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A prospective study of PTSD following recovery from first-episode psychosis: the threat from persecutors, voices, and patienthood
- Authors:
- BRUNET Kat, et al
- Journal article citation:
- British Journal of Clinical Psychology, 51(4), November 2012, pp.418-433.
- Publisher:
- Wiley
Focusing on post-traumatic symptoms and people with psychosis, this prospective study tested hypotheses based on retrospective findings that threat appraisals of voices, persecutors, or the new label of 'mental health patient' predict symptoms of post-traumatic stress disorder (PTSD). Fifty patients in Birmingham in the acute phase of a first psychotic episode were assessed for appraisals of threat from voices, other persecutors, and the diagnosis. 39 patients completed the follow-up stage 18 months later, which was designed to establish PTSD symptom levels and diagnosis. The article describes the study methodology, analysis, and results. It reports that 31% of participants who completed the follow up phase met criteria for PTSD diagnosis, and 49% were still distressed by memories of their psychosis or the associated treatment. Appraisals of threat from voices and persecutors during the acute phase of psychosis were generally not predictive of subsequent post-traumatic stress. The authors discuss the findings and suggest that further research is required to assess the true impact of psychosis on PTSD.
Distress or disability? Proceedings of a symposium held at Lancaster University 15-16 November 2011
- Authors:
- ANDERSON Jill, SAPEY Bob, SPANDLER Helen, (eds.)
- Publisher:
- Lancaster University. Centre for Disability Research
- Publication year:
- 2012
- Pagination:
- 113p.
- Place of publication:
- Lancaster
This symposium was organised jointly by Mental Health in Higher Education, the Centre for Disability Research at Lancaster University, and the School of Social Work at the University of Central Lancashire. The symposium was by invitation only and brought together academics, activists and research students from the north-west of England to explore the issues that arise from trying to situate mental distress or ’madness’ within the social model of disability, focussing specifically on psychosis, hearing voices and other extra-ordinary experiences. Participants at the symposium were asked to build upon a discussion document ‘Distress or Disability?’ written in 1994 by Anne Plumb for the Greater Manchester Coalition of Disabled People. In this paper she argued for the autonomy of mental health system survivor activism and highlighted some of the difficulties of integrating mental distress within broader disability politics. After reproducing Plumb’s paper, this e-book draws together the papers presented at the symposium in order to collate and disseminate the ideas that were shared.
The clinical profile of young people accessing a low secure adolescent unit
- Authors:
- NADKARNI Jo, et al
- Journal article citation:
- British Journal of Forensic Practice, 14(3), 2012, pp.217-226.
- Publisher:
- Emerald
The Westwood Centre, the first NHS forensic low secure unit for adolescents, became operational in 2004. This paper looked at service utilisation and initial outcomes for the young people admitted in the first 45 months and compared these with young people accessing a neighbouring open adolescent unit. Data were extracted from available clinical and health service records regarding, demographics, locality, admission status, length of stay, medication use, presenting problem, diagnosis, previous and discharge destination. Thirty of the 56 Westwood young people were male, the mean age at admission was 16.3 years and mean length of stay was 202 days. Twenty-five young people had a discharge diagnosis related to psychosis, the remainder having primary problems relating to emotional and/or conduct problems. Of the total 26 were discharged to another hospital setting and 20 returned to their home of origin. Young people accessing the low secure unit were significantly older at admission and there was a trend for a higher proportion of females to be admitted to the open setting. In addition, the low secure unit had a greater proportion of young people with psychotic disorders and longer lengths of stay. Case examples illustrate a pilot of initial outcomes. Most young people progressed positively from the low secure service onto open or community settings.
The prevalence, incidence and risk factors for delirium in Dutch nursing homes and residential care homes
- Authors:
- BOORSMA Marijke, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 27(7), July 2012, pp.709-715.
