Mental Health Clinical Practice Research Articles

Simulation with standardized patients to prepare undergraduate nursing students for mental health clinical practice: An integrative literature review

ObjectiveTo evaluate the available evidence supporting the efficacy of using simulation with standardized patients to prepare nursing students for mental health clinical practice. DesignIntegrative literature review. Data sourcesA systematic search of the electronic databases CINAHL (EBSCOhost), Embase, MEDLINE, PsycINFO, and SveMed+ was conducted to identify empirical studies published until November 2016. Multiple search terms were used. Original empirical studies published in English and exploring undergraduate nursing students' experiences of simulation with standardized patients as preparation for mental health nursing practice were included. A search of reference lists and gray literature was also conducted. In total, 1677 studies were retrieved; the full texts of 78 were screened by 2 of the authors, and 6 studies reminded in the review. Review methodsThe authors independently reviewed the studies in three stages by screening the titles, abstracts, and full texts, and the quality of the included studies was assessed in the final stage. Design-specific checklists were used for quality appraisal. The thematic synthesizing method was used to summarize the findings of the included studies. ResultsThe studies used four different research designs, both qualitative and quantitative. All studies scored fairly low in the quality appraisal. The five themes identified were enhanced confidence, clinical skills, anxiety regarding the unknown, demystification, and self-awareness. ConclusionsThe findings of this study indicate that simulation with standardized patients could decrease students' anxiety level, shatter pre-assumptions, and increase self-confidence and self-awareness before entering clinical practice in mental health. More high-quality studies with larger sample sizes are required because of the limited evidence provided by the six studies in the present review.

Knowledge discovery for Deep Phenotyping serious mental illness from Electronic Mental Health records

Background: Deep Phenotyping is the precise and comprehensive analysis of phenotypic features in which the individual components of the phenotype are observed and described. In UK mental health clinical practice, most clinically relevant information is recorded as free text in the Electronic Health Record, and offers a granularity of information beyond what is expressed in most medical knowledge bases. The SNOMED CT nomenclature potentially offers the means to model such information at scale, yet given a sufficiently large body of clinical text collected over many years, it is difficult to identify the language that clinicians favour to express concepts. Methods: By utilising a large corpus of healthcare data, we sought to make use of semantic modelling and clustering techniques to represent the relationship between the clinical vocabulary of internationally recognised SMI symptoms and the preferred language used by clinicians within a care setting. We explore how such models can be used for discovering novel vocabulary relevant to the task of phenotyping Serious Mental Illness (SMI) with only a small amount of prior knowledge. Results: 20 403 terms were derived and curated via a two stage methodology. The list was reduced to 557 putative concepts based on eliminating redundant information content. These were then organised into 9 distinct categories pertaining to different aspects of psychiatric assessment. 235 concepts were found to be expressions of putative clinical significance. Of these, 53 were identified having novel synonymy with existing SNOMED CT concepts. 106 had no mapping to SNOMED CT. Conclusions: We demonstrate a scalable approach to discovering new concepts of SMI symptomatology based on real-world clinical observation. Such approaches may offer the opportunity to consider broader manifestations of SMI symptomatology than is typically assessed via current diagnostic frameworks, and create the potential for enhancing nomenclatures such as SNOMED CT based on real-world expressions.

Knowledge discovery for Deep Phenotyping serious mental illness from Electronic Mental Health records

Background: Deep Phenotyping is the precise and comprehensive analysis of phenotypic features, where the individual components of the phenotype are observed and described. In UK mental health clinical practice, most clinically relevant information is recorded as free text in the Electronic Health Record, and offers a granularity of information beyond that expressed in most medical knowledge bases. The SNOMED CT nomenclature potentially offers the means to model such information at scale, yet given a sufficiently large body of clinical text collected over many years, it's difficult to identify the language that clinicians favour to express concepts. Methods: Vector space models of language seek to represent the relationship between words in a corpus in terms of cosine distance between a series of vectors. When utilising a large corpus of healthcare data and combined with appropriate clustering techniques and manual curation, we explore how such models can be used for discovering vocabulary relevant to the task of phenotyping Serious Mental Illness (SMI) with only a small amount of prior knowledge. Results: 20 403 n-grams were derived and curated via a two stage methodology. The list was reduced to 557 putative concepts based on eliminating redundant information content. These were then organised into 9 distinct categories pertaining to different aspects of psychiatric assessment. 235 (42%) concepts were found to be depictions of putative clinical significance. Of these, 53 (10%) were identified having novel synonymy with existing SNOMED CT concepts. 106 (19%) had no mapping to SNOMED CT. Conclusions: We demonstrate a scalable approach to discovering new depictions of SMI symptomatology based on real world clinical observation. Such approaches may offer the opportunity to consider broader manifestations of SMI symptomatology than is typically assessed via current diagnostic frameworks, and create the potential for enhancing nomenclatures such as SNOMED CT based on real world depictions.

