Local Mental Health Center Research Articles

Physical activity and treatment adherence in patients with mental disorders: a randomized controlled trial

IntroductionLack of adherence to pharmacological treatment is considered a multifactorial phenomenon, remarkably frequent in clinical practice. Non-adherence is associated with increased number of relapses, poor clinical and functional outcomes, and worsening of patient health status, with a resulting increase in healthcare costs, particularly in people with severe mental disorders (SMD). Treatment adherence rates remain extremely low, highlighting the need to develop innovative and integrated strategies; one of these is represented by the promotion of healthy lifestyle behaviours, including regular physical activity.ObjectivesThe aim of this study is to assess how the rates of treatment adherence vary in patients with SMD after receiving a psychosocial intervention, focusing on the positive relationship between treatment adherence and physical activity.MethodsLIFESTYLE is a randomized controlled trial comparing the efficacy of a structured psychosocial lifestyle intervention involving moderate physical activity exercises over a brief psychoeducational intervention. Levels of physical activity was assessed thorough the IPAQ scale, while treatment adherence was evaluated by the Morisky Medication Adherence Scale (MMAS).ResultsThe sample includes 401 patients, with a mean duration of illness was 16.3 (±17.8) years. All patients were receiving a pharmacological drug treatment; in particular, 59.6% (N=239) were treated with a second-generation antipsychotic and 54.9% (N=220) with a mood stabilizer. Our results show that moderate physical activity improves rates of treatment adherence. After 6 months, adherence to treatment increased from 35.8% at baseline to 47.6% at baseline in the experimental group, along with improvement in clinical health parameters (reduction in BMI, weight, and metabolic parameters). Another significant inverse correlation was found between adherence and quality of life (Rho di Person: -.140, p<.005). Furthermore, this study indicates that having a diagnosis of major depression, a better cognitive functioning, a shorter duration of illness and contact time with the local mental health centre are factors that positively influence treatment adherence. Remarkably, treatment adherence was not influenced by symptom severity and type of pharmacological treatment.ConclusionsModerate physical activity can represent a valid strategy to increase treatment adherence in patients with SMD. Therefore, promoting physical activity exercises in our clinical practice may be associated with better outcomes. However, further studies that evaluate patients with acute mental disorders are needed.Disclosure of InterestNone Declared

Geografisk variasjon i vaksnes bruk av avtalespesialistar og DPS i psykisk helsevern

Background: Equitable mental healthcare regardless of area of residence is a political aim in Norway. The purpose of this study is to evaluate geographical variation in private practitioner coverage, and explore differences between private practitioners with public reimbursement and local community mental health centers (CMHCs) in terms of diagnoses and scope of outpatient treatment, with a focus on mood and neurotic disorders. Method: Cross-sectional registry-based study of adults in outpatient mental healthcare at private practitioners or CMHCs in Norway in 2014–2018. We calculated distribution of diagnoses, geographical variation in rates of private practitioners, and analyzed scope of treatment for patients with mood and neurotic disorders (ICD-10 disorders F3, F4). We estimate cost per treated patient and report geographic variation for hospital catchment areas. Results: Patients with F3, F4 disorders accounted for 64.7 % at private practitioners, and 31.5 % at CMHCs, and received more treatment at private practitioners, five more consultations in a 42 day longer period. There is considerable geographical variation in private practitioner coverage, highest in South-East Norway and lowest in North Norway. Implications: As long as management and priority setting are differently organized for CMHCs and private practitioners in mental health care, we must expect geographical variation in access and use. It appears as an equity paradox that a group of patients, rejected by or not referred to CMHC, receive more treatment by private practitioners. Keywords: mental healthcare, outpatient consultations, private practitioners, CMHC, geographical variation, equal access, equity, priority setting

Detecting Clinically Relevant Emotional Distress and Functional Impairment in Children and Adolescents: Protocol for an Automated Speech Analysis Algorithm Development Study.

