Treatment Of Severe Mental Illness Research Articles

The relationship between having a job and the outcome of brief therapy in patients with common mental disorders

BackgroundPrevious studies have shown that being employed is associated not only with patients’ health but also with the outcome of their treatment for severe mental illness. This study examined what influence employment had on improvements in mental health and functioning among patients with common mental disorders who received brief treatment and how patients’ diagnosis, environmental and individual factors moderated the association between being employed and treatment outcome.MethodsThe study used naturalistic data from a cohort of patients in a large mental health franchise in the Netherlands. The data were obtained from electronic registration systems, intake questionnaires and Routine Outcome Monitoring (ROM). The International Classification of Functioning, Disability and Health (ICF) framework was used to identify potential subgroups of patients. Logistic regression models were used to analyze the relationship between employment status and treatment outcome and to determine how the relationship differed among ICF subgroups of patients.ResultsA strong relationship was found between employment status and the outcome of brief therapy for patients with common mental disorders. After potential confounding variables had been controlled, patients who were employed were 54% more likely to recover compared to unemployed patients. Two significant interactions were identified. Among patients who were 60 years of age or younger, being employed was positively related to recovery, but this relationship disappeared in patients older than 60 years. Second, among patients in all living situations there was a positive effect of being employed on recovery, but this effect did not occur among children (18+) who were living with a single parent.ConclusionsBeing employed was positively associated with treatment outcome among both people with a severe mental illness and those with a common mental disorder (CMD). The main strength of this study was its use of a large dataset from a nationwide franchised company. Attention to work is important not only for people with a severe mental illness, but also for people with a CMD. This means that in addition to re-integration methods that focus on people with a severe mental illness, more interventions are needed for people with a CMD.

Role of faith healers in the treatment of severe mental illness in India

Background: The cultural diversity has influenced the beliefs of people regarding health and illness. An aim of the study was to assess the role of faith healers in the treatment of severe mental illness. Methods: It is a retrospective cross-sectional study with convenience sampling technique was used, on 123 caregivers of patients with severe mental illnesses using standardized tools like MINI, BPRS, and YMRS. Results: 41.5% participants firstly contacted faith healer while 86% visited faith healer anytime during the course of illness. 47.2% took treatment from faith healer for <6 months, 21.1% took 6-12 months and 17.9% more than 13 months. 22.8% circulated between faith healer to faith healer, 18.7% from psychiatrist to faith healer and 27.6% from medical professional to faith healer. Conclusions: There is an immense need to create awareness regarding mental illness and treatment options available.

The Fusion Clinic: Integrating the care of people with severe mental illness and diabetes.

People with coexisting severe mental illness (SMI) and type 2 diabetes have a shorter life expectancy and poorer diabetes outcomes than those without SMI. This is partly explained by the separate treatment of diabetes and SMI, which occurs in parallel silos in many healthcare systems. The Steno Diabetes Center Sjaelland and Region Zealand established the Fusion Clinic to offer combined psychiatric and diabetes care delivered by both diabetes and mental healthcare professionals. This study describes how the clinic was established and the initial diabetes outcomes. The Fusion Clinic was co-designed by people with diabetes and SMI and healthcare professionals to improve the care of adults with diabetes and SMI. The clinic approach utilised the F-ACT model. The 63 people referred to the Fusion Clinic between 01.02.2020 and 01.01.2022 who attended the clinic for more than 6 months were included in this study. Diabetes outcomes were recorded in the electronic medical records (Sundhedsplatformen EPIC). There was a high prevalence of diabetes complications at baseline. Furthermore, 70% had one or more additional concomitant diseases, as well as SMI and diabetes. Assessment of diabetes complications and measurements of HbA1c and lipid profile improved after referral to the clinic. HbA1c declined during the first 6 months of attendance at the clinic. This model of service delivery has the potential to improve the quality of care for people with SMI and type 2 diabetes.

Towards the standardization of physical activity programs for severe mental ill health: A survey of current practice across 54 mental health trusts in England

AimsWhile physical activity (PA) is recommended in the treatment of severe mental illness (SMI), there are no standardized processes for implementing PA in mental healthcare, and the extent to which PA programs have been implemented is unknown. Therefore, we sought to describe usual care in terms of the provision of PA in the National Health Service (NHS) mental health trusts in England for people with SMI. MethodsWe invited all NHS Mental Health Trusts across England to participate in a bespoke survey. ResultsFifty-two mental health trusts (96.2%) responded, of which 47 (87%) offered some form of physical activity provision. The provision across these 47 trusts comprised 93 different types of PA programs. The programs that were identified showed vast differences in the types of physical activity offered, the settings in which they were provided, and the providers. ConclusionsAlthough existing mental healthcare services are demonstrating good practice in some areas, the findings of this survey underline the pressing need for more standardization of PA programs that are delivered to people with SMI, better allocation of resources, staff training, improved monitoring of the delivery of these programs, and better PA support for patients as they transition to community care.