Applying a Cognitive Neuroscience Perspective to Disruptive Behavior Disorders: Implications for Schools

ABSTRACTA cognitive neuroscience perspective seeks to understand behavior, in this case disruptive behavior disorders (DBD), in terms of dysfunction in cognitive processes underpinned by neural processes. While this type of approach has clear implications for clinical mental health practice, it also has implications for school-based assessment and intervention with children and adolescents who have disruptive behavior and aggression. This review articulates a cognitive neuroscience account of DBD by discussing the neurocognitive dysfunction related to emotional empathy, threat sensitivity, reinforcement-based decision-making, and response inhibition. The potential implications for current and future classroom-based assessments and interventions for students with these deficits are discussed.

Tiresias and His Trouble with Ambiguity in Gender

Tiresias and His Trouble with Ambiguity in Gender Marco Posadas (bio) To begin, I would like to identify my position as chair of the Sexual and Gender Diversity Studies Committee of the International Psychoanalytical Association (IPA). The IPA is the first, oldest, and largest international psychoanalytical association in the world. It was created by Freud with the help of Ferenzci, Jung, Eitington, Abraham, and Jones in 1910 with the purpose of organizing what started to be a body of theory and clinical mental health practice, and for the promotion of scientific activities at an international level. Today the IPA has almost fourteen thousand members and more than six thousand candidates within three consolidated regions—North America (including China, Korea, and Japan), Europe (including New Zealand, Australia, India, and South Africa), and Latin America—and a new, fourth region, Asia, which hopes to consolidate China, Korea, Japan, India, New Zealand, and Australia. It organizes a biannual international congress that is one of the largest psychoanalytic events in the world. The IPA has four official languages—English, French, German, and Spanish—and more than fifty languages among all its constituent psychoanalytic societies and institutes. A large part of its organizational and scientific work is divided, planned and executed by committees. Committees are appointed by the executive committee and ratified by the IPA board. The committee I chair was appointed by Stefano Bolognini's administration in June 2017. Our committee is fortunate to continue to be strongly supported [End Page 93] by Virginia Ungar, the first female president of the IPA, and Vice President Sergio Nick's administration. Before the creation of the Sexual and Gender Diversity Studies Committee, during its planning stages, there was already a lot of ambiguity around addressing issues of gender and sexual diversities in psychoanalysis. An important part of the committee's mandate is to create spaces for IPA-affiliated psychoanalysts and candidates and for non-IPA-affiliated psychodynamic clinicians and psychotherapists, among an increasing number of people interested in psychoanalysis, to discuss issues pertaining to psychoanalytic clinical theory and practice and to the intersection of sexual and gender diversity. Although our committee had anticipated the resistance that has been historically present when addressing these types of topics in psychoanalytic institutions (Drescher 2008; Roughton 1995, 2002), we were not able to identify and agree upon a specific point of contingence within psychoanalytic theory and practice that could cause the most resistance. This article is an initial step to engage with the resistance encountered in analytic spaces when we shift from a binary system to a non-binary way of thinking gender and sexuality. I will describe the experience in an attempt to provide models of understanding and working through these types of conflicts. Why am I calling it a conflict? This will be better answered with an example, in this case a non-clinical general vignette. I will disguise the participants' identities and will use a composite vignette to protect confidentiality. The Trouble with Ambiguity In 2016, I was delivering a workshop to strengthen clinical skills when working with racialized LGBTQ patients from a psychoanalytic perspective using an anti-oppressive approach. I was surprised to hear a senior analyst openly state from the back of the room that they preferred to hold on to their prejudices regarding trans and gender-creative patients. The audience mostly consisted of psychoanalysts, psychoanalytic candidates, training [End Page 94] analysts, and psychology graduates interested in psychoanalysis. Given the wide range of the audience and our shared interest in psychoanalysis, I usually clarify Freud's "progressive" perspective toward homosexual patients and the distortions of Freud's statements as the message got passed around through generations of culturally sanctioned homophobic clinicians (Socarides 1968; Roughton 2002). The questions from this particular audience led to a discussion about misconceptions in psychoanalytic literature about trans experiences and of trans bodies being misrepresented and misdiagnosed as psychotic (Millot 1989). Addressing misrepresentations of gender variance rooted in prejudiced formulations of trans subjectivities within psychoanalytic theory and proposing less-biased ways of approaching gender polymorphism from a non-pathological perspective can be a complicated task. This is not unheard-of in our field; in fact, queer theorists, Lacanian analysts, and transgender...

