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What is the Relationship of Post-traumatic Stress Disorder to End-of-life Care Received by Dying Veterans?

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Research Paper Title

The Relationship of Post-traumatic Stress Disorder to End-of-life Care Received by Dying Veterans: a Secondary Data Analysis.

Background

Post-traumatic stress disorder (PTSD) can be exacerbated by subsequent trauma, but it is unclear if symptoms are worsened by impending death

PTSD symptoms, including hyperarousal, negative mood and thoughts, and traumatic re-experiencing, can impact end-of-life symptoms, including pain, mood, and poor sleep.

Thus, increased symptoms may lead to increased end-of-life healthcare utilisation.

Therefore, the purpose of this study was to determine if veterans with PTSD have increased end-of-life healthcare utilisation or medication use and to examine predictors of medication administration.

Methods

Secondary analysis of a stepped-wedge design implementation trial to improve end-of-life care for Veterans Affairs (VA) inpatients. Outcome variables were collected via direct chart review. Analyses included hierarchical, generalized estimating equation models, clustered by medical center.

Veterans, inpatient at one of six VA facilities, dying between 2005 and 2011.

Emergency room (ER) visits, hospitalisations, and medication administration in the last 7 days of life.

Results

Of 5341 veterans, 468 (8.76%) had PTSD.

Of those, 21.4% (100/468) had major depression and 36.5% (171/468) had anxiety. Veterans with PTSD were younger (mean age 65.4 PTSD, 70.5 no PTSD, p < 0.0001) and had more VA hospitalisations and ER visits in the last 12 months of life (admissions: PTSD 2.8, no PTSD 2.4, p < 0.0001; ER visits: 3.2 vs 2.5, p < 0.0001).

PTSD was associated with antipsychotic administration (OR 1.52, 95% CI 1.06-2.18). Major depression (333/5341, 6.2%) was associated with opioid administration (OR 1.348, 95% CI 1.129-1.609) and benzodiazepines (OR 1.489, 95% CI 1.141-1.943).

Anxiety disorders (778/5341, 14.6%) were only associated with benzodiazepines (OR 1.598, 95% CI 1.194-2.138).

Conclusions

PTSD’s association with increased end-of-life healthcare utilisation and increased antipsychotic administration in the final days of life suggests increased symptom burden and potential for terminal delirium in individuals with PTSD.

Understanding the burden of psychiatric illness and potential risks for delirium may facilitate the end-of-life care for these patients.

Reference

Bickel, K.E., Kennedy, R., Levy, C., Burgio, K.L. & Bailey, F.A. (2019) The Relationship of Post-traumatic Stress Disorder to End-of-life Care Received by Dying Veterans: a Secondary Data Analysis. Journal of General Internal Medicine. doi: 10.1007/s11606-019-05538-x. [Epub ahead of print].

Strategies used by Families to Cope with Chronic Mental Illnesses

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Research Paper Title

Strategies used by families to cope with chronic mental illnesses: Psychometric properties of the family crisis oriented personal evaluation scale.

Background

This study was aimed at investigating the psychometric properties of the Family Crisis Oriented Personal Evaluation Scale (F-COPES) for Turkish society, which assesses the coping skills of caregivers of individuals with chronic mental illnesses.

Methods

The study was conducted with 153 family caregivers of patients with a chronic mental illness admitted to the inpatient and outpatient units of two university hospitals and İzmir Schizophrenia Solidarity Association.

For the language validity, the translation-back translation method was performed, for the content validity, expert opinions were obtained, for the construct validity, exploratory and confirmatory factor analysis was performed.

For the reliability analysis, Cronbach α reliability coefficient was calculated and the test-retest reliability analysis was performed.

Results

The content validity index of the scale was 0.96.

The Cronbach’s α reliability coefficient for the overall scale was .80. Factor loadings of the subscales ranged between 0.56 and 0.69 for the Acquiring Social Support subscale, between 0.43 and 0.74 for the Reframing subscale, between 0.53 and 0.74 for the Seeking Spiritual Support subscale.

The model fit indexes were as follows: χ2  = 176.369, df = 116, χ2 /df = 1.52, RMSEA = 0.059, CFI = 0.90, IFI = 0.91, GFI = 0.88.

