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The purpose of this paper is to describe experiences of caregivers in managing psychotic symptoms of persons with schizophrenia in various circumstances.

The data were obtained via a focus group and in-depth interviews among caregivers who cared for relatives with schizophrenia for more than five years. Thematic analysis was used for data analysis.

“Making it better” emerged as the main theme describing caregivers’ experiences in trying to manage psychotic symptoms. It comprises four sub-themes including cutting off the wind, protecting from harm, preventing relapses and pulling back to normality. The caregivers gradually learned and adjusted their strategies through trial and error. They tried to stop aggressive and violent behaviors soon after they had begun by giving cool water to their relatives to drink or shower, while expressing their own affect with gently talking. They also dealt with a hardship in protecting the patients, other people, their properties and their own selves from harm resulting from violent behavior. When the psychotic symptoms improved, the caregivers tried to prevent relapses by using various strategies to maintain medication adherence and by soothing their relatives’ mental state. They also tried to pull their relatives back to normal as much as they could by promoting their relatives’ memories and abilities to perform daily functions.

The findings increase knowledge in nursing regarding psychotic symptoms management. The findings can be applied to the development of a program to help caregivers to manage psychotic symptoms effectively in order to promote good clinical outcomes of patients and alleviate the caregivers’ burden.

The purpose of this paper is to discuss the challenges of assessment and management of psychotic symptoms in a background of intellectual disability (ID) and treatment-resistant epilepsy caused by a genetic syndrome.

Ring chromosome 20 [r(20)] syndrome is characterised by the triad of severe refractory epilepsy, mild to severe ID and behavioural problems. This paper describes the presentation of r(20) syndrome in a young woman with moderate ID and treatment-resistant epilepsy, who experiences psychotic symptoms at times of improved seizure control.

There are several diagnostic possibilities for such a presentation, including psychotic symptoms due to adverse effects of anti-epileptic medications and forced normalisation (alternating psychosis).

This paper advocates judicious use of antipsychotic medication to manage psychotic symptoms, as well as involvement of both patient and close family members throughout all stages of care. It is essential to strike a balance between control of epileptic seizures and psychiatric symptoms, providing an optimal benefit to the patients’ quality of life by meeting their complex needs through a multidisciplinary and multi-agency team input.

Despite the efficacy, political will and numbers of mental health practitioners trained in psychosocial interventions, they remain scarcely available in routine clinical practice. External factors such as the inability of mental health organisations to develop strategies to support the use of psychosocial interventions have been implicated. This study compares data from two groups, one that had completed psychosocial intervention training (n=104) and one that had not received psychosocial intervention training (n=102). Both groups completed measures of self‐efficacy, locus of control and an application of psychosocial interventions to practice. Results showed that psychosocial intervention training significantly increased the level of self‐efficacy for using psychosocial interventions in practice. The group that had received psychosocial interventions training had lower internal locus of control orientation. Self‐efficacy was significantly related to using psychosocial interventions in practice. There is a discussion of the implications of these findings.

The widespread provision of evidence‐based psychosocial interventions (PSI) for people who experience psychosis and their families requires that the mental health workforce has access to educational and training programmes in these treatment approaches. Such training has been available in England since 1992 when the first PSI programmes were established at The Institute of Psychiatry, London and The University of Manchester. While training is now more widely available (Brooker, 2002), little is known about the extent and distribution of training across England, or of the detail of individual programmes. To remedy this, the NIMHE National PSI Implementation Workgroup conducted a survey of university accredited PSI education/training in January 2006.Twenty‐six courses were represented in the returns from the eight regions served by CSIP regional development centres. This paper presents the findings of this survey and discusses the current provision of PSI training in England in 2006.

The purpose of this study is to assess if the new community-enhanced rehabilitation team reduced anxiety and readmissions in service users discharged from an inpatient rehabilitation setting.

The study used both qualitative and quantitative methodology. Service user’s anxiety level was measured before being discharged and at the end of the Community Enhanced Rehabilitation Team (CERT) transition intervention. Six service users were interviewed to gain further understanding of their experiences of anxiety.

Findings showed the anxiety score was significantly lower (M = 1.5, 95% CI [0.051,2.99], t(20) = 2.159, p = 0.043) following the CERT intervention (M = 8.6, SD = 6.4) compared to before (M = 10.1, SD = 7.0). No service user receiving the CERT intervention was readmitted to hospital within 12 weeks of discharge from the inpatient setting, compared to three service users (15% of those discharged) who were discharged to other community services.

Community rehabilitation pathways would benefit from having interventions to aid patient transitions from inpatient to the community. The National Health Service (NHS) trusts develop community rehabilitation teams as recommended by the National Institute for Health and Care Excellence (NICE), and they should consider including transitional support as part of their model.

It is recommended that as NHS trusts design and implement community mental health teams, they should consider including transition support as part of their model.

People with severe and enduring mental health difficulties who have been in an inpatient rehabilitation setting would benefit from community transitional support. This study suggests that such support helps reduce anxiety and readmission.

Community rehabilitation teams are currently being developed across the NHS as part of the NHS long-term plan. These teams are new, and as such, there is a dearth of information regarding their effectiveness. To the best of the authors’ knowledge, this is one of the first studies to evaluate outcomes in these new teams.

The purpose of this paper is to assess the prevalence and nature of presentation of unipolar depression in individuals with Prader-Willi syndrome (PWS).

