Substance misuse brief interventions during psychiatric hospital admissions

Purpose: There are greater financial costs and negative impact on functioning associated with psychiatric admissions for people who experience co-occurring severe mental heath and substance misuse problems. In addition, their engagement in treatment is often problematic. Methodology: A brief integrated motivational intervention (BIMI) is described that was developed and pilotted in a randomised controlled trial to assess whether If given the opportunity to speak about their use of alcohol and/or drugs whilst on the ward, inpatients may be more “cognitively open” to think about their use and the impact it has on their mental health. Intervention: The BIMI is delivered in short burst of 15-30 mins over a two-week period and adopts a simple 3-step approach that can be delivered by routine ward staff. It incorporates: an assessment of substance use, mental health and motivation with personalised feedback; increasing awareness of the impact on mental health and facilitates the development of goals and a change plan.Findings: The intervention has been shown to lead to higher levels of engagement in clients’ exploration of alcohol and drug use and impacts on mental health. Findings suggest that both staff and inpatients found the intervention feasible and acceptable.Originality: Routine ward staff were trained to deliver a brief intervention to inpatients during an acute hospital admission. <br/

Substance misuse brief interventions during psychiatric hospital admissions

Purpose: To provide a summary of the principles, theories and basic components of a recently developed brief integrated motivational intervention (BIMI) for working with individuals experience co-ccurring severe mental health and substance use problems in inpatient settings, including the outcomes of a feasiblity randomised controlled trial (RCT). There are greater financial costs and a negative impact on functioning associated with psychiatric admissions for people who experience co-occurring severe mental heath and substance misuse problems. In addition, their engagement in treatment is often problematic. Design/methodology/approach: The BIMI described was evaluated via a feasibility RCT that assessed whether the opportunity to discuss use of substances whilst on an inpatient ward represented an opportunity to engage inpatients in thinking about their use and the impact it has on their mental health. Findings: The BIMI is delivered in short burst sessions of 15-30 minutes over a two-week period adopting a simple 3-step approach that can be delivered by routine ward staff. It incorporates an assessment of substance use, mental health and motivation followed by personalised feedback, a focus on increasing awareness of the impact on mental health and development of goals and a change plan. The intervention has been shown to lead to higher levels of engagement in clients exploration of substance use and the impact on mental health. Findings suggest both staff and inpatients found the intervention feasible and acceptable. Originality/value: Routine ward staff were trained to deliver a brief intervention to inpatients during an acute hospital admission

Mental health hospital admissions:a teachable moment and window of opportunity to promote change in drug and alcohol misuse

Hospital admissions provide a “teachable moment”. Many patients admitted to mental health hospitals have co-existing substance misuse. As acute symptoms decline, a window of increased insight into factors that contributed to becoming unwell and admission may present. This study used this “teachable” opportunity to assess the acceptability of delivering a brief integrated motivational intervention (BIMI) to inpatients and the feasibility of delivery by inpatient staff. Qualitative interviews were completed with 21 inpatients experiencing co-occurring schizophrenia-related or bipolar disorder diagnoses and substance misuse who received the BIMI. Twelve staff members completed either individual interviews or a focus group. Four themes were identified from the qualitative interviews with participants; these were openness/readiness to talk about substance use, feeling valued, understanding substance use and helpful skills and processes; each with a number of subthemes. Participants appeared to find the intervention useful; although, felt they did not always have the “headspace”. One theme emerged from the staff data, the acceptability of the approach for inpatient ward staff, which had four subthemes; training in the intervention; delivering the intervention; joint working; and feasibility. Staff considered the targeted style of the BIMI useful. Delivery considerations included “timing” and competing ward duties. Hospital admission presents a natural window of opportunity for staff to start conversations with inpatients about substance misuse

Transancestral mapping and genetic load in systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is an autoimmune disease with marked gender and ethnic disparities. We report a large transancestral association study of SLE using Immunochip genotype data from 27,574 individuals of European (EA), African (AA) and Hispanic Amerindian (HA) ancestry. We identify 58 distinct non-HLA regions in EA, 9 in AA and 16 in HA (∼50% of these regions have multiple independent associations); these include 24 novel SLE regions (P<5 × 10-8), refined association signals in established regions, extended associations to additional ancestries, and a disentangled complex HLA multigenic effect. The risk allele count (genetic load) exhibits an accelerating pattern of SLE risk, leading us to posit a cumulative hit hypothesis for autoimmune disease. Comparing results across the three ancestries identifies both ancestry-dependent and ancestry-independent contributions to SLE risk. Our results are consistent with the unique and complex histories of the populations sampled, and collectively help clarify the genetic architecture and ethnic disparities in SLE