- Publisher:
- Wiley
Delirium is characterised by acute onset, fluctuating course and disturbances of consciousness, attention and perception. Its fluctuating course presents challenges to staff. This study compares the prevalence and incidence of delirium and its risk factors in residents of Dutch nursing and residential care homes. Data were drawn from a study involving a total of 3627 residents using the Long-Term Care Facility (inter RAI-LTCF) version of the Resident Assessment Instrument. Of the residents, 828 residents were from six nursing homes and 1365 from 23 residential homes. Delirium was defined as a positive score on the adjusted Nursing Home–Confusion Assessment Method. The prevalence of delirium was 8.9% in the nursing homes and 8.2% in the residential homes. The incidence was highest in the nursing homes; 20.7 versus 14.6 per 100 person-years. Multivariate tests of risk factors for delirium included chair restraints (OR 2.3); dementia (OR 3.3) and Parkinson's disease (OR 2.3) in nursing homes, and dementia (OR 1.8 and falls (OR 1.7) in residential care homes. The authors that conclude delirium is an important clinical problem in both settings. They suggest there is a need for greater focus on the modifiable risk factors revealed in the analyses.
Severe mental illness in 33 588 prisoners worldwide: systematic review and meta-regression analysis
- Authors:
- FAZEL Seena, SEEWALD Katherine
- Journal article citation:
- British Journal of Psychiatry, 200(5), May 2012, pp.364-373.
- Publisher:
- Cambridge University Press
High levels of psychiatric morbidity in prisoners are well documented but it is not known whether these are increasing or whether prevalence differs between low, middle, and high income countries. This systematic review evaluated prevalence studies for psychotic illness and major depression in prisoners. Inclusion criteria were, publication 1966- 2012, unselected prison samples and use of clinical examination or semi-structured instruments to make DSM or ICD diagnoses. A total of 109 samples were identified, including 33 588 prisoners in 24 countries. Data were meta-analysed using random-effects models. The pooled prevalence of psychosis was 3.6% in male prisoners and 3.9% in females. There were high levels of heterogeneity, some of which was explained by studies in low–middle-income countries reporting higher prevalences of psychosis (5.5%). The pooled prevalence of major depression was 10.2% in male prisoners and 14.1% in females. Apart from depression in the USA, the prevalence of these disorders did not appear to be increasing over time. High levels of psychiatric morbidity have been consistently reported in prisoners from many countries over the four decades. However, further research is needed to confirm whether higher rates of mental illness are found in low- and middle-income nations, and to examine trends over time within nations with large prison populations.
The Mental Capacity Act and mental healthcare in prison: opportunities and challenges
- Authors:
- DAVIES Sharon, DIMOND Claire
- Journal article citation:
- Psychiatrist (The), 36(7), July 2012, pp.241-243.
- Publisher:
- Royal College of Psychiatrists
The UK Mental Health Act 1983 does not apply in prison. The legal framework for the care and treatment of people with mental illness in prison is provided by the Mental Capacity Act 2005. In this editorial, the authors suggest that psychiatrists in England and Wales have been slow to recognise the need to take account of the Mental Capacity Act in the treatment of psychiatric in patients. They raise a number of dilemmas regarding implementation of the Act within prisons in relation to people with psychotic illness. In particular they highlight how assessing best interests and defining harm involves making challenging judgments and interpretations, which have potentially significant impacts on clinical practice within a prison context.
Impact of ethnic density on adult mental disorders: narrative review
- Authors:
- SHAW Richard J., et al
- Journal article citation:
- British Journal of Psychiatry, 201(1), July 2012, pp.11-19.
- Publisher:
- Cambridge University Press
Research suggests that mental health and the use of mental health services frequently varies by ethnic origin. The ‘ethnic density hypothesis’ proposes that members of ethnic minority groups may have better mental health when they live in areas with higher proportions of people of the same ethnicity. The literature on this subject is complex and sometimes disparate. This new literature study covered work published to January 2011. Studies were included if they had a defined ethnic minority sample; some measurement of ethnic density defined at a geographical scale smaller than a nation or a US state; and a measure ascertaining mental health or disorder. Thirty four papers were identified. Protective associations between ethnic density and mental disorders were most consistent in older US ecological studies of admission rates. More recent multilevel studies showed some evidence of ethnic density being protective against depression and anxiety for African American people and Hispanic adults in the USA. However, Hispanic, Asian–American and Canadian ‘visible minority’ adolescents have higher levels of depression at higher ethnic densities. Studies in the UK showed mixed results, with evidence for protective associations most consistent for psychoses. Overall they had limited statistical power, and given the heterogeneity of their designs, could only provide tentative conclusions.