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Clinical Problems in Community Mental Health Care for Patients with Severe Borderline Personality Disorder

The objective of this research was to assess the problems that professionals perceive in the community mental health care for patients with severe borderline personality disorder that do not fit into specialized therapy. A group of national experts (n = 8) participated in a four-phase Delphi-procedure to identify and prioritize the problems. A total of 36 problems reflecting five categories was found: patient-related, professional-related, interaction-related, social system-related, and mental health care-related. Problems with attachment and dependency and social issues were important patient problems while a lack of skills was an important professional problem. Support from the patient’s social system and the mental health system were identified as limited, which resulted in both the patient and the professional feeling isolated. Patient, professional, and organisational characteristics of community care differ substantially from those of specialized care. The field is thus in need of a more tailored approach that takes these differences into account

Development of an intervention program to increase effective behaviours by patients and clinicians in psychiatric services: Intervention Mapping study

BACKGROUND: Health clinicians perceive certain patients as 'difficult' across all settings, including mental health care. In this area, patients with non-psychotic disorders that become long-term care users may be perceived as obstructing their own recovery or seeking secondary gain. This negative perception of patients results in ineffective responses and low-quality care by health clinicians. Using the concept of illness behaviour, this paper describes the development, implementation, and planned evaluation of a structured intervention aimed at prevention and management of ineffective behaviours by long-term non-psychotic patients and their treating clinicians. METHODS: The principles of Intervention Mapping were applied to guide the development, implementation, and planned evaluation of the intervention. Qualitative (individual and group interviews), quantitative (survey), and mixed methods (Delphi-procedure) research was used to gain a broad perspective of the problem. Empirical findings, theoretical models, and existing evidence were combined to construct a program tailored to the needs of the target groups. RESULTS: A structured program to increase effective illness behaviour in long-term non-psychotic patients and effective professional behaviour in their treating clinicians was developed, consisting of three subsequent stages and four substantial components, that is described in detail. Implementation took place and evaluation of the intervention is being carried out. CONCLUSIONS: Intervention Mapping proved to be a suitable method to develop a structured intervention for a multi-faceted problem in mental health care

Relapse prevention in patients with schizophrenia : A nursing intervention study

This thesis describes a study into the development and testing of a nursing intervention with a view to preventing psychotic relapses in patients suffering from schizophrenia or a related disorder. The purpose of the intervention is to recognise the early signs of an oncoming psychotic relapse. If warning signs signalling the onset of a psychosis are adequately recognised at an early stage, action may be taken to prevent a serious psychotic episode and to help the patient regain his equilibrium. Following a general introduction in chapter 1, chapter 2 describes the results of a literature review. Chapter 3 focuses on a number of methodological aspects of developing interventions for nursing practice. Chapters 4 and 5 describe the results of an exploratory study into existing early recognition and early intervention practices. The study was carried out so as to gain a better understanding of the early recognition and early intervention methods that are already in place. In addition, the study focused on how patients, their families and health care professionals experienced those methods. A total of 25 qualitative interviews were held in six different settings. The two chapters are concluded by a schematic presentation showing the outlines of an early recognition and early intervention protocol. This schematic structure was worked out in greater detail in chapter 6.The draft protocol was presented for validation to a number of experts in the field of schizophrenia care. It was also tested in nine case studies on feasibility in nursing practice. Chapters 7 and 8 report on research that was carried out into the effects of the intervention protocol by means of a randomised controlled trial (RCT). Chapter 7 describes the results of a survey among nurses who participated in the RCT in the experimental group. A large majority of the nurses concluded that relapse prevention plans contributed greatly to the treatment of patients. They were optimistic about the practical application possibilities of working with a relapse prevention plan as part of their nursing relationship with the patients Chapter 8 of this thesis discusses the quantitative effects of intervention. The relapse percentage in the experimental group was 12.5% versus 26.2% in the control group. This difference is not significant (X2(1)=2.445; p=.12). The relative risk of a psychosis for patients in the control group was more than twice the risk rate for patients in the experimental group (1/RR=2.095 / CI 95%: 0.79<X<5.0). No significant or interpretable differences between the two groups could be discerned at the level of a number of secondary outcome variables (insight, quality of working alliance and use of anti-psychotic drugs). The results of the RCT are analysed in greater detail at the end of Chapter 8

Richtlijn schizofrenie 2012: basiszorg op het gebied van psychosociale interventies en verpleegkundige zorg.

Background An updated version of the Dutch multidisdplinaiy guideline on schizophrenia was published in 2012. aim We aim to provide an overview of the psychosocial interventions and nursing care which, according to the guideline, should be included in basic care programmes for patients with schizophrenia. We consider which interventions are effective and which are optional. In addition, we argue for continuous updating of the guideline so that it rejlects current developments. method We conducted a systematic review on the basis of specific predefined search terms. We included articles published up to February 2010. We used the methodfor evidence-based guideline development in order to formulate treatment recommendations. conclusion Cognitive behavioural therapy and Jamily interventions are scientifically proven interventions that should be included in the care programmes. Although there is no clear evidence that psycho-education is effective, it is nevertheless recommended. Optional interventions are peer support groups and, in the case of negative symptoms, psychomotor therapy. Although scientific evidence concerning nursing care is limited, we do make some recommendations. We are strongly in/avour of a 'living guideline' that is constantly developed and updated