Is adherence therapy an effective adjunct treatment for patients with schizophrenia spectrum disorders? A systematic review and meta-analysis

Background Poor adherence to medication in schizophrenia spectrum disorders leads to inadequate symptom control. Adherence therapy (AT) is an intervention that seeks to reduce patients’ psychiatric symptoms by enhancing treatment adherence. We aimed to systematically review the trial evidence of the effectiveness of AT on improving clinical outcomes in these patients. Method Systematic review and meta-analysis of published RCTs. We included studies testing AT as an adjunct intervention against treatment as usual or a comparator intervention in the general adult psychiatric population. The primary outcome of interest was improvement in psychiatric symptoms. Results We included six studies testing AT in schizophrenia spectrum disorders published since 2006. A meta-analysis showed AT significantly reduced psychiatric symptoms compared to usual treatment over a follow-up period of less than 1 year. We found no significant effects of AT on patients’ adherence and adherence attitudes. Conclusions AT is an effective adjunctive treatment for people with schizophrenia spectrum disorders

How to inform relatives and loved ones of a patient's death

Rationale and key points ▶ Informing relatives and loved ones of a patient's death is a sensitive and often stressful task frequently undertaken by nurses. ▶ Effective communication skills and demonstrating compassion are essential when informing relatives and loved ones of a patient's death. ▶ The nurse should use suitable language and choose an appropriate environment to ensure that information is conveyed clearly, sensitively and without interruptions. Reflective activity Clinical skills articles can help update your practice and ensure it remains evidence based. Apply this article to your practice. Reflect on and write a short account of: 1. How you think this article will change your practice when informing relatives and loved ones of a patient's death. 2. How you could use this article to educate your colleagues. Subscribers can upload their reflective accounts at: rcni.com/portfolio

Alexithymia in young adults with substance use disorders: Critical issues about specificity and treatment predictivity

Several studies have reported high rates of alexithymia in drug-dependent individuals, but supporting evidence attests association between alexithymia and a variety of psychiatric disorders, raising doubts about its specificity. Moreover, controversies are emerging about alexithymia assessment: self-report measures present shortcomings with respect to discriminant validity and reliability. As regards treatment for substance use disorders (SUDs), alexithymia has been linked to poorer outcomes, but the results are inconsistent. The aim of the present study is to investigate alexithymia in substance-dependent young adults by examining: (a) the specificity of alexithymia in drug-dependent inpatients, compared to healthy individuals and patients with psychiatric disorders (behavioral and emotional disorders) and (b) the predictivity of alexithymia in determining treatment outcomes in terms of relapses, drop outs from treatment and the rate of relapse per month of treatment. Two studies were conducted to fulfill these aims: Study 1 and Study 2. Study 1 involved 90 late adolescents, aged 17-21. To fulfill the first aim, 30 inpatients diagnosed with SUD were compared with 30 healthy controls and 30 individuals referred to an outpatient neuropsychiatric unit (a). The participants completed the Toronto Alexithymia Scale-20 (TAS-20) and the Symptom Checklist-90-Revised (SCL-90-R). The results indicated that both clinical groups reported higher TAS-20 scores than the non-clinical subjects, but they did not differ from each other (a); moreover, a large correlation was detected between alexithymia and depressive symptoms, as assessed by the SCL-90-R. Study 2 involved 55 inpatients with SUD recruited in a therapeutic community. The participants completed the TAS-20, and clinicians filled out the Observer Alexithymia Scale (OAS). No association was found between self-report and observational measures. Neither self-reported nor observed alexithymia predicted the number of relapses, drop-out from treatment, or the rate of relapses per month of treatment (b). When the interaction with gender was explored, the global score of alexithymia and the "Distant" OAS subscale predicted the number rate relapses only in males. The TAS-20 did not discriminate between the clinical groups. The limited ability of both observed and self-reported measures in predicting treatment outcome raises questions on the specificity of alexithymia among the substance-dependent inpatient population

Measuring Interpersonal Dependency in Adolescent Psychiatric Inpatients

The successful inpatient treatment of emotionally troubled adolescents must facilitate their achievement of developmentally appropriate independence while minimizing the maladaptive dependency that can be fostered by the hospitalization experience. Levels of interpersonal dependency were measured in seven adolescent psychiatric inpatients over a ninety day period. The Interpersonal Dependency Inventory by Hirschfeld, Klerman, Gough, Barrett, Korchin, & Chodoff was utilized. The individual therapist of each participant independently assessed the participant\u27s response to hospitalization at forty-five and ninety days using a five point Leikert type scale. The study demonstrated no significant changes in dependency levels at forty-five and ninety days. The therapist\u27s assessment proved to have no relationship to levels of dependency as measured by The Interpersonal Dependency Inventory

An investigation of factors associated with depression in older adults

As the population ages, there is a need for continued research into the etiology of geriatric depression and improved ways to detect individuals at risk for developing this disorder. The current study explores relationships between depression, health perception, life satisfaction, and loneliness for 44 older (51-79) subjects. Relationships between the four variables and marital status, bereavement, monthly income, satisfaction with income, residence, occupation, education, size of household, and the number of living children and siblings are also examined; Descriptive statistics for the depression measures and their correlates are presented, followed by a breakdown of the measures by demographic characteristics. Furthermore, the results of correlational analyses with the major variables of interest are followed by the results of multiple regression analyses conducted for each of the depression measures. (Abstract shortened with permission of author.)