Conclusions

The results of the present study show that the levels of psychometric properties of F-COPES in Turkish society are acceptable.

It is thought that it would be useful to use the F-COPES in the assessment of coping behaviours of individuals who give care to patients with a chronic mental illness and that it can be used as measurement tool in studies to be conducted with caregivers of patients with a chronic mental illness to assess their coping skills.

Reference

Sari, A. & Çetinkaya Duman, Z. (2019) Strategies used by families to cope with chronic mental illnesses: Psychometric properties of the family crisis oriented personal evaluation scale. Perspectives in Psychiatric Care. doi: 10.1111/ppc.12457. [Epub ahead of print].

What Can We Learning from Nurses’ Experiences of Events involving Physiological Deterioration of Consumers in Acute Inpatient Mental Health Settings?

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Research Paper Title

Clarity, confidence, and complexity: Learning from nurses’ experiences of events involving physiological deterioration of consumers in acute inpatient mental health settings.

Background

The objective of the current study was to capture the experiences of nurses in relation to the acutely physiologically deteriorating consumer.

Improving the physical health care of consumers with mental illness has been widely adopted as a priority for mental health nursing. Much of the effort thus far has focused on routine screening, prevention and treatment of common comorbidities including cardiovascular disease, diabetes mellitus, and cancer.

There has been less focus on the acutely physiologically deteriorating consumer in the mental health setting.

Further study is warranted since this issue poses a set of highly complex challenges for nurses within the inpatient setting.

Methods

An exploratory, descriptive study was employed using focus groups to gather narrative data which was then subject to qualitative analysis.

Eleven mental health inpatient wards within a local health district in Sydney, Australia were studied, comprising ward-based nurses (n = 64) and nurse unit managers (n = 8).

This paper follows the COREQ guidelines for reporting qualitative health research.

Results

Qualitative data analysis revealed three themes central to the nurses’ experience:

  1. Lack of clarity (subthemes: procedures and leadership accountability);
  2. Confidence in the workforce (subthemes: knowledge & skills, training needs, relevant experience, collaboration with emergency and medical teams, stigmatising attitudes); and
  3. Complexity (subthemes: complexity as the new norm, and suitability of the mental health environment).

Conclusions

The themes found in this study can be used to guide and inform health care policy, protocols, education and processes around building a more confident nurse workforce for the acutely physiologically deteriorating consumer.

Findings provide a rich dataset for the generation of measurement tools and protocols to guide physical healthcare and evaluate performance.

Reference

Brunero, S., Everett, B., Ramjan, L.M., Salamonson, Y., Steel, K., Johnson, A.M., Stokes, M., Langdon, R. & Dickens, G.L. (2019) Clarity, confidence, and complexity: Learning from nurses’ experiences of events involving physiological deterioration of consumers in acute inpatient mental health settings. Journal of Clinical Nursing. doi: 10.1111/jocn.15126. [Epub ahead of print].

Childhood Trauma: Time, Trust, and Opportunities

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Research Paper Title

Repairing the effects of childhood trauma: The long and winding road.

Background

  • What is known on this subject:
    • Domestic and family violence contributes to mental distress and the development of mental illness and can reverberate throughout a person’s life.
  • What this paper adds to existing knowledge.
    • Therapeutic work with people who experience domestic and family violence needs to take considerable time to allow the process to unfold.
    • Understanding the triggers that cause past traumas to be re-experienced helps people to recognise and change their conditioned emotional responses.
  • What are the implications for practice?
    • Time needs to be invested to develop a secure and trusting relationship to enable a person to work through childhood experiences that have the potential to overwhelm.
    • It is important for adults who have experienced childhood trauma to have an opportunity to process the abuse to help minimise its intrusion in their lives.

Reference

Palmer, C., Williams, Y. & Harrington, A. (2019) Repairing the effects of childhood trauma: The long and winding road. Journal of Psychiatric and Mental Health Nursing. doi: 10.1111/jpm.12581. [Epub ahead of print].

Cognitive Subgroups of Schizophrenia: Are There Brain Morphological & Functional Features?

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Research Paper Title

Brain morphological and functional features in cognitive subgroups of schizophrenia.