Even before the onset of the COVID-19 pandemic, children and adolescents were experiencing a mental health crisis, partly due to a lack of quality mental health services. The rate of suicide for Black youth has increased by 80%. By 2025, the health care system will be short of 225,000 therapists, further exacerbating the current crisis. Therefore, it is of utmost importance for providers, schools, youth mental health, and pediatric medical providers to integrate innovation in digital mental health to identify problems proactively and rapidly for effective collaboration with other health care providers. Such approaches can help identify robust, reproducible, and generalizable predictors and digital biomarkers of treatment response in psychiatry. Among the multitude of digital innovations to identify a biomarker for psychiatric diseases currently, as part of the macrolevel digital health transformation, speech stands out as an attractive candidate with features such as affordability, noninvasive, and nonintrusive. The protocol aims to develop speech-emotion recognition algorithms leveraging artificial intelligence/machine learning, which can establish a link between trauma, stress, and voice types, including disrupting speech-based characteristics, and detect clinically relevant emotional distress and functional impairments in children and adolescents. Informed by theoretical foundations (the Theory of Psychological Trauma Biomarkers and Archetypal Voice Categories), we developed our methodology to focus on 5 emotions: anger, happiness, fear, neutral, and sadness. Participants will be recruited from 2 local mental health centers that serve urban youths. Speech samples, along with responses to the Symptom and Functioning Severity Scale, Patient Health Questionnaire 9, and Adverse Childhood Experiences scales, will be collected using an Android mobile app. Our model development pipeline is informed by Gaussian mixture model (GMM), recurrent neural network, and long short-term memory. We tested our model with a public data set. The GMM with 128 clusters showed an evenly distributed accuracy across all 5 emotions. Using utterance-level features, GMM achieved an accuracy of 79.15% overall, while frame selection increased accuracy to 85.35%. This demonstrates that GMM is a robust model for emotion classification of all 5 emotions and that emotion frame selection enhances accuracy, which is significant for scientific evaluation. Recruitment and data collection for the study were initiated in August 2021 and are currently underway. The study results are likely to be available and published in 2024. This study contributes to the literature as it addresses the need for speech-focused digital health tools to detect clinically relevant emotional distress and functional impairments in children and adolescents. The preliminary results show that our algorithm has the potential to improve outcomes. The findings will contribute to the broader digital health transformation. DERR1-10.2196/46970.

Practical experiences from the Changhua County Community Mental Health Center

<p>本文為彰化縣社區心理衛生中心的實務經驗介紹：一、服務佈點：配合社會安全網全力推動轄區內服務佈點，以八大生活圈規劃1中心8副中心27據點；二、個案管理為共同照護整合服務，以家庭為中心，發掘「潛在個案」並給予協助及資源連結。三、簡介中心6項特色服務：1.高齡者整合式健康檢查（4D健檢）、2.物質濫用防治—菸害防制教育、3.物質濫用防治—第三、四級毒品危害講習、4.精神病友照顧者成長團體、5.長照2.0家庭照顧者支持網絡計畫、6.安寧居家療護；四、人員訓練機制。期能讓各界更了解地方社區心理衛生中心提供的服務與資源，照顧需要的病友，進而減緩家庭照顧者之壓力。</p> <p> </p><p>This article introduces the practical experiences of the Changhua County Community Mental Health Center. Part I. Service deployment. Changhua County Government has aligned itself with the effort to establish a social safety net and has established service locations across 8 regions of the county, with services available at 1 center, 8 subcenters, and 27 other locations. Part II. Case management. It involves shared care and integrated services that are family-centered. We identify potential cases of mental illnesses, provide them with assistance, and connect them with resources. Part III. Brief introduction to the 6 featured services of the center. (1) Integrated geriatric health check (a.k.a. the 4D health check). (2) Substance abuse prevention: tobacco hazard prevention education. 3. Substance abuse prevention: Lectures on the hazards of Category 3 and Category 4 narcotics. 4. Growth group for caregivers of patients with mental illnesses. 5. Long-term Care 2.0 Plan’s family caregiver support network program. 6. Hospice home care. Part IV. Personnel training. We hope to offer further understanding to the services and resources provided by local community mental health centers, to care for patients, and to ameliorate the stress of family caregivers. </p> <p> </p>

Effects of sunshine duration on daily outpatient visits for depression in Suzhou, Anhui Province, China.

