Search results for ‘Subject term:"mental health problems"’ Sort:
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A comparison of different models to meet the mental health needs of adults with intellectual disabilities
- Authors:
- SHEEHAN Rory, PASCHOS Dimitrios
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 7(3), 2013, pp.161-168.
- Publisher:
- Emerald
This paper aims to review the current knowledge on different ways of structuring psychiatric services to meet the needs of people with intellectual disability and co-morbid mental illness. It summarises the current debate and presents evidence from original research and opinion from clinical experience. It briefly at a number of different models, including: community care, community intellectual disability services, mainstream services, teritary' specialist services, in-patient care, generic vs specialist wards, specialist in-patient beds on general psychiatric wards, and emergency psychiatric services. The authors find a lack of robust research evidence to support any particular model of service provision. However, it seems to be increasingly accepted that purely generic models of care for people with intellectual disabilities and co-morbid mental illness are not appropriate. Integration of the expertise from specialist services within mainstream services is presented as potentially the most advantageous approach. (Edited publisher abstract)
Risk of psychopathology in adolescent offspring of mothers with psychopathology and recurrent depression
- Authors:
- SELLERS Ruth, et al
- Journal article citation:
- British Journal of Psychiatry, 202(2), 2013, pp.108-114.
- Publisher:
- Cambridge University Press
Offspring of mothers with depression are at heightened risk of psychiatric disorder. Many mothers with depression have comorbid psychopathology. How these co-occurring problems affect child outcomes has rarely been considered. This study considers whether the overall burden of co-occurring psychopathology in mothers with recurrent depression predicts new-onset psychopathology in offspring. Parents were recruited predominantly from primary care in South Wales, UK. Mothers with recurrent depression and their adolescent offspring (9–17 years at baseline) were assessed in 2007 and on two further occasions up to 2011. Mothers completed questionnaires assessing depression severity, anxiety, alcohol problems and antisocial behaviour. Psychiatric disorder in offspring was assessed using the Child and Adolescent Psychiatric Assessment. The number of co-occurring problems in mothers (0, 1 or 2+) predicted new-onset offspring disorder. Rates varied from 15.7 to 34.8% depending on the number of co-occurring clinical problems. This remained significant after controlling for maternal depression severity. The burden of co-occurring psychopathology among mothers with recurrent depression indexes increased risk of future onset of psychiatric disorder for offspring. This knowledge can be used in targeting preventive measures in children at high risk of psychiatric disorder. (Edited publisher abstract)
Six-month outcomes following an emergency hospital admission for older adults with co-morbid mental health problems indicate complexity of care needs
- Authors:
- BRADSHAW Lucy E., et al
- Journal article citation:
- Age and Ageing, 42(5), 2013, pp.582-588.
- Publisher:
- Oxford University Press
Background: Two-thirds of older patients admitted as an emergency to a general hospital have co-existing mental health problems including delirium, dementia and depression. This study describes the outcomes of older adults with co-morbid mental health problems after an acute hospital admission. Methods: A follow-up study of 250 patients aged over 70 admitted to 1 of 12 wards (geriatric, medical or orthopaedic) of an English acute general hospital with a co-morbid mental health problem and followed up at 180 days. Results: Twenty-seven per cent did not return to their original place of residence after the hospital admission. After 180 days 31% had died, 42% had been readmitted and 24% of community residents had moved to a care home. Only 31% survived without being readmitted or moving to a care home. However, 16% spent >170 of the 180 days at home. Significant predictors for poor outcomes were co-morbidity, nutrition, cognitive function, reduction in activities of daily living ability prior to admission, behavioural and psychiatric problems and depression. Only 42% of survivors recovered to their pre-acute illness level of function. Clinically significant behavioural and psychiatric symptoms were present at follow-up in 71% of survivors with baseline cognitive impairment, and new symptoms developed frequently in this group. Conclusions: The variable, but often adverse, outcomes in this group implies a wide range of health and social care needs. Community and acute services to meet these needs should be anticipated and provided for. (Publisher abstract)
Impact of physical health on treatment for co-occurring depression and substance dependence
