Criteria For Serious Mental Illness Research Articles

Efficacy of cognitive-behavioral group therapy in patients at risk for serious mental illness presenting with subthreshold bipolar symptoms: Results from a prespecified interim analysis of a multicenter, randomized, controlled study.

Most patients with bipolar disorders (BD) exhibit prodromal symptoms before a first (hypo)manic episode. Patients with clinically significant symptoms fulfilling at-risk criteria for serious mental illness (SMI) require effective and safe treatment. Cognitive-behavioral psychotherapy (CBT) has shown promising results in early stages of BD and in patients at high risk for psychosis. We aimed to investigate whether group CBT can improve symptoms and functional deficits in young patients at risk for SMI presenting with subthreshold bipolar symptoms. In a multicenter, randomized, controlled trial, patients at clinical risk for SMI presenting with subthreshold bipolar symptoms aged 15-30years were randomized to 14weeks of at-risk for BD-specific group CBT or unstructured group meetings. Primary efficacy endpoints were differences in affective symptomatology and psychosocial functioning at 14weeks. At-risk status was defined as a combination of subthreshold bipolar symptomatology, reduction of psychosocial functioning and a family history for (schizo)affective disorders. A prespecified interim analysis was conducted at 75% of the targeted sample. Of 128 screened participants, 75 were randomized to group CBT (n=38, completers=65.8%) vs unstructured group meetings (n=37, completers=78.4%). Affective symptomatology and psychosocial functioning improved significantly at week 14 (P<.001) and during 6months (P<.001) in both groups, without significant between-group differences. Findings are limited by the interim character of the analysis, the use of not fully validated early detection interviews, a newly adapted intervention manual, and the substantial drop-outs. Results suggest that young patients at-risk for SMI presenting with subthreshold bipolar symptoms benefit from early group sessions. The degree of specificity and psychotherapeutic interaction needed requires clarification.

Clinical Outcomes From a 10-Week Follow-Up Psychoeducational Program for Dual Diagnosis

ABSTRACTBackground: Dual diagnosis covers a broad spectrum of mental health and substance misuse conditions occurring concurrently (NICE, 2016). Its manifestation is complex and, as such, the disorder is recognized as influencing adherence to prescribed medication and service engagement and has a worse prognosis than substance use and mental health conditions occurring independently. Aims: To determine the effectiveness of psychoeducational group therapy in a sample of dual diagnosis patients. Methods: Patients who met the Diagnostic and Statistical Manual of Mental Disorders-IV Axis 1 criteria for serious mental illness and current substance misuse were approached to take part in a psychoeducational program. Those who consented were assessed at baseline and end point using measures of psychiatric syptomatology, psychological well-being, and substance use patterns with the following scales: the Brief Psychiatric Rating Scale, the Hospital Anxiety and Depression Scale, the Maudsley Addiction Profile, and the Warwick-Edinburgh Mental Wellbeing Scale. Results: Fifty-one patients completed the program, while 29 dropped out after initial assessment. Between baseline and follow-up, there was a decline in the number of participants using alcohol, cannabis, cocaine, amphetamine, illicit benzodiazepines and methadone. However, the number of participants using heroin remained constant. The mean amount of substances used was not reduced over the study period except in the case of alcohol. Overall improvements in syptomatology and psychological well-being were observed. Discussion: Mental health services should focus on integrated approaches via multimodal treatment interventions that encapsulate harm reduction and educational initiatives. Despite the modest sample, the findings have emphasized the importance of a broad range of treatment approaches delivered within a unitary delivery system.

Serious mental illness among young adult women who use drugs in the club scene: co-occurring biopsychosocial factors

Young women who regularly attend nightclubs are at risk for numerous health and social consequences, including mental distress, sexual and physical victimization and substance dependence. This paper uses a biopsychosocial framework to examine co-occurring mental health problems, victimization, substance dependence, sexual risk and physical pain among a sample of young women who use drugs (N = 222) in Miami’s club scene. The majority of women were under 24 years old, Hispanic, and identified as heterosexual. Almost all the women reported past 90-day use of alcohol, ecstasy/MDMA, marijuana, cocaine and prescription opioids and benzodiazepines; 32% of women reported being in a monogamous relationship while 41.9% reported having three or more sexual partners in the past 90 days; 65.3% met DSM-IV criteria for substance dependence; 60.4% met DSM-IV criteria for serious mental illness (SMI) and 59.9% were victimized as minors. Women who had SMI had higher odds of substance dependence, concurrent physical pain, three or more sexual partners in the past 90 days, childhood victimization and severe abuse-related trauma. The high levels of interconnected mental health, victimization, trauma, physical pain, substance dependence and sexual risk factors observed are underreported in the literature, as young women club scene participants appear to be more similar to other marginalized drug-involved populations than previously considered. While further research is needed, it appears these young women are in great need of outreach for primary health, mental health, HIV prevention, increased social support and substance abuse treatment services.

Identifying students at risk for mental health problems.

Almost one-quarter of school-age children in the United States meet criteria for serious mental illness. School nurses can identify children at risk or suffering from undetected mental illness through observation, consultation with teachers and parents, interview techniques, and simple written tools. Valid and reliable tools that are in the public domain and can be accessed via the Internet are included. Referral to mental health providers within the school system or community is necessary for students at risk.

