Clinical Practice and Epidemiology in Mental Health
Công bố khoa học tiêu biểu
* Dữ liệu chỉ mang tính chất tham khảo
Sắp xếp:
Needs for care among patients with schizophrenia in six European countries: a one-year follow-up study
Clinical Practice and Epidemiology in Mental Health - Tập 2 - Trang 1-10 - 2006
This article compares needs for care among patients with schizophrenia across six European countries and examines how this relates to the diversity of psychiatric systems in Europe. A one-year prospective cohort study was set up. Inclusion criteria for patients were: a clinical lifetime diagnosis of schizophrenia according to ICD-10 (F20) diagnostic criteria for research, age between 18 and 65 years and at least one contact with mental health services in 1993. The patients were assessed for their clinical diagnosis and symptoms using the SCAN interview (Schedules for Clinical Assessment in Neuropsychiatry) and the interventions proposed to them were recorded through the systematic use of the NFCAS (Needs For Care Assessment Schedule). 438 patients were included and 391 were followed up. The mean age was 38 years, the mean age at onset was 22 years, and 59% were out-patients, 24% in day care and 15% hospitalized. The populations in the different centres were significantly different for almost all the variables: sociodemographic, clinical and social, and the problems identified remained relatively stable over the year. Comparisons highlighted cultural differences concerning the interventions that were proposed. Centres in Italy, Spain and Portugal proposed many interventions even though they were relatively deprived in terms of resources, and the tendency seems to be the reverse for the Northern European countries. On average, one in four patients suffered from needs that were not adequately met by the mental health service in their region. These needs (on average 6 per patient) varied from psychotic symptoms to managing their own affairs. The number of interventions was not correlated to the need status. The availability of community-based treatment, rehabilitation and residential care seems to predict smaller proportions of patients with unmet needs. There appeared to be a systematic relationship between the availability of community-based mental health care and the need status of schizophrenic patients: the fewer out-patient and rehabilitation services available, the more unmet needs there were.
Depression in cancer patients: a critical review
Clinical Practice and Epidemiology in Mental Health - Tập 3 - Trang 1-9 - 2007
Cancer patients experience several stressors and emotional upheavals. Fear of death, interruption of life plans, changes in body image and self-esteem, changes in social role and lifestyle are all important issues to be faced. Moreover, Depressive Disorders may impact the course of the disease and compliance. The cost and prevalence, the impairment caused, and the diagnostic and therapeutic uncertainty surrounding depressive symptoms among cancer patients make these conditions a priority for research. In this article we discuss recent data, focusing on detection of Depressive Disorders, biological correlates, treatments and unmet needs of depressed cancer patients.
Association of chronic hepatitis C with major depressive disorders: irrespective of interferon-alpha therapy
Clinical Practice and Epidemiology in Mental Health - Tập 3 - Trang 1-4 - 2007
Mood and anxiety symptoms in chronic hepatitis C (CHC) may be related to the patient awareness of the diagnosis and prognosis, to side effects induced by interferon (IFN)-alpha treatment, as well as to substance abuse. However, the observation of metabolic alterations in patients with CHC has led to hypothesize a direct effect of hepatitis C virus (HCV) on brain function. This study was aimed at elucidating whether CHC is associated with specific anxiety or mood disorders independently of confounding factors. Patient cohort: consecutive patients, 135 with CHC and 76 with chronic hepatitis B (CHB). Exclusion criteria: previous treatment with IFN-alpha, co-infection with HCV and hepatitis B virus, infection with human immunodeficiency virus, drug or alcohol abuse, or malignancies. Controls: subjects without evidence of hepatitis randomly extracted from the database of a previous epidemiological study; they were divided into two groups of 540 (332 males) and 304 (220 males) as controls for patients with CHC and CHB, respectively. The psychiatric diagnosis was formulated by means of the Composite International Diagnostic Interview Simplified carried out by a physician according to DSM-IV criteria. A higher lifetime prevalence of major depressive disorder (MDD) was observed among CHC compared to CHB or controls. The risk of MDD was not statistically different between CHB and controls. Both the CHC and CHB groups showed a significantly higher frequency of panic disorder when compared to controls. No statistical differences were observed in the prevalence of general anxiety disorder and social phobia when CHC or CHB were compared to controls. The present study provides the first evidence of an association between CHC and MDD, diagnosed on the basis of well-defined international criteria. This association is independent of treatment with IFN-alpha and is not influenced by substance or alcohol abuse. By contrast, anxiety disorders do not appear to be specifically associated with CHC.
