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A 2-year follow-up of involuntary admission's influence upon adherence and outcome in first-episode psychosis.

https://arctichealth.org/en/permalink/ahliterature145997
Source
Acta Psychiatr Scand. 2010 May;121(5):371-6
Publication Type
Article
Date
May-2010
Author
S. Opjordsmoen
S. Friis
I. Melle
U. Haahr
J O Johannessen
T K Larsen
J I Røssberg
B R Rund
E. Simonsen
P. Vaglum
T H McGlashan
Author Affiliation
Department of Psychiatry, Oslo University Hospital, Ullevål and Institute of Psychiatry, University of Oslo, Norway. o.s.e.ilner@medisin.uio.no
Source
Acta Psychiatr Scand. 2010 May;121(5):371-6
Date
May-2010
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Antipsychotic Agents - therapeutic use
Combined Modality Therapy
Commitment of Mentally Ill
Cross-Sectional Studies
Female
Follow-Up Studies
Humans
Male
Norway
Patient Admission - statistics & numerical data
Patient Compliance - psychology - statistics & numerical data
Psychiatric Status Rating Scales
Psychotherapy - statistics & numerical data
Psychotic Disorders - epidemiology - rehabilitation
Sex Factors
Young Adult
Abstract
To see, if voluntary admission for treatment in first-episode psychosis results in better adherence to treatment and more favourable outcome than involuntary admission.
We compared consecutively first-admitted, hospitalised patients from a voluntary (n = 91) with an involuntary (n = 126) group as to psychopathology and functioning using Positive and Negative Syndrome Scale and Global Assessment of Functioning Scales at baseline, after 3 months and at 2 year follow-up. Moreover, duration of supportive psychotherapy, medication and number of hospitalisations during the 2 years were measured.
More women than men were admitted involuntarily. Voluntary patients had less psychopathology and better functioning than involuntary patients at baseline. No significant difference as to duration of psychotherapy and medication between groups was found. No significant difference was found as to psychopathology and functioning between voluntarily and involuntarily admitted patients at follow-up.
Legal admission status per se did not seem to influence treatment adherence and outcome.
PubMed ID
20085554 View in PubMed
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Are Posttraumatic Stress Symptoms Related to Mental Health Service Use? A Prospective Study of Danish Soldiers Deployed to Afghanistan.

https://arctichealth.org/en/permalink/ahliterature282788
Source
J Clin Psychiatry. 2016 Oct;77(10):e1226-e1232
Publication Type
Article
Date
Oct-2016
Author
Trine Madsen
Søren Bo Andersen
Karen-Inge Karstoft
Source
J Clin Psychiatry. 2016 Oct;77(10):e1226-e1232
Date
Oct-2016
Language
English
Publication Type
Article
Keywords
Adult
Cohort Studies
Cross-Sectional Studies
Denmark
Drug Utilization - statistics & numerical data
Female
Follow-Up Studies
Health Services Needs and Demand - statistics & numerical data
Humans
Male
Mental Health Services - utilization
Patient Admission - statistics & numerical data
Prospective Studies
Psychotherapy - statistics & numerical data
Psychotropic Drugs - therapeutic use
Statistics as Topic
Stress Disorders, Post-Traumatic - diagnosis - epidemiology - psychology - therapy
Surveys and Questionnaires
Utilization Review - statistics & numerical data
Veterans - psychology - statistics & numerical data
Abstract
Investigating the use of mental health services by combat veterans can help illuminate utilization and unmet needs of this population. The aims of this study were to estimate the use of mental health services and to examine how such use is associated with self-reported symptoms of posttraumatic stress disorder (PTSD) in soldiers before and after deployment to Afghanistan.
Prospectively, 703 Danish soldiers who deployed from January 2009 to August 2009 were followed up with 6 assessments from predeployment to 2.5 years postdeployment in 2012. At assessments, the soldiers responded to a comprehensive questionnaire including a measure of PTSD symptoms (the PTSD Checklist-Civilian version). These self-reported data were combined with individual-level records of receiving psychotherapy from the Military Psychological Division at the Danish Defense and psychiatric treatment from the Danish registers.
The prevalence of PTSD symptoms increased over time, and almost 10% of the sample reported high levels of PTSD symptoms 2.5 years postdeployment. Overall, 37% of the soldiers utilized mental health services; 6% utilized psychiatric services, and 12.4% redeemed a prescription for psychiatric medicine. Approximately one-third received psychotherapy at the Military Psychological Division. In those reporting high PTSD symptomatology, 83% utilized 1 or more types of mental health service. At predeployment and homecoming, high PTSD symptomatology was significantly (P
PubMed ID
27529142 View in PubMed
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Association Between Prescription of Major Psychotropic Medications and Violent Reoffending After Prison Release.

