Quality of life in patients with severe mental illness: a cross-sectional survey in an integrated outpatient health care model

Purpose: This study (a) assessed quality of life (QoL) in a patient sample with severe mental illness in an integrated psychiatric care (IC) programme in selected regions in Germany, (b) compared QoL among diagnostic groups and (c) identified socio-demographic, psychiatric anamnestic and clinical characteristics associated with QoL. Methods: This cross-sectional study included severely mentally ill outpatients with substantial impairments in social functioning. Separate dimensions of QoL were assessed with the World Health Organisation’s generic 26-item quality of life (WHOQOL-BREF) instrument. Descriptive analyses and analyses of variance (ANOVAs) were conducted for the overall sample as well as for diagnostic group. Results: A total of 953 patients fully completed the WHOQOL-BREF questionnaire. QoL in this sample was lower than in the general population (mean 34.1; 95% confidence interval (CI) 32.8 to 35.5), with the lowest QoL in unipolar depression patients (mean 30.5; 95% CI 28.9 to 32.2) and the highest in dementia patients (mean 53.0; 95% CI 47.5 to 58.5). Main psychiatric diagnosis, living situation (alone, partner/relatives, assisted), number of disease episodes, source of income, age and clinical global impression (CGI) scores were identified as potential predictors of QoL, but explained only a small part of the variation. Conclusion: Aspects of health care that increase QoL despite the presence of a mental disorder are essential for severely mentally ill patients, as complete freedom from the disorder cannot be expected. QoL as a patient-centred outcome should be used as only one component among the recovery measures evaluating treatment outcomes in mental health care

International Expert Opinions and Recommendations on the Use of Melatonin in the Treatment of Insomnia and Circadian Sleep Disturbances in Adult Neuropsychiatric Disorders

Introduction: Insomnia and circadian rhythm disorders, such as the delayed sleep phase syndrome, are frequent in psychiatric disorders and their evaluation and management in early stages should be a priority. The aim of this paper was to express recommendations on the use of exogenous melatonin, which exhibits both chronobiotic and sleep-promoting actions, for the treatment of these sleep disturbances in psychiatric disorders. Methods: To this aim, we conducted a systematic review according to PRISMA on the use of melatonin for the treatment of insomnia and circadian sleep disorders in neuropsychiatry. We expressed recommendations for the use of melatonin in psychiatric clinical practice for each disorder using the RAND/UCLA appropriateness method. Results: We selected 41 studies, which included mood disorders, schizophrenia, substance use disorders, attention deficit hyperactivity disorders, autism spectrum disorders, neurocognitive disorders, and delirium; no studies were found for both anxiety and eating disorders. Conclusion: The administration of prolonged release melatonin at 2–10 mg, 1–2 h before bedtime, might be used in the treatment of insomnia symptoms or comorbid insomnia in mood disorders, schizophrenia, in adults with autism spectrum disorders, neurocognitive disorders and during sedative-hypnotics discontinuation. Immediate release melatonin at <1 mg might be useful in the treatment of circadian sleep disturbances of neuropsychiatric disorders

Intensive Outpatient Treatment Program for Patients with Depressive Disorder: A Parental Perspective

Psychosocial support from family is important in outpatient treatment programs for individuals with depressive disorder. The purpose of this phenomenological study was to explore the lived experiences and perceptions of parents of patients with depressive disorder regarding intensive outpatient treatment. The research question was what are the experiences and perceptions of parents of patients with depression regarding their role as caretakers in intensive outpatient treatment? The conceptual framework was a biopsychosocial framework and family systems theory. Content analysis was used to analyze data provided from interviews with parent participants (n = 8). Many participants reported high levels of involvement with various forms of support. They maintained positive relations with professionals, were involved in patient socialization, and facilitated adherence to patients\u27 treatment plans. The results of this study indicated that family caregivers experienced ambivalent emotions toward their roles and patients. Findings also indicated experiences of exhaustion, strong emotions about the burden of having to support the patient, and concern for their own and the rest of the family\u27s well-being. Future researchers should study these aspects further. Researchers, clinical practitioners, and policy makers must increase efforts to support those who help family members suffering from depression to intensify the search for effective ways to reduce the toll on those caregivers. Because of these findings, researchers could expand literature to illuminate the decisions and practices of psychotherapists, leading to improvements in intensive treatment programs for both patients and their caretakers. This study impacts social change by providing insights to aid policy makers in ensuring that outpatients receive the best treatment program available and that their primary caretakers are psychologically prepared and healthy