- Authors:
- TRIPP Jessica C., et al
- Journal article citation:
- Journal of Dual Diagnosis, 9(3), 2013, pp.239-248.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Objective: There is a high rate of comorbidity among substance dependence, depression, and physical health problems. This study aimed to examine the impact of pre-treatment physical health stressors (acute and chronic conditions) on outcomes of treatment in a sample of veterans with dual disorders (depression and substance dependence) who were randomised to integrated cognitive behavioural therapy versus 12-step interventions. Methods: This study included 205 veterans (89.8% male, mean age = 49.5 years) enrolled in a clinical treatment outcomes trial. Chronic health problems (persistent, ongoing conditions lasting 2 weeks or more; e.g., arthritis, diabetes) and acute health events (occurring on a discrete date; e.g., injury, surgery, myocardial infarction) were coded dichotomously (presence versus absence) and evaluated separately. The impact of physical health stressors on abstinence (defined dichotomously), percentage of days abstinent, and depression symptoms were analyzed at the end of 12 and 24 weeks of treatment. Additionally, associations between intake motivation to change, health stressors, and substance use were examined. Results: Analyses revealed that participants who had experienced a pre-treatment acute health event had higher rates of abstinence at 12 weeks, higher percentage of days abstinent at 24 weeks, and higher depression symptoms at intake. Participants with chronic health difficulties had more severe depression at intake and those participants with severe chronic difficulties had greater depression symptoms across all time points. Chronic health difficulties were related to the “taking steps” factor of motivation to change substance use, but acute health events were not related to motivation to change. Motivation to change was also not related to substance outcomes in our sample. Conclusions: Physical health appears to have a complex relationship with co-occurring depression and substance dependence. Acute health problems predicted lower substance use, whereas chronic health problems were associated with higher depression levels. Explicitly addressing the connection between substance use and health events during treatment may improve addiction treatment outcomes. However, individuals with chronic health problems may benefit from extending treatment or adjunct strategies focused on addressing chronic health concerns. This is an analysis of data collected as part of a clinical trial registered at www.ClinicalTrials.gov as NCT00108407. (Publisher abstract)
Recent violence among persons entering short-term residential mental health and substance abuse treatment
- Authors:
- HAVASSY Barbara E., MERICLE Amy A.
- Journal article citation:
- Journal of Dual Diagnosis, 9(3), 2013, pp.222-227.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Objective: Large-scale epidemiologic studies have consistently found that co-occurring mental health and substance use disorders are associated with increased risk of involvement in violence. Individuals with co-occurring mental and substance use disorders can present either in mental health or substance abuse treatment systems, and both systems must be able to respond to their needs. This study examined the prevalence and correlates of recent violence (both perpetration and victimisation) among adults (N = 419) entering short-term residential mental health and substance abuse treatment. Methods: Approximately 41% (n = 171) of participants reported having any involvement in violence, and for the majority of them (n = 144; 84%) that included victimation. For analytic purposes, we classified participants with involvement in violence as any perpetration (n = 87) or only victimization (n = 84) and conducted bivariate and multivariate logistic regression analyses examining potential correlates of these different types of violence. Results: Homelessness (adjusted odds ratio [AOR] = 1.6, 95% confidence interval [CI] [1.0–2.4], p < .04), alcohol use disorder (AOR = 1.8, 95% CI [1.1–2.9], p < .03), and the interaction of comorbidity and substance abuse treatment system (AOR = 2.8, 95% CI [1.0–7.6], p < .05) were associated with an increased likelihood of any violence. Alcohol use disorder (AOR = 1.8, 95% CI [1.0–3.3], p < .05) increased the likelihood of perpetration. Homelessness (AOR = 1.9, 95% CI [1.1–3.2], p < .02) and the interaction of comorbidity and being recruited from substance abuse treatment (AOR = 5.1, 95% CI [1.8–14.2], p < .003) increased the likelihood of involvement in only victimization. Conclusions: Victimization was far more prevalent than perpetration. Comorbidity was not a significant predictor of violence, but individuals with comorbidity recruited from the substance abuse treatment system were more likely to be involved in violence. (Publisher abstract)
Health care integration for formerly homeless people with serious mental illness