Previous epidemiological studies have reported seasonal variation patterns of depression symptoms, which may be influenced by bad weather conditions, such as a lack of sunlight. However, evidence on the acute effects of sunshine duration on outpatient visits for depression is limited, especially in developing countries, and the results are inconsistent. We collected daily outpatient visits for depression from the local mental health centre in Suzhou, Anhui Province, China, during 2017-2019. We defined the 5th and 95th sunshine percentiles as short and long sunshine durations, respectively. A quasi-Poisson generalized linear regression model combined with a distributed lag nonlinear model was used to quantitatively assess the effects of short and long sunshine durations on outpatient visits for depression. Stratified analyses were further performed by gender, age and number of visits to identify vulnerable populations. A total of 26,343 depression cases were collected during the study period. An approximate U-shaped exposure-response association was observed between sunshine duration and depression outpatient visits. The cumulative estimated relative risks (RRs) for short and long sunshine durations at lag 0-21 days were 1.53 [95% confidence intervals (CI): 1.14, 2.06] and 1.13 (95% CI: 0.88, 1.44), respectively. Moreover, a short sunshine duration was associated with a greater disease burden than a long sunshine duration, with attributable fractions (AFs) of 16.64% (95% CI: 7.8%, 23.89%) and 2.24% (95% CI: -2.65%, 5.74%), respectively. Subgroup analysis showed that males, people aged less than 45 years and first-visit cases may be more susceptible to a lack of sunlight. For a long sunshine duration, no statistically significant associations were found in any population groups. Our study found that a short sunshine duration was associated with an increased risk of depression. The government, medical institutions, family members and patients themselves should fully recognize the important role of sunlight and take active measures to prevent depression.

Tastes Like War by Grace M. Cho

Reviewed by: Tastes Like War by Grace M. Cho Sunhay You (bio) Tastes Like War, by Grace M. Cho. New York: Feminist Press, 2021, 296 pp. ISBN: 9781952177941. An “unintended sequel” to Haunting the Korean Diaspora, Grace Cho’s memoir, Tastes Like War, engages in a sociological mode of storytelling (6). Her voice is familiar, evoking the autoethnographic portions of her first book: an “experimental writing voice . . . intended to show the mixing up of fact and fiction, of self and other, so neither a discreet narrator nor a clear storyline is always [End Page 143] present” (203). True to her commitments to unraveling the limits of a discreet authorial subject, Cho weaves together Korean recipes, psychological texts, history, personal anecdotes, and dreams to uncover the tacit knowledge that lies in the wake of her mother’s schizophrenia. The memoir peels away at the insights of her first book, revealing another US imperial structure of shame and secrecy besides the military bride: mental disability. In the opening prologue, Cho claims that she was raised by at least three different mothers. The mother of her early childhood is a charismatic entrepreneur who sells foraged wild blackberries while supporting other racial minorities. Cho’s teenage years mark the onset of her mother’s schizophrenia, when she becomes a “prisoner to the voices that told her to stop doing the things she used to do” (3). In her thirties, Cho begins to observe her mother's vivacious qualities return while teaching Cho how to cook Korean food. The breaks in these three mothers organize the breaks between parts 2 to 4 of the memoir, the prologue and part 1 offering the sociological framework to her storytelling. As Cho cites throughout the first section, theories on the relationship between mental disability and structures of racial-sexual violence are relatively new. While research on schizophrenia from the 1970s and 80s explains the condition as “the result of a bad gene,” more recent studies suggest that schizophrenia is symptomatic of a social disease as much as a biological anomaly (4). Referring to T. M. Lurhmann’s 2016 study Our Most Troubling Madness: Studies in Schizophrenia, Cho explains that five of the six risk factors associated with schizophrenia apply to her mother: low socioeconomic status, childhood adversity, physical or sexual trauma, immigration, and “being a person of color in a white neighborhood” (56). Indeed, besides narratives of her mother’s passage to the United States as a military bride, many of Cho’s early recollections of her mother take place in Chehalis, Washington. She notes that the city is known for having hosted a regional meeting of approximately seventy thousand members of the KKK in 1924, a legacy of white supremacy that continues today. Cho’s mother grows especially paranoid about being a target of “the John Birch Society, a radical right-wing organization founded in 1958 and named after an American who had been killed by the Chinese at the end of World War II” (136). Through these details,Cho demonstrates how her mother’s experiences of racial-sexual violence undergird developments in her schizophrenic paranoia, which would later confine her to the home, the curtains drawn and cabinets closed on a dwindling supply of food. In part 3, Cho delves into the structural obstacles she faced as a teenager trying to help her mother in the absence of such a nuanced understanding of schizophrenia. A doctor at the local mental health center told her that if her mother was in danger of hurting someone, the police could force her mother [End Page 144] to seek treatment. Given her age and inability to convince her mother of her schizophrenia, Cho resorts to calling the police after aggravating one of her mother’s schizophrenic episodes. This event plants a seed of mistrust that casts a shadow over Cho’s future attempts to care for her mother. These careful and honest observations present a wide-spanning cognitive map of institutional structures, histories, and cultural forces that have impacted her mother's mental health as a military bride. Anecdotes about the healing power of food interrupt the more daunting stories of racial-sexual violence that give shape to her mother...