Differences Between Introverts and Extraverts with Bipolar Disorder

People living with bipolar disorder have vastly different presentations and experiences despite sharing a common diagnosis. While some research has explored the role of temperament in these different presentations (Azorin, Adida, & Belzeaux, 2015; Graham, Parker, Breakspear, & Mitchell, 2015; Iasevoli et al., 2013), little is currently known about whether individuals’ levels of introversion or extraversion are related to the symptoms they experience or their general way of understanding their experiences with bipolar disorder. For this study, participants were asked to complete an online survey that measured their level of extraversion, their symptoms of mania, and background information concerning their diagnosis and treatment history. Participants were also asked to complete an open-ended questionnaire about their subjective experiences with bipolar disorder. This study used a qualitative design. Qualitative data collected from three responses were analyzed using Interpretive Phenomenological Analysis (IPA) in order to gain a better understanding of how introverted and extraverted individuals with bipolar disorder make sense of their experiences. Several major clusters of themes were identified from the participants’ descriptions of their experiences: (a) common symptoms, (b) atypical experiences, (c) initial awareness of manic episode, (d) negative effects of symptoms, (e) positive experiences of symptoms, (f) seeking support, (g) most and least helpful coping mechanisms, and (h) effect on identity. While several of their experiences overlapped, some differences were noted in how participants of varying levels of extraversion described their experiences within each theme

Neuro-informed Music Therapy for the Treatment of Anxiety and Depression: A Literature Review

This capstone thesis project is a literature review of research specifically regarding the neuroscience and neurochemistry of music and how it can inform music therapy treatment of mental health. Mental health is a large, overarching term that includes many disorders that refer to one’s psychological and/or emotional condition(s), which further includes an individual’s social well-being. This can include, but is not limited to, depression, anxiety, schizophrenia, and obsessive-compulsive disorder (OCD). This paper will focus in on a research-based, neuro-informed music therapy treatment of anxiety and depression. The goal of this paper was to provide research toward a future method in music therapy where therapists can take a research based and neuro-informed approach to treating anxiety and depression. With the current available research, it can be suggested that a neuro-informed music therapy approach can be used to treat mood disorders, specifically anxiety and depression, however, further research will be needed to support this method

The role of psychosocial stress on a family-based treatment for adolescents with problematic behaviors

The stressful life events experienced by adolescents with problematic behaviors, should be considered for implementing effective interventions. This study aimed to examine the adjustment of adolescents with problematic behaviors, and to assess the effectiveness of a family-based treatment, namely Scene-Based Psychodramatic Family Therapy (SB-PFT), according to different stress profiles. Ten SB-PFT sessions, over 17 trials were implemented. Stressful life events and adolescent adjustment were evaluated at pretest and posttest, for the SB-PFT participants (n = 104 adolescents) and a control group (n = 106). The adolescents were categorized into three profiles depending on the nature of the stressors: family stress profile, individual and family stress profile, and low stress profile. The individual and family stress group showed worse adjustment. Effectiveness analyses revealed improvements in SB-PFT participants’ emotional intelligence, but not in anger and hostility. Furthermore, adolescents with low and family-related stress profiles showed enhancements in parent attachment. In conclusion, interventions involving adolescents with problematic behaviors must be tailored to the stressful life events experienced. Specific treatments should be used alongside SB-PFT, when adolescents are met with individual-related stress. Nevertheless, SB-PFT seemed to promote emotional intelligence and parent attachment, particularly in adolescents with problematic behaviors that experienced only family stressors.Ministerio de Economía, Industria y Competitividad EDU2013-41441-PMinisterio de Educación, Cultura y Deportes FPU Program-311

Re-examining adolescent bipolar disorder and related psychopathology using meta-analysis and item response theory

The aims of this thesis were to summarise and synthesise the current research into BD; critically evaluate existing literature to assess whether age of onset is associated with poorer outcomes in BD; and examine whether individual symptoms may be clinically useful as risk markers in childhood and adolescence. Study one was a meta-analysis of existing research investigating outcomes associated with an early onset of BD. Data was analysed from fifteen papers that compared clinical presentation and outcomes in BD grouped according to age of onset (Total n = 7370). Clinical features found to have the strongest relationship with an earlier age of onset were those amenable to intervention such as comorbid anxiety, substance use, and treatment delay. Study two used a novel analytical approach to evaluate whether individual clinical symptoms differed in their capacity to discriminate between those scoring high and low on underlying traits of depression and mania; or in the information they provided in relation to severity. The sample consisted of n=186 participants aged 12–21yrs including n=105 with a first degree relative diagnosed with BD (At Risk); n=63 control participants; and n=18 with a confirmed diagnosis of BD. Results support hypotheses from previous research that specific mood symptoms are more informative of risk in BD than general symptoms; and are in line with previous findings that indicate increased energy is a core feature of mania. These findings are important in relation to ongoing controversy around diagnoses of paediatric BD, and the broadening of diagnostic criteria. Overall, the studies in this thesis provide information useful to clinicians in identifying at risk populations that may benefit from early support, monitoring and intervention; and identify key risk areas in adolescent populations informing important areas of future research