Complex Mental Illness Research Articles

Training Clinicians to Care for Patients Where They Are.

Homelessness remains a pervasive, long-standing problem in the United States and is poised to increase as a result of the COVID-19 pandemic. Individuals experiencing homelessness bear a higher burden of complex medical and mental health illnesses and often struggle to obtain quality and timely health care. The United States desperately needs to train a workforce to confront this large and growing crisis, but few health professional schools currently devote curricula to the clinical needs of people experiencing homelessness. This article discusses educational and curricular strategies for health professional students. Understanding the health needs of-and the social influences on the lives of-people experiencing homelessness is crucial for addressing this health equity challenge.

We Need to Find Right Balance Between Telehealth, In-Person Care

We Need to Find Right Balance Between Telehealth, In-Person Care

Shaping the Trans-Scale Properties of Schizophrenia via Cerebral Alterations on Magnetic Resonance Imaging and Single-Nucleotide Polymorphisms of Coding and Non-Coding Regions.

Schizophrenia is a complex mental illness with genetic heterogeneity, which is often accompanied by alterations in brain structure and function. The neurobiological mechanism of schizophrenia associated with heredity remains unknown. Recently, the development of trans-scale and multi-omics methods that integrate gene and imaging information sheds new light on the nature of schizophrenia. In this article, we summarized the results of brain structural and functional changes related to the specific single-nucleotide polymorphisms (SNPs) in the past decade, and the SNPs were divided into non-coding regions and coding regions, respectively. It is hoped that the relationship between SNPs and cerebral alterations can be displayed more clearly and intuitively, so as to provide fresh approaches for the discovery of potential biomarkers and the development of clinical accurate individualized treatment decision-making.

Transdiagnostic biomarker approaches to mental health disorders: Consideration of symptom complexity, comorbidity and context

Depression is a multifaceted disorder characterized by heterogeneous symptom profiles and high rates of comorbidity with other commonly occurring mental illnesses. Considering the burden of mental health disorders and the lack of efficacy of available treatments, there is a need for biomarkers to predict tailored or personalized treatments. However, identifying reliable biomarkers for complex mental illnesses, such as depression, anxiety and PTSD, has been challenging, likely owing to the heterogeneity, comorbidity and differences in experiences and histories of individuals. For these reasons, taking a transdiagnostic approach, which identifies biomarkers that map onto shared symptoms/constructs across disorders could be most effective for informing personalized or precision medicine approaches in psychiatry. Transdiagnostic features of anxiety, depression and anhedonia have been examined in relation to brain activity and connectivity patterns. Neuroendocrine and inflammatory markers, which are altered in depression and other comorbid illness, such as post-traumatic stress disorder (PTSD), might be useful in differentiating transdiagnostic symptom profiles as well as treatment responses. Ultimately, biomarker research that looks beyond diagnostic categories and embraces the complexity of individuals' lives and experiences might be more effective in moving towards precision medicine in psychiatry.

Little-described forms of acutely developed dementia after trauma

Daily clinical experience shows that gross tremors of the body and, in particular, bruises of the head, can be accompanied by a variety of mental disorders, ranging from very elementary changes in memory, mood, etc., and ending with the most complex mental illnesses with a complete change in intelligence, will, mood , character and personality in general in all its phases.

Advocacy, Collaboration, and Conflict Management: Teaching Core Skill Sets in Mental Health Nursing.

Caring for individuals with mental illness requires a core set of skills: knowledge of various disorders; therapeutic communication; collaboration with the multidisciplinary team; proficiency as an advocate whether for individuals, families, groups, or populations; and conflict management. In the current study, students completed toolkits with standardized patient experiences (SPEs) to practice core skill sets. Growth occurred in students' therapeutic communication and their ability to care for standardized or simulated patients with complex mental health issues. Proficiency in interprofessional collaboration, advocacy, and conflict management was also noted. Providing students with opportunities to apply leadership skills to care for individuals with complex mental illness may not always be possible in "real world" settings. Use of SPEs and toolkit activities can bridge the gap between classroom/clinical and real world settings and were highly effective in helping students meet core skill sets in mental health settings. [Journal of Psychosocial Nursing and Mental Health Services, 59(9), 26-29.].