- Authors:
- WENSTEIN Lara Carson, et al
- Journal article citation:
- Journal of Dual Diagnosis, 9(1), 2013, pp.72-77.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Objective: The primary objective of this study was to evaluate medical health and health care in a programme of integrated primary and behavioral health care for people with experiences of homelessness and mental illness. Methods: Using a retrospective chart review, we examined health status and rates of health care quality indicators in a group of 123 Housing First participants with histories of chronic homelessness and diagnoses of serious mental illness, including a subgroup of 43 participants who received integrated medical and behavioural health care. Results: In addition to having serious mental illness, participants had high rates of comorbid chronic disease and risk behaviour: 76% had at least one chronic disease, 59% had two or more chronic diseases, 6.5% had HIV, and 83% used tobacco. The integrated care programme subgroup had relatively high rates of documentation of some health care quality indicators: 62% with body mass index, 73% with blood pressure, 77% with tobacco use history, 87% with substance use history. Conclusions: Our study confirms that people with experiences of homelessness and serious mental illness also have serious medical comorbidities and documents the feasibility of providing on-site integrated primary care and health screenings in supportive housing programmes. (Publisher abstract)
Enhanced case management versus substance abuse treatment alone among substance abusers with depression
- Authors:
- STRILEY Catherine W., et al
- Journal article citation:
- Social Work Research, 37(1), 2013, pp.19-25.
- Publisher:
- Oxford University Press
This pilot study evaluated the effectiveness of enhanced case management for substance abusers with comorbid major depression, which was an integrated approach to care. One hundred and 20 participants admitted to drug treatment who also met Computerized Diagnostic Interview Schedule criteria for major depression at baseline were randomized to enhanced case management (ECM) (n = 64) or treatment as usual (TAU) (n = 56). Both groups were followed up at six and 12 months. Participants' current clinical status across a broad range of domains in the past 90 days was assessed using the Global Appraisal of Individual Needs and included their Depressive Symptom Scale, Homicidal–Suicidal Thought Index, and Mental Health Treatment Index scores. The findings did not reveal any statistically significant effects of ECM on outcome measures. However, in view of the high rates of adverse treatment outcomes among comorbid groups, including suicide, the finding of a clinically significant reduction in homicidal and suicidal thoughts warrants further research; the comprehensive approach to treatment tested may be especially helpful to depressed substance abusers with such ideations. (Publisher abstract)
Forensic rehabilitation in Asperger syndrome: a case report
- Authors:
- KELBRICK Marlene, RADLEY Jane
- Journal article citation:
- Journal of Intellectual Disabilities and Offending Behaviour, 4(1/2), 2013, pp.60-64.
- Publisher:
- Emerald
Purpose – People with Asperger syndrome are at increased risk of co-morbid mental health problems. The core features underlying autism are likely to play an important role in offending behaviour amongst this population. Forensic rehabilitation includes a multidisciplinary approach and combination of therapeutic interventions. However there is limited evidence in the literature of what constitutes effective treatment within this setting, and how the process of rehabilitation is experienced by patients. The purpose of this paper is to describe a case of Asperger syndrome with co-morbid psychosis and offending behaviour and the process of forensic rehabilitation. Design/methodology/approach – The authors briefly review the literature related to Asperger syndrome, offending in this population and co-morbidity. The authors then describe and reflect on a case of a young man with Asperger syndrome, sexual offending and the process of forensic rehabilitation, and offer an insight from the patient's perspective. Findings – Co-morbid mental illness, when detected early, can be successfully managed with limited additional disability. The process of forensic rehabilitation includes a multidisciplinary approach. Therapeutic interventions specifically aimed at addressing core features of autism, risk and offence-related factors are effective in promoting recovery amongst those with autism and offending behaviour. Originality/value – The paper highlights how core features of autism can lead to offending behaviour, the importance of early recognition and treatment of co-morbidity, and the process of forensic rehabilitation and recovery. Also included are quotes from the patient's perspective on what it is like to have Asperger syndrome, and what has been the key learning from the rehabilitation process. (Publisher abstract)