Background

Previous studies have reported different brain morphologies in different cognitive subgroups of patients with schizophrenia. The researchers aimed to examine the brain structures and functional connectivity in these cognitive subgroups of schizophrenia.

Methods

The researchers compared brain structures among healthy controls and cognitively deteriorated and preserved subgroups of patients with schizophrenia according to the decline in intelligence quotient.

Connectivity analyses between subcortical regions and other brain areas were performed using resting-state functional magnetic resonance imaging among the groups.

Results

Whole brain and total cortical gray matter, right fusiform gyrus, left pars orbitalis gyrus, right pars triangularis, left superior temporal gyrus and left insula volumes and bilateral cortical thickness were decreased in the deteriorated group compared to the control and preserved groups.

Both schizophrenia subgroups had increased left lateral ventricle, right putamen and left pallidum and decreased bilateral hippocampus, left precentral gyrus, right rostral middle frontal gyrus and bilateral superior frontal gyrus volumes compared with controls.

Hyperconnectivity between the thalamus and a broad range of brain regions was observed in the deteriorated group compared to connectivity in the control group, and this hyperconnectivity was less evident in the preserved group.

The researchers also found hyperconnectivity between the accumbens and the superior and middle frontal gyri in the preserved group compared with connectivity in the deteriorated group.

Conclusions

These findings provide evidence of prominent structural and functional brain abnormalities in deteriorated patients with schizophrenia, suggesting that cognitive subgroups in schizophrenia might be useful biotypes to elucidate brain pathophysiology for new diagnostic and treatment strategies.

Reference

Yasuda, Y., Okada, N., Nemoto, K., Fukunaga, M., Yamamori, H., Ohi, K., Koshiyama, D., Kudo, N., Shiino, T., Morita, S., Morita, K., Azechi, H., Fujimoto, M., Miura, K., Watanabe, Y., Kasai, K. & Hashimoto, R. (2019) Brain morphological and functional features in cognitive subgroups of schizophrenia. Psychiatry and Clinical Neurosciences. doi: 10.1111/pcn.12963. [Epub ahead of print].

Specialist Mental Health Nurse Practitioner Candidate Roles & the Benefits these Roles can have in Reducing the Significant Morbidity & Mortality of Mental Health Consumers

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Research Paper Title

Improving physical health outcomes for people with severe mental illness: A proof-of-concept study of nurse practitioner candidate practice.

Background

People with severe mental illness have significantly reduced life expectancy and higher risk of cardiovascular diseases than the general population.

There is a critical need for quality physical health care to improve consumers’ health outcomes.

There is minimal knowledge, however, on the impact of mental health nurse practitioner candidate (NPC) practices on consumers’ health outcomes.

The aim of this proof-of-concept study was to describe the impacts of NPC practices on the quality of physical healthcare provision and physical health outcomes (cardiovascular and cardiometabolic) of consumers in community mental health service settings.

Methods

Using a mixed methods design, quantitative data were collected for 12 months prior to (Period 1), and 12 months during (Period 2), the candidacy period.

Qualitative interviews were conducted with a purposive sample of n = 10 consumers to explore their perspectives on physical healthcare provision by the NPCs.

During the 12-month candidacy period, the number of metabolic monitoring assessments rose from n = 55 in Period 1 to n = 146 in Period 2 (P < 0.01, χ2 = 41.20).

Advanced practices provided by NPCs included taking an extensive holistic history and clinical examination, ordering diagnostic pathology, and clinical simulation of physical health medication prescription (under medical supervision).

Results

Analysis of consumer interviews resulted in two themes:

  • Positive and helpful NPC health care; and
  • Improvements in physical and mental health.

Conclusions

The findings add new knowledge on specialist mental health nurse practitioner candidate roles and demonstrate the benefits these roles can have in reducing the significant morbidity and mortality of mental health consumers.

Reference

Furness, T., Giandinoto, J.A., Wordie-Thompson, E., Woolley, S., Dempster, V. & Foster, K. (2019) Improving physical health outcomes for people with severe mental illness: A proof-of-concept study of nurse practitioner candidate practice. International Journal of Mental health Nursing. doi: 10.1111/inm.12680. [Epub ahead of print].

