Symptomatic and functional remission in young adults with a psychotic disorder in a rehabilitation focused team

The aim of this study is to assess symptomatic remission (SR) and functional remission (FR) in a rehabilitation focused program for young adults with a psychotic disorder in the Netherlands, and to investigate which individual and mental health care (MHC) factors are associated with SR and/or FR, by using Routine Outcome Monitoring data and data on met needs and unmet needs for care. Data of 287 young adults were collected. Almost 40% achieved or maintained SR, 34% FR, and 26% achieved or maintained both. In addition to sociodemographic factors, living independently, paid employment, higher levels of compliance with treatment, and better fulfillment of unmet needs for care in relation to psychological distress, company and daytime activities were associated with better outcomes on SR and/or FR. Our findings underscore that to successfully improve and sustain remission in young adults with a psychotic disorder, it is needed to conduct specific research into the relationship between SR and FR

The development and psychometric evaluation of the Questionnaire Epistemic Trust (QET):A self-report assessment of epistemic trust

Epistemic trust (ET) refers to the predisposition to trust information as authentic, trustworthy and relevant to the self. Epistemic distrust - resulting from early adversity - may interfere with openness to social learning within the therapeutic encounter, reducing the ability to benefit from treatment. The self-report Questionnaire Epistemic Trust (QET) is a newly developed instrument that aims to assess ET. This study presents the first results on the psychometric properties of the QET in both a community and a clinical sample. Our findings indicate that the QET is composed of four meaningful subscales with good to excellent internal consistency. The QET shows relevant associations with related constructs like personality functioning, symptom distress and quality of life. QET scores clearly distinguish between a clinical and community sample and are associated with the quality of the therapeutic alliance. The QET provides a promising, brief and user-friendly instrument that could be used for a range of clinical and research purposes. Future studies with larger samples are needed to strengthen construct validity and to investigate the value of the QET to predict differential treatment responses or to study mechanisms of change

Identifying social participation subgroups of individuals with severe mental illnesses:a latent class analysis

Purpose To investigate factors that influence participation in and needs for work and other daytime activities among individuals with severe mental illnesses (SMI). Methods A latent class analysis using routine outcome monitoring data from 1069 patients was conducted to investigate whether subgroups of individuals with SMI can be distinguished based on participation in work or other daytime activities, needs for care in these areas, and the differences between these subgroups. Results Four subgroups could be distinguished: (1) an inactive group without daytime activities or paid employment and many needs for care in these areas; (2) a moderately active group with some daytime activities, no paid employment, and few needs for care; (3) an active group with more daytime activities, no paid employment, and mainly met needs for care; and (4) a group engaged in paid employment without needs for care in this area. Groups differed significantly from each other in age, duration in MHC, living situation, educational level, having a life partner or not, needs for care regarding social contacts, quality of life, psychosocial functioning, and psychiatric symptoms. Differences were not found for clinical diagnosis or gender. Conclusions Among individuals with SMI, different subgroups can be distinguished based on employment situation, daytime activities, and needs for care in these areas. Subgroups differ from each other on patient characteristics and each subgroup poses specific challenges, underlining the need for tailored rehabilitation interventions. Special attention is needed for individuals who are involuntarily inactive, with severe psychiatric symptoms and problems in psychosocial functioning

Symptomatic and Functional Remission in Young Adults with a Psychotic Disorder in a Rehabilitation Focused Team

The aim of this study is to assess symptomatic remission (SR) and functional remission (FR) in a rehabilitation focused program for young adults with a psychotic disorder in the Netherlands, and to investigate which individual and mental health care factors are associated with SR and/or FR, by using Routine Outcome Monitoring data and data on met needs and unmet needs for care. Data of 287 young adults were collected. Almost 40% achieved or maintained SR, 34% FR, and 26% achieved or maintained both. In addition to sociodemographic factors, living independently, paid employment, higher levels of compliance with treatment, and better fulfillment of unmet needs for care in relation to psychological distress, company and daytime activities were associated with better outcomes on SR and/or FR. Our findings underscore that to successfully improve and sustain remission in young adults with a psychotic disorder, it is needed to conduct specific research into the relationship between SR and FR

Clients’ experiences of the Boston Psychiatric Rehabilitation Approach: A qualitative study

The Boston Psychiatric Rehabilitation Approach (BPR) is person-centered and characterized by being based entirely on the individual's unique needs and preferences in the areas of working, learning, social contacts, and living environment. Nevertheless, the person-centered approach is lacking firm evidence regarding outcomes, and empirical studies regarding clients’ experiences of this particular model are needed. A qualitative content analysis of 10 transcribed semistructured individual interviews was used to describe and explore clients’ experiences of the BPR during an implementation project in Sweden. The findings from the interviews could be summarized in “A sense of being in communion with self and others” theme, consisting of three categories: increased self-understanding, getting new perspectives, and being in a trusting relationship. The results showed that clients do not always recognize nor are able to verbalize their goals before they have been given the possibility to reflect their thoughts in collaboration with a trusted person. The guidelines of the approach are intended to support the clients’ ability to participate in decision making regarding their own care. More research about efficacy of different rehabilitation approaches and exploration of fidelity to guidelines of rehabilitation programs are required

Routine outcome monitoring en benchmarking: hoe kunnen we behandelresultaten op een zorgvuldige manier vergelijken?

