contract is widely recommended as an important intervention in the care of suicidal patients; however, there are no data demonstrating its effectiveness or its acceptance in the professional community. This study examines the use of no-suicide contracts by psychiatrists in Minnesota. METHOD A postcard questionnaire was mailed to 514 psychiatrists in Minnesota inquiring about their practices and experiences with no-suicide contracts. RESULTS There were 267 responses, yielding a response rate of 52%. No-suicide contracts were used by 152 (57%) of the respondents. Within this group, 62 (41%) of the psychiatrists had patients who committed suicide or made serious attempts after entering into a no-suicide contract. CONCLUSIONS Among the respondents to the questionnaire, slightly more than half used no-suicide contracts, indicating that such contracts are not universally accepted as standard practice among these psychiatrists. More data are needed to determine the effectiveness of no-suicide contracts in preventing suicide.
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Baetz M, Griffin R, Bowen R, Marcoux G. Spirituality and psychiatry in Canada: psychiatric practice compared with patient expectations. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2004; 49:265-71. [PMID: 15147025 DOI: 10.1177/070674370404900407] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This study compares psychiatrists' and psychiatric patients' practice, attitudes, and expectations regarding spirituality and religion. METHOD We mailed surveys to all Canadian psychiatrists registered with the Royal College of Physicians and Surgeons of Canada (n = 2890). The response rate was 42% (n = 1204). We recruited patients from a Canadian on-line survey (n = 67) and from a local mental health clinic (n = 90). RESULTS Psychiatrists had lower levels of beliefs and practices than did patients and the general population. In both groups, 47% felt there was "often or always" a place to include spirituality in psychiatric assessment, although the perceived importance differed. Among patients, 53% felt it important to have this issue addressed, and 24% considered the psychiatrist's spiritual interest important in their choice of psychiatrist. Barriers to addressing the issue of spirituality and mental health related to psychiatrists' concern regarding its appropriateness and patients' perception that interest is lacking. Psychiatrists' own beliefs and practices were strong predictors of spiritual inquiry. CONCLUSIONS Although psychiatrists report lower levels of spiritual and religious belief than do patients, they acknowledge that it is important to include this topic in patient care. Increased discussion and education may lower reported barriers to including spirituality and religion in routine psychiatric assessment.
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Reynolds CF, Lewis DA, Detre T, Schatzberg AF, Kupfer DJ. The future of psychiatry as clinical neuroscience. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2009; 84:446-450. [PMID: 19318776 PMCID: PMC2769014 DOI: 10.1097/acm.0b013e31819a8052] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Psychiatry includes the assessment, treatment, and prevention of complex brain disorders, such as depression, bipolar disorder, anxiety disorders, schizophrenia, developmental disorders (e.g., autism), and neurodegenerative disorders (e.g., Alzheimer dementia). Its core mission is to prevent and alleviate the distress and impairment caused by these disorders, which account for a substantial part of the global burden of illness-related disability. Psychiatry is grounded in clinical neuroscience. Its core mission, now and in the future, is best served within this context because advances in assessment, treatment, and prevention of brain disorders are likely to originate from studies of etiology and pathophysiology based in clinical and translational neuroscience. To ensure its broad public health relevance in the future, psychiatry must also bridge science and service, ensuring that those who need the benefits of its science are also its beneficiaries. To do so effectively, psychiatry as clinical neuroscience must strengthen its partnerships with the disciplines of public health (including epidemiology), community and behavioral health science, and health economics.The authors present a Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis of psychiatry and identify strategies for strengthening its future and increasing its relevance to public health and the rest of medicine. These strategies encompass new approaches to strengthening the relationship between psychiatry and neurology, financing psychiatry's mission, emphasizing early and sustained multidisciplinary training (research and clinical), bolstering the academic infrastructure, and reorganizing and refinancing mental health services both for preventive intervention and cost-effective chronic disease management.
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Research Support, N.I.H., Extramural |
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Hilty DM, Rabinowitz T, McCarron RM, Katzelnick DJ, Chang T, Bauer AM, Fortney J. An Update on Telepsychiatry and How It Can Leverage Collaborative, Stepped, and Integrated Services to Primary Care. PSYCHOSOMATICS 2017; 59:227-250. [PMID: 29544663 DOI: 10.1016/j.psym.2017.12.005] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 12/15/2017] [Accepted: 12/18/2017] [Indexed: 01/01/2023]
Abstract
INTRODUCTION In this era of patient-centered care, telepsychiatry (TP; video or synchronous) provides quality care with outcomes as good as in-person care, facilitates access to care, and leverages a wide range of treatments at a distance. METHOD This conceptual review article explores TP as applied to newer models of care (e.g., collaborative, stepped, and integrated care). RESULTS The field of psychosomatic medicine (PSM) has developed clinical care models, educates interdisciplinary team members, and provides leadership to clinical teams. PSM is uniquely positioned to steer TP and implement other telebehavioral health care options (e.g., e-mail/telephone, psych/mental health apps) in the future in primary care. Together, PSM and TP provide versatility to health systems by enabling more patient points-of-entry, matching patient needs with provider skills, and helping providers work at the top of their licenses. TP and other technologies make collaborative, stepped, and integrated care less costly and more accessible. CONCLUSION Effective health care delivery matches the intensity of the services to the needs of a patient population or clinic, standardizes interventions, and evaluates both process and clinical outcomes. More research is indicated on the application of TP and other technologies to these service delivery models.
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