21.2 MICHIGAN CHILD COLLABORATIVE CARE PROGRAM (MC3): TEN YEARS OF GROWTH, ADAPTATION, AND LEARNING

Objectives: This presentation aims to describe the unique opportunities and challenges encountered in the development and delivery of telepsychiatric consultation services through the Michigan Child Psychiatry Access Program (MC3). We will specifically address outreach to vulnerable populations, and to adaptations during the time of COVID-19. Methods: A review of existing program data will describe the populations served, number of consultations provided, naming of types of services offered, funding relationships, and current state of service delivery within the MC3 program. Results: Over the course of 10 years, the MC3 program has provided 8500 consultations to pediatric primary care and perinatal providers. Pilot programming has also included services to populations of specific need, particularly the children and families of Flint, and the Tribal Health Centers of Michigan. The most common diagnoses discussed are related to anxiety, depression, and ADHD. During 2020, approximately 30% of consultations were related to the impact of COVID-19. The rate of consultation during the initial period of the pandemic fell by 37% from the year prior, and beginning in November of 2020, the rate of consultation resumed to rates maintained prior to the pandemic. We will present more detailed demographic data on the sociodemographic representation of patients we consulted on during the pandemic time period. We will also describe additional education efforts that include 87 live and recorded educational presentations on a variety of topics. Conclusions: Scaffolding a telepsychiatry program such as MC3 requires significant foundational and ongoing resources. A dedicated staff, ongoing relationships with the existing community mental health infrastructure, and sustainable funding allow for this program to be responsive to the changing needs of a state’s population. Despite this, significant work remains to leverage this service as a tool to narrow healthcare disparities in child mental health. Responsive changes to data collection and direct engagement with local community mental health centers can allow for the identification of needs specific to certain populations, particularly during this time of the COVID-19 pandemic. CON, TVM, DEI

A pilot study on the effectiveness of low-intensity cognitive behavioural therapy (LiCBT) for common mental disorders in Hong Kong.

To cope with the rising demand for psychological treatment, evidence-based low-intensity cognitive behavioural therapy (LiCBT) delivered by trained para-professionals was introduced internationally. This pilot study aimed at examining the effectiveness of LiCBT in Hong Kong. This study was of an uncontrolled pre- and post-treatment design, testing LiCBT at a local community mental health centre in Hong Kong. Two hundred and eighty-five Chinese adult help-seekers to the centre attended two or more sessions of LiCBT delivered by trained para-professionals. These participants also rated their depression and anxiety on the Patient Health Questionnaire-9 (PHQ-9) and Generalised Anxiety Disorder Scale-7 (GAD-7), respectively, at pre- and post-treatment. Comparison of the pre- and post-treatment PHQ-9 and GAD-7 scores of 285 participants indicated significant improvements in depression and anxiety with large effect sizes (depression: d = 0.87; anxiety: d = 0.95). For those participants reaching the clinical level of either depression and/or anxiety at pre-treatment (n = 229, 80.4%), they reported even larger effect sizes (depression: d = 1.00; anxiety: d = 1.15). The recovery rate was 55.9% with a reliable improvement rate of 63.9%. An average of 5.6 sessions was offered to the participants with each session spanning a mean of 42 minutes. The baseline clinical conditions and participants' educational level were predictive of post-treatment recovery. The results supported the effectiveness and cost-efficiency of LiCBT for depression and anxiety at a Hong Kong community mental health centre. The effect sizes and the recovery and reliable improvement rates achieved were comparable to those reported from countries such as the UK and Australia.

Factors Influencing Depression among Firefighters - Focusing on Stress, Alcohol, and Suicidal Thoughts -

