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Changing the oil while driving the car.

Psychiatr Serv. 2009 May;60(5):575

Authors: Sederer LI

PMID: 19411341 [PubMed - indexed for MEDLINE]

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Impact of a mental health training course for correctional officers on a special housing unit.

Psychiatr Serv. 2009 May;60(5):640-5

Authors: Parker GF

OBJECTIVE: This study determined the impact of a ten-hour mental health training program developed by the Indiana chapter of the National Alliance on Mental Illness (NAMI-Indiana) for correctional officers on a prison special housing (”supermax”) unit. METHODS: The training was delivered to all of the correctional officers on the unit in five weekly sessions and was repeated 15 months later for new unit staff. The number of incidents reported by unit staff in standard monthly reports, consisting of use of force by the officers and battery by bodily waste on the officers by the offenders, was compared for the nine months before and after both training sessions. RESULTS: Attendance at the initial training ranged from 48 to 57 officers per session, and on the basis of Likert ratings, training was well received by the officers. The total number of incidents, the use of force by the officers, and battery by bodily waste all declined significantly after the first mental health training, and the total number of incidents and battery by bodily waste declined significantly after the second training. CONCLUSIONS: The provision of ten hours of mental health training to correctional officers was associated with a significant decline in use of force and battery by bodily waste.

PMID: 19411352 [PubMed - indexed for MEDLINE]

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Apples don’t fall far from the tree: influences on psychotherapists’ adoption and sustained use of new therapies.

Psychiatr Serv. 2009 May;60(5):671-6

Authors: Cook JM, Schnurr PP, Biyanova T, Coyne JC

OBJECTIVE: The purpose of this investigation was to identify influences on the current clinical practices of a broad range of mental health providers as well as influences on their adoption and sustained use of new practices. METHODS: U.S. and Canadian psychotherapists (N=2,607) completed a Web-based survey in which they rated factors that influence their clinical practice, including their adoption and sustained use of new treatments. RESULTS: Empirical evidence had little influence on the practice of mental health providers. Significant mentors, books, training in graduate school, and informal discussions with colleagues were the most highly endorsed influences on current practice. The greatest influences on psychotherapists’ willingness to learn a new treatment were its potential for integration with the therapy they were already providing and its endorsement by therapists they respected. Clinicians were more often willing to continue to use a new treatment when they were able to effectively and enjoyably conduct the therapy and when their clients liked the therapy and reported improvement. CONCLUSIONS: Implications for dissemination and sustained use of new psychotherapies by community psychotherapists are discussed. For example, evidence-based treatments may best be promoted through therapy courses and workshops, beginning with graduate studies; to ensure future use of new therapies, developers of training workshops should emphasize ways to integrate their approaches into clinicians’ existing practices.

PMID: 19411356 [PubMed - indexed for MEDLINE]

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Military deployment: the impact on children and family adjustment and the need for care.

Curr Opin Psychiatry. 2009 Jul;22(4):369-73

Authors: McFarlane AC

PURPOSE OF REVIEW: Over a million children and their families have now experienced the stress of the deployment of a family member during the recent wars in Iraq and Afghanistan. Whereas there is an extensive clinical literature about the developmental challenges facing children and issues of family adjustment, there is a lack of systematic research. This review summarizes the findings of recent publications. RECENT FINDINGS: Some veterans develop posttraumatic stress disorder as a consequence of their experiences. This condition drives many of the adverse changes in the families of returning veterans through the effects on intimacy and nurturance in their families of withdrawal, numbing and irritability that are components of posttraumatic stress disorder. There is the more general challenge that all families and children face when a partner/parent deploys of role ambiguity consequent on anxiety that is provoked by the threat that deployed family members experience. A study of Kuwaiti military showed that mothers’ anxiety had the greatest impact on the children of deployed fathers, although absence of posttraumatic stress disorder in mothers could mitigate the effects of their fathers’ posttraumatic stress disorder. Intervention programs are described, but there is a poverty of their evaluation. SUMMARY: A substantial advantage of focusing on family adjustment is that it can facilitate access to mental healthcare for veterans while assisting families’ positive adaptation.