Effects of Mental health clinical practice on the attitude toward the mental illness, social distance, psychiatry nurses' image of Nursing Students

Effects of Mental health clinical practice on the attitude toward the mental illness, social distance, psychiatry nurses' image of Nursing Students

Promoting mental health recovery and improving clinical assessment using video technology.

Although individuals with medical problems (e.g., diabetes, hypertension) can monitor their symptoms using objective measures (e.g., blood glucose, blood pressure), objective measures are not typically used by individuals with psychotic disorders to monitor symptoms of mental illness. To examine the benefits and limitations of the use of video self-observation for treatment of individuals with psychotic disorders. The authors reviewed studies examining video self-observation among individuals with severe mental illnesses. Individuals with psychotic disorders who viewed videos of themselves while symptomatic reported some benefit to this approach, with 1 study showing sustained improvement in understanding of mental illness. Still, some individuals reported negative feelings about the process, and also attributed symptoms to stress or drug abuse rather than their psychotic disorder. The authors found no studies examining the potential for video self-observation as a strategy to improve clinical decision-making in the context of mental health care. Implications of this approach for mental health recovery and clinical practice are discussed. (PsycINFO Database Record

What is the impact of research champions on integrating research in mental health clinical practice? A quasiexperimental study in South London, UK

ObjectivesKey challenges for mental health healthcare professionals to implement research alongside clinical activity have been highlighted, such as insufficient time to apply research skills and lack of support and resources....

“Her Anger Frightens Me!” Using Group-Work Practice Principles and Feature Films in Teaching Clinical Practice in Mental Health

ABSTRACTCombining group-work practice principles and the arts (feature films) can contribute to more effective teaching and enhance student clinical practice competency. By treating teaching as a form of group work and introducing a feature film into the classroom group, an instructor can reduce student-learning anxieties, teach core clinical concepts and skills, and enhance the classroom’s socioemotional climate. Vignettes demonstrate how this approach to teaching enriched students’ learning in an introductory clinical social work class on adult mental health.

Improving our understanding of the in vivo modelling of psychotic disorders: A protocol for a systematic review and meta-analysis.

Psychosis represents a set of symptoms against which current available treatments are not universally effective and are often accompanied by adverse side effects. Clinical management could potentially be improved with a greater understanding of the underlying biology and subsequently with the introduction of novel treatments. Since many clinical drug candidates are identified through in vivo modelling, a deeper understanding of the pre‐clinical field, might help us understand why translation of results from animal models to inform mental health clinical practice has so far been weak. We set out to give a shallow, but broad unbiased overview of experiments looking at the in vivo modelling of psychotic disorders using a systematic review and meta‐analysis. This protocol describes the exact methodology we propose to follow in order to quantitatively review both studies characterizing a model and those experiments that investigate the effects of novel therapeutic options. We are interested in assessing the prevalence of the reporting of measures to reduce risk of bias, and the internal and external validity of the animal models and outcome measures used to validate these models. This generation of strong empirical evidence has the potential to identify areas for improvement, make suggestions for future research avenues, and ultimately inform what we think we know to improve the current attrition rate between bench and bedside in psychosis research. A review like this will also support the reduction of animal numbers used in research and the refinement of experiments to maximize their value in informing the field.