https://arctichealth.org/en/permalink/ahliterature277998
Source
JAMA. 2016 Nov 01;316(17):1798-1807
Publication Type
Article
Date
Nov-01-2016
Author
Zheng Chang
Paul Lichtenstein
Niklas Långström
Henrik Larsson
Seena Fazel
Source
JAMA. 2016 Nov 01;316(17):1798-1807
Date
Nov-01-2016
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aftercare
Cohort Studies
Crime - statistics & numerical data
Drug Prescriptions - statistics & numerical data
Female
Humans
Male
Middle Aged
Prisoners - statistics & numerical data
Psychotherapy - statistics & numerical data
Psychotropic Drugs - administration & dosage
Substance-Related Disorders - therapy
Sweden
Violence - statistics & numerical data
Abstract
Individuals released from prison have high rates of violent reoffending, and there is uncertainty about whether pharmacological treatments reduce reoffending risk.
To investigate the associations between major classes of psychotropic medications and violent reoffending.
This cohort study included all released prisoners in Sweden from July 1, 2005, to December 31, 2010, through linkage of population-based registers. Rates of violent reoffending during medicated periods were compared with rates during nonmedicated periods using within-individual analyses. Follow-up ended December 31, 2013.
Periods with or without dispensed prescription of psychotropic medications (antipsychotics, antidepressants, psychostimulants, drugs used in addictive disorders, and antiepileptic drugs) after prison release. Prison-based psychological treatments were investigated as a secondary exposure.
Violent crime after release from prison.
The cohort included 22?275 released prisoners (mean [SD] age, 38 [13] years; 91.9% male). During follow-up (median, 4.6 years; interquartile range, 3.0-6.4 years), 4031 individuals (18.1%) had 5653 violent reoffenses. The within-individual hazard ratio (HR) associated with dispensed antipsychotics was 0.58 (95% CI, 0.39-0.88), based on 100 events in 1596 person-years during medicated periods and 1044 events in 11?026 person-years during nonmedicated periods, equating to a risk difference of 39.7 (95% CI, 11.3-57.7) fewer violent reoffenses per 1000 person-years. The within-individual HR associated with dispensed psychostimulants was 0.62 (95% CI, 0.40-0.98), based on 94 events in 1648 person-years during medicated periods and 513 events in 4553 person-years during nonmedicated periods, equating to a risk difference of 42.8 (95% CI, 2.2-67.6) fewer violent reoffenses per 1000 person-years. The within-individual HR associated with dispensed drugs for addictive disorders was 0.48 (95% CI, 0.23-0.97), based on 46 events in 1168 person-years during medicated periods and 1103 events in 15?725 person-years during nonmedicated periods, equating to a risk difference of 36.4 (95% CI, 2.1-54.0) fewer violent reoffenses per 1000 person-years. In contrast, antidepressants and antiepileptics were not significantly associated with violent reoffending rates (HR?=?1.09 [95% CI, 0.83-1.43] and 1.14 [95% CI, 0.79-1.65], respectively). The most common prison-based program was psychological treatments for substance abuse, associated with an HR of 0.75 (95% CI, 0.63-0.89), which equated to a risk difference of 23.2 (95% CI, 10.3-34.1) fewer violent reoffenses per 1000 person-years.
Among released prisoners in Sweden, rates of violent reoffending were lower during periods when individiduals were dispensed antipsychotics, psychostimulants, and drugs for addictive disorders, compared with periods in which they were not dispensed these medications. Further research is needed to understand the causal nature of this association.
Notes
Comment In: JAMA. 2016 Nov 1;316(17 ):1771-177227802525
PubMed ID
27802545 View in PubMed
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Association of psychotherapy with disability benefit claim closure among patients disabled due to depression.