Relationship between severe mental illness and physical multimorbidity: a meta-analysis and call for action

BackgroundPeople with severe mental illness (SMI) have a higher prevalence of several chronic physical health conditions, and the prevalence of physical multimorbidity is expected to rise. The aim of this...

Regional clozapine, ECT and lithium usage inversely associated with excess suicide rates in male adolescents

Advanced psychiatric treatments remain uncertain in preventing suicide among adolescents. Across the 21 Swedish regions, using nationwide registers between 2016–2020, we found negative correlation between adolescent excess suicide mortality (AESM) and regional frequencies of clozapine, ECT, and lithium (CEL) usage among adolescents (β = −0.613, p = 0.0003, 95% CI: −0.338, −0.889) and males (β = −0.404, p = 0.009, 95% CI: −0.130, −0.678). No correlation was found among females (p = 0.197). Highest CEL usage among male adolescents was seen in regions with lowest quartile (Q1) AESM (W = 74, p = 0.012). Regional CEL treatment frequency in 15–19-year-olds was related to lower AESM in males, reflecting potential treatment efficacy, treatment compliance or better-quality mental health care. Suicide prevention may benefit from early recognition and CEL treatment for severe mental illness in male adolescents. The results indicate association but further research, using independent samples and both prospective and observational methodologies, is needed to confirm causality.

Investigating the effects of antipsychotics on brain insulin action: Study protocol for a multi-modality magnetic resonance imaging (MRI) study in healthy controls.

Antipsychotics (APs) are the cornerstone of treatment for schizophrenia (SCZ) but are unfortunately associated with serious metabolic adverse effects including weight gain and type 2 diabetes. The pathophysiology of AP-induced metabolic dysfunction is largely undetermined. Brain insulin resistance has been posited to be at the cross-roads of many cognitive and metabolic disorders, and disruption of central insulin action has emerged as a possible explanatory mechanism underlying AP induced metabolic dysfunction. Previous studies suggest that change in neuroimaging-based parameters with intranasal insulin administration can be leveraged to investigate brain insulin resistance. In this proof-of-concept study, we will utilize neural signatures of insulin action in the brain to examine if APs disrupt brain insulin signaling. It is hypothesized that: 1) intranasal insulin (INI), but not intranasal placebo (INP), will change cerebral blood flow and resting state connectivity, as well as increase glutamate levels in the striatum and dorsolateral prefrontal cortex; 2) oral olanzapine (OLA), but not oral placebo (PL), will inhibit the effect of INI on these parameters. Thirty-two healthy volunteers will undergo a single blind, cross-over design, wherein all participants receive the following four treatment combinations, 2-6 weeks apart, in a random sequence: INP + PL, INP + OLA, INI + PL, and INI + OLA. Participants will undergo an MRI-based assay of brain insulin resistance 15 minutes after administering 160 IU INI or INP. The scanning protocol includes resting and task-based functional MRI, arterial spin labelling, and proton magnetic resonance spectroscopy. Demonstrating that OLA can acutely induce brain insulin resistance is clinically relevant to metabolic health in SCZ. Evidence of brain insulin resistance induced by acute AP dosing can inform the early use of adjunctive insulin sensitizers for the treatment of metabolic comorbidities associated with AP treatment in severe mental illness. Trial registration ClinicalTrials.gov Registration: NCT03741478.

Arbeidsrettet behandling ved alvorlig psykisk lidelse i spesialisthelsetjenesten

Employment is an important focus area in the treatment of severe mental illness and substance use disorders. Health and welfare services are instructed to collaborate closely on implementing evidence-based practices of vocational rehabilitation such as Individual Placement and Support (IPS) in treatment guidelines, clinical pathways and the current national healthcare plan (2020–2023). Although evidence of the effectiveness of IPS continues to grow and there is broad political commitment to finance and implement IPS, challenges remain. System-level cooperation between services and legislative issues on integrating employment specialists in mental health services poses potential implementation barriers that need clarification to allow successful provision of IPS. In this paper, we describe how IPS is integrated in specialized mental health treatment. The empirical and practical basis for the current article comes from five different research groups. New directions, challenges and opportunities in IPS implementation are also discussed in light of new regulations from the Norwegian Directorate of Health. Keywords: Individual Placement and Support, employment, health and welfare services, integration, employment specialist, implementation

Home Treatment "Bremen ambulant vor Ort (BravO)"

The existing legal framework to foster home treatment for severe mental illness imposes challenges for implementation. 'Bremen ambulant vor Ort (BravO)' provides home treatment on basis of the "Bundespflegesatzverordnung". The concept and framework of BravO will be outlined, routine data on the BravO treatment from October 1st, 2019 to September 30th, 2021 were analysed. Financial and staff resources of 20 in-patient treatment places were equivalently transferred into BravO. 298 patients generating 392 cases received treatment. Median treatment span was 36 days, with 21 days (median) of service delivery. 74.7 % were diagnosed either in ICD-10 groups F2 or F3. BravO was successfully implemented into routine care. BravO allows flexible home treatment for people with severe mental illness apart from existing treatment framework.

