The LORS-enabled dialogue: improving insight in psychotic illnesses

Patients often underestimate the degree of their psychiatric illness and consequently have difficulty effectively participating in interventions to optimize recovery. This problem of insight may be connected with neurological difficulties resulting in poor explicit memory; however, most interventions nurses use to help patients improve their understanding of illness rely on explicit memory. The discrepancy between clinician and patient scores on the Levels of Recovery from Psychotic Disorders Scale (LORS) has been correlated with measures of insight and psychopathology. This difference can be used in a therapeutic dialogue, the LORS-Enabled Dialogue (LED). This intervention engages patients' implicit memory, asking a series of open-ended questions and using motivational interviewing to help promote patients' attainment of life goals. Large-scale studies of this intervention are currently underway and should help better define questions about the effectiveness of the LED.     

Long-acting injectable risperidone: an emerging tool in schizophrenia treatment

Long-term treatment of patients with schizophrenia remains challenging. Functional and cognitive declines associated with schizophrenia compromise patients' ability to adhere to therapy. While medications can improve outcomes, partial adherence limits effectiveness and is associated with relapse and rehospitalization. Partial adherence has been shown to be high with both oral conventional and oral atypical antipsychotic agents. While long-acting conventional antipsychotic agents provide ensured medication delivery and reduce relapse rates, they carry a substantial risk of movement disorders. A new long-acting formulation of the atypical agent risperidone has shown improved efficacy with decreased risk of adverse events. Its use, along with psychosocial approaches focused on adherence, may help, if initiated during inpatient treatment, by promoting adherence immediately postdischarge and improving long-term treatment outcomes.     

Beyond the prescription pad: psychosocial treatments for individuals with schizophrenia

Individuals with schizophrenia face multiple barriers to the achievement of optimal health, including apathy and poor concentration, sedative effects of medication, and poverty and lack of access to health education and treatment programs. In addition, the symptoms of the disease negatively affect their social functioning, which may result in isolation and lack of social support. In addition to providing psychiatric care and monitoring, both generalist nurses and advanced practice psychiatric nurses may assess physical and psychological risk factors, monitor medication responses, and provide health promotion to these individuals. Health promotion for individuals with schizophrenia includes psychosocial treatments to prevent relapse (e.g., education on the importance of treatment adherence) and to promote recovery (e.g., involving family members in treatment when possible). This article describes the key elements of recommended psychosocial treatments, briefly reviews the evidence for these treatments, and discusses clinical implications for all psychiatric nurses.     

Long-term safety of stimulant medications used to treat children with ADHD

Attention-deficit/hyperactivity disorder (ADHD) is a common mental health condition that affects children, adolescents, and adults. Because it is a chronic condition and typically requires effective treatment for several years or more, information on the benefits and risks of long-term pharmacotherapy for ADHD is vital to clinicians. This article reviews the emerging literature on the safety of long-term stimulant medications in ADHD-the most commonly prescribed medications for this condition. Common side effects, including cardiovascular effects, growth effects, and tics, are discussed, as well as treatment of children younger than age 6 and evidence of carcinogenic and reproductive effects.     

The best and worst of 2018, and hopes and fears for 2019

With public understanding growing every day about the need to address substance use disorders (SUDs) with the full array of health responses our nation deploys for other major illnesses, we hope to see great progress in the coming year. Progress should include dramatic expansion of all quality prevention, treatment services and medications, and recovery supports, with financial investment increased sufficiently to meet the need; full coverage of all SUD treatment services and medications by every state's Medicaid program and by Medicare; much stronger enforcement of federal and state requirements for parity in commercial insurance and Medicaid, including prohibitions on prior authorization, fail‐first, overly burdensome utilization review and inadequate reimbursement for care; availability of all effective and quality SUD treatment and medications at every level of the criminal justice system and throughout the child welfare system; and elimination of discriminatory barriers facing people still suffering or in recovery from SUD, including those with criminal histories, as they seek employment, housing, government benefits, the right to vote and other necessities of life.     

How Effective are Interventions to Enhance Adherence to Psychiatric Medications? Practice Implications for Social Workers Working With Adults Diagnosed With Severe Mental Illness

This study integrates eight systematic reviews of adherence enhancement interventions to develop practice guidelines for social workers who work with adults who do not adhere to prescribed psychiatric medications. Findings indicate that existing investigations are disparate in their adherence definitions, methodologies employed, and sampling strategies, rendering it difficult to construct overall guidelines for social work practice. However, themes associated consistently with increased adherence are collaboration between clients and providers regarding medication decisions, consistent follow-up care, and a comprehensive network of professionals and caregivers who support clients in their use of medication to facilitate stabilization of mental health symptoms.     