The Care Programme Approach, sexual violence and clinical practice in mental health

IntroductionResearch in Sexual Assault Referral Centres has shown that 40% of those attending are known to mental health services. The question we posed in this study was to what extent do mental health services know about this group? This was a pertinent question to ask as in 2008 the Department of Health (DH) amended the Care Programme Approach (CPA) to include a question on sexual abuse/violence as part of the overall assessment. AimsTo assess the extent to which Mental health Trusts were implementing DH guidance on the CPA in relation to assessment of sexual violence and abuse. Method1. Freedom of Information (FOI) requests were sent to all Mental Health Trusts. 2. The Information base at the Health and Social Care Information Centre (HSCIC) was interrogated as Trusts can make returns on this CPA question, however it is not mandatory. Results1. The FOI requests revealed that: only 66% of staff were trained to 'ask the question' (range 35–100%) and only five out of 53 Trusts audited whether the question was asked. 2. The HSCIC data revealed that in 2014/15 there were 335,727 people in the CPA in England and there was a record in only 17% of cases of the question being asked. Over half (57%) of the 69 providers who did not submit any information on the indicator in 2014/15 as well as, for those 30 providers who did submit information, the data field was only 41% complete. ConclusionsThe impetus for ‘asking the question’ first established in 2008 with the establishment of eight pilot training programmes, has been lost. It is clear that Trusts are not training adequate number of staff nor are they returning useable data to HSCIC. If 40% of people attending SARCs are known to mental health services we suspect that few staff in mental health trusts known much about such a referral. Research shows convincingly that sexual violence and abuse plays a clear role in the aetiology of mental health disorders. A history of such violence/abuse should be always established (or otherwise).

A critical interpretive synthesis of the most commonly used self-report measures in Australian mental health research.

To critically examine the self-report measures most commonly used in Australian mental health research in the last 10 years. A critical interpretive synthesis was conducted using seven outcome measures that were identified as most popular in 43 studies from three mental health journals. Results suggest that the amount and type of language used in outcome measures is important in both increasing the accuracy of the data collected and fostering positive experiences of data collection for participants. Results indicate that many of the measures most often used in Australian mental health research may not align with the current contemporary philosophy of mental health clinical practice in Australia.

The relationship between mental illness and violence in a mentally disordered offender sample: evaluating criminogenic and psychopathological predictors

ABSTRACTThe importance of mental illness as a risk factor for violence has been debated with significant implications for mental health policy and clinical practice. In offender samples, psychopathology tends to be unrelated to recidivism, although some researchers have noted that this relationship may be dependent upon certain moderating factors. In the present, prospective investigation, psychopathology is examined as predictors of recidivism in 121 provincially sentenced (i.e. less than 2 years) mentally disordered offenders. Results indicated that psychopathological predictors were generally poor predictors of recidivism in univariate and multivariate analyses. Consistent with our hypotheses, age of onset of criminal activity was a significant moderating factor on the relationship between mental illness and recidivism, although results were not in the expected direction for certain classes of mental illness. Results are discussed in the context of a social learning model of crime and in terms of the treatment of mentally disordered offenders.

Assessing the reliability, predictive and construct validity of historical, clinical and risk management-20 (HCR-20) in Mexican psychiatric inpatients

abstractIntroduction: Assessing dangerousness to gauge the likelihood of future violent behaviour has become an integral part of clinical mental health practice in forensic and non-forensic psychiatric settings, one of the most effective instruments for this being the Historical, Clinical and Risk Management-20 (HCR-20). Objective: To examine the HCR-20 factor structure in Mexican psychiatric inpatients and to obtain its predictive validity and reliability for use in this population. Method: In total, 225 patients diagnosed with psychotic, affective or personality disorders were included. The HCR-20 was applied at hospital admission and violent behaviours were assessed during psychiatric hospitalization using the Overt Aggression Scale (OAS). Construct validity, predictive validity and internal consistency were determined. Results: Violent behaviour remains more severe in patients classified in the high-risk group during hospitalization. Fifteen items displayed adequate communalities in the original designated domains of the HCR-20 and internal consistency of the instruments was high. Conclusion: The HCR-20 is a suitable instrument for predicting violence risk in Mexican psychiatric inpatients.

Nursing Students' Perceptions of a Hearing Voices Simulation and Role-Play: Preparation for Mental Health Clinical Practice.