본 연구는 소방공무원의 스트레스, 음주, 자살생각, 우울의 관계 및 우울에 영향을 미치는 요인을확인하기 위한 서술적 조사 연구이다. 수집된 자료는 SPSS Program을 이용하여 분석하였으며, 대상자의 스트레스, 음주실태, 자살생각이 우울에 미치는 영향은 회귀분석을 사용하였다. 본 연구결과소방공무원의 우울에 미치는 영향요인은 스트레스와 자살생각이 우울에 영향력을 나타내었으며, 우울에 대한 설명력은 69.1%였다. 스트레스가 높을수록 자살생각이 많을수록 우울수준이 높아진다는 본 연구결과를 바탕으로 소방공무원에 다양한 접근 방법을 통해 우울을 조기에 발견하고 지역의정신건강증진센터 등과 관련 기관과 연계하여 관리하고 치료함으로써 소방공무원의 자살생각을 감소시키고 궁극적으로 자살을 예방할 수 있도록 지속적인 관심과 확인이 필요하다. 또한 더 나아가소방공무원의 직업적 특성을 고려한 정신건강 관리 프로그램 개발과 이에 따른 제도적인 방안이마련되어야 할 것이다.This is a descriptive research to identify the relationship between stress, alcohol, suicidal thoughts and depression, as well as other factors influencing depression of firefighters. The SPSS program was used to run a regression analysis to determine the effects of the subject’s stress level, alcohol consumption and suicidal thoughts on depression. Stress level and suicidal thoughts were found as significant factors influencing depression of firefighters, with the explainatory power of 69.1%. It is also found that the higher the stress and the more suicidal thoughts, the higher the level of depression. Therefore, the early detection of depression as well as management and treatment in connection with local mental health centers could lower suicidal thoughts in firefighters. There is a need for continuous attention to develop mental health programs in consideration of the job characteristics of firefighters and institutional plans for suicide prevention and mental health promotion.

Mother–Child Relationships Following a Disaster: The Experiences of Turkish Mothers Living in a Container City After the 2011 Van Earthquake

In this qualitative study, informed by ethnography and phenomenology, we aimed to explore the impact of mass trauma on mother–child relationships. Specifically, affected relational processes that might interrupt healthy parenting practices and child behavioral and emotional outcomes were explored. Fifteen Turkish mothers exposed to a massive earthquake in 2011 and relocated to a container city in the Van province, Turkey, were interviewed for this study in 2013. Data analysis was informed by elements of Spradley’s Developmental Research Sequence (DRS) and interpretive phenomenological analysis. Findings indicated that psychological trauma resulting from the earthquake and consequent displacement disrupted and exacerbated mothers’ ability to cope with distress. This, in turn, influenced mothers’ ability to manage their negative emotions and resulted in more yelling, beatings, and higher aggression towards their children as well as a lack of positive emotional and physical engagement. Mothers perceived their own struggles as increasing their children’s disruptive behaviors, such as being less compliant, becoming emotionally distant and modeling mothers’ negative behaviors. The counseling mothers received at the local mental health center supported mothers in building greater physical and emotional connection with their children, regulating their negative emotions and gaining effective parenting skills to discipline their children. The current study represents a preliminary step towards understanding parenting experiences of Turkish mothers in mass trauma contexts.

Weight control and behavior rehabilitation in a patient suffering from Prader Willi syndrome.

BackgroundThis study reports a case of Prader Willi syndrome (PWS), a genomic imprinting disease related to chromosome regions 15q11.2–q13 15, which includes hypothalamic dysfunction leading to hyperphagia, obesity, shortness, sleep abnormalities. Our case is extremely severe, in comparison to other PWS cases described in literature, due to the association with severe emotional and psychiatric symptoms: oppositional behaviour, rigidity of thought, skin picking and pathological hoarding.Case presentationWe described the case of a Caucasian male patient suffering from PWS, treated in outpatient care by local Mental Health Centre and supported by Social Service, who was admitted to a residential rehabilitative facility. After a 2-year follow-up, the patient showed a global improvement in symptoms and functioning, as registered by the rating scales administered. At the end of observation period, we also reported an important improvement in weight control, reducing the risk of obesity and related diseases, therefore improving the prognosis of life.ConclusionThis case highlights the need for long-term, individualized and multi-professional treatment in patients suffering from a complex genetic syndrome with both organic and psychological alterations, for which medical care setting and pharmacological treatments are not sufficient. Clinical observation of this case leads us to compare PWS to drug addiction and indirectly endorse the neurophysiological hypothesis that food and drugs stimulate the same brain circuits in the limbic system.

Therapeutic Assessment in Psychological Triage Using the PAI

ABSTRACTThis case illustrates the utility of incorporating therapeutic assessment in a triage context that typically involves a focus on gathering information. A man referred to our clinic by a local mental health center was seen by our assessment team for a triage that includes the administration of a single psychological test, the Personality Assessment Inventory (PAI). Although this triage must rapidly gather information to determine client suitability and treatment assignment, we still attempt to work with clients to collaboratively develop goals for this assessment that include addressing questions that are central concerns for the clients. In this case, the test results suggested a severe disorder that accounted for many phenomena that he had been experiencing but had apparently been reluctant to share. The information gathered led to a referral to a different treatment program that could provide pharmacological and more intensive forms of treatment. However, the collaborative bond formed between the assessor and the client during this triage was sufficiently strong that it was our assessor to whom the client turned in a subsequent crisis precipitated by a symptomatic exacerbation. This case illustrates complementary information gathering and therapeutic goals of assessment even in the context of a brief assessment.

