The "Three Approaches to Psychotherapy" ("TAP") videotape series introduces students to three major schools of psychotherapy: client-centered therapy, Gestalt therapy, and rational-emotive therapy. A ...sample of undergraduate students viewed the "TAP" series. The students were surveyed about their observations of Gestalt therapy and Fritz Perls' interactions with and treatment of Gloria, the client. This importance of the film series is its presentation of psychotherapy as done in that time by the founders of these schools. Videotapes are routinely employed educationally to show therapy techniques and illuminate theory. This paper examines the usefulness of this video to teach gestalt therapy to psychology students in four sections--two underclass and two upper class sections--in the same term. Student perceptions of this 40-year-old film series are explored. The gender relationship of therapist and client is shown as an example of the apparent sexism of the culture and cognitive processes of the time and its participants. Results found to today's instructionally sophisticated students agreed with Perls' explanation and portrayal of gestalt therapy and interactions with Gloria, his adult client.
Purpose
To compare patterns and mechanisms of injuries during and after the UK Nationwide lockdown during the COVID-19 pandemic.
Methods
This prospective cohort study included all major trauma ...admissions during the 10-week period of the nationwide lockdown (09/03/2020–18/05/2020), compared with admissions in the 10-weeks following the full lifting of lockdown restrictions (04/07/20–12/09/2020). Differences in the volume, spectrum and mechanism of injuries presenting during and post-lockdown were compared using Fisher’s exact and Chi-squared tests as appropriate. The associated risk of 30-day mortality was examined using univariable and multivariable logistic regression.
Results
A total of 692 major trauma admissions were included in this analysis. Of these, 237 patients were admitted during the lockdown and 455 patients were admitted post-lockdown. This represented a twofold increase in trauma admission between the two periods. Characteristically, both cohorts had a higher proportion of male patients (73.84% male during lockdown and 72.5% male post-lockdown). There was a noted shift in age groups between both cohorts with an overall more elderly population during lockdown (
p
= 0.0292), There was a significant difference in mechanisms of injury between the two cohorts. The 3-commonest mechanisms during the lockdown period were: Road traffic accidents (RTA)—31.22%, Falls of less than 2 m—26.58%, and falls greater than 2 m causing 22.78% of major trauma admissions. However, in the post-lockdown period RTAs represented 46.15% of all trauma admissions with falls greater than 2 m causing 17.80% and falls less than 2 m causing 15.16% of major trauma injuries. With falls in the elderly associated with an increased risk of mortality. In terms of absolute numbers, there was a twofold increase in major trauma injuries due to stabbings and shootings, rising from 25 admitted patients during the lockdown to 53 admitted patients post-lockdown.
Conclusions
The lifting of lockdown restrictions resulted in a twofold increase in major trauma admissions that was also associated with significant changes in both the demographic and patterns of injuries with RTA’s contributing almost half of all injury presentations.
Trial registration:
This study was classed as a service evaluation and registered with the local audit department, registration number: 20-177C.
People with severe mental illnesses such as schizophrenia are three times more likely to smoke than the wider population, contributing to widening health inequalities. Smoking remains the largest ...modifiable risk factor for this health inequality, but people with severe mental illness have not historically engaged with smoking cessation services. We aimed to test the effectiveness of a combined behavioural and pharmacological smoking cessation intervention targeted specifically at people with severe mental illness.
In the smoking cessation intervention for severe mental illness (SCIMITAR+) trial, a pragmatic, randomised controlled study, we recruited heavy smokers with bipolar disorder or schizophrenia from 16 primary care and 21 community-based mental health sites in the UK. Participants were eligible if they were aged 18 years or older, and smoked at least five cigarettes per day. Exclusion criteria included substantial comorbid drug or alcohol problems and people who lacked capacity to consent at the time of recruitment. Using computer-generated random numbers, participants were randomly assigned (1:1) to a bespoke smoking cessation intervention or to usual care. Participants, mental health specialists, and primary care physicians were unmasked to assignment. The bespoke smoking cessation intervention consisted of behavioural support from a mental health smoking cessation practitioner and pharmacological aids for smoking cessation, with adaptations for people with severe mental illness—such as, extended pre-quit sessions, cut down to quit, and home visits. Access to pharmacotherapy was via primary care after discussion with the smoking cessation specialist. Under usual care participants were offered access to local smoking cessation services not specifically designed for people with severe mental illnesses. The primary endpoint was smoking cessation at 12 months ascertained via carbon monoxide measurements below 10 parts per million and self-reported cessation for the past 7 days. Secondary endpoints were biologically verified smoking cessation at 6 months; number of cigarettes smoked per day, Fagerström Test for Nicotine Dependence (FTND) and Motivation to Quit (MTQ) questionnaire; general and mental health functioning determined via the Patient Health Questionnaire-9 (PHQ-9), the Generalised Anxiety Disorder-7 (GAD-7) questionnaire, and 12-Item Short Form Health Survey (SF-12); and body-mass index (BMI). This trial was registerd with the ISRCTN registry, number ISRCTN72955454, and is complete.