Baccalaureate nursing students experience anxiety before working with patients with mental illness who hear voices. A hearing voices simulation and role-play was proposed as an approach to preparing students for clinical practice. A qualitative interpretive phenomenological method was used to determine students' perceptions of the simulation experience before their first mental health clinical rotation. Through the experience of the Walking in the Shoes of Patients activity, written student surveys revealed themes of Reflecting on Past Experiences, Developing Changed Perspectives, and Different Approaches to Care. The hearing voices simulation provided students with a greater understanding of the experience of hearing voices, and the role-play helped students to gain personal insight into patients' behaviors and practice skills learned in preparation for their first mental health clinical experience.

Auditing of discharge summaries Contet at Al Amal medical complex

Introduction and aimsPatient's records are the most important clinical assets and tools which are required in consultations. Patient records also support the accurate continuity of care when patients return to other health providers.ObjectiveUnderstand the extent of Discharge Summaries, which conform to the set best practise guidelines on the Mental Health Service.MethodA cross-section retrospective study on Discharge Summary contents was conducted at Al Amal Medical Complex. Chart review of randomly selected patient files (200 of a total 495), of Discharge Summaries for Psychiatric Patients in 2014 was performed. The data was statistically analysed using descriptive statistics taking into account proportions and frequencies. Pearson chi square and Fisher's test methodologies were used.ResultThis study found of the 200 randomly selected Discharge Summaries that documented data of mental health examination 94% (n = 188), data of discharge date 100% (n = 200) while data of social investigation and family work up 82% (n = 164). The above three categories were the only categories to conform to standard discharge guidelines. The other thirteen items studies were found not conforming to the defined standard guidelines.Conclusion and recommendationThere is an active challenge for clinicians to introduce good clinical practice in Mental Health. Standard guidelines must be followed by clinician's in order to reduce potential areas of concern and achieve a good clinical practise. Regular recurring audits are highly needed& recommended to ensure the alignment with standard guidelines for the writing of Discharge Summaries.Disclosure of interestThe author has not supplied his/her declaration of competing interest.

The black and white and shades of grey of boundary violations

Using a Constructivist Grounded Theory approach (Charmaz, 2006), this research examined the social construct of the “professional boundary” necessary in mental health therapeutic work and the problem of professional boundary violations in the therapeutic relationship. Thirteen mental health clinicians from various professional disciplines commonly found in mental health clinical practice responded to three specific questions designed to gain an understanding about how clinicians gauge the differences between minor and serious boundary violations. The three questions facilitated further exploration of boundary violations specifically to explore the difficulties of determining what is and what is not considered a boundary violation often resulting in polarised views or “black and white” descriptions and opinions. However many shades of grey were also revealed during the interviews. Almost all participants rated intimacy or sexual contact with a client or an ex-client as being a serious boundary violation, on the other hand there was a great deal of variety in the examples offered as minor boundary violations. Whilst the “Black” is clearly defined by clinicians in this research, the “White” only seemed to create more “Grey” areas, with descriptions of behaviours that fell into the Grey area being more difficult to define.

Young Women’s Experiences of Coping with Violence in Intimate Relationships

This study examined the lived experiences of coping with physically violent living-as-married or marital relationships for women aged 19–24. Information was collected from five women through semi-structured interviews and analyzed using the transcendental phenomenological approach (Moustakas, 1994). Three major themes emerged from their experiences. The first, within-person coping, involved self-soothing, enjoying positive experiences, cognitively rationalizing and minimizing violence, and personal beliefs, including spiritual beliefs. The second, managing violence within the relationship, included purposeful communication, managing violence, and escape. The third related to experiences with informal and formal support. Spirituality and the role of others are also explored in some detail. Implications for clinical mental health practice and directions for future research are discussed.

