Mental Health Matters

Patients Dependent on Benzodiazepines: Make Alliances

Published on 01/23/202001/19/2020 by Andrew MarshallLeave a comment

Research Paper Title

Making Alliances With Patients Dependent on Benzodiazepines: A Provider’s Experience.

Abstract

Tens of millions of benzodiazepine (BZD) prescriptions are written annually for the outpatient management of anxiety disorders and insomnia.

Many prescribers do not follow published treatment guidelines for these disorders.

Psychiatric-mental health nurse practitioners (PMHNPs) regularly meet patients who have been treated with BZDs for years.

The dangers posed by outpatient BZD use are recognised, especially among older adults, and their use should be minimised or eliminated.

There are multiple manualised approaches to outpatient down-titration of BZDs, but little evidence about which methods really work.

To effect change, it is essential that PMHNPs establish a sound therapeutic alliance with these patients, especially by using their skills in therapeutic communication.

One major conflict that may occur early in the relationship is the patient’s expectation that the BZD medication regimen will continue indefinitely and their unwillingness to risk discontinuing the drug.

This conflict commonly raises non-adherence to a down-titration plan or patient termination of the relationship.

It is essential that PMHNPs take the time and patience to build strong therapeutic alliances with patients to design and implement a successful BZD discontinuation regimen.

Reference

Amberg, A. (2020) Making Alliances With Patients Dependent on Benzodiazepines: A Provider’s Experience. Journal of Pyschosocial Nursing and Mental Health Services. 58(1), pp.29-32. doi: 10.3928/02793695-20191218-06.

Suicide in Older Adults: A Critical Problem

Published on 01/22/202001/19/2020 by Andrew MarshallLeave a comment

Research Paper Title

Suicide in Older Adults.

Abstract

Suicide in older adults is a critical problem that nurses and other health professionals need to address. Evidence-based interventions for prevention of late-life suicide are urgently needed, as well as increased availability of health care professionals with knowledge and skills to recognise suicide risks and intervene to provide effective care for this vulnerable population.

Reference

Sorrell, J.M. (2020) Suicide in Older Adults. Journal of Psychosocial Nursing and Mental Health Services. 58(1), pp.17-20. doi: 10.3928/02793695-20191218-04.

Examining the Role the Inflammatory Process & Immune System Play in Mental Disorder

Published on 01/21/202001/19/2020 by Andrew MarshallLeave a comment

Research Paper Title

Inflammatory Response and Treatment-Resistant Mental Disorders: Should Immunotherapy Be Added to Pharmacotherapy?

Abstract

Treatment resistance continues to challenge and frustrate mental health clinicians and provoke psychiatric researchers to seek additional explanatory theories for psychopathology.

Because the inflammatory process activates symptoms of depression, anxiety, and psychosis, it is a reasonable route to follow for primary and/or indirect contribution to mental disorders.

The current article reviews the research literature regarding the role the inflammatory process and immune system play in mental disorders as well as novel treatments under investigation for resistant depression, anxiety, substance use, and psychotic disorders.

Reference

Limandri, B.J. (2020) Inflammatory Response and Treatment-Resistant Mental Disorders: Should Immunotherapy Be Added to Pharmacotherapy? Journal of Psychosocial Nursing and Mental Health Services. 58(1), pp.11-16. doi: 10.3928/02793695-20191218-03.

MedSupport: Patient Perceptions & Perceived Support

Published on 01/20/202001/19/2020 by Andrew MarshallLeave a comment

Research Paper Title

Enabling patients to cope with psychotropic medication in mental health care: Evaluation and reports of the new inventory MedSupport.

Background

This cross sectional study examined patients’ perceptions of professional support regarding use of psychotropic medication in a specialist mental health care setting.

The aims were to evaluate reliability and validity of the MedSupport inventory, and investigate possible associations between MedSupport scores and patient characteristics.

Methods

A cross-sectional study was performed. The patients completed the MedSupport, a newly developed self-reported 6 item questionnaire on a Likert scale ranged 1 to 5 (1 = strongly disagree to 5 = strongly agree), and the Beliefs about Medicines Questionnaire.