The Structure of Co-Occurring Bullying Experiences and Associations with Suicidal Behaviors in Korean Adolescents.

ObjectiveThis study had two main goals: to examine the structure of co-occurring peer bullying experiences among adolescents in South Korea from the perspective of victims and to determine the effects of bullying on suicidal behavior, including suicidal ideation and suicide attempts, among adolescents.MethodThis study used data gathered from 4,410 treatment-seeking adolescents at their initial visits to 31 local mental health centers in Gyeonggi Province, South Korea. The structure of peer bullying was examined using latent class analysis (LCA) to classify participants’ relevant experiences. Then, a binomial logistic regression adjusted by propensity scores was conducted to identify relationships between experiences of being bullied and suicidal behaviors.ResultsThe LCA of experiences with bullying revealed two distinct classes of bullying: physical and non-physical. Adolescents who experienced physical bullying were 3.05 times more likely to attempt suicide than those who were not bullied. Victims of (non-physical) cyber bullying were 2.94 times more likely to attempt suicide than were those who were not bullied.ConclusionsBoth physical and non-physical bullying were associated with suicide attempts, with similar effect sizes. Schools and mental health professionals should be more attentive than they currently are to non-physical bullying.

Psychological Intervention in Primary Care After Earthquakes in Lorca, Spain.

After the earthquakes that occurred in Lorca, Spain, on May 11, 2011, the regional mental health management employed 2 clinical psychologists for 6 months to provide care to people referred by primary care physicians. The objective was to address the expected increased demand for treatment of mental disorders, notably posttraumatic stress disorder (PTSD) and adjustment disorders. Referred individuals were evaluated and treated according to a clinical protocol designed ad hoc from June 12, 2011, to November 30, 2011. The protocol provided a stepped intervention guided by clinical and psychometric assessment using "normalization" for those with no psychiatric diagnosis, brief group treatment for mild to moderate PTSD or adjustment disorders, individual treatment for more severe PTSD, and referral to the local mental health center for other mental health disorders. Standard adult and child scales to assess posttraumatic, depression, and anxiety symptoms and resilience were used at initial assessment to guide treatment allocation and repeated to assess outcome status. Psychologists also provided a clinical assessment of symptom resolution at the end of the study. Rates of symptom resolution and improvements on all scales (PTSD, depression, anxiety, and resilience) demonstrated clinically and statistically significant improvement in all treatment groups (P = .000). Dropout was low. Medications were prescribed frequently to adults; no child received medication as a result of the earthquakes. No case of mental disorder related to the earthquakes was referred to the local mental health center during the 6 months of psychologist intervention. The structured intervention resulted in a high resolution of cases and low dropout, allowing treatment of a larger number of people with optimal frequency (weekly), devoting more time to the most severe cases and less to those moderately or mildly affected.

EPA-1124 - Use of lithium in the clinical practice: Results from a multicentric italian study

Introduction According to several international guidelines, lithium is still the first choice for treating mania and for prophylaxis of bipolar disorder. Nevertheless, in the last decades clinicians prefer to use anticonvulsivant drugs such as valproate and carbamazepine to lithium, which are easier to manage and with less side effects. Objectives 1)to describe prescribing patterns in Italian mental health centres in patients with bipolar I disorder;2)to assess clinical and social characteristics of patients receiving lithium. Aims to assess the current status of use of lithium in the Italian clinical practice. Methods The study, coordinated by the Department of Psychiatry of the University of Naples SUN, was carried out in 11 randomly recruited Italian mental health centres. In each site, 16 patients were recruited if they had a diagnosis of bipolar I disorder, were aged between 18-65 years, were on the caseload of the local mental health centre for at least six months, and had experienced at least one affective episode in the past three years. Data on pharmacological treatments were obtained from clinical records. Results The sample consisted of 140 patients, 118(84%) were receiving mood stabilizers, 84(60%) antipsychotics, 57(41%) antidepressants and 45(32%)benzodiazepines. Valproate was the mood stabilizer more frequently prescribed(58%); lithium was prescribed to 35% of patients. Those receiving lithium had a longer contact with the local mental health centre(105.9±77.6monthsvs. 79.0±68.5;p Conclusions Our data confirm the general principle that lithium is not frequently prescribed in clinical practice and it is given only to more severe patients.