Psychological problems in gastroenterology outpatients: A South Australian experience. Psychological co-morbidity in IBD, IBS and hepatitis C
Clinical Practice and Epidemiology in Mental Health - Tập 4 - Trang 1-8 - 2008
In independent studies, IBD, IBS and HCV have each been associated with a substantially increased risk of psychological problems such as depression and anxiety and impairment of quality of life compared to the general healthy population. However, the relative psychological burden for each of these diagnoses is unknown as it has never been compared contemporaneously at one institution. Current local data are therefore needed to enable an evidence-based allocation of limited clinical psychological resources. Overall, 139 outpatients (64 IBD, 41 HCV, and 34 IBS) were enrolled in this cross-sectional study. The HADS, SCL90, SF-12 and appropriate disease-specific activity measures were administered. Differences between groups were assesed with ANOVA, the Chi-Square test and the independent samples t-test (two-tailed). Each of the three groups had significantly lower quality of life than the general population (p < 0.05). Overall, a total of 58 (42%) participants met HADS screening criteria for anxiety and 26 (19%) participants for depression. The HCV group had a significantly higher prevalence of depression than either of the other groups (HCV = 34%, IBS = 15% and IBD = 11%, p = 0.009). In the SCL90, the three disease groups differed on 7 out of 12 subscales. On each of these subscales, the HCV group were most severely affected and differed most from the general population. Patients with these common chronic gastrointestinal diseases have significant impairment of quality of life. Anxiety is a greater problem than depression, although patients with HCV in particular, should be regularly monitored and treated for co-morbid depression. Evaluation of specific psychological interventions targeting anxiety is warranted.
The effect of using NHS number as the unique identifier for patients who self-harm: a multi-centre descriptive study
Clinical Practice and Epidemiology in Mental Health - Tập 3 - Trang 1-5 - 2007
Processing personal data for research purposes and the requirement of anonymity has been the subject of recent debate. We aimed to determine the proportion of individuals who present to emergency departments with non-fatal suicidal behavior where an NHS number has been successfully traced and to investigate the characteristics of patients associated with non-capture. This was a descriptive study of people attending after self-harm using allocation of NHS numbers as main outcome measurement. Data from the Multicentre Monitoring of Self-Harm Project from 3 centres in England were used to identify consecutive patients (N = 3000) who were treated in six emergency departments in Oxford, Manchester and Leeds in 2004 and 2005 following self-harm. NHS number was available between 55–73% of individuals across centres. Characteristics associated with non-recording of NHS number in more than one centre included those from ethnic minority groups (Oxford: chi-squared statistic = 13.6, df = 3, p = 0.004; Manchester: chi-squared statistic = 13.6, df = 3, p ≤0.001) and the homeless or living in a hostel or other institution (Oxford: chi-squared statistic = 40.9, df = 7, p = <0.001; Manchester: chi-squared statistic = 23.5, df = 7, p = 0.001). Individual centre characteristics included being of male gender (Leeds: chi-squared statistic = 4.1, df = 1, p = 0.4), those under 25 years (Oxford: chi-squared statistic = 10.6, df = 2, p = 0.005), not being admitted to general hospital (Leeds: chi-squared statistic = 223.6, df = 1, p ≤0.001) and using self-injury as a method of harm (Leeds: chi-squared statistic = 41.5, df = 2, p ≤0.001). Basing research studies on NHS number as the unique identifier, as suggested by the Data Protection Act 1998 and the Patient Information Advisory Group, would exclude some of the most vulnerable groups for further self-harm or suicide. This bias may also affect other research registers.