Transancestral mapping and genetic load in systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is an autoimmune disease with marked gender and ethnic disparities. We report a large transancestral association study of SLE using Immunochip genotype data from 27,574 individuals of European (EA), African (AA) and Hispanic Amerindian (HA) ancestry. We identify 58 distinct non-HLA regions in EA, 9 in AA and 16 in HA (B50% of these regions have multiple independent associations); these include 24 novel SLE regions (Po5 10 8), refined association signals in established regions, extended associations to additional ancestries, and a disentangled complex HLA multigenic effect. The risk allele count (genetic load) exhibits an accelerating pattern of SLE risk, leading us to posit a cumulative hit hypothesis for autoimmune disease. Comparing results across the three ancestries identifies both ancestry-dependent and ancestry-independent contributions to SLE risk. Our results are consistent with the unique and complex histories of the populations sampled, and collectively help clarify the genetic architecture and ethnic disparities in SL

Rubin-Euclid Derived Data Products:Initial Recommendations

This report is the result of a joint discussion between the Rubin and Euclid scientific communities. The work presented in this report was focused on designing and recommending an initial set of Derived Data products (DDPs) that could realize the science goals enabled by joint processing. All interested Rubin and Euclid data rights holders were invited to contribute via an online discussion forum and a series of virtual meetings. Strong interest in enhancing science with joint DDPs emerged from across a wide range of astrophysical domains: Solar System, the Galaxy, the Local Volume, from the nearby to the primaeval Universe, and cosmology

Cognitive behavioural integrated treatment (C BIT) : a treatment manual for substance misuse in people with severe mental health problems/ Hermine L. Graham (et.al)

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A pilot study to assess the feasibility and impact of a brief motivational intervention on problem drug and alcohol use in adult mental health inpatient units : study protocol for a randomized controlled trial

Background: Substance misuse in those with severe mental health problems is common and associated with poor engagement in treatment and treatment outcomes. Up to 44% of those admitted into psychiatric inpatient facilities have coexisting substance-misuse problems. However, this is not routinely addressed as part of their treatment plan. A mental health admission may present a window of opportunity for inpatients to reevaluate the impact of their substance use. This study will aim to evaluate the effectiveness of a targeted brief motivational intervention in improving engagement in treatment and to assess how feasible and acceptable this intervention is to inpatients and staff as a routine intervention. Methods/Design: This randomized controlled trial will use concealed randomization; blind, independent assessment of outcome at 3 months; characterization of refusers and dropouts; and be analyzed according to the intention-to-treat principle. After baseline assessments, eligible participants will be randomized either to the Brief Integrated Motivational Intervention plus Treatment As Usual, or Treatment as Usual alone. Eligible participants will be those who are new admissions; >18 years; ICD-10 diagnosis of -schizophrenia or related disorder, bipolar affective disorder, recurrent depressive disorder, and DSM-IV diagnosis of substance abuse or dependence over the last 3 months. The primary outcome is engagement in treatment for substance misuse, and secondary outcomes include readiness to change substance misuse together with a cost-effectiveness analysis. Qualitative interviews with staff and participants will assess the acceptability of the intervention. Discussion: This pilot randomized trial will provide the first robust evidence base for inpatient care of people with severe mental health problems and co-morbid substance misuse and provide the groundwork for confirmatory trials to evaluate a potentially feasible, cost-effective, and easy-to-implement treatment option that may be readily integrated into standard inpatient and community-based care

A consultation-liaison service on integrated treatment : a program description

Objective: This article reports the results of an evaluation of a consultation-liaison service for people with combined mental health and substance use problems. The service is one component of an overall integrated service framework for this group of clients developed and delivered across one of the largest Mental Health Foundation Trusts in the UK. A full description of the client group referred to consultation-liaison over a 3-year period is provided, as well as a description of different referral pathways and a preliminary evaluation of a brief intervention offered as part of the service. Methods: Service evaluation data were collected through routine practice and provided demographic and diagnostic information on the clients who were referred to the consultation-liaison service (N = 173). A sample of these clients (n = 39) received a full brief motivational intervention consisting of six sessions delivered over a 12-week period. Quantitative questionnaire data collected for clients who received this component subsequently allowed a baseline and follow-up cohort assessment of changes on various substance-related outcomes in those receiving the brief intervention. Results: The results indicated that clients referred to the service (N = 173) were typically male (69.9%), in their mid-30s (M = 36.6 years, SD = 9.98) and considered to be white British (61.8%). They often presented with psychotic (52.6%) or depressive (16.8%) disorders and were commonly using alcohol (67.1%) or cannabis (47.4%). Of the clients who completed the full brief intervention (n = 39), baseline and follow-up outcome measures were available on a subsample (n ranged from 11 to 25 depending on each specific measure) and results showed significant changes in a number of areas, including increased engagement with treatment (p < .001), reduced alcohol (p = .001) and cannabis use (p = .015), fewer signs of hazardous alcohol use (p = .026), and improved confidence to change substance use (p = .006). These findings have to be considered as preliminary given the limitations of the service evaluation methodology. Conclusions: The consultation-liaison service appears to be a helpful component within an overall service framework for dual diagnosis in a number of ways, for example through the enhancement of existing services such as assessment, advice, and consultation, as well as the delivery of a brief intervention