CCBHC Thrive launches MAT with CODAC in Rhode Island

Last week, Thrive Behavioral Health and CODAC Behavioral Healthcare announced they would work together to provide medication‐assisted treatment (MAT) for opioid use disorder adjacent to Kent Hospital in Rhode Island. A certified community behavioral health Clinic (CCBHC), Thrive provides a comprehensive range of services that increase access, stabilize individuals in crisis and treat children, adults and families facing serious, complex mental illnesses and substance use disorders. “When Thrive applied for the CCBHC grant, we were charged with identifying gaps in services and creating solutions to those gaps that would break down treatment barriers,” stated Dawn Allen, CCBHC project director. “We determined that there was a need for medication‐assisted treatment in Kent County. Together with CODAC, we are connecting our community members to high‐quality treatment, decreasing their risk of experiencing a fatal overdose, expediting their transitions into long‐term recovery and providing support for them to live healthy, fulfilling lives.” CODAC's President and CEO Linda Hurley stated, “We are proud to partner with Thrive Behavioral Health on this important initiative. Together, we are moving forward in treating individuals struggling with addiction as patients, just like those facing diabetes or cancer, and offering them the most comprehensive, evidence‐based therapeutic approaches available.” Founded in 1971, CODAC has provided MAT services in Rhode Island for more than 40 years, and is the state's longest‐running not‐for‐profit outpatient opioid use disorder treatment provider. CODAC will administer the MAT services, and additional clinical support will come from Thrive's adult outpatient program, which offers wraparound services including individual, group and family counseling; psychiatric medication evaluation and management; case management services;, and an Intensive Outpatient Program for substance use and co‐occurring substance use and mental health disorders.

Sex differences in association between cognitive impairment and clinical correlates in Chinese patients with first-episode drug-na\xefve schizophrenia

BackgroundSchizophrenia is a complex mental illness with significant sex differences. Cognitive impairment is common in patients with schizophrenia, even in remission. This study was designed to examine the sex differences in the relationship between cognitive impairment and clinical correlations with first-episode drug-naïve (FEDN) schizophrenia.Methods93 FEDN patients (male/female = 45/48) and 160 controls (male/female = 74/86) were enrolled to compare the sex differences in cognitive functions measured by the MATRICS Consensus Cognitive Battery (MCCB). Positive and Negative Syndrome Scale (PANSS) and Hamilton Depression Scale (HAMD) were used to evaluate patients' clinical symptoms. We compared cognitive impairment with sociodemographic characteristics and measures of different genders, as well as group-by-sex interactions.ResultsOur results showed that male patients had significantly lower scores for symbol coding, digital sequence, and verbal learning than female patients, while the healthy controls showed similar sex differences. In female patients, multiple linear regression analysis confirmed that PANSS negative symptoms and general psychopathology scores, HAMD total score, and education level were independent contributors to MCCB total score. In male patients, only education was an independent contributor to MCCB total score.ConclusionsThese findings revealed significant sex differences in cognitive impairments and clinical symptoms in FEDN, which will be worthy of a follow-up study of schizophrenia in the future.

Multi-omics Analysis of the Amygdala in a Rat Chronic Unpredictable Mild Stress Model of Depression

Major depressive disorder is a serious and complex mental illness, and multiple brain regions are involved in its pathogenesis. There is increasing evidence that the amygdala is involved in depression; however, the underlying molecular mechanisms remain unclear. In this study, we applied a combination of liquid chromatography-tandem mass spectrometry (LC–MS/MS)-based metabolomic and isobaric tags for relative and absolute quantitation (iTRAQ) proteomic to study changes in the amygdala in a chronic unpredictable mild stress (CUMS) rat model of depression. Differential analysis identified 42 metabolites and 171 proteins that were differentially expressed in the CUMS and control groups. Integrated analyses revealed two major changes in the amygdala of CUMS rats: (1) perturbations in amino acids and carbohydrate metabolism, transport-/catabolism-related proteins activity, and metabolic enzyme activity; (2) abnormal expression of synaptogenesis and oxidative phosphorylation-associated proteins.

Dietetic intervention for adult outpatients with an eating disorder: a systematic review and assessment of evidence quality.