Diagnosis and treatment information were obtained at the clinical visits and from patient records.

Among the 992 patients recruited, 567 patients (57%) used psychotropic medications, and 514 (91%) of these completed the MedSupport and were included in the study.

Results

The MedSupport showed an adequate internal consistency (Cronbach alpha.87; 95% CI.86-89) and a convergent validity toward the available variables.

The MedSupport mean score was 3.8 (standard deviation.9, median 3.8).

Increasing age and the experience of stronger needs for psychotropic medication were associated with perception of more support to cope with medication, whereas higher concern toward use of psychotropic medication was associated with perception of less support.

Patients diagnosed with behavioural and emotional disorders, onset in childhood and adolescence perceived more support than patients with Mood disorders.

Conclusions

The MedSupport inventory was suitable for assessing the patients’ perceived support from health care service regarding their medication.

Awareness of differences in patients’ perceptions might enable the service to provide special measures for patients who perceive insufficient medication support.

Reference

Drivenes, K., Vederhus, J.K., Haaland, V.Ø., Ruud, T., Hauge, Y.L., Regevik, H., Falk, R.S. & Tanum, L. (2020) Enabling patients to cope with psychotropic medication in mental health care: Evaluation and reports of the new inventory MedSupport. Medicine (Baltimore). 99(1):e18635. doi: 10.1097/MD.0000000000018635.

New Channel 4 TV Series on Mental Health – Losing It: Our Mental Health Emergency

Published on 01/20/202001/19/2020 by Andrew MarshallLeave a comment

Introduction

As attitudes to mental health change during a surge in the number of people asking for help or harming themselves, this series joins the frontline care services in Nottinghamshire

Outline Series 01

Channel 4 begins broadcasting a new series on mental health on Tuesday 21 January 2020 at 10 pm.

Titled Losing It: Our Mental; Health Emergency, the series gains access to Nottinghamshire Healthcare, one of the UK’s largest mental health trusts.

With demand rising and resources stretched like never before, this series explores the unprecedented pressure on mental health services and the seemingly impossible decisions that clinicians have to make every day.

The series places viewers at the heart of the complex decision-making process, giving a unique insight into the pressures and challenges mental health trusts and patients must deal with daily.

Told with a frank first person perspective, this series gives a very personal view of mental illness in 2019; the tragedy, humour and complex challenges.

Outline Series 01, Episode 01

Two weeks after becoming a mum, Laura is sectioned having tried to drive into a brick wall.

And is 11-year-old Briena really suicidal, or is the underlying diagnosis more complicated?

About Nottinghamshire Healthcare NHS Foundation Trust

Nottinghamshire Healthcare provides integrated healthcare services, including mental health, intellectual disability and physical health services.

Over 9000 dedicated staff provide these services in a variety of settings, ranging from the community through to acute wards, as well as secure settings.

The Trust manages two medium secure units, Arnold Lodge in Leicester and Wathwood Hospital in Rotherham, and the high secure Rampton Hospital near Retford.

It also provides healthcare in prisons across the East Midlands.

Its budget for 2019/20 is £465m.

Why Do It?

The Trust made the decision to take part in the series in April 2019 to try and further reduce the stigma associated with mental illness.

The production company, Story Films, has an impressive track record in making sensitive films that deal with difficult topics.

Filming took place across Nottinghamshire during the summer of last year and features patients with a wide variety of diagnoses, including young people, families and people in crisis.

Production & Filming Details

Production: Story Films.
Distributor: Channel 4.
Release Date: 21 January 2020 (UK).
Running Time: 50 minutes.

A Review of Effective/Cost Effective Interventions of Child Mental Health Problems in Low- and Middle-Income Countries (LAMIC)

Published on 01/17/202001/12/2020 by Andrew MarshallLeave a comment

Research Paper Title

Effective/cost effective interventions of child mental health problems in low- and middle-income countries (LAMIC): Systematic review.

Background

This systematic review protocol aims to examine the evidence of effectiveness and cost-effectiveness of interventions for children and adolescents with, or at risk of developing mental disorders in low- and middle-income countries (LAMICs).