https://arctichealth.org/en/permalink/ahliterature108796
Source
PLoS One. 2013;8(6):e67162
Publication Type
Article
Date
2013
Author
Shanil Ebrahim
Gordon H Guyatt
Stephen D Walter
Diane Heels-Ansdell
Marg Bellman
Steven E Hanna
Irene Patelis-Siotis
Jason W Busse
Author Affiliation
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario Canada. shanil.ebrahim@utoronto.ca
Source
PLoS One. 2013;8(6):e67162
Date
2013
Language
English
Publication Type
Article
Keywords
Adult
Canada - epidemiology
Depressive Disorder, Major - epidemiology - therapy
Female
Humans
Insurance Benefits - statistics & numerical data
Insurance, Disability - statistics & numerical data
Kaplan-Meier Estimate
Male
Middle Aged
Proportional Hazards Models
Psychotherapy - statistics & numerical data
Return to Work - statistics & numerical data
Treatment Outcome
Abstract
Depression is the most frequent reason for receiving disability benefits in North America, and treatment with psychotherapy is often funded by private insurers. No studies have explored the association between the provision of psychotherapy for depression and time to claim closure.
Using administrative data from a Canadian disability insurer, we evaluated the association between the provision of psychotherapy and short-term disability (STD) and long-term disability (LTD) claim closure by performing Cox proportional hazards regression.
We analyzed 10,508 STD and 10,338 LTD claims for depression. In our adjusted analyses, receipt of psychotherapy was associated with longer time to STD closure (HR [99% CI]?=?0.81 [0.68 to 0.97]) and faster LTD claim closure (1.42 [1.33 to 1.52]). In both STD and LTD, older age (0.90 [0.88 to 0.92] and 0.83 [0.80 to 0.85]), per decade), a primary diagnosis of recurrent depression versus non-recurrent major depression (0.78 [0.69 to 0.87] and 0.80 [0.72 to 0.89]), a psychological secondary diagnosis (0.90 [0.84 to 0.97] and 0.66 [0.61 to 0.71]), or a non-psychological secondary diagnosis (0.81 [0.73 to 0.90] and 0.77 [0.71 to 0.83]) versus no secondary diagnosis, and an administrative services only policy ([0.94 [0.88 to 1.00] and 0.87 [0.75 to 0.996]) or refund policy (0.86 [0.80 to 0.92] and 0.73 [0.68 to 0.78]) compared to non-refund policy claims were independently associated with longer time to STD claim closure.
We found, paradoxically, that receipt of psychotherapy was independently associated with longer time to STD claim closure and faster LTD claim closure in patients with depression. We also found multiple factors that were predictive of time to both STD and LTD claim closure. Our study has limitations, and well-designed prospective studies are needed to establish the effect of psychotherapy on disabling depression.
Notes
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PubMed ID
23840614 View in PubMed
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Conformance to evidence-based treatment recommendations in schizophrenia treatment services.

https://arctichealth.org/en/permalink/ahliterature124807
Source
Can J Psychiatry. 2012 May;57(5):317-23
Publication Type
Article
Date
May-2012
Author
Donald Addington
Emily McKenzie
Harvey Smith
Henry Chuang
Stephen Boucher
Beverly Adams
Zahinoor Ismail
Author Affiliation
Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada. addingto@ucalgary.ca
Source
Can J Psychiatry. 2012 May;57(5):317-23
Date
May-2012
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Antipsychotic Agents - therapeutic use
Canada
Cohort Studies
Community Mental Health Services - statistics & numerical data
Cross-Sectional Studies
Evidence-Based Medicine
Female
Guideline Adherence - statistics & numerical data
Humans
Male
Middle Aged
Process Assessment (Health Care) - statistics & numerical data
Psychotherapy - statistics & numerical data
Quality Indicators, Health Care - statistics & numerical data
Rehabilitation, Vocational - statistics & numerical data
Schizophrenia - therapy
Abstract
To assess quality of health care provided in a representative Canadian mental health service using conformance to evidence-based treatment recommendations, and to examine differences from published US results.
We used a cross-sectional cohort design involving a randomly selected sample of patients diagnosed with schizophrenia attending 1 of 3 mental health clinics in 1 Canadian regional health system. The sample size was calculated to detect differences with the US sample. Conformance criteria were based on a published protocol. Data were collected using patient interviews and a structured review of health records. Conformance to 9 key Schizophrenia Patient Outcomes Research Team recommendations was assessed.
Conformance ranged between 58% and 90% for pharmacological recommendations, and 0% to 81% for psychosocial recommendations. No patients who met criteria for assertive case management had been referred to an assertive case management team. Significant differences in conformance rates to some treatment recommendations were found between Canadian and published US results.
It proved possible to assess health care quality using process measures of conformance to treatment recommendations. Conformance to clinical recommendations for pharmacotherapy is higher than for psychosocial therapies. The absence of barriers to access for pharmacological therapies likely enhances the higher conformance to these recommendations. Limited or variable access to psychosocial services, specifically assertive community treatment, likely negatively affects conformance to psychosocial treatment recommendations. Methodological limitations preclude drawing conclusions on comparisons between Canadian and US services.
Notes
Comment In: Can J Psychiatry. 2012 Sep;57(9):583; author reply 583-423073036
PubMed ID
22546064 View in PubMed
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Counselling for burnout in Norwegian doctors: one year cohort study.