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) (2009) checklist for systematic reviews was followed where possible.

Seven studies were included in the qualitative synthesis from a total of 261 records identified. The quality of the studies was then assessed: scores for each study design ranged from between 3 and 6 of a possible score total of 6. The frequency of depression ranged between studies from 4 to 22 per cent. four studies showed over 50 per cent of patients appeared to suffer from psychotic symptoms. Low mood, anhedonia and irritability were described as features of depression, although no fixed pattern of psychopathology arose from across the studies (excluding psychosis). This review has provided evidence to suggest that depression is a frequent occurrence in the PWS population. One study found that the incidence of depression differed between the genetic subtypes, raising questions regarding the relationship between genotype and behavioural phenotypes. A high proportion of individuals with depression suffered from psychotic symptoms.

The small number of heterogeneous studies included in this study precluded meta-analysis of the results. This highlights the need for further original research in this field.

An increased awareness of the frequency of depressive symptoms within the PWS population will aid in the timely diagnosis and management of the disorder which will reduce psychiatric morbidity. The noted high proportion of psychotic symptoms associated with depression should raise the index of suspicion with clinicians and aid appropriate management decisions.

This review has provided preliminary evidence for the nature of presentation of unipolar depression in PWS. It has highlighted the possibility of an increased propensity towards depression with psychotic symptoms. There is some suggestion of a differing presentation and course of unipolar depression between the common genetic subtypes of PWS which warrants further investigation.

The purpose of this paper is to examine the experience and impact of targeted training involving simulation of auditory hallucinations on attitudes and practice of professionals working with people with mental illness.

Pragmatic mixed-method study. Data were collected from 83 professionals who completed training using cross-sectional survey and focus groups. Descriptive, comparative and thematic analyses were performed.

Training was associated with changes in thinking and attitude related to working with people who hear voices. Participants, who commonly found the simulation confronting, drew on the experience to deepen appreciation of coping with voices that are distressing and develop a new frame of reference for practice. They positioned themselves differently and described adopting a range of practices consistent with the recovery approach. Environmental constraints variously impacted on capacity to enact these practices.

The study was conducted in one centre using a bespoke survey instrument with a sample intrinsically motivated to complete training. Hence, caution should be exercised with regard to generalisability. However, findings are consistent with the limited published literature and the mixed-method approach provided a comprehensive understanding.

The paper demonstrated that the training employed can support development of patient centred, recovery-oriented practices. These are likely essential to optimising patient and service outcomes. Further research is needed to examine the impact of training on a broader cross section of professionals and the outcomes for patients.

The paper provides important new insights regarding the mechanisms by which training can contribute to development of patient-centred care.

The purpose of this paper is to explore the relationship between attachment style, sub-clinical symptoms of psychosis and aggression in a general population sample.

Using both convenience and snowball sampling, participants in the community (n=213) completed an online questionnaire including previously validated measures of adult attachment, aggression and psychotic experiences.

Results suggested that there were statistically significant correlations between all study variables. Multiple linear regression demonstrated that total psychotic-like experiences and attachment scores significantly predicted variance in total aggression. Moderation approaches revealed that the relationship between psychotic-like events and aggression was stronger in individuals with more insecure attachment styles.

This generalisability of the results is compromised by the sampling methodology and the use of self-report tools. However, the significant results would support larger scale replications investigating similar variables.

This study suggests there is a relationship between psychotic-like experiences (PLEs) and facets of aggression in the general population. These results suggest that attachment is a contributing factor to aggression associated with PLEs, and highlight the need for similar investigations within clinical samples. The results imply that attachment may be a useful construct for explanatory models of the relationship between adverse childhood experiences, psychotic experiences and aggression.

Italy has recently become a country of net immigration, posing new challenges for health care, particularly psychiatry. Previous studies on migration and mental health have focused predominantly on individual psychopathologies or individual immigrant populations. The aim of this work is to determine the demand by foreign citizens for intervention at Padova‐based psychiatric services and to assess any differences in presentation of psychopathological symptoms in the various immigrant groups, with a view to developing adequate organisational and clinical responses. We reviewed 3,385 psychiatric consultations with Italian and immigrant patients, conducted between 2003 and 2004. Eleven per cent of these consultations were for immigrants, who were younger than their Italian counterparts. The most common geographical area of origin was Eastern Europe. North African immigrants were mainly male, while Eastern Europeans and Americans were chiefly female. Eastern European immigrants had a similar psychopathological pattern to Italians; North and Sub‐Saharan African and Asian patients presented more psychotic symptoms. The results of this study may contribute to planning treatment and prevention of psychotic disorders and to improving management of somatoform disorders by strengthening access to psychiatric treatment in the community.

This study reports a recovery‐themed cognitive behavioural educational group for clients suffering from chronic positive and negative symptoms of schizophrenia, on a low secure inpatient unit. Nine participants completed baseline and post‐intervention measures of insight, self‐esteem and knowledge about schizophrenia. Additional post‐intervention measures included compliance with medication, feelings about schizophrenia, qualitative views and access to the community. Overall, the results were positive within the limits of this small‐scale study. Following the intervention, most participants reported that they were less frightened about psychosis, and felt more in control of their illness and more optimistic about their future. This study suggests that there may be clinical benefits of having CBT‐orientated educational groups in low secure settings with clients with longstanding co‐existing positive and negative symptoms of schizophrenia. Recovery style should be evaluated systematically in future studies.