Group work in the mental health field: researching outcome

This paper reviews outcome studies from groups facilitated for persons living with serious mental illness. Although the research base is limited (groups posing considerable methodological challenges), available studies show that, in general, group work is as effective as individual work, if not more so. This paper describes findings from studies of short-term, long-term and self-help groups dealing with mood disorders, schizophrenia, eating disorders and borderline personality disorders over the last 10 years. The concept of ‘time-effective’ group work is discussed as are the potentially harmful effects of group participation. The paper concludes by arguing that group work is an effective and less expensive treatment option that would benefit from further research to establish an evidence base, both for current practice and for the expansion of group work practice in the future.     

ACHIEVING INDIVIDUALLY SUSTAINED COMMITMENT TO TREATMENT THROUGH SELF-CONSTRUCTED MODELS OF MEDICAL ADHERENCE

One of the main challenges facing medication adherence research is to provide a framework that allows patients and practitioners to effectively use the many efficacious treatments that will undoubtedly be developed in the new millennium. This framework, especially for chronic disorders, must be based on requiring patients to make the long-term behavioral changes needed to achieve a high level of commitment to these treatments. The best way to generate this high level of commitment is through a paradigm shift away from medical and patient models toward models that incorporate the social psychological literature focusing on how people's sense of self is constructed, enacted, and sustained over the life course. This review demonstrates the need, value, and appearance of this shift. First, it describes a previous paradigm shift in the medication adherence literature and then argues that a new paradigm shift is necessary. Second, it identifies and describes the models currently used in adherence research and notes three critical shortcomings of these models. Finally, it demonstrates how symbolic interaction's identity theory may be used creatively to overcome these shortcomings and convert efficacious treatments into effective treatments. Developing such an approach would well position the medication adherence research field for excellent contributions to the treatment of chronic disorders in the twenty-first century.     

How does the stigma of problem gambling influence help-seeking,treatment and recovery? a view from the counselling sector

Problem gambling attracts considerable public stigma and can cause significant self-stigma. However, little research has investigated the role of stigma during treatment-assisted recovery from problem gambling. This study aimed to examine gambling counsellors’ perspectives on whether and how the stigma associated with problem gambling influences problem acknowledgement, help-seeking, treatment and recovery. In-depth interviews with nine gambling counsellors from Victoria, Australia, were analysed to extract shared meanings of experiences using interpretative phenomenological analysis. Counsellors indicated that the burden of problem gambling is typically increased by the addition of stigma and its impacts. This stigma is created and maintained by a lack of public understanding about problem gambling and its causes, and internalization of self-stigmatizing beliefs, leading to delayed help-seeking, anxiety about attending treatment, concerns about counsellor attitudes, and fear of relapse. Counsellors maintained that, before effective gambling treatment could occur, they needed to help clients overcome their self-stigmatizing beliefs to establish confidence and trust in the counsellor, restore self-esteem, enhance stigma coping skills and foster a belief that recovery is possible. Harnessing support from significant others and preparing clients for relapse were also important inclusions to lower stigma. Addressing stigma early in treatment can help to improve treatment adherence and recovery.     

Mental Health on the Campus Revisited

Abstract

The author briefly reviews Mental Health on the Campus: A Field Study, published in 1973, noting areas of consensus and points of tension or disagreement that were reported in that study. He then assesses the extent to which the current state of mental health on the campus is an echo of that report. These comparisons form the basis for anticipating the probable direction of future developments in campus mental health. The areas and issues considered include the increased diversity of the student body, the stable incidence of psychotic disorders, the increased prevalence of gender-related diagnoses such as sexual abuse and eating disorders, the continuing financial pressures bearing on campus mental health programs, and the forms of care and treatment that fiscal and other circumstances are imposing. The author concludes that although the resources available and the particular challenges that are faced may have changed, the traditional goals of a campus mental health program, as articulated 75 years ago when the American College Health Association was founded, remain valid, even if they are difficult to attain.     

Revising a medication education program on an inpatient child and adolescent psychiatric unit

Adherence to a medication regimen can be challenging for children and adolescents with mental health disorders. Medication education can be a beneficial tool for nurses to help promote adherence to psychotropic medications. This article describes an initiative to improve medication education offered to children and adolescents and their families on an acute child and adolescent inpatient unit in a mental health facility. Strategies included adding a game to medication education groups, creating and distributing medication education handouts, and developing and implementing medication education sessions for parents. When used by the patients and families, the interventions were appreciated. Having successful interventions in place may help meet the diverse educational needs of this population as nurses seek to improve medication adherence.     