Giúp ưu tiên các can thiệp cho trầm cảm và triệu chứng kinh nguyệt: sử dụng các Chỉ số Tác động Dân số Dịch bởi AI
Clinical Practice and Epidemiology in Mental Health - - 2006
Để chứng minh tiềm năng của Chỉ số Tác động Dân số trong việc giúp ưu tiên các can thiệp thay thế cho ngành tâm thần, bài báo này ước tính số lần tái phát và nhập viện lại được ngăn chặn cho trầm cảm và tâm thần phân liệt bằng cách áp dụng các khuyến nghị thực hành tốt nhất. Các kết quả được thiết kế để liên quan đến các quần thể địa phương cụ thể. Các ước tính dựa trên tài liệu về tỷ lệ bệnh tật, tỷ lệ tái phát và nhập viện lại, tỷ lệ điều trị hiện tại và thực hành tốt nhất, mức độ tuân thủ các can thiệp và giảm rủi ro tương đối liên quan đến các can thiệp khác nhau đã được thu thập và các phép tính về Số sự kiện được ngăn chặn trong quần thể của bạn (NEPP) đã được thực hiện. Trong một quần thể giả định của 100.000 người lớn, khi chuyển từ thực hành hiện tại sang thực hành 'tốt nhất' cho các can thiệp khác nhau, số lần tái phát được ngăn chặn trong năm tới cho tâm thần phân liệt là 6 (tăng cường tuân thủ thuốc), 23 (can thiệp gia đình), 43 (ngăn ngừa tái phát) và 44 (can thiệp sớm); và đối với trầm cảm, số lần tái phát được ngăn chặn trong năm tới là 100 (tăng cường quản lý chăm sóc), 227 (tiếp tục điều trị bằng thuốc chống trầm cảm), 279 (tăng tỷ lệ chẩn đoán) và 325 (Liệu pháp Hành vi Nhận thức). Số lần nhập viện lại được ngăn chặn trong năm tới cho tâm thần phân liệt là 6 (tăng cường tuân thủ thuốc), 36 (ngăn ngừa tái phát) và 40 (can thiệp sớm). Các chỉ số tác động dân số cung cấp khả năng cho một nhà hoạch định chính sách thấy được tác động của một can thiệp mới đối với toàn thể dân số, và so sánh các can thiệp thay thế để cải thiện kết quả bệnh tâm thần. Các phương pháp này đơn giản hơn nhiều so với các phương pháp khác và có lợi thế là minh bạch.
#Chỉ số Tác động Dân số #trầm cảm #tâm thần phân liệt #can thiệp tâm thần #thực hành tốt nhất
Adaptation and validation of the Portuguese version of the Lithium Knowledge Test (LKT) of bipolar patients treated with lithium: cross-over study
Clinical Practice and Epidemiology in Mental Health - Tập 2 - Trang 1-6 - 2006
Adherence problems are a common feature among bipolar patients. A recent study showed that lithium knowledge was the main difference between adherent and non adherents bipolar patients. The Lithium Knowledge Test (LKT), a brief questionnaire, was developed as a means of identifying aspects of patients' practical and pharmacological knowledge which are important if therapy is to be safe and effective. The original English version is validated in psychiatric population, but a validated Portuguese one is not yet available. One hundred six patients selected were diagnosed with bipolar disorder (I or II) according to DSM-IV criteria and had to be on lithium treatment for at least one month. The LKT was administered on only one occasion. We analysed the internal consis tency, concurrent validity, sensitivity and specificity of the LKT for the detection of the knowledge about lithium treatment of bipolar patients. The internal consistency, evaluated by Cronbach's alpha was 0.596. The mean of total score LKT by bipolar patients was 9.0 (SD: 0.75) for men and 8.74 (SD: 0.44) for women. Concurrent validity based on plasma lithium concentration showed a significant correlation between the total LKT score and plasma lithium (r = 0,232; p = 0.020). The sensitivity was 84% and specificity was 81%. LKT is a rapid, reliable instrument which appears to be as effective as a lengthier standard interview with a lithium clinic doctor, and which has a high level of acceptability to lithium patients. We found that the psychometric assessment of the Portuguese version of LKT showed good internal consistency, sensitivity and specificity.
Animal-assisted therapy with farm animals for persons with psychiatric disorders: effects on self-efficacy, coping ability and quality of life, a randomized controlled trial
Clinical Practice and Epidemiology in Mental Health - Tập 4 - Trang 1-7 - 2008
The benefits of Animal-Assisted Therapy (AAT) for humans with mental disorders have been well-documented using cats and dogs, but there is a complete lack of controlled studies using farm animals as therapeutic agents for psychiatric patients. The study was developed in the context of Green care, a concept that involves the use of farm animals, plants, gardens, or the landscape in recreational or work-related interventions for different target groups of clients in cooperation with health authorities. The present study aimed at examining effects of a 12-week intervention with farm animals on self-efficacy, coping ability and quality of life among adult psychiatric patients with a variety of psychiatric diagnoses. The study was a randomized controlled trial and follow-up. Ninety patients (59 women and 31 men) with schizophrenia, affective disorders, anxiety, and personality disorders completed questionnaires to assess self-efficacy (Generalized Self-Efficacy Scale; GSE), coping ability (Coping Strategies Scale), and quality of life (Quality of Life Scale; QOLS-N) before, at the end of intervention, and at six months follow-up. Two-thirds of the patients (N = 60) were given interventions; the remaining served as controls. There was significant increase in self-efficacy in the treatment group but not in the control group from before intervention (SB) to six months follow-up (SSMA), (SSMA-SB; F1,55 = 4.20, p= 0.05) and from end of intervention (SA) to follow-up (SSMA-SA; F1,55 = 5.6, p= 0.02). There was significant increase in coping ability within the treatment group between before intervention and follow-up (SSMA-SB = 2.7, t = 2.31, p = 0.03), whereas no changes in quality of life was found. There were no significant changes in any of the variables during the intervention. AAT with farm animals may have positive influences on self-efficacy and coping ability among psychiatric patients with long lasting psychiatric symptoms.