Prevention and treatment of psychiatric disorders through physical activity, exercise, and sport

Prevention and treatment of psychiatric disorders through physical activity, exercise, and sport

A 1961 Portrait of Harold F. Searles

ABSTRACT This article explores various dimensions of the case presentation, especially connections with Searles’ extensive interviews with Robert Langs, which provide much relevant personal and professional background for his work with Joan Douglas. Since Searles told me in 2000 that he believed some of his previous patients actually had multiple personality, I explore what Searles once called multiple identity functioning in Joan. I also respond to selected topics presented in the other commentary articles in this issue. I challenge the current belief that medications are the most important treatments for severe mental illness, and I suggest that what we can learn about treatment from this 1961 case conference remains relevant today, and psychodynamic treatment approaches for severely ill patients should not be abandoned.

Time to go green?

Time to go green?

Developing a physical activity initiative for a community mental health service

Developing a physical activity initiative for a community mental health service

Web-based exercise therapy for the treatment of depression

Web-based exercise therapy for the treatment of depression

Profiling the Skeletal Muscle Proteome in Patients on Atypical Antipsychotics and Mood Stabilizers.

Atypical antipsychotics (AAP) are used in the treatment of severe mental illness. They are associated with several metabolic side effects including insulin resistance. The skeletal muscle is the primary tissue responsible for insulin-stimulated glucose uptake. Dysfunction of protein regulation within the skeletal muscle following treatment with AAPs may play a role in the associated metabolic side effects. The objective of this study was to measure protein abundance in the skeletal muscle of patients on long-term AAP or mood stabilizer treatment. Cross-sectional muscle biopsies were obtained from patients with bipolar disorder and global protein abundance was measured using stable isotope labeling by amino acid (SILAC) combined with high-performance liquid chromatography-electrospray ionization tandem mass spectrometry (HPLC-ESI-MS/MS). Sixteen patients completed muscle biopsies and were included in the proteomic analyses. A total of 40 proteins were significantly different between the AAP group and the mood stabilizer group. In-silico pathway analysis identified significant enrichment in several pathways including glucose metabolism, cell cycle, apoptosis, and folate metabolism. Proteome abundance changes also differed based on protein biological processes and function. In summary, significant differences in proteomic profiles were identified in the skeletal muscle between patients on AAPs and mood stabilizers. Future work is needed to validate these findings in prospectively sampled populations.

Parents' perspectives on user participation and shared decision‐making in adolescents' inpatient mental healthcare

BackgroundParents are a resource that can be of considerable importance in supporting their adolescents' recovery and shared decision‐making processes. However, involving both adolescents and their parents in treatment creates challenges. Understanding the roles of all decision stakeholders is vital to the implementation of shared decision‐making and delivery of high‐quality healthcare services.ObjectiveThe aim of this study is to explore parents' experiences with adolescents' participation in mental health treatment and how parents perceive being involved in decision‐making processes.DesignThis was a qualitative study with a phenomenological, inductive design. Content analysis of data from qualitative interviews was performed.Setting and ParticipantsThis study took place in a Norwegian public healthcare setting. Twelve parents of adolescents who received treatment for severe mental illness participated.ResultsFour themes were identified: (1) self‐determined treatment, but within limits; (2) the essential roles of parents; (3) the need for information and support; and (4) the fight for individualized treatment and service coordination.ConclusionUser participation is vital in adolescent mental healthcare and parents play essential roles regarding the shared decision‐making process. However, user participation and shared decision‐making pose several dilemmas. Parental involvement in treatment decisions may be necessary when adolescents are mentally ill, but could simultaneously hinder those adolescents' empowerment and recovery. Cooperation among parents, adolescents and healthcare professionals can improve treatment engagement and adherence, but may be challenged by divergent interests. Health services should provide family‐oriented services to utilize the potential of parents as a resource and minimize conflicting interests.Patient or Public ContributionTwo adolescent user representatives participated in designing the study.