Methods

The researchers will search Medline Ovid, EMBASE Ovid, PsycINFO Ovid, CINAHL, LILACS, BDENF and IBECS. We will include randomised and non-randomised controlled trials, economic modelling studies and economic evaluations.

Participants are 6 to 18 year-old children and adolescents who live in a LAMIC and who present with, or are at high risk of developing, one or more of the conditions: depression, anxiety, behavioural disorders, eating disorders, psychosis, substance abuse, autism and intellectual disabilities as defined by the DSM-V.

Interventions which address suicide, self-harm will also be included, if identified during the extraction process.

The researchers will include in person or e-health interventions which have some evidence of effectiveness (in relation to clinical and/or functional outcomes) and which have been delivered to young people in LAMICs.

They will consider a wide range of delivery channels (e.g., in person, web-based or virtual, phone), different practitioners (healthcare practitioners, teachers, lay health care providers) and sectors (i.e., primary, secondary and tertiary health care, education, guardianship councils).

In the pilot of screening procedures, 5% of all references will be screened by two reviewers.

Divergences will be resolved by one expert in mental health research.

Reviewers will be retrained afterwards to ensure reliability. The remaining 95% will be screened by one reviewer.

Covidence web-based tool will be used to perform screening of references and full text paper, and data extraction.

Results

The protocol of this systematic review will be disseminated in a peer-reviewed journal and presented at relevant conferences.

The results will be presented descriptively and, if possible, meta-analysis will be conducted. Ethical approval is not needed for anonymised secondary data.

Conclusions

The systematic review could help health specialists and other professionals to identify evidence-based strategies to deal with child and adolescents with mental health conditions.

Reference

Grande, A.J., Ribeiro, W.S., Faustino, C., de Miranda, C.T., Mcdaid, D., Fry, A., de Moraes, S.H.M., de Oliveira, S.M.D.V.L., de Farias, J.M., de Tarso Coelho Jardim, P., King, D., Silva, V., Ziebold, C. & Evans-Lacko, S. (2020) Effective/cost effective interventions of child mental health problems in low- and middle-income countries (LAMIC): Systematic review. Medicine (Baltimore). 99(1):e18611. doi: 10.1097/MD.0000000000018611.

Veterans: We’re Afraid to Say Suicide

Published on 01/16/202003/23/2020 by Andrew MarshallLeave a comment

Research Paper Title

“We’re Afraid to Say Suicide”: Stigma as a Barrier to Implementing a Community-Based Suicide Prevention Program for Rural Veterans.

Background

Suicide is a significant public health concern for veterans residing in rural communities.

Although various initiatives have been implemented to prevent suicide among veterans, efforts specific to rural veterans remain limited.

Methods

To aid such efforts, the researchers examined stigma as a potential barrier to community readiness in the implementation of a community-based suicide prevention program for rural veterans.

In this qualitative study, community readiness interviews were conducted with 13 participants in a rural community.

Themes included lack of awareness regarding veteran suicide, rare discussions of veteran suicide, and suicide-related stigma within the community.

Results

Results suggest that prioritising destigmatisation may be particularly important to implementing community-based suicide prevention programming in rural communities.

Conclusions

In particular, addressing community misconceptions regarding veteran suicide, while increasing knowledge of the extent to which veteran suicide occurs locally may facilitate increased awareness and thus community readiness to prevent suicide among rural veterans.

Reference

Monteith, L.L., Smith, N.B., Holliday, R., Dorsey Holliman, B.A., LoFaro, C.T. & Mohatt, N.V. (2019) “We’re Afraid to Say Suicide”: Stigma as a Barrier to Implementing a Community-Based Suicide Prevention Program for Rural Veterans. The Journal of Nervous and Mental Disease. doi: 10.1097/NMD.0000000000001139. [Epub ahead of print].

Have Antidepressant Prescriptions, Including Tricyclics, Increased in Canadian Children?

Published on 01/15/202001/12/2020 by Andrew MarshallLeave a comment

Research Paper Title

Antidepressant Prescriptions, Including Tricyclics, Continue to Increase in Canadian Children.