Contains fulltext : 157216.pdf (publisher's version ) (Open Access)Achtergrond: Het structureel meten van de resultaten van een behandeling in de geestelijke gezondheidszorg en het vergelijken daarvan tussen instellingen helpen om inzicht te krijgen in het effect van behandelingen in de reguliere praktijk. Doel: Geven van een overzicht van de kwesties die van belang zijn bij het vergelijken van instellingen. Methode: Analyseren van documentatie en beleidsinformatie over en praktijkervaring met routine outcome monitoring (rom). Resultaten: We beschrijven knelpunten die kunnen ontstaan bij het vergelijken van instellingen en formuleren oplossingsrichtingen voor deze knelpunten. Daarbij staat centraal dat het werken met rom een groeiproces is, waarbij men experimenteert met verschillende oplossingsrichtingen en op basis van ervaringen definitieve keuzes maakt. Conclusie: Het is leerzaam om instellingen te vergelijken, zowel onderling als met 'best practices' (benchmarking). Instellingen verschillen echter in cliëntenpopulaties, meetprocedures en instrumentarium. Een zinvolle vergelijking is op termijn toch mogelijk.5 p

An argument for physician-assisted suicide and against euthanasia

The article opens with the hypothesis that the default position that should guide healthcare providers when treating patients at the end-of-life is that patients opt for life. In the absence of an explicit request to die, we may assume that patients wish to continue living. Thus, the role of the medical profession is to provide patients with the best possible conditions for continued living. The article makes a case for physician-assisted suicide legislation. It examines the 'quality-of-life' argument, and the issue of the patient's autonomy and competence. It is argued that (1) quality-of-life is a subjective concept. Only the patient can conclude for herself that her quality-of-life is so low to warrant ending it, and that (2) only competent patients may request ending their lives. Patients' lives should not be actively terminated by the medical team without the explicit consent of patients. The article then probes the role of physicians at the end-of-life, arguing that medicine should strive to cater to the wishes of all patients, not only the majority of them. Physicians should not turn their backs to justified requests by their patients. Physicians are best equipped to come to the help of patients at all stages of their illness, including their end-of-life. At the same time, in ending life, the final control mechanism should be with the patient. Thus, physician-assisted suicide is preferred to euthanasia in order to lower the possibility of abuse and of ending the lives of patients without their consent and against their wishes. As matters of life and death are grave, they should be taken with utmost seriousness, requiring the instalment of ample checks against abuse and facilitating mechanisms designed to serve the patient's best interests. The article concludes with 19 careful and detailed guidelines for physician-assisted suicide. These are necessary measures designed to ensure that the best interests of the patients are served as they wished.RésuméL’article commence par l’hypothèse que la position par défaut qui doit guider les fournisseurs de soins de santé lors du traitement de patients à la fin de la vie est que les patients optent pour la vie. En l’absence d’une demande explicite de mourir, nous pouvons supposer que les patients souhaitent continuer à vivre. Ainsi, le rôle de la profession médicale est de fournir aux patients les meilleures conditions possibles pour poursuivre la vie. L’article fait un cas pour la législation du suicide assisté par un médecin. Il examine l’argument « qualité de vie », et la question de l’autonomie et de la compétence du patient. On fait valoir que (1) la qualité de vie est un concept subjectif. Seul le patient peut conclure pour lui-même que sa qualité de vie est si faible pour justifier y mettre fin, et (2) que les seul le patient compétent peut demander de mettre fin à sa vie. Il ne devrait pas être mis fin activement à la vie des patients par l’équipe médicale sans le consentement explicite des patients. L’article explore ensuite le rôle des médecins à la fin de la vie, en faisant valoir que la médecine doit s’efforcer de répondre à toutes les attentes des patients, pas seulement à la majorité d’entre elles. Les médecins ne devraient pas tourner le dos aux demandes motivées de leurs patients. Les médecins sont les mieux équipés pour venir en aide à leurs patients à tous les stades de leur maladie, y compris en fin de vie. Dans le même temps, en fin de vie, le mécanisme de réglage final doit se faire avec le patient. Ainsi le suicide médicalement assisté est préférable à l’euthanasie pour réduire les abus comme mettre fin à la vie des patients sans leur consentement ou contre leur volonté. Comme les questions de la vie et de la mort sont graves, elles doivent être prises avec le plus grand sérieux. L’article conclut sur 19 directives précises et détaillées concernant le suicide médicalement assisté. Ces mesures nécessaires visent à assurer le meilleur intérêt des patients