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Book Full text available online for free

How to support integration to promote care for people with multimorbidity in Europe?

Authors:
HUJALA Anneli, TASKINEN Helena, RISSANEN Sari
Publisher:
World Health Organization. Regional Office for Europe
Publication year:
2017
Pagination:
28
Place of publication:
Denmark

The complex care needs of people with multimorbidity heightens the demand for integrated care. This policy briefing looks how to improve integrated care for people with the co-occurrence of multiple chronic conditions, focusing on: coordination of care across organisational boundaries, collaboration between care professionals and strengthening professional competencies. Drawing on the findings of the ICARE4EU (Innovating Care for People with Multiple Chronic Conditions in Europe) project provides examples of how integration, in particular coordination of care, collaboration between professionals and related competencies have been addressed in care organisations in order to improve the care of people with multiple chronic conditions. Key messages for policy-makers trying to encourage integrated care for multimorbidity include the importance of effective connections between health and social care and that linking formal and informal care. (Edited publisher abstract)

Journal article

Combined effects of physical illness and comorbid psychiatric disorder on risk of suicide in a national population study

Authors:
QIN Ping, et al
Journal article citation:
British Journal of Psychiatry, 204(6), 2014, pp.430-435.
Publisher:
Royal College of Psychiatrists

Background: People with physical illness often have psychiatric disorder and this comorbidity may have a specific influence on their risk of suicide. Aims: To examine how physical illness and psychiatric comorbidity interact to influence risk of suicide, with particular focus on relative timing of onset of the two types of illness. Method: Based on the national population of Denmark, constituted significant risk factors for suicide, their relative timing of onset in individuals with comorbidity significantly differentiated the associated risk of suicide. While suicide risk was highly elevated when onsets of both physical and psychiatric illness occurred close in time to each other, regardless which came first, psychiatric comorbidity developed some time after onset of physical illness exacerbated the risk of suicide substantially. Conclusions: Suicide risk in physically ill people varies substantially by presence of psychiatric comorbidity, particularly the relative timing of onset of the two types of illness. Closer collaboration between general and mental health services should be an essential component of suicide prevention strategies. (Publisher abstract)

Journal article

Autobiographical memory specificity in borderline personality disorder: associations with co-morbid depression and intellectual ability

Authors:
REID Tamar, STARTUP Mike
Journal article citation:
British Journal of Clinical Psychology, 49(3), September 2010, pp.413-420.
Publisher:
Wiley-Blackwell

Difficulties with the recall of specific autobiographical memories have been found to be associated with self-harm, depression, and trauma-related disorders. All of these problems occur at high rates in borderline personality disorder (BPD). The aims of the present study were to clarify the relationship between BPD and overgeneral autobiographical memory by comparing memory specificity in BPD individuals, both with and without comorbid depression, to healthy controls; and to test whether differences between BPD individuals and healthy controls are mediated by differences in general intelligence and years of education. Patients were recruited from an out-patient programme specialising in the treatment of BPD. Twenty-two depressed and 9 non-depressed patients who met criteria for BPD were matched by age and gender with 29 healthy controls. All were assessed with the Autobiographical Memory Test and the National Adult Reading Test. The results showed no difference in memory specificity was found among people with BPD between those who had a comorbid diagnosis of major depression disorder and those who did not. Individuals with BPD were less specific than controls but the relationship between memory specificity and borderline diagnosis was largely mediated by group differences in IQ and education. The article concludes that differences in autobiographical specificity between patients with BPD and healthy controls may be due not to borderline disorder nor to current major depression but to differences in cognitive ability

Journal article

Occurrence of depression and its correlates in early onset dementia patients

Authors:
ROSNESS Tor Atle, BARCA Maria Lage, ENGEDAL Knut
Journal article citation:
International Journal of Geriatric Psychiatry, 25(7), July 2010, pp.704-711.
Publisher:
Wiley-Blackwell

Co-morbid depressive symptoms are common in all forms of dementia. This study investigated the occurrence of depression in early onset dementia patients and which characteristics were associated with depressive symptoms. The participants were 221 patients from the memory clinic at Ullevaal university hospital in Oslo, Norway who were diagnosed with dementia before the age of 65. The mean age of the participants was 58.6 years and 50.6% were women. Depression in these patients was measured by the Montgomery Asberg depression scale (MADRS). History of depression, current psychiatric co-morbidity and usage of antidepressants were recorded. The results showed that 123 patients (55.6%) had a mild degree of depression, 21 patients (9.5%) had a moderate degree of depression and 1 patient had a severe degree of depression. A factor analysis produced 2 factors. The first factor described dysphoria: lack of concentration, pessimistic thoughts, inner tension, suicidal thoughts, lassitude and lack of sleep. The second factor denoted sadness: observed sadness, reported sadness, lack of appetite and inability to feel. In an adjusted linear regression analysis, history of depression was the only significant variable associated with the MADRS total score and both factors 1 and 2. The article concludes that a high occurrence of depressive symptoms in early onset dementia patients was found; 65.7% of all the patients had some degree of depression. A history of depression was the most important correlate of depression in these patients.