Comparing the Validity of the K6 When Assessing Depression, Anxiety, and PTSD Among Male and Female Jail Detainees

A lack of a consistent and valid approach to screening within the jail often hinders identification and treatment. Furthermore, screening instruments developed for jail populations are often inadequate in detecting serious depression and anxiety disorders in women. While the remedy thus far has been the use of separate screening instruments for men and women, others have suggested that the K6, a six-item measure validated in large epidemiologic studies, may hold promise. Building on prior research, this study assesses the validity of the K6 in detecting depression, posttraumatic stress disorder, and anxiety disorders among 494 male and 515 female jail detainees. The authors found that 15% of males and 36% of females meet criteria for serious mental illness on the K6, with receiver operating characteristics--area under the curve scores of .84 and .93, respectively. This study not only establishes the validity and efficiency of using the K6 for screening within jails but also suggests a need for adjusting scale cut points.

County-Level Estimates of Need for Mental Health Professionals in the United States

County-Level Estimates of Need for Mental Health Professionals in the United States

Illicit Drug Use Among Women with Children in the United States: 2002–2003

Given research that shows youth exposed to maternal addiction have increased rates of cognitive, socioemotional, and behavioral problems, we examined the prevalence and correlates of past year illicit drug abuse or dependence among women with children younger than 18 years of age in the home to identify maternal risk factors. Data were from the 2002 and 2003 National Survey on Drug Use and Health, a nationally representative sample of the U.S. civilian population. The current analysis utilized a subsample of women (N=19,300) who reported having children younger than 18 years in the home. Past year abuse or dependence on cocaine, heroin, marijuana, stimulants, and hallucinogens as well as nonmedical use of prescription medications were assessed. The prevalence of illicit drug abuse or dependence was 1.9%. Mothers reporting drug abuse or dependence had increased odds of being unmarried, controlling for other demographics. They also were more likely to report stress, poorer health status, and meet the criteria for serious mental illness (SMI). Prevention and intervention strategies should focus on developing and testing methods to screen for both risk factors associated with maternal drug abuse and actual substance abuse in primary and emergency care settings to reduce youth exposure and improve child developmental outcomes.

Psychological Distress and Impaired Quality of Life Common among Community-Dwelling Adults with Lower Gastrointestinal Disorders

This study examines the comparison of psychological well-being and health-related quality of life (HRQOL) between adults with and without lower gastrointestinal (GI) disorders and between adults with lower GI disorders and those with other common chronic illnesses. Data of adults aged 18 years or older from the 2002 National Health Interview Survey (n=29,828) were analyzed. Approximately 5.4% of survey participants reported they had been told by a physician that they had lower GI disorders. Those reporting lower GI disorders were 1.8 times more likely to meet the criteria for serious mental illness (SMI) and were significantly more likely to report impaired HRQOL than those without GI disorders. In addition, those with lower GI disorders were significantly more likely than those with heart disease and diabetes and equally as likely as those with arthritis and asthma to meet the criteria for SMI. Because psychological comorbidity is common among adults with lower GI disorders and may complicate their course and treatment, clinicians should consider screening patients presenting with lower GI disorders for these comorbid conditions.

Assessment of Psychosocial Impairment in a Supermaximum Security Unit Sample

This article concerns a study of Washington State supermaximum security unit (SMU) residents conducted to generate systematic, empirical data for this population and to investigate behavioral, institutional, and policy issues that affect their treatment. The Brief Psychiatric Rating Scale (BPRS) is used to standardize interview-based assessments of participants’ psychosocial functioning, in conjunction with other operational, situation-specific measures. Results indicate that the BPRS is a reliable and effective measure of psychosocial impairment in SMU residents. Comparison of factor-based BPRS scores in this sample with scores and factor analysis solutions achieved in other populations points to considerations specific to this population that require further study. Finally, assessment of SMU residents using the BPRS and convergent measures of impairment indicates that a significant number demonstrate psychosocial impairment and/or meet criteria for serious mental illness.

Test of Grocery Shopping Skills: Discrimination of People with and without Mental Illness

Abstract The Test of Grocery Shopping Skills (TOGSS) is a performance measure of shopping ability in a grocery store that requires complex cognitive skills. The present study examines the validity of the TOGSS by comparing performance of two groups with significant cognitive impairments i.e., individuals who have schizophrenia or bipolar disorders and meet the criteria for serious mental illness (SMI), with a normative population. Individuals in the normative group took less time and showed less redundancy in the completing the task than individuals with schizophrenia or bipolar disorder. There was no difference between groups on accuracy of finding items.

The positive family contribution of those with serious mental illness.

Fifty-five patients who met criteria for serious mental illness nominated a relative with whom they had lived for at least the previous 6 months to be sent a questionnaire that included a scale for rating patients' contribution to family life in 10 specific areas. Thirty-six relatives returned completed questionnaires. Patients rated their own contributions using the same scale. Overall, relatives rated patients' contributions as positive, and their ratings of patients when well generally agreed with patients' self-ratings. For women only, relatives rated contributions as significantly less when the patient was ill. Patients' self-rated level of psychological symptoms was the best predictor of relatives' overall satisfaction with them. Ratings of patients' contributions mirrored sex-role stereotypes.