Eating disorders (EDs) are complex mental illnesses that require medical, psychological, and dietetic intervention to assist patients achieve recovery. Available evidence was reviewed regarding dietetic intervention for adult outpatients with an ED and the quality of this evidence was assessed. Systematic literature searches were conducted using 5 databases (MEDLINE, PreMEDLINE, EMBASE, CINAHL, PsycINFO) for studies comparing adults with an ED receiving a dietetic intervention with those receiving a psychological intervention alone, those receiving a combined dietetic and psychological intervention, or a control group. Literature searches returned 3078 results, with 10 articles reporting on 9 randomized controlled trials meeting the inclusion criteria. The quality of evidence was assessed using the Cochrane Risk-of-Bias tool and Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. GRADE assessments for studies involving individuals with anorexia nervosa indicated very low quality of evidence for outcomes including weight, ED psychopathology and ED behaviors , and no studies measured nutritional changes. For studies conducted with participants with bulimia nervosa or binge eating disorder, only 1 study included a group receiving combined evidence-based psychological and dietetic intervention. A combined intervention produced moderate-quality evidence for lower attrition, greater abstinence from ED behaviors, and more meals eaten per week in comparison with a stand-alone psychological or dietetic intervention. There is currently limited evidence to sufficiently assess the impact of incorporating dietetic interventions into outpatient treatment for adults with an ED; however, available evidence supports clinical practice guidelines that dietetic intervention should not be delivered as a stand-alone treatment. Additional methodologically sound studies in larger samples are required to fully inform dietetic treatment in EDs and incorporation of such interventions as part of a multidisciplinary treatment approach.

Characteristics of effective online interventions: implications for adolescents with personality disorder during a global pandemic.

In recent years, the necessity of providing online interventions for adolescents, as an alternative to face-to-face interventions, has become apparent due to several barriers some adolescents face in accessing treatment. This need has become more critical with the coronavirus disease 2019 (COVID-19) global pandemic impacting the delivery of psychotherapy and limiting accessibility of face-to-face therapy. Whilst it has been established that face-to-face psychotherapy for adolescents with personality disorder can be effective in reducing the impact these complex mental illnesses have on functioning, online interventions for adolescents are rare, and to our knowledge there are no empirically validated online interventions for personality disorder. The development of novel online interventions are therefore necessary. To inform the development of online interventions for adolescents with personality disorder or symptoms of emerging personality disorder, a two-phase rapid review was conducted. Phase one consisted of a search and examination of existing online mental health programs for adolescents with symptoms of personality disorder, to understand how to best use online platforms. Phase two consisted of a rapid review of empirical literature examining online interventions for adolescents experiencing symptoms of personality disorder to identify characteristics that promote efficacy. There were no online programs specific to personality disorder in adolescence. However, 32 online mental health programs and 41 published empirical studies were included for analysis. Common intervention characteristics included timeframes of one to two months, regular confidential therapist contact, simple interactive online components and modules, and the inclusion of homework or workbook activities to practice new skills. There is an urgent need for online interventions targeting personality dysfunction in adolescence. Several characteristics of effective online interventions for adolescents were identified. These characteristics can help inform the development and implementation of novel online treatments to prevent and reduce the burden and impact of personality disorder, or symptoms of emerging personality disorder, in adolescents. This has implications for the COVID-19 pandemic when access to effective online interventions has become more urgent.

Review of Australian initiatives to reduce stigma towards people with complex mental illness: what exists and what works?

BackgroundAustralian national mental health policy outlines the need for a nationally coordinated strategy to address stigma and discrimination, particularly towards people with complex mental illness that is poorly understood in the community. To inform implementation of this policy, this review aimed to identify and examine the effectiveness of existing Australian programs or initiatives that aim to reduce stigma and discrimination.MethodPrograms were identified via a search of academic databases and grey literature, and an online survey of key stakeholder organisations. Eligible programs aimed to reduce stigma towards people with complex mental illness, defined as schizophrenia, psychosis, personality disorder, or bipolar disorder; or they focused on nonspecific ‘mental illness’ but were conducted in settings relevant to individuals with the above diagnoses, or they included the above diagnoses in program content. Key relevant data from programs identified from the literature search and survey were extracted and synthesized descriptively.ResultsWe identified 61 programs or initiatives currently available in Australia. These included face-to-face programs (n = 29), online resources (n = 19), awareness campaigns (n = 8), and advocacy work (n = 5). The primary target audiences for these initiatives were professionals (health or emergency), people with mental illness, family or carers of people with mental illness, and members of the general population. Most commonly, programs tended to focus on stigma towards people with non-specific mental illness rather than on particular diagnostic labels. Evidence for effectiveness was generally lacking. Face-to-face programs were the most well-evaluated, but only two used a randomised controlled trial design.ConclusionsThis study identified areas of strength and weakness in current Australian practice for the reduction of stigma towards people with complex mental illness. Most programs have significant input from people with lived experience, and programs involving education and contact with a person with mental illness are a particular strength. Nevertheless, best-practice programs are not widely implemented, and we identified few programs targeting stigma for people with mental illness and their families, or for culturally and linguistically diverse communities, Aboriginal and Torres Strait Islander communities and LGBTIQ people. These can inform stakeholder consultations on effective options for a national stigma and discrimination reduction strategy.