Journal article

Co-morbid post-traumatic stress disorder and opioid dependence syndrome

Author:
MOSELHY Hamdy Fouad
Journal article citation:
Journal of Dual Diagnosis, 5(1), January 2009, pp.30-40.
Publisher:
Taylor and Francis
Place of publication:
Philadelphia, USA

An interview-based study was conducted with 70 participants in a large UK urban addiction treatment centre using the Maudsley Addiction Profile, the Severity of Dependence Scale, the Impact of Events Scale and ICD-10 clinical criteria. Nearly a third of the participants met ICD-10 criteria for post-traumatic stress disorder, with clinically significant levels of intrusive (45%) and avoidant (65.7%) symptoms reported. Participants reported a higher perceived rate of childhood threat to life from sexual abuse, physical abuse and witnessing physical fights between parents. In adulthood the main traumatic events were physical injuries and rape.

Book Full text available online for free

National programme for improving mental health and well-being small research projects initiative 2006: accessing the mental health support worker service in Wester Hailes: exploring issues of accessibility to a service for people with co-morbid problems

Authors:
ROBERTSON A, STENHOUSE R
Publisher:
Scotland. Scottish Government
Publication year:
2008
Pagination:
2p.
Place of publication:
Edinburgh

The aim of the study was to explore the issues of accessibility to the Mental Health Support Worker (MHSW) service in Wester Hailes in order to facilitate the development of the service to meet the needs of the community. The views of clients and those who make referrals to the service were sought. Two methods of data collection were used: postal questionnaires and interviews.

Journal article Full text available online for free

Comorbid substance use and age at onset of schizophrenia

Authors:
BARNES Thomas R.E., et al
Journal article citation:
British Journal of Psychiatry, 188, March 2006, pp.243-249.
Publisher:
Royal College of Psychiatrists

This study aimed to examine the association between substance use and age at onset in substance use and age at onset in a UK, inner-city sample of people with recent-onset schizophrenia. The study sample consisted of 152 people recruited to the West London First-Episode Schizophrenia Study. Self-reported data on drug and alcohol use, as well as information on age at onset of psychosis, were collected. Mental state, cognition (IQ, memory and executive function) and social function were also assessed. Intotal, 60% of the participants were smokers, 27% reported a history of problems with alcohol use, 35% reported current substance use (not including alcohol), and 68% reported lifetime substance use (cannabis and psychostimulants were most commonly used). Cannabis use and gender had independent effects on age at onset of psychosis, after adjusting for alcohol misuse and use of other drugs. The strong association between self-reported cannabis use and earlier onset of psychosis provides further evidence that schizophrenia may be precipitated by cannabis use and/or that the early onset of symptoms is a risk factor for cannabis use.

Journal article

Small steps: barriers and facilitators to physical health self-management by people living with mental illness

Authors:
KEMP Vivien, et al
Journal article citation:
International Journal of Mental Health Promotion, 16(4), 2014, pp.216-230.
Publisher:
Taylor and Francis

It has been established that people with mental illness experience mortality and morbidity from all the major health conditions at 2–3 times the rate of those without mental illness. One way to overcome this problem is to encourage consumers of mental health services to self-manage their physical health. The purpose of the study was to investigate the facilitators and barriers to physical health self-management by people living with a mental illness. The study was underpinned by a hermeneutic phenomenological framework and utilised focus groups for data collection. A total of 27 participants, who lived in the community, had a diagnosed mental illness and who also had a co-morbid chronic physical health condition were included in one of three focus groups. The collected data were thematically analysed to identify common experiences and difficulties. It was found that participants were well aware of the need to attend to physical health issues. However, a number of factors at the individual, social and system levels impeded their ability to do so. Barriers to self-management included the debilitating nature of mental illness, poor physical health literacy, stigma from medical staff and social isolation, which resulted in a lack of support. Whereas informal peer networks, group participation and where it was offered, the support and encouragement from healthcare professionals facilitated health self-management. (Publisher abstract)

Journal article

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)

Journal article

A systematic review of parenting in relation to the development of comorbidities and functional impairments in children with attention-deficit/hyperactivity disorder (ADHD)

Author:
DEAULT Louise C.
Journal article citation:
Child Psychiatry and Human Development, 41(2), April 2010, pp.168-192.
Publisher:
Springer Netherlands
Place of publication:
Netherlands

The majority of the 22 studies included in this narrative review focused on the association between family functioning and comorbid oppositional defiant disorder (ODD) and conduct disorder (CD) in children with ADHD. The evidence suggests that parental psychopathology and family conflict are more strongly associated with these comorbidities than with ADHD symptoms but it is limited by the methodological variability of the studies. Very little research on internalising problems, such as depression or anxiety, or functional impairments was identified.

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