A Theory of Mental Health and Optimal Service Delivery for Homeless Children

Homeless children are a vulnerable group with high risk for developing mental health disorders. The pathways to disorders among homeless children have not been fully elucidated, with significant logistical and measurement issues challenging accurate and thorough assessment of need. The environments of homeless children are uniquely chaotic, marked by frequent moves, family structure changes, household and neighborhood disorder, parenting distress, and lack of continuous services. Despite high rates of service use, mental health outcomes remain poor. This paper reviews the literature on homeless children’s mental health, as well as prior theoretical explorations. Finally, the paper proposes a theoretical model that explains elevated rates of mental health problems among homeless children as consequences of harmful stress reactions triggered by chronic household instability along with repeated service disruptions. This model draws upon existing conceptual frameworks of child development, family poverty, health services utilization, and the biology of stress to clarify the role of environmental chaos in the development of child emotional and behavioral problems. Potential strategies to mitigate the risk for mental health disorders among homeless children and future research directions are discussed.     

Medication adherence

Although most patients will derive some benefit from appropriately prescribed medication for various mental disorders, many patients do not always take medication reliably. Therefore, medication adherence is a practically important issue in pharmacotherapy practice. In this article, I discuss the importance of medication adherence, the factors associated with poor adherence, and some approaches for improving adherence.     

The Service Provider and Medication Usage Grids: A New Method to Measure “Treatment as Usual” (TAU)

This article reviews the creation and evaluation of two instruments that measure “treatment as usual” (TAU) in a clinical research setting. The Service Provider and Medication Usage Grids were developed to assess children’s past and current utilization of mental health services and medications. A pilot study revealed that compared to information gathered from other sources, these instruments provide an accurate method to assess, record, and track TAU in clinical studies. In addition, these instruments provide a clear and concise way to organize this information and do not require much time to administer. Limitations and directions for future research are discussed.     

Predicting program success for adult offenders with serious mental illness in a court ordered diversion program

ABSTRACT

Individuals with mental illnesses are disproportionately involved with the criminal justice system and are now being diverted from jails to community-based supervision. This study examines secondary data from a state hospital, mental health diversion program. Logistic regression was used to examine risk factors that best predicted successful program completion. Results indicate that non-whites are more likely to complete. Participants in supervised housing, ever been re-hospitalized, diagnosed with a depressive or psychotic disorder or who had their probation revoked were less likely to complete. Findings indicate practitioners should provide a holistic and individually oriented treatment approach for success.     

Assessment & treatment of persons with pedophilia

1. Like any other form of major mental disorders, pedophilia is an AXIS-I diagnosis that warrants psychiatric treatment. 2. The combination of anti-androgenic medications and individual/group psychotherapy are common treatments for pedophilia. 3. The social stigmatization of pedophilia brands mental health professionals who provide treatment for pedophiles as supporters of illegal sexual acts against children rather than as professionals treating a psychiatric disorder.     

A framework for treating partner aggressive women

Women are increasingly referred to intervention programs to address their use of physical violence against intimate partners. This article reviews the scant treatment outcome and attrition literature for partner aggressive women and describes important characteristics of partner aggressive women that must be taken into consideration in designing treatment. Recommended treatment modules are described in detail and include skill-building to enhance safety planning, conflict management, emotional regulation, communication and negotiation, and stress management. Additional modules should be included for some women based on individualized needs. These may include parenting skills and education and referral for treatment of conditions that undermine emotional stability, such as posttraumatic stress symptoms, substance abuse, and mood disorders. Treatment structure is outlined and pragmatic issues regarding the implementation of treatment are discussed. Interventions for partner aggressive woman must be designed to address women's victimization experiences as well as their perpetration.     

Family psychoeducation and schizophrenia: a review of the literature

Family psychoeducation has emerged as a treatment of choice for schizophrenia, bipolar disorder, major depression, and other disorders. More than 30 randomized clinical trials have demonstrated reduced relapse rates, improved recovery of patients, and improved family well-being among participants. Interventions common to effective family psychoeducation programs have been developed, including empathic engagement, education, ongoing support, clinical resources during periods of crisis, social network enhancement, and problem-solving and communication skills. Application of family psychoeducation in routine settings where patients having these disorders are usually treated has been limited, reflecting attitudinal, knowledge, practical, and systemic implementation obstacles. Through consensus among patient and family advocacy organizations, clinician training, and ongoing technical consultation and supervision, this approach has been implemented in routine clinical settings.