Academy of Nutrition and Dietetics: Revised 2020 Standards of Practice and Standards of Professional Performance for Registered Dietitian Nutritionists (Competent, Proficient, and Expert) in Eating Disorders

Eating disorders (ED) are complex mental illnesses and are not a result of personal choice. Full recovery from an ED is possible. The severity and inherent lethality of an ED is undisputed, and the role of the registered dietitian nutritionist (RDN) is essential. Clinical symptomology presents at varying developmental milestones and is perpetuated through a sociocultural evaluation of beauty and drive for ascetic idealism. ED are globally prevalent in 4.4% of the population aged 5 to 17 years, yet affect individuals across the entire lifespan, including all cultures and genders. The Behavioral Health Nutrition Dietetic Practice Group, along with the Academy of Nutrition and Dietetics Quality Management Committee, revised the Standards of Practice (SOP) and Standards of Professional Performance (SOPP) for RDNs in Eating Disorders. Including the RDN in ED treatment is vital for all levels of care. The RDN must be perceptive to negative symptoms indicative of psychological triggers when exploring food belief systems, patterns of disinhibition, and nutrition misinformation with clients. Through a conscious awareness of medical, psychological, and behavioral strategies, the implementation of the SOP and SOPP supports a dynamic and holistic view of ED treatment by the RDN. The SOP and SOPP are complementary resources for RDNs and are intended to be used as self-evaluation tools for assuring competent practice in ED and for determining potential education, training, supervision, and mentorship needs for advancement to a higher practice level in a variety of settings.

Factors Associated to the Onset of Mental Illness Among Hospitalized Migrants to Italy: A Chart Review.

Migration is a complex phenomenon and mental illness among immigrants remains a major matter of concern in Italy and worldwide. 243 medical and pharmacy records of patients admitted to University of Foggia hospital between 2004 and 2018 were retrospectively screened and included in the study. Socio-demographic data and clinical characteristics of inpatients were compared in those with and without first-episode of mental illness (FEMI). Subjects (140 men, 103 women; aged 34.4 ± 10.2 years) represented 6.66 ± 3.73% of all hospitalizations in 15 years. Nearly half of them (48.5%) had emigrated from other European countries. 30.8% were diagnosed with a DSM-IV TR unspecified psychosis. 103 patients (42.3%) were in first-lifetime episodes of mental illness. Factors significantly associated with FEMI were: younger age, sex (men), immigrating from Africa, poor language proficiency, lower amount of prescribed psychotropics. Mental health among immigrants is of major concern in Italy. Our findings report on factors possibly associated to the onset of mental illness among immigrant psychiatric inpatients.

Am I Really Bipolar? Personal Accounts of the Experience of Being Diagnosed With Bipolar II Disorder.

Bipolar disorder (BD) is a complex and chronic mental illness with highs and lows beyond the ordinary, which induces a significant risk of suicide. The aim of this study was to explore the experience of being diagnosed with BD and the impact that receiving a correct diagnosis had had on life situations and relationships with others. Semi-structured qualitative interviews were conducted with seven people diagnosed with BD. The results showed that the primary treatment all participants had received or were currently receiving was pharmacotherapy, typically without any psychological component. A major concern that arose was delayed diagnosis, leading to inadequate treatment, and lack of knowledge among professionals about non-typical forms of BD. Moreover, the experiences of others’ reactions were multifold, though generally surprisingly positive. Generally, the participants had learned to recognize, understand and tackle early symptoms of both hypomanic and depressive episodes to avoid developing a full-blown acute episode. This study highlights the crucial importance of a collaborative relationship between the clinician and the patient.

Major Neuropsychological Impairments in Schizophrenia Patients: Clinical Implications.

Schizophrenia is a complex severe mental illness with high morbidity and mortality. It is characterized by positive symptoms, negative symptoms, and cognitive impairment. Cognitive impairment is strongly associated with functional impairment and presents a major barrier to recovery. This article reviews some of the most recent research on cognition in schizophrenia and the clinical implications. There have been recent studies related to the genomics of cognition and neural structures involved in cognition. We review recent investigations into the assessment of social cognition and the implications of impaired introspective accuracy. A recent network analysis assessed the relationship of neurocognition and social cognition to functional capacity. We further discuss the role of specific symptoms in functioning, including negative symptoms and symptoms related to autism spectrum disorder. We conclude with a discussion of a novel computerized treatment for social cognition. Recent research has sought to better understand several dimensions of cognition including genomics, brain structure, social cognition, functional capacity, and symptomatology. This recent research brings us closer to understanding the complex clinical picture of schizophrenia and the best treatments to achieve recovery.

