HIV positive black African women: attitudes to HIV, disclosure and psychological well-being

Objective: Using a sample of 56 HIV positive black African women, the study sought to explore the attitudes a HIV positive individual held towards persons with HIV and what the same individuals perceived the attitudes of their community to be towards individuals with HIV. The study also examined issues surrounding disclosure of HIV status and determined levels of psychological well being and health related quality of life. Design: A one group, cross sectional design, was used. Methods: Seven questionnaires were completed by the sample. In addition a small sub sample was interviewed about the factors affecting disclosure. Results: Respondents reported moderately liberal attitudes towards persons with HIV but perceived the community attitudes to be less liberal than their own. They had higher levels of HIV related mental distress, lower levels of support and poorer health related quality of life in comparison to other HIV samples. A mixture of social and psychological factors predicted mental health related quality of life and HIV distress. Disclosure decisions were considered to be affected by a range of factors including stigma management and the need to achieve psychological well being. Conclusions and implications: The results were discussed in terms of previous research. Implications for HIV positive African women were considered, with particular reference to the need for more cross culturally appropriate research

Informal Caregiving Relationships in Psychosis: Reviewing the Impact of Patient Violence on Caregivers

A modest association can be found between people with a schizophrenia spectrum diagnosis (psychosis) and perpetrating acts of violence. When a person with psychosis does engage in violence, it is their informal carers, when compared to those from the general population, who are more likely to be the targets, and violence will often occur within the family home. Despite the importance of carer support for improving patient outcomes, our understanding of how carers are impacted by patient initiated violence in psychosis remains limited. This paper reviews literature documenting the effects of patient-initiated violence in psychosis on carer functioning. The review comprised searches of Medline, PsychInfo, Embase, and Web of Science databases and the hand searches of reference lists from relevant published papers. The review was limited to English language publications from inception to 11th September 2017, and where carer experiences following reports of violence from patients with psychosis were specifically recorded. Data from 20 papers using mixed methodologies were reviewed. Patient violence in psychosis was linked to poorer carer outcomes, including carer reports of burden, trauma, fear, and helplessness. There is, however, a significant need for further studies to systematically quantify the impact and correlates of patient initiated violence on psychosis caregivers, and improve prevention

Delivering Cognitive-Behavioural Family Interventions for Schizophrenia

Background: In 1993, Kavanagh and colleagues outlined outcomes from a training programme designed to equip mental health practitioners to deliver evidence-based cognitive-behavioural family interventions within routine care. The authors highlighted how the training had not been able to deliver notable increases in the numbers of families being seen by the trained clinicians. There were significant issues in the translation and provision of family interventions within clinical settings, specifically difficulties with the integration of family interventions and caseload demands, and insufficient time within job plans and service settings to undertake the work. The authors posed the question: what can the matter be? Interestingly, the same question was being asked over a decade later. Objective: The current article provides a narrative review of the issues on implementation of family interventions in psychosis. Results: Current evidence suggests that while there exist pockets of good practice and provision for family interventions, it was a mistake to assume that care coordinators would be able to include these family interventions as part of their role, effectively to add duties without significant modification to their current roles and duties. It also seems to have been an underestimate of the skills required for delivering family work in psychosis and the ongoing requirements for high-quality supervision. Conclusion: We argue for carer specialists to be involved in mental health teams, particularly early intervention teams, and for a triage system to offer families a range of evidence-based support, as well as family interventions for more complex problems and presentations.</p

Exploring experiences with alcohol and how drinking has changed over time among minority ethnic groups with a diagnosed mental health problem

Introduction: Minority ethnic groups are more likely to experience poor mental health but lesslikely to seek formal support. Mental health problems and alcohol use (including non-drinking)co-occur, the reasons for this among minority ethnic groups are not well understood. This studyexplored i) alcohol use among minority ethnic individuals with a mental health problem,ii) howalcohol was used before individuals received support for their mental health,iii) how alcoholchanged whilst and after individuals received treatment for their mental health.Methods: Participants were purposively sampled through community/online mental healthorganisations. Participants took part if they i)were not White British, ii) had a mental healthdiagnosis, iii) drank at hazardous and above levels or former drinkers. Telephone/online semistructured interviews were conducted. Data were analysed using framework analysis with anintersectional lens.Results: 25 participants took part. Four themes were developed; “drinking motivations”, “mentalhealth literacy and implications on drinking behaviour”, “cultural expectations and its influenceon mental health problems and drinking practices”, and “reasons for changes in drinking”. Themesreflect reasons for drinking and the role of understanding the range of mental health problems andimplicit cultural expectations. An intersectional lens indicated gendered, ethnic and religiousnuances in experiences with alcohol and seeking support. Engaging with formal support promptedchanges in drinking which were facilitated through wider support.Conclusion: There were specific reasons to cope among minority ethnic individuals who have amental health problem. Applying an intersectional lens provided an insight into the role of culturaland gendered expectations on mental health and drinking practices. Mental health literacy andimplicit cultural expectations within specific minority ethnic groups can affect both mental healthand drinking practices. Healthcare professionals and wider community play an important role inprompting changes in drinking among minority ethnic groups who have a mental health problem.<br/

Real-world effectiveness of admissions to a tertiary treatment-resistant psychosis service: 2-year mirror-image study

Background Treatment-resistant schizophrenia is a major disabling illness which often proves challenging to manage in a secondary care setting. The National Psychosis Unit (NPU) is a specialised tertiary in-patient facility that provides evidence-based, personalised, multidisciplinary interventions for complex treatment-resistant psychosis, in order to reduce the risk of readmission and long-term care costs. Aims This study aimed to assess the long-term effectiveness of treatment at the NPU by considering naturalistic outcome measures. Method Using a mirror image design, we compared the numbers of psychiatric and general hospital admissions, in-patient days, acuity of placement, number of psychotropic medications and dose of antipsychotic medication prescribed before and following NPU admission. Data were obtained from the Clinical Records Interactive Search system, an anonymised database sourced from the South London and Maudsley NHS Trust electronic records, and by means of anonymous linkage to the Hospital Episode Statistics system. Results Compared with the 2 years before NPU admission, patients had fewer mental health admissions (1.65 ± 1.44 v. 0.87 ± 0.99, z = 5.594, P < 0.0001) and less mental health bed usage (335.31 ± 272.67 v. 199.42 ± 261.96, z = 5.195 P < 0.0001) after NPU admission. Total in-patient days in physical health hospitals and total number of in-patient days were also significantly reduced (16.51 ± 85.77 v. 2.83 ± 17.38, z = 2.046, P = 0.0408; 351.82 ± 269.09 v. 202.25 ± 261.05, z = 5.621, P < 0.0001). The reduction in level of support required after treatment at the NPU was statistically significant (z = −8.099, P < 0.0001). Conclusions This study demonstrates the long-term effectiveness of a tertiary service specialising in treatment-resistant psychosis