PMID: 19424067 [PubMed - indexed for MEDLINE]

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It is time to adjust the adjustment disorder category.

Curr Opin Psychiatry. 2009 Jul;22(4):409-12

Authors: Baumeister H, Kufner K

PURPOSE OF REVIEW: A recent review highlighted the existing lack of evidence concerning adjustment disorders. It concluded that we should wait to adjust adjustment disorders until evidence is available. This is circular reasoning, fixing the poor definition of adjustment disorders. The present article outlines why we should amend adjustment disorders and which major obstacles need to be removed when revising this category. RECENT FINDINGS: Adjustment disorder is a frequent disorder at least in medical settings. Many of these patients do not fulfill the criteria of a more specific diagnosis, but are still regarded as ‘in need of treatment’. Clinicians appreciate the possibility of assigning adjustment disorders as ‘wild card’ diagnoses. The drawback of this clinical utility consists in the lack of operational diagnostic specificity. This leads to the resistance of adjustment disorders being researched properly, resulting in a substantial proportion of patients receiving treatments that are not evidence based. Thus, there is a need for revision of adjustment disorders. Thereby, the border disputes of what differentiates adjustment disorders from normal human adaptation processes and from other (more specific) disorders need to be solved. SUMMARY: Given the high prevalence rates of adjustment disorders and their scientific neglect, it is time to revise adjustment disorders.

PMID: 19436201 [PubMed - indexed for MEDLINE]

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Community-dwelling, older women’s perspectives on Therapeutic Life Review: a qualitative analysis.

Issues Ment Health Nurs. 2009 May;30(5):288-94

Authors: Binder BK, Mastel-Smith B, Hersch G, Symes L, Malecha A, McFarlane J

The purpose of this study was to elicit the participants’ perspective of a Therapeutic Life Review intervention program delivered by a home care worker. Following the intervention by the home care worker, 13 of the 14 older women receiving home care services were interviewed to examine their experiences. Qualitative data analysis revealed five themes: (1) Someone was there to listen to my story, (2) It was a special time, (3) A valued interaction with the home care worker developed, (4) Remembering was meaningful and pleasurable, and (5) Integration with one’s lived experiences was healing. Three case scenarios illustrate the lives of these older women.

PMID: 19437247 [PubMed - indexed for MEDLINE]

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“On the spot” interventions by mental health nurses in inpatient psychiatric wards in Greece.

Issues Ment Health Nurs. 2009 May;30(5):327-36

Authors: Koukia E, Madianos MG, Katostaras T

The objective of this research was to explore the “on-the spot” clinical interventions mental health nurses make in critical incidents on inpatient psychiatric wards. Mental health nurses play a key role in the management of psychiatric critical incidents. Nurses’ autonomy, decision-making, and training in clinical interventions are important issues in psychiatric nursing practice. A descriptive study was conducted among mental health nurses working on inpatient wards of three major psychiatric hospitals in the greater Athens area, using semi-structured interviews. Nurses’ personal views also were documented. Semi-structured interviews were conducted with 103 mental health nurses, who were encouraged to make personal remarks. The results of this study show that in the majority of critical incidents, the nurses were found to be in contact with the psychiatrist on call; physical restraints were used frequently in violent episodes; reassurance and support were common interventions; the majority of nurses would have preferred not to intervene with critical incidents; and nurses expressed a need for skills training and higher autonomy. The nurses implemented a specific number of interventions in confronting the various types of crises. The need for specialized training was noticed and problems like accountability, autonomy, and medication administration, were considered crucial by the mental heath nurses.

PMID: 19437252 [PubMed - indexed for MEDLINE]

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Application of a model for the development of a mental health service delivery collaboration between police and the health service.