Increasing participation in research with therapy dogs: A qualitative study at a large urban mental health and addiction hospital.

The benefits of involving patients as partners in research across diverse medical and psychiatric settings are well established in the literature. However, researchers continue to struggle to access, engage and retain participants from hard-to-reach populations. The main objective of this study was to co-create pet therapy activities with patients admitted for serious and complex mental illness to a large urban mental health and addiction hospital. Informed by the principles of participatory action research methodology, we conducted focus group discussions with 38 inpatients in seven different clinical units. An experienced volunteer handler and a certified therapy dog helped facilitate our discussions. Participating researchers, recreational therapists, volunteer handlers and our participants all reported that the presence of a certified therapy dog at each of our discussions was integral to their success. Certified therapy dogs increased the motivation to participate in our study, helped to build rapport with participants and created connections in our discussions that enriched our data. To our knowledge our study is the first to demonstrate the value of using a therapy dog as a participatory research tool in a healthcare setting. The authors believe that therapy dogs are a low-tech intervention that could be used effectively to engage hard-to-reach populations in research about their treatment and care in a diverse range of medical settings. These findings support the creation of a pilot study to test the value of including therapy dogs in patient-centered research with vulnerable and hard-to-reach populations.

ŞİZOFRENİYA, ONUN ƏLAMƏTLƏRİ VƏ ƏSAS SİMPTOMLARI

Schizophrenia is a serious and complex mental illness. It is mainly considered as an abnormality of brain physiology. At the heart of schizophrenia is a disorder of thinking and perception. During the disease, individual characteristics and self-control are lost. At the onset of schizophrenia, the patient experiences failures in his current occupation, truancy, inability to perform work at work, and disturbances in family, work, and relationships with friends. Key words: personality variability, fragmentation, auditory hallucinations, speech and thinking disorders.

Prescription medication-induced psychosis: A high alert for drug experts

Psychosis is a complex mental illness of behavioral, psychological, and emotional disturbances. Secondary psychosis can be elicited by prescription medications and literature is replete with examples of such drugs. Objectives: The goal of this article is to gather information from multiple published sources to highlight the culprit prescription medications that are linked with psychotic episodes and compose the findings into a simplified, standalone publication for readers to conveniently become aware of this phenomenon. It is also intended to reiterate the critical role and significance of the pharmacist as a vital player in a health care team. Methods: The scientific literature was searched on the PubMed database using the key search phrase “psychosis, medicines or drug or prescription.” The search was limited to the time period from 1960-2019 to ensure the inclusion of the vast majority of previously reported cases of currently available medicines and their related psychoses. Conclusion: Commonly prescribed medications can cause serious, albeit preventable, psychiatric issues. Pharmacists as vital players in patient care can avert the untoward psychotic episode by taking timely steps in notifying the prescribers or counseling the patient on measures to avoid serious and fatal psychotic issues.

Efficacy and safety of acupuncture in treating post-traumatic stress disorder: A protocol for systematic review and meta-analysis.

Background:Post-traumatic stress disorder (PTSD) acts as a complex mental illness in which individuals are prone to long-lasting mental disorders after suffering traumatic events. PTSD is usually accompanied by some comorbidities, such as depressive disorder and sleep disorder, which seriously threaten patients’ life and health. Evidences showed that acupuncture could remarkably relieve the symptoms of PTSD patients. The review aims at assessing the safety and effectiveness exhibited by acupuncture for treating PTSD patients.Methods and analysis:The literature identified by searching 8 English electronic databases and 5 Chinese electronic databases from their inception to April 20, 2020 will be incorporated into the study. Two researchers will independently take charge of the research selection, the data extraction, as well as the assessment on research quality. The primary outcomes will be total PTSD symptoms, measured by different instruments including interviews and self-report measures. Data analysis will be performed via the RevMan 5 software, and Grading of Recommendations Assessment, Development, and Evaluation will help to assess the evidence level. A heterogeneity x2 test, the Higgins’ I2 test as well as visually inspecting the forest plot will help to investigate the heterogeneity of data. A sensitivity analysis and subgroup analyses will assist in investigating the sources of heterogeneity.Ethics and dissemination:The review neither assesses the individual information of patients nor impacts their rights, so it is not necessary for it to be approved by ethical institution. The article will be published in a peer-reviewed journal and present at relevant conferences.OSF registration number:https://osf.io/dc3js.