Background

Few studies have longitudinally followed trends in antidepressant prescribing for Canadian children following the Black Box warning issued in 2004.

Using a national data source, we aim to describe trends in antidepressant recommendations for Canadian children ages 1-18 during 2012 to 2016.

Methods

A database called the Canadian Disease and Therapeutic Index (CDTI), provided by IQVIA, was used to conduct analyses. The CDTI dataset collects a quarterly sample of paediatric antidepressant recommendations, projected using a weight procedure from a dynamic sample of 652 Canadian office-based physicians.

The term “recommendations” is used because nonprescription drugs may be recommended and there is no confirmation in the database that the prescriptions were filled or medications taken.

The data were collected from 2012 to 2016 and the sample population was projected by IQVIA to be representative of the entire Canadian paediatric population.

Results

The total number of projected antidepressant recommendations for children increased from 2012 to 2016. Selective serotonin reuptake inhibitors were the most recommended class of antidepressants.

Analysis indicated that fluoxetine was the most frequently recommended drug.

Findings also suggest that recommendations for tricyclic antidepressants (TCAs) are increasing, but predominantly for reasons other than treatment of depression.

Conclusions

Overall, antidepressant use in Canadian children increased over the study period.

Unsurprisingly, fluoxetine was the most recommended antidepressant for Canadian children.

However, the observed increase in TCA use for a paediatric population is unexpected.

The data source is descriptive and lacks detailed measures supporting comprehensive explanation of the findings, therefore, further research is required.

Reference

Lukmanji, A., Pringsheim, T., Bulloch, A.G., Stewart, D.G., Chan, P., Tehrani, A. & Patten, S.B. (2020) Antidepressant Prescriptions, Including Tricyclics, Continue to Increase in Canadian Children. Journal of Child and Adolescent Psychopharmacology. doi: 10.1089/cap.2019.0121. [Epub ahead of print].

Inter Partner Violence & Post-Traumatic Stress Disorder

Published on 01/14/202001/12/2020 by Andrew MarshallLeave a comment

Research Paper Title

An Evidence-Based Assessment Tool for Estimating Future Post-Traumatic Stress Disorder: A 7-Year Follow-Up Study.

Background

Intimate partner violence (IPV) affects up to one in three women across the world.

Post-traumatic stress disorder (PTSD) is a common outcome.

Many, but not all, women suffer long after they first sought help for IPV.

Validated tools for estimating the likelihood of future PTSD are lacking.

Methods

Women who sought IPV support services for the first time in 2011-2012 (N = 300) completed a seven-item screen for the presence or absence of clinically significant PTSD symptoms and the first assessment screening tool for post-traumatic stress disorder (FAST-PTSD), a tool designed to estimate future PTSD among women seeking help for IPV.

Seven years later, in 2018, 271 (90%) women again completed the seven-item screen for clinically significant PTSD symptoms.

A two-step binary logistic regression was conducted to determine the 7-year validity of the FAST for clinically significant symptoms of PTSD while controlling for baseline PTSD symptoms.

Results

More than 25% of the women reported clinically significant PTSD at 7 years. Baseline moderate- and high-risk scores on the FAST-PTSD were associated with clinically significant levels of PTSD.

Moderate risk was associated with nearly two and one-half times (odds ratio [OR] = 2.4) the risk of clinically significant symptoms of PTSD, and high risk with nearly eight times (OR = 7.8) the risk of PTSD at 7 years.

Conclusions

PTSD is commonly associated with IPV and if untreated can compromise functioning of women and their children.

The FAST-PTSD is a valid indicator of significant clinical PTSD symptoms 7 years following first contact with IPV support services.

Using the FAST-PTSD to triage women at risk for sustained PTSD to early, preventive intervention may improve outcomes for women and their children.

Reference

McFarlane, J., Maddoux, J., Paulson, R., Symes, L. & Jouriles, E.N. (2020) An Evidence-Based Assessment Tool for Estimating Future Post-Traumatic Stress Disorder: A 7-Year Follow-Up Study. Journals of Women’s Health. doi: 10.1089/jwh.2019.7699. [Epub ahead of print].