Issues Ment Health Nurs. 2009 May;30(5):337-41

Authors: Laing R, Halsey R, Donohue D, Newman C, Cashin A

Changing societal trends have revealed an increased prevalence of mental illness and diminished health resources from which to offer services. This has lead to a need to develop new and more efficient police and health service models of practice. Services offered by the police department in the management of mental health crisis in the community are essential in minimising the risk of individuals with mental health problems causing harm to themselves or a member of the public. In addressing the difficulties associated with police playing an important role in the management of mental health crisis in the community, but having little training in mental health issues, this paper discusses a proposed innovation for New South Wales police in Australia through the development of a Crisis Intervention Team model.

PMID: 19437253 [PubMed - indexed for MEDLINE]

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Personality and self-reported treatment effectiveness in depression.

Aust N Z J Psychiatry. 2009 Jun;43(6):518-25

Authors: Parker G, Crawford J

OBJECTIVE: The aim of the present study was to examine the associations between eight personality styles and retrospective self-reported response to a wide range of treatments for depression, including pharmacological, psychological and alternative strategies. METHOD: An online survey posted on the Black Dog Institute website was completed by 3486 respondents reporting a history of treatment for depression. Inclusion criteria resulted in a sample of 2692 respondents. Participants completed the Temperament and Personality Questionnaire, which assesses eight personality dimensions: anxious worrying, perfectionism, personal reserve, irritability, social avoidance, rejection sensitivity, self-criticism and self-focus. RESULTS: A series of linear regressions quantified that the personality dimensions–as well as age and gender–accounted for very little of the variance in self-reported treatment effectiveness (1-7%). Self-criticism was associated with a poorer response to most treatments, and social avoidance was associated with a poorer response to psychological treatments (e.g. cognitive behaviour therapy) and behavioural strategies (e.g. exercise). Several other weak associations are reported. CONCLUSION: The association between personality style and retrospective self-reported treatment response was overall weak at most. The association between a personality style of self-criticism and poor treatment response warrants clarification.

PMID: 19440883 [PubMed - indexed for MEDLINE]

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Cost-effectiveness of combination therapy versus antidepressant therapy for management of depression in Japan.

Aust N Z J Psychiatry. 2009 Jun;43(6):539-47

Authors: Sado M, Knapp M, Yamauchi K, Fujisawa D, So M, Nakagawa A, Kikuchi T, Ono Y

OBJECTIVE: Major depression is expected to become the second leading contributor to disease burden worldwide by 2020. Only a few studies, however, have compared the cost-effectiveness of a combination of cognitive behavioural therapy and antidepressant therapy versus antidepressant therapy alone. The purpose of the present study was therefore to analyse cost-effectiveness, from the perspective of the health-care system and also from a social perspective, comparing combined cognitive behavioural therapy + antidepressant therapy and antidepressant therapy alone in the Japanese setting. METHOD: A formal decision analytical model was constructed. The analyses were performed from both the perspective of the health-care system and the societal perspective. The clinical outcomes were determined from published articles and reports of expert panels. Because no patient-level data were available, deterministic costing of the different treatment strategies was carried out. Cost-effectiveness was assessed first by determining the incremental cost-effectiveness ratio (ICER) per successfully treated patient, and then by the ICER per quality-adjusted life years (QALYs). RESULTS: The combined therapy increased the rate of successfully treated patients, QALY of severe depression and QALY of moderate depression by 0.15, 0.08 and 0.04, respectively. The combined therapy proved to be more expensive from the health-care system perspective, but the incremental costs were completely offset by the considerable reduction of productivity loss from the social perspective. From the health-care perspective, the ICER per successfully treated patient, ICER per QALY of severe depression and ICER per QALY of moderate depression were JPY 140,418, JPY 268,550 and JPY 537,100, respectively. All the ICERs appeared to be negative from the social perspective. CONCLUSION: The combined therapy appeared to be cost-effective from the health-care system perspective and the dominant strategy from the social perspective.

PMID: 19440886 [PubMed - indexed for MEDLINE]

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