https://arctichealth.org/en/permalink/ahliterature91308
Source
BMJ. 2008;337:a2004
Publication Type
Article
Date
2008
Author
Rø Karin E Isaksson
Gude Tore
Tyssen Reidar
Aasland Olaf G
Author Affiliation
Research Institute, Modum Bad, NO-3370 Vikersund, Norway. karin.roe@modum-bad.no
Source
BMJ. 2008;337:a2004
Date
2008
Language
English
Publication Type
Article
Keywords
Burnout, Professional - etiology - rehabilitation
Cohort Studies
Counseling - statistics & numerical data
Female
Follow-Up Studies
Humans
Job Satisfaction
Male
Middle Aged
Multivariate Analysis
Norway
Patient satisfaction
Physician Impairment - statistics & numerical data
Psychotherapy - statistics & numerical data
Sick Leave - statistics & numerical data
Workload
Abstract
OBJECTIVE: To investigate levels and predictors of change in dimensions of burnout after an intervention for stressed doctors. DESIGN: Cohort study followed by self reported assessment at one year. SETTING: Norwegian resource centre. PARTICIPANTS: 227 doctors participating in counselling intervention, 2003-5. INTERVENTIONS: Counselling (lasting one day (individual) or one week (group based)) aimed at motivating reflection on and acknowledgement of the doctors' situation and personal needs. MAIN OUTCOME MEASURES: Levels of burnout (Maslach burnout inventory) and predictors of reduction in emotional exhaustion investigated by linear regression. RESULTS: 185 doctors (81%, 88 men, 97 women) completed one year follow-up. The mean level of emotional exhaustion (scale 1-5) was significantly reduced from 3.00 (SD 0.94) to 2.53 (SD 0.76) (t=6.76, P
PubMed ID
19001492 View in PubMed
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General practice and mental health care: determinants of outpatient service use.

https://arctichealth.org/en/permalink/ahliterature149266
Source
Can J Psychiatry. 2009 Jul;54(7):468-76
Publication Type
Article
Date
Jul-2009
Author
Helen-Maria Vasiliadis
Raymond Tempier
Alain Lesage
Nick Kates
Author Affiliation
Département des sciences de la santé communautaire, Université de Sherbrooke, Sherbrooke, Quebec. helen-maria.vasiliadis@usherbrooke.ca
Source
Can J Psychiatry. 2009 Jul;54(7):468-76
Date
Jul-2009
Language
English
Publication Type
Article
Keywords
Adaptation, Psychological
Adult
Ambulatory Care - statistics & numerical data
Canada
Chronic Disease
Cross-Sectional Studies
Family Practice - statistics & numerical data
Female
Health Resources - utilization
Health Services Needs and Demand - statistics & numerical data
Health Surveys
Humans
Male
Mental Disorders - epidemiology - therapy
Mental Health Services - utilization
Middle Aged
Motivation
Psychotherapy - statistics & numerical data
Quality of Life - psychology
Referral and Consultation - utilization
Sex Factors
Socioeconomic Factors
Utilization Review - statistics & numerical data
Abstract
To examine the determinants that lead Canadian adults to consult family physicians, psychiatrists, psychologists, psychotherapists, and other health professionals for mental health reasons and to compare the determinants of service use across provider types.
Data from the Canadian Community Health Survey: Mental Health and Well-Being were used for people aged 18 years and older (n = 35,236). A multivariate logistic regression was used to model outpatient consultations with different providers as a function of predictive determinants.
Three types of variables were examined: need, enabling, and predisposing factors. Among need, the most common predictors of service use for mental health reasons were self-rated mental health, the presence of chronic conditions, depression and panic attacks, unmet mental health needs, psychological well-being, and the ability to handle daily demands. Among enabling factors, emotional and informational support and income were important predictors. Among predisposing factors, men were less likely to consult with a family physician and other resources but not with psychiatrists; and people with less education were less likely to consult psychologists and other health providers.
Need factors were the most important predictors of both psychiatrist and combined family physician and psychiatrist consultation in the previous year. However, sex barriers remain and promotion campaigns in seeking mental health care should be aimed toward men. Further, education and income barriers exist in the use of specialty providers of psychotherapy and policies should thus focus on rendering these services more accessible to disadvantaged people.
PubMed ID
19660169 View in PubMed
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How much therapy is enough? Comparing dose-effect and good-enough models in two different settings.