Adjustment Disorder: epidemiology, diagnosis and treatment
Clinical Practice and Epidemiology in Mental Health - Tập 5 - Trang 1-15 - 2009
Adjustment Disorder is a condition strongly tied to acute and chronic stress. Despite clinical suggestion of a large prevalence in the general population and the high frequency of its diagnosis in the clinical settings, there has been relatively little research reported and, consequently, very few hints about its treatments. the authors gathered old and current information on the epidemiology, clinical features, comorbidity, treatment and outcome of adjustment disorder by a systematic review of essays published on PUBMED. After a first glance at its historical definition and its definition in the DSM and ICD systems, the problem of distinguishing AD from other mood and anxiety disorders, the difficulty in the definition of stress and the implied concept of 'vulnerability' are considered. Comorbidity of AD with other conditions, and outcome of AD are then analyzed. This review also highlights recent data about trends in the use of antidepressant drugs, evidence on their efficacy and the use of psychotherapies. AD is a very common diagnosis in clinical practice, but we still lack data about its rightful clinical entity. This may be caused by a difficulty in facing, with a purely descriptive methods, a "pathogenic label", based on a stressful event, for which a subjective impact has to be considered. We lack efficacy surveys concerning treatment. The use of psychotropic drugs such as antidepressants, in AD with anxious or depressed mood is not properly supported and should be avoided, while the usefulness of psychotherapies is more solidly supported by clinical evidence. To better determine the correct course of therapy, randomized-controlled trials, even for the combined use of drugs and psychotherapies, are needed vitally, especially for the resistant forms of AD.
Can thiết bị can thiệp tâm lý giáo dục và phòng ngừa tái phát trong rối loạn tâm thần phân liệt trong mạng lưới tâm thần cộng đồng tại Ý Dịch bởi AI
Clinical Practice and Epidemiology in Mental Health - Tập 3 - Trang 1-12 - 2007
Việc thiếu tuân thủ điều trị liên quan đến nguy cơ tăng cao về việc nhập viện và thay đổi hoặc bổ sung điều trị so với việc tuân thủ. Sự kết hợp giữa liệu pháp thuốc và can thiệp tâm lý xã hội có thể mang lại nhiều lợi ích hơn trong điều trị. Một nghiên cứu triển vọng đã được tiến hành trên 150 bệnh nhân mắc chứng tâm thần phân liệt tại 15 trung tâm ở Ý. Nhóm thử nghiệm được điều trị bằng liệu pháp thuốc và can thiệp tâm lý xã hội truyền thống cùng với giáo dục tâm lý cho bệnh nhân và gia đình họ, trong khi nhóm đối chứng chỉ nhận can thiệp tâm lý xã hội và thuốc truyền thống trong 1 năm. Nhóm thử nghiệm cho thấy sự cải thiện có ý nghĩa thống kê (p < 0,05) trên hầu hết các thang đo đã được đánh giá (BPRS, SAPS, SANS, Thang đo SIMPSON-ANGUS, Thang đo chất lượng cuộc sống Lancashire). Sự giảm đáng kể số lần nhập viện và số ngày nằm viện cũng được ghi nhận. Như đã được thể hiện trong tài liệu quốc tế, can thiệp giáo dục tâm lý cho bệnh nhân tâm thần phân liệt và gia đình có thể giảm thiểu khả năng tái phát.
#can thiệp tâm lý #phát lại #tâm thần phân liệt #y học cộng đồng #nghiên cứu cách tiếp cận
Tổng số: 103
- 1
- 2
- 3
- 4
- 5
- 6
- 10