Perceived quality of life and associated factors among patients with severe mental illness in Ethiopia: a cross-sectional study

BackgroundSevere mental illness is strongly associated with an impaired quality of life. This intern can affect the treatment adherence and outcomes of the illness. However, there are insufficient studies in the literature pertaining to the quality of life of patients with severe mental illness in Ethiopia. Therefore, assessing the quality of life of patients with severe mental illness and its correlates is a yardstick measure of the effectiveness of the mental health service.MethodsAn institutional based cross-sectional study was conducted from May 1 to 16, 2019 at Amanuel Mental Specialized Hospital. A systematic random sampling technique was used to get a total number of 387 samples. Data were collected using interview-administered questionnaires; World Health Organization Quality of Life Brief Version, Morisky Medication Adherence Screening Tool, Oslo Social Support Scale, and Jacoby Stigma Scale. Simple and multiple linear regression analysis were used to assess the contributing factors of quality of life in the participants and B coefficient with 95% CI confidence interval was used. The statistical significance was accepted at p value < 0.05.ResultsThe result showed that the Mean quality of life score of patients with severe mental illness for each domain (mean ± SD) was 41.3 ± 7.5, 42.8 ± 8.2, 38.9 ± 8.9, and 41.8 ± 6.5 for physical, psychological, social and environmental, respectively. Multiple regression analysis showed that age of participants was strongly positively correlated with all domains of quality of life. It predicts above 45% of the variability in each domain. Social support is also another strong predictor which was negatively correlated with all domains of quality of life, except physical.ConclusionThis study revealed that the mean score quality of life of patients with severe mental illness in each domain was low. This demonstrates a need for improving the quality of life of people with severe mental illness by integration of a positive mental health approach and bio-psychosocial view with biological treatment of severe mental illness. Moreover, in Collaboration with medical professionals, people with severe mental illness should screen and managed for any comorbid medical conditions.

Antipsychotic Polypharmacy and High Doses in a Rural Portuguese Community Mental Health Service

Introduction: Antipsychotic polypharmacy (APP) and high dose (APHD) remain a common practice in the treatment of severe mental illness, even though they are not supported by current international guidelines.&#x0D; Methods: We aimed to establish the prescribing patterns of antipsychotics in a community mental health service in a rural setting, to determine the prevalence of APP and APHD treatment and to identify associated factors.&#x0D; Results: We identified 284 patients. APP was present in 46.5% patients and was associated to younger age, single status, more previous psychiatric admissions, and anticholinergic prescription. Prescription of APHD was observed in 14.4% patients and was associated with previous inpatient admissions, being prescribed with a first generation long‑acting injectable antipsychotic and anticholinergics. We also found that APP and APHD were mutually associated.&#x0D; Conclusion: Despite current guidelines, we found prevalences of APP and APHD of 46.5% and 14.4%, respectively. Further studies are necessary to better evaluate the antipsychotic prescription patterns in Portugal.

Physical activity as an intervention in severe mental illness

SUMMARYPhysical activity is a modifiable risk factor for several physical and mental health conditions. It is well established that people with severe mental illness have increased risk of physical health complications, particularly cardiovascular disease. They are also more likely to be physically inactive, contributing to the elevated cardiovascular and metabolic risks, which are further compounded by antipsychotic medication use. Interventions involving physical activity are a relatively low risk and accessible way of reducing physical health problems and weight in people with severe mental illness. They also have wider benefits for mental health symptoms and quality of life. However, many barriers still exist to the widespread implementation of physical activity interventions in the treatment of severe mental illness. A more concerted effort is needed to facilitate their translation into routine practice and to increase adherence to activity interventions.

Implementation of Psychodynamic Multifamily Groups for Severe Mental Illness: A Recovery-Oriented Approach.

Background: Among Family-Based Services for the treatment of severe mental illnesses, multi-family models gained particular attention, given the potential usefulness of mutual feed-back, motivation and encouragement among families.Methods: The Psychodynamic Multi-Family Group Model has been proposed since 1997 in some Community Mental Health Services in Rome. Since 2011 multifamily groups are held weekly in all the six Districts of the Department of Mental Health that serves a population of more than one million people, and data have been collected since 2015 in three Districts. A total of 794 individuals attended the meetings in the period 2015–2019.Results: Eighty-six percent of those who started, attended more than one meeting. The mean of occurrences of participation among patients was 18.6, among mothers 25.6 and among fathers 21.6. The 794 participants belonged to 439 family units, among which 180 comprised only the patient, 76 only parent(s) or other close person(s), and 183 comprised parent(s) or close person(s) with the patient. Patients participating alone were older than those of families who participated as a whole. Families including the patient showed the longest duration of attendance and the highest prevalence of a diagnosis of schizophrenia in the index patient. Families who had been attending the multifamily groups since a long time maintained a high rate of attendance.Conclusions: Multifamily groups represent a setting where patients can meet with other people and professionals in a free still structured way, and with not strictly therapeutic objectives. The high number of patients who attended alone suggests that such participation corresponds to a self-perceived need of open and free setting facilitating sharing of problems and solutions. The good tenure of the interventions, the high participation, and the feasibility in the long-term suggest that multifamily groups can be implemented in the mental health services of a large city, are sustainable over many years, and can represent a valuable resource for many patients and families.