Teachers’ Perceptions of their Learners’ Mental Health Problems

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Research Paper Title

A qualitative study on teachers’ perceptions of their learners’ mental health problems in a disadvantaged community in South Africa.

Background

The combination of extensive poverty, violence and HIV has potential mental health impacts on children in Southern Africa.

This article is nested in a broader study to evaluate the strength and difficulties questionnaire (SDQ) among Sotho speakers, and assess the mental health status of children made orphans by AIDS.

The aim of this study was to describe the mental health problems that the teachers perceive among learners in their classrooms, to understand what the teachers saw as causing these problems and to identify potential approaches to address these problems within the school setting.

Methods

As part of the larger study, 10 teachers were purposively selected to write a report describing the mental health problems among learners in their class.

These findings were discussed at two later meetings with a larger grouping of teachers to validate the findings and obtain additional input.

Results

The teachers were concerned about the emotional state of their pupils, especially in relation to depression, anxiety, substance abuse, scholastic problems and aggression.

These problems were felt to arise from the children’s lived context; factors such as poverty, death of parents and caregivers from AIDS and trauma, parental substance abuse and child abuse.

The teachers expressed a desire to assist the affected learners, but complained that they did not get support from the state services.

Conclusions

Many learners were evaluated by teachers as struggling with mental health issues, arising from their social context.

The teachers felt that with support, schools could provide assistance to these learners.

Reference

Skinner, D., Sharp, C., Marais, L., Serekoane, M. & Lenka, M. (2019) A qualitative study on teachers’ perceptions of their learners’ mental health problems in a disadvantaged community in South Africa. Curationis. 42(1), pp.e1-e7. doi: 10.4102/curationis.v42i1.1903.

Reduction of Plasma Procoagulant Activity in Patients with Schizophrenia during Pharmacotherapy

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Research Paper Title

[Reduction of plasma procoagulant activity in patients with schizophrenia during pharmacotherapy: thrombodynamic parameters of coagulation before and after treatment].

Background

To detect plasma procoagulant activity in patients with schizophrenia at admission to the hospital in a state of exacerbation before (point 1) and after (point 2) pharmacotherapy and evaluate plasma and platelet hemostasis abnormalities.

Methods

The study included 80 women, aged from 16 to 57 years, median age 28 years, with schizophrenia with continuous, paroxysmal-progressive or paroxysmal course (F20.00, F20.01, F20.02 according to ICD-10).

In 42 of 80 patients, depressive disorders in the structure of schizophrenia were observed. The thrombodynamic test (TD) was performed on T-2 Trombodynamis device according to the manufacturer’s instructions (Hemacore LLC, Moscow, Russia).

Blood for the TD test was taken in admission to the hospital (point 1) and on discharge (point 2). All patients received standard pharmacotherapy according to their condition.

Results

For the first time, it was established that in the whole group of patients (n=46) thrombodynamic indicators of the rate of growth of the clot: initial velocity (Vin), stationary velocity (Vst) and adjusted for spontaneous clots velocity (V) and the amount of clot for 30 minutes test TD (ClotSize, CS) were significantly higher compared to normal values.

The mean time of occurrence of spontaneous thrombosis (Tsp) was significantly less than 30 min (p<0.0001), indicating rapid, spontaneous thrombosis. Other parameters of TD did not differ significantly from the norm.

As a result of treatment, the initial growth rate of the clot from the activator (Vi) decreased from 58,5 μm/min to 54,5 μm/min; V speed from 37,4 μm/min to 33,5 μm/min; CS clot size from 1249 μm to 1219 μm; clot density – from 24 874 units up to 23 658 units. All these changes are significant.

Such dynamics of plasma haemostasis clearly indicates a significant decrease in the coagulation activity of the blood plasma of patients as a result of treatment.

An increase in the time of appearance of spontaneous clots after treatment (from 23.5 minutes to 30.5 minutes) indicates a decrease in the procoagulant activity of platelet microparticles after treatment, i.e. the reduction of platelet activation as a result of treatment.

Conclusions

The study has shown for the first time that treatment of patients with antidepressants and antipsychotics reduces the generation of spontaneous clots. The treatment of patients with schizophrenia is accompanied by a decrease in the activity of plasma and platelet haemostasis. This is of great practical importance, since hypercoagulation of spontaneous clots in schizophrenic patients aggravates their chronic inflammatory disorders and affects their resistance to treatment.