https://arctichealth.org/en/permalink/ahliterature279147
Source
Psychotherapy (Chic). 2016 Mar;53(1):130-9
Publication Type
Article
Date
Mar-2016
Author
Fredrik Falkenström
Albin Josefsson
Tore Berggren
Rolf Holmqvist
Source
Psychotherapy (Chic). 2016 Mar;53(1):130-9
Date
Mar-2016
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Female
Humans
Male
Mental Disorders - therapy
Middle Aged
Psychotherapy - statistics & numerical data
Surveys and Questionnaires
Sweden
Time Factors
Treatment Outcome
United States
Young Adult
Abstract
The Dose-Effect model holds that longer therapy leads to better outcome, although increasing treatment length will yield diminishing returns, as additional sessions lead to progressively less change in a negatively accelerating fashion. In contrast, the Good-Enough-Level (GEL) model proposes that patients, therapists, or patients-with-therapists decide on ending treatment when treatment outcome is satisfactory, meaning that patients who change faster will have shorter treatments. If true, this means that aggregating among patients with different treatment lengths would yield biased results. Most previous research has shown that symptom change rate depends on treatment length, but all of these studies used data from University counseling centers in the United States. There is a need to test if previous results hold in different settings. Two datasets from Swedish community-based primary care (n = 640) and psychiatric care (n = 284) were used. Patients made session-wise ratings on the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM). Multilevel models indicated better fit for a model in which treatment length moderated symptom change rate. In the primary care sample, patients in longer treatments achieved more symptom change from pre- to posttreatment, despite having slower rate of improvement. The most important aspect of the GEL model was supported, and no evidence was found for a negatively accelerating Dose-Effect curve. Results cannot be generalized beyond about 12 sessions, due to scarcity of data for longer treatments.
PubMed ID
26928273 View in PubMed
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Incidence of critical events in professional practice: a statewide survey of psychotherapy providers.

https://arctichealth.org/en/permalink/ahliterature3641
Source
Psychol Rep. 2001 Apr;88(2):387-97
Publication Type
Article
Date
Apr-2001
Author
A H Harris
Author Affiliation
Stanford Counseling Institute, School of Education, Stanford University, Stanford, CA 94305, USA. alex.harris@stanford.edu
Source
Psychol Rep. 2001 Apr;88(2):387-97
Date
Apr-2001
Language
English
Publication Type
Article
Keywords
Adult
Alaska - epidemiology
Female
Humans
Male
Middle Aged
Population Surveillance
Professional-Patient Relations
Psychotherapy - statistics & numerical data
Questionnaires
Sexual Behavior - statistics & numerical data
Suicide - statistics & numerical data
Violence - statistics & numerical data
Abstract
The goal was to tabulate the incidences of clients' suicide, attack by a client, and sexual contact with clients in an Alaskan sample of masters and doctoral-level psychotherapy providers (excluding psychiatrists) and to assess which, if any, demographic or professional characteristics were associated with each critical event. Results from 151 respondents (response rate 43.5%) indicated that 42.7% of providers had experienced at least one client's suicide, 28% had been physically attacked by a client, 4% reported having had sexual contact with a then current client, and 6% reported sexual contact with a former client. Areas for research are outlined, specifically the importance of using methods other than surveys and exploring variables other than standard demographic data.
PubMed ID
11351877 View in PubMed
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23 records – page 1 of 3.