Mediating Effect of Depressive Symptoms on the Relationship between Adult Attention Deficit Hyperactivity Disorder and Quality of Life.

ObjectiveThe aim of this study was to investigate whether depressive symptoms affect the relationship between adult attention deficit hyperactivity disorder (ADHD) and the quality of life (QOL) in Korean soldiers.MethodsWe evaluated past and present symptoms of adult ADHD (the Korean Adult Attention-Deficit/Hyperactivity Disorder Scale and the Wender Utah Rating Scale), depression (the Center for Epidemiological Studies Depression Scale) and QOL (the Korean version of the SmithKline Beecham 'Quality of Life' scale) in 131 soldiers during mental health screenings performed by a local mental health center. A structured equation model using AMOS 19.0 was used to evaluate the mediating effect of depression.ResultsIn our first model (without depressive symptoms), adult ADHD significantly affected QOL (standardized regression weight=-0.51, p<0.01). After depressive symptoms were added to this model, the direct effect of adult ADHD on QOL was not significant (standardized regression weight=0.10, p=0.43). Regarding the indirect effect, adult ADHD significantly affected depression (standardized regression weight=0.78, p<0.01), and depression also affected QOL (standardized regression weight=-0.79, p<0.01).ConclusionThrough structural equation modeling, the complete mediation model for the influence of depressive symptoms on ADHD and QOL was confirmed. These findings indicated that it might be important to consider comorbidities, such as depression, when adult ADHD is being evaluated.

The Y-Worri Project: study protocol for a randomised controlled trial

BackgroundAnxiety disorders are one of the most common psychological problems in adolescents. The school system has been identified as an ideal setting for the implementation of prevention and early intervention programs for anxiety; however, few programs are routinely delivered in schools and little is known about the best delivery methods. The aim of the current project is two-fold: to test the effectiveness of an intervention program for anxiety relative to a control condition, and to compare two methods of implementing the program.Methods/designThis study is a three-arm cluster randomised controlled trial consisting of a wait-list control condition and two intervention conditions evaluating the effectiveness of an Internet-based program for preventing generalised anxiety. The first intervention condition will involve classroom teachers supervising student completion of the intervention program, while the second intervention condition will involve the classroom teacher and an education officer from the local youth mental health centre supervising the program’s completion. At least 30 schools from across Australia will be recruited to the trial, with adolescents aged between 14 and 18 years invited to participate. Participants in the intervention conditions will complete the e-couch Anxiety and Worry program during class periods over six weeks. The primary outcome measure will be a scale reflecting the number and severity of generalised anxiety symptoms, while secondary outcomes will be symptoms of depression, social anxiety and anxiety sensitivity. Data will be collected at pre-intervention, post-intervention, 6- and 12-month follow-up. Intention-to-treat analyses will be conducted.DiscussionIf demonstrated effective, a new service delivery model for the implementation of mental health programs in schools could be indicated. Such a model would significantly contribute to the mental health of young people in Australia by providing preventive interventions for mental health problems and consequently reducing the need for clinical services.Trial registrationThe Australian New Zealand Clinical Trials Registry ACTRN12610001103055

Self-inflicted burns: A case series

Self-inflicted burns are regularly admitted to burns units worldwide. Most of these patients are referred to psychiatric services and are successfully treated however some return to hospital with recurrent self-inflicted burns. The aim of this study is to explore the characteristics of the recurrent self-inflicted burn patients admitted to the Royal North Shore Hospital during 2004–2011. Burn patients were drawn from a computerized database and recurrent self-inflicted burn patients were identified. Of the total of 1442 burn patients, 40 (2.8%) were identified as self-inflicted burns. Of these patients, 5 (0.4%) were identified to have sustained previous self-inflicted burns and were interviewed by a psychiatrist. Each patient had been diagnosed with a borderline personality disorder and had suffered other forms of deliberate self-harm. Self-inflicted burns were utilized to relieve or help regulate psychological distress, rather than to commit suicide. Most patients had a history of emotional neglect, physical and/or sexual abuse during their early life experience. Following discharge from hospital, the patients described varying levels of psychiatric follow-up, from a post-discharge review at a local community mental health centre to twice-weekly psychotherapy. The patients who engaged in regular psychotherapy described feeling more in control of their emotions and reported having a longer period of abstinence from self-inflicted burn. Although these patients represent a small proportion of all burns, the repeat nature of their injuries led to a significant use of clinical resources. A coordinated and consistent treatment pathway involving surgical and psychiatric services for recurrent self-inflicted burns may assist in the management of these challenging patients.