Reference

Brusov, O.S., Karpova, N.S., Faktor, M.I., Sizov, S.V. & Oleichik, I.V. (2019) [Reduction of plasma procoagulant activity in patients with schizophrenia during pharmacotherapy: thrombodynamic parameters of coagulation before and after treatment]. In Russian. Zhurnal Nevrologii i Psikhiatrii Imeni S.S. Korsakova. 119(10):51-55. doi: 10.17116/jnevro201911910151.

Resilience Training: Guided Self-reflection as an Alternative to Coping Skills in Military Officer Cadets

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Research Paper Title

Strengthening resilience in military officer cadets: A group-randomized controlled trial of coping and emotion regulatory self-reflection training.

Background

This group-randomised control trial examined the efficacy of guided coping and emotion regulatory self-reflection as a means to strengthen resilience by testing the effects of the training on anxiety and depression symptoms and perceived stressor frequency after an intensive stressor period.

Methods

The sample was 226 officer cadets training at the Royal Military College, Australia. Cadets were randomised by platoon to the self-reflection (n = 130) or coping skills training (n = 96). Surveys occurred at 3 time points: baseline, immediately following the final reflective session (4-weeks post-baseline), and longer-term follow-up (3-months post-initial follow-up).

Results

There were no significant baseline differences in demographic or outcome variables between the intervention groups. On average, cadets commenced the resilience training with mild depression and anxiety symptoms. Analyses were conducted at the individual-level after exploring group-level effects.

No between-groups differences were observed at initial follow-up. At longer-term follow-up, improvements in mental health outcomes were observed for the self-reflection group, compared with the coping skills group, on depression (Cohen’s d = 0.55; 95% CI [0.24, 0.86]), anxiety symptoms (Cohen’s d = 0.69; 95% CI [0.37, 1.00]), and perceived stressor frequency (Cohen’s d = 0.46; 95% CI [0.15, 0.77]).

Longitudinal models demonstrated a time by condition interaction for depression and anxiety, but there was only an effect of condition for perceived stressor frequency. Mediation analyses supported an indirect effect of the intervention on both anxiety and depression via perceived stressor frequency.

Conclusions

Findings provide initial support for the use of guided self-reflection as an alternative to coping skills approaches to resilience training.

Reference

Crane, M.F., Boga, D., Karin, E., Gucciardi, D.F., Rapport, F., Callen, J. & Sinclair, L. (2019) Strengthening resilience in military officer cadets: A group-randomized controlled trial of coping and emotion regulatory self-reflection training. Journal of Consulting and Clinical Psychology. 87(2), pp.125-140. doi: 10.1037/ccp0000356. Epub 2018 Nov 29.

Linking Spatial Working Memory, Affective Disorders, & Mild Current Depression

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Research Paper Title

[Disorders of spatial working memory in affective disorders with mild current depression and their neurophysiological correlates].

Background

To assess spatial working memory disorders in patients with mild depressive disorders and determine their neurophysiological correlates.

Methods

Thirty patients (right-handed) with ICD-10 diagnosis Mood Disorders (F31.3, F32.0, F33.0, F34.1), aged 37±8 years, were examined before treatment. A control group included 30 mentally and somatically healthy individuals (32±7 years old). The study of spatial working memory was carried out using the Corsi Block-Tapping test. EEG was recorded and the values of the spectral power of theta, alpha and beta rhythms were analysed.

Results and Conclusions

A decrease in the level of working memory that was correlated with higher values of theta rhythm power in the frontal and occipital regions and alpha rhythm in the frontal cortex was observed in affective disorders with mild depressive symptoms.

Reference

Galkin, S.A., Peshkovskaya, A.G., Simutkin, G.G., Vasil’eva, S.N., Roshchina, O.V., Ivanova, S.A. & Bokhan, N.A. (2019) [Disorders of spatial working memory in affective disorders with mild current depression and their neurophysiological correlates]. (in Russian). Zhurnal Nevrologii i Psikhiatrii Imeni S.S. Korsakova. 119(10):56-61. doi: 10.17116/jnevro201911910156.