Keohane, K.and Petersen, A. (eds) The Social Pathologies of Contemporary Civilization. Farnham: Ashgate. 2013. 218pp £60.00 (hbk) ISBN 9781409445050

At present many are struggling to make sense of increasing rates of mental distress within different populations. Since the 1950s biological explanations of mental distress have risen to the fore within many psychiatric, medical and nursing training programmes. This rise has been accompanied by paradoxical effects among professionals and the general public – with apparently decreasing professional empathy in response to biological understandings, and increasing desire for public distance from those with psychotic experiences (Angermeyer et al. 2013; Lebowitz and Ahn 2014). Against this background, explorations of the social experience of mental distress serve to allow greater understanding of the experience of disorder in contemporary settings. This book, based on the proceedings from a conference of the same name hosted in Denmark, 2010, seeks to advance understanding of the concept of experiences of psychic distress as a manifestation, not solely of individual experience but as a more collective pathology of ‘civilisation’. The contents consist of a series of papers presented by various authors and edited by Keohane and Petersen into three overarching themes. The claim for a pathology of civilisation is clearly not uncontroversial and the opening section of the book sets out the thinking of conference contributors in relation to defining understanding and nomenclature. The second section presents a series of case studies considering the experience of varying forms of mental distress and the impact of societal change in recent decades on these phenomena. The book's closing section steps its analysis up to a higher order, considering the impact of social movements, for example the impact of biomedical interpretations of distress, on society. The authors' arguments describing the impact of societal change on the experience of individuals, and the pressures placed on them leading to a discharge of distress, are strong and this is represented in the depth of the case studies presented describing varying experiences of psychic distress. The question is raised though as to why the pathologies presented were chosen over others for consideration – is there much to be said and learnt perhaps regarding the increasing rate of stimulant prescription in children, or the rising rates of antipsychotic and mood stabilising medication prescriptions? The argument that it is civilisation itself that becomes pathological as a result of disordered processes within it versus the position that individuals within society experience distress secondary to societal pressures is more difficult to maintain, but still compelling when the discussions presented are considered. The book's central hypothesis that ‘various health-related symptoms are part of a radical change of our civilization’ (p.3) is however supported by the presented papers and warrants further exploration. The arguments presented within this book are not necessarily novel in their consideration of social pressure leading to psychic distress. However, in the current political climate their synthesis in this way is certainly timely and serves to provide an alternative perspective to a well-established debate within the field of clinical mental health practice. Because of these discussions, this book will prove interesting for clinicians as well as those with an academic interest in the social expression of mental distress. For clinicians the papers contained within will serve to underline the importance of considering the social environment around individuals who seek help and support in relation to their experiences. The message this book conveys is important: we can no longer continue to consider the experience of individuals alone, isolated from the groups, communities and societies that contain and constitute their experiences. In this regard the essays contained within serve as an introduction to a discussion. There are no solutions as yet, but the discussion needs to be heard.

Challenges in treatment of posttraumatic stress disorder in refugees: towards integration of evidence-based treatments with contextual and culture-sensitive perspectives

BackgroundResearch shows that trauma-focused therapy and multimodal interventions are the two most often used strategies in treatment of refugees suffering from posttraumatic stress disorder (PTSD). While preliminary evidence suggests that trauma-focused approaches may have some efficacy, this could not be established for multimodal interventions. However, it may be that multimodal interventions have been studied in more treatment-resistant refugees with very high levels of psychopathology, disability, and chronicity. In the past decades, various models for understanding of the complex relationship between mental health problems and well-being have emerged. They aim at framing mental health problems in individualized, contextual, epigenetic, and culturally sensitive ways, and may be useful in tailoring content and timing of multimodal interventions.ObjectiveTo draw clinicians’ attention to the possibility of using the Integrative Contextual Model for understanding and assessment of posttrauma mental health sequelae while tailoring multimodal interventions; to present a possible way of combining multimodal with evidence-based trauma-focused approaches; and to improve the understanding and treatment of PTSD and other mental health problems in refugee survivors of prolonged and repeated trauma.MethodBased on literature, clinical experience, and presentation of a fictional case, the use of the Integrative Contextual Model in tailoring the treatment of severe PTSD in a refugee patient is presented and discussed.ResultsThe Integrative Contextual Model for understanding and assessing factors, which may play a role in causing and maintaining of PTSD and comorbidity in refugees, may help tailoring of multimodal interventions. These interventions can be combined with evidence-based trauma-focused treatments.ConclusionThe field of refugee mental health intervention and clinical practice with traumatized refugees may be enriched with the use of contextual and developmental models for assessment and conceptualization of posttrauma sequelae. Multimodal and trauma-focused interventions may be applied sequentially in a course of the treatment trajectory.