34 research outputs found
Self-management interventions for people with severe mental illness: a systematic review and meta-analysis
BACKGROUND:
Self-management is intended to empower individuals in their recovery
by providing the skills and confidence they need to take active steps to recognise and
manage their own health problems. Evidence supports such interventions in a range
of long-term physical health conditions, but a recent systematic synthesis is not
available for people with severe mental health problems.
// AIMS:
To evaluate the effectiveness of self-management interventions for adults with
severe mental illness (SMI).
// METHODS:
A systematic review of randomised controlled trials was conducted. A
meta-analysis of symptomatic, relapse, recovery, functioning and quality of life
outcomes was conducted using Revman.
// RESULTS:
Thirty-seven trials were included with 5790 participants. From the metaanalysis, self-management interventions conferred benefits in terms of reducing
symptoms and length of admission, and improving functioning and quality of life
both at the end of treatment and at follow up. Overall the effect size was small to
medium. The evidence for self-management interventions on readmissions was
mixed. However, self-management did have a significant effect compared to control
on subjective measures of recovery such as hope and empowerment at follow up, and
self-rated recovery and self-efficacy at both time points.
// CONCLUSION:
There is evidence that the provision of self-management interventions
alongside standard care improves outcomes for people with severe mental illness.
Self-management interventions should form part of the standard package of care
provided to people with severe mental illness and should be prioritised in guidelines:
research on best methods of implementing such interventions in routine practice is
needed
Neoliberalism and University Education in Sub-Saharan Africa
This article reviews the history of university development in Sub-Saharan Africa (SSA) and discusses the impact of neoliberal policies. This will be followed by an examination of the problems facing universities in the region. The following questions will be explored: (a) Are the existing universities in SSA serving the development needs of the region? (b) Are these universities up to the task of moving SSA out of the predicaments it faces such as famine, HIV/AIDS, poverty, diseases, debt, and human rights abuses? Finally, the article argues that for universities to play a role in the development of the region, a new paradigm that makes university education a public good should be established
Current Data on and Clinical Insights into the Treatment of First Episode Nonaffective Psychosis: A Comprehensive Review
Implementing the most suitable treatment strategies and making appropriate clinical decisions about individuals with a first episode of psychosis (FEP) is a complex and crucial task, with relevant impact in illness outcome. Treatment approaches in the early stages should go beyond choosing the right antipsychotic drug and should also address tractable factors influencing the risk of relapse. Effectiveness and likely metabolic and endocrine disturbances differ among second-generation antipsychotics (SGAs) and should guide the choice of the first-line treatment. Clinicians should be aware of the high risk of cardiovascular morbidity and mortality in schizophrenia patients, and therefore monitoring weight and metabolic changes across time is mandatory. Behavioral and counseling interventions might be partly effective in reducing weight gain and metabolic disturbances. Ziprasidone and aripiprazole have been described to be least commonly associated with weight gain or metabolic changes. In addition, some of the SGAs (risperidone, amisulpride, and paliperidone) have been associated with a significant increase of plasma prolactin levels. Overall, in cases of FEP, there should be a clear recommendation of using lower doses of the antipsychotic medication. If no or minimal clinical improvement is found after 2 weeks of treatment, such patients may benefit from a change or augmentation of treatment. Clinicians should provide accurate information to patients and relatives about the high risk of relapse if antipsychotics are discontinued, even if patients have been symptom free and functionally recovered on antipsychotic treatment for a lengthy period of time.This review was carried out at the Hospital Marque´s de Valdecilla, University of Cantabria, Santander, Spain, with the following Grant support: Instituto de Salud Carlos III PI020499, PI050427, PI060507, Plan Nacional de Drugs Research Grant 2005-Orden sco/3246/2004, SENY Fundacio´ Research Grant CI 2005-0308007, Fundacio´n Marque´s de Valdecilla API07/011 and CIBERSAM