Systematic review of studies of mental health nurses' experience of anger and of its relationships with their attitudes and practice

IntroductionEmotional regulation is important in mental health nursing practice but individual emotions may require different regulation strategies. There is ample evidence that nurses experience anger specifically during their work, for example when experiencing patient aggression. It is, therefore, important to consolidate what is known about how anger manifests in mental health nursing practice.AimWe aimed to systematically identify, evaluate, and synthesise results from studies about mental health nurses and anger, where anger was measured objectively.MethodsSystematic literature review based on PRISMA guidelines.Results.We identified 12 studies. A range of validated and non-validated instruments were used. Mental health nurses may have lower levels of anger than normative samples but anger is commonly reported as an issue for them. Anger was studied in relation to its links with i) clinical management of patients, notably violence containment; and ii) employment issues more generally, notably job motivation. Anger is related to nurses’ attitudes about the acceptability of coercion but there is no evidence that it results in more coercion.Implications for practiceNurses should be aware of the potential influence of anger on their practice. Anger, specifically, should be considered when supporting mental health nurses, for example in clinical supervision. Emotional regulation training should target anger

Gambling addiction and life meaning

Addictive Gambling has plagued mankind for thousands of years. However, it has only recently been studied extensively. One proposed cause for addiction, which has been used in studying alcohol and drug abuse, is a lack of meaning in the addict\u27s life. However, a causal link between life meaning and gambling addiction has not yet been examined. This study used a sample of 355 normal people and compared scores on the South Oaks Gambling Screen (SOGS), the Purpose in Life (PIL) Test, the short form of the Beck Depression Inventory (BDI), and the Michigan Alcoholism Screening Test (MAST). Relationships between the level of gambling addiction, as shown on the SOGS, and the level of meaning in life, as shown on the PIL, were examined. The effect of depression on these variables, as measured on the short form of the BDI, was considered. The relationship of alcohol addiction to gambling and meaning in life, as measured on the MAST, was examined. The study found a mild negative correlation between scores on the SOGS and those on the PIL. This correlation increased as the level of alcoholism among the participants decreased

Verification of the Addiction Severity Index Japanese Version (ASI-J) as a Treatment-Customization, Prediction, and Comparison Tool for Alcohol-Dependent Individuals

Objective: To demonstrate the usefulness of the Addiction Severity Index Japanese Version (ASI-J) in Japanese alcohol-dependent individuals. The ASI is a frequently used clinical and research instrument that measures severities in seven functional domains in people with substance abuse disorders. Methods: A total of 370 male inpatients with a history of alcohol dependence participated in the study. Forty-nine participants were excluded in the final analysis due to lack of reliability (i.e., patient misrepresentation or inability to understand). We used the ASI-J and a series of indexes that determined patient states during and post-treatment. Results: The correlations between ASI Composite Scores (CSs), which were calculated through a weighted formula and indicated the severity of each problem area, were significant but low in eight relations and not significant in 13 relations, indicating substantial independence of the problem areas. Significant differences were found in Family/Social CSs between abstinent and relapsed alcohol-dependent individuals. The questions of undesirable attitude were significantly related to the CSs of Employment, Drug use, Family/Social, and Psychiatric sections. Significant differences were observed in patient demographics, CS, and ASI Severity Rating (SR) and interviewer’s subjective scoring between alcohol-dependent individuals and drug abusers. CSs in Japanese alcohol-dependent individuals were generally similar to corresponding CSs in individuals from other countries, with the exception of The Netherlands. Conclusions: This study demonstrated that the ASI-J is useful for understanding individual profiles of problems for each patient and planning customized treatment. The ASI-J served as a predictive tool for relapse and compliance to treatment afterward and was shown to be useful as a comparison tool in clarifying similarities and differences between substance abuser groups

A mixed methods survey to explore views of staff and patients in mental health inpatient wards prior to introduction of a digital early warning system for physical deterioration

Introduction Technological innovation offers opportunities to improve mental health care, however, little evidence exists regarding attitudes of inpatient staff and patients to such changes. We present a survey of staff and patients prior to introduction of a digital version of the National Early Warning Score (eNEWS) system for identifying physical deterioration. Aim To collate views of staff and inpatients related to prospective use of eNEWS, to inform the plan for implementation. Method Paper questionnaires were distributed to both groups in six wards prior to eNEWS implementation. Two discussion groups were then held. Results Eighty two staff and 26 inpatients completed questionnaires. Some inpatients expressed concerns about data confidentiality. Most staff were neutral or positive about the planned change, but raised possible safety risks and the risk of electronic recording being misinterpreted by patients. The implementation plan was modified in response to this information, principally by improving communication processes with patients. Discussion This study adds to the existing evidence by reporting specific staff and patient concerns towards a form of information technology. Further evaluations would help determine the transferability of these findings. Implications for Practice Listening to patient and staff views about planned technological innovation is essential for effective implementation