Theory implementation: Stein's theory of meaning through cognitive-behavioural process: a pilot study

This theory development was a partial fulfilment of doctoral course work at University of Colorado Denver Health Sciences Center. It is an interactive/integrated theory which can be utilized in multiple practice settings to promote growth of the client as well as the nurse. Tools were developed pertaining to this theory. A pilot study was accomplished at a local mental health centre.

Cognitive Therapy Helps Patients With Schizophrenia

Back to table of contents Previous article Next article Clinical & Research NewsFull AccessCognitive Therapy Helps Patients With SchizophreniaMark MoranMark MoranSearch for more papers by this authorPublished Online:18 Nov 2011https://doi.org/10.1176/pn.46.22.psychnews_46_22_18_2AbstractCognitive therapy can be successful in promoting clinically meaningful improvements in functional outcome, motivation, and positive symptoms in low-functioning schizophrenia patients with significant cognitive impairment. That was the finding from a randomized trial to evaluate the efficacy of an 18-month recovery-oriented cognitive-therapy program to improve psychosocial functioning and negative symptoms of avolition-apathy and anhedonia-asociality in patients with schizophrenia. A report on the findings appears in the October Archives of General Psychiatry."The message for clinicians is, 'Don't give up on these low-functioning patients,' " lead author Paul Grant, Ph.D., of the University of Pennsylvania School of Medicine, told Psychiatric News . "They have hidden potential. Despite a long course of disorder, we have seen that these patients can improve and achieve their goals and develop a better quality of life." Sixty participants were randomly assigned to the study intervention condition, which consisted of cognitive therapy plus standard treatment, or to the control condition of standard treatment alone. (Randomization was stratified by sex because females with schizophrenia have a better course and may respond better to cognitive therapy.)A single-blind design was used in which outcome assessors were not aware of assigned study condition.Participants in the cognitive-therapy intervention received up to 18 months of outpatient sessions. The sessions typically lasted 50 minutes and were scheduled on a weekly basis. The central features of this psychotherapy were its goal-directed framework and personalized treatment planning.As described by Grant in a presentation at this year's International Congress of Schizophrenia Research, the intervention is a form of therapy developed especially for schizophrenia patients by Aaron Beck, M.D., the primary developer of cognitive therapy (Psychiatric News, May 20).Specific deficiencies such as deficits in attention, executive function, and social skills were targets for the therapy. Later sessions were devoted to relapse prevention and consolidation of functional gains. The treatment was tailored to the participant's level of functioning, such that special adaptations were made for problems due to poor engagement, neurocognitive impairment, thought disorder, or lack of insight. Standard treatment consisted, at a minimum, of antipsychotic pharmacotherapy. But most participants were also actively engaged in services provided by local community mental health centers, including case management, supportive counseling, day-treatment services, housing services, peer support, and vocational rehabilitation, the researchers noted.Results showed that patients treated with cognitive therapy showed a clinically significant mean improvement in global functioning from baseline to 18 months that was greater than the improvement seen with standard treatment. Patients receiving cognitive therapy also showed a greater mean reduction in avolition-apathy and positive symptoms (hallucinations, delusions, disorganization). There were no meaningful group differences in baseline antipsychotic medications (class or dosage) or in medication changes during the trial.Traditionally, negative symptoms in low-functioning patients have been viewed as deeply embedded, possibly reflecting a neurobiological deficit in the most severe cases designated as "deficit syndrome." Grant told Psychiatric News that the study did not specifically recruit patients designated as having "deficit syndrome," but said the study results indicate that severe negative symptoms can respond to psychosocial therapy. "The trial provides evidence that these low-functioning patients respond to psychosocial treatment, suggesting that their symptoms are not as entrenched as one might have expected based upon case histories and the literature on such patients," he said. "A treatment protocol with psychological targets, such as defeatist beliefs, works in this population, indicating they are like other patients and warrant a biopsychosocial formulation." "Randomized Trial to Evaluate the Efficacy of Cognitive Therapy for Low-Functioning Patients With Schizophrenia" is posted at < http://archpsyc.ama-assn.org/cgi/content/full/archgenpsychiatry.2011.129>. ISSUES NewArchived