Between Oct 7, 2015, and Dec 16, 2016, 526 eligible patients were randomly assigned to the bespoke smoking cessation intervention (n=265) or usual care (n=261). 309 (59%) participants were male, median age was 47·2 years (IQR 36·3–54·5), with high nicotine dependence (mean 24 cigarettes per day SD 13·2), and the most common severe mental disorders were schizophrenia or other psychotic illness (n=343 65%), bipolar disorder (n=115 22%), and schizoaffective disorder (n=66 13%). 234 (88%) of intervention participants engaged with the treatment programme and attended 6·4 (SD 3·5) quit smoking sessions, with an average duration of 39 min (SD 17; median 35 min, range 5–120). Verified quit data at 12 months were available for 219 (84%) of 261 usual care and 223 (84%) of 265 intervention participants. The proportion of participants who had quit at 12 months was higher in the intervention group than in the usual care group, but non-significantly (34 15% of 223 13% of those assigned to group vs 22 10% of 219 8% of those assigned to group, risk difference 5·2%, 95% CI −1·0 to 11·4; odds ratio OR 1·6, 95% CI 0·9 to 2·9; p=0·10). The proportion of participants who quit at 6 months was significantly higher in the intervention group than in the usual care group (32 14% of 226 vs 14 6% of 217; risk difference 7·7%, 95% CI 2·1 to 13·3; OR 2·4, 95% CI 1·2 to 4·6; p=0·010). The incidence rate ratio for number of cigarettes smoked per day at 6 months was 0·90 (95% CI 0·80 to 1·01; p=0·079), and at 12 months was 1·00 (0·89 to 1·13; p=0·95). At both 6 months and 12 months, the intervention group was non-significantly favoured in the FTND (adjusted mean difference 6 months −0·18, 95% CI −0·53 to 0·17, p=0·32; and 12 months −0·01, −0·39 to 0·38, p=0·97) and MTQ questionnaire (adjusted mean difference 0·58, −0·01 to 1·17, p=0·056; and 12 months 0·64, 0·04 to 1·24, p=0·038). The PHQ-9 showed no difference between the groups (adjusted mean difference at 6 months 0·20, 95% CI −0·85 to 1·24 vs 12 months −0·12, −1·18 to 0·94). For the SF-12 survey, we saw evidence of improvement in physical health in the intervention group at 6 months (adjusted mean difference 1·75, 95% CI 0·21 to 3·28), but this difference was not evident at 12 months (0·59, −1·07 to 2·26); and we saw no difference in mental health between the groups at 6 or 12 months (adjusted mean difference at 6 months −0·73, 95% CI −2·82 to 1·36, and 12 months −0·41, −2·35 to 1·53). The GAD-7 questionnaire showed no difference between the groups (adjusted mean difference at 6 months −0·32 95% CI −1·26 to 0·62 vs 12 months −0·10, −1·05 to 0·86). No difference in BMI was seen between the groups (adjusted mean difference 6 months 0·16, 95% CI −0·54 to 0·85; 12 months 0·25, −0·62 to 1·13).
This bespoke intervention is a candidate model of smoking cessation for clinicians and policy makers to address high prevalence of smoking. The incidence of quitting at 6 months shows that smoking cessation can be achieved, but the waning of this effect by 12 months means more effort is needed for sustained quitting.
National Institute for Health Research Health Technology Assessment Programme.
Participants who were randomised to receive the intervention engaged well, whereas none of those randomised to treatment as usual went on to use routine NHS smoking cessation services. 3 The National ...Institute for Health Research Health Technology Assessment Programme is now supporting the large scale Smoking Cessation Intervention for Severe Mental Ill-Health Trial (SCIMITAR PLUS), which will fully assess the clinical and cost effectiveness of this bespoke smoking cessation programme.
Safety profile of lamotrigine in overdose Alabi, Akintunde; Todd, Adam; Husband, Andrew ...
Therapeutic Advances in Psychopharmacology,
12/2016, Letnik:
6, Številka:
6
Book Review, Journal Article
Recenzirano
Odprti dostop
Background:
Lamotrigine is an anticonvulsant as well as a mood stabilizer. Apart from its established use in the treatment of epilepsy, there has been an expansion of its use in the treatment of ...mental disorders. Patients with epilepsy as well as those with mental disorders are at increased risk of deliberate drug overdoses. An evidence base for the safety profile of lamotrigine in overdose is an essential tool for prescribers. The objective of this study was to carry out a narrative synthesis of the existing evidence for the safety profile of lamotrigine in overdose.
Methods:
A systematic search was conducted of EMBASE (1974 to December 2015), MEDLINE (1946 to December 2015), PsycINFO (1806 to December 2015) and CINAHL (1981 to December 2015) databases. Studies were included in which there was a deliberate or accidental single drug overdose of lamotrigine, with its toxic effects described. Studies that did not involve an overdose were excluded. A narrative synthesis of the described toxic effects was carried out.
Results:
Out of 562 articles identified, 26 studies were included, mainly in the form of case reports and series. The most commonly described toxic effects of lamotrigine were on the central nervous system, specifically seizures, movement disorders and reduced consciousness. Other toxic effects included QTc interval and QRS complex prolongations, hypersensitivity reactions, serotonin syndrome as well as rhabdomyolysis possibly due to seizures and/or agitation. Deaths were recorded in two studies, with cardiovascular and neurological toxic effects described.
Conclusions:
Even though lamotrigine has been reported to be well tolerated, there is a risk of toxic effects which can be life threatening in overdose. This needs to be borne in mind when prescribing to patients at an increased risk of deliberate drug overdose.
Balancing harms in support of recovery Sykes, Michael J.; Brabban, Alison; Reilly, Joe
Journal of mental health (Abingdon, England),
06/2015, Letnik:
24, Številka:
3
Journal Article
Recenzirano
Abstract
Background: Harm in mental health has traditionally been viewed as "unambiguous" and measured in terms of suicide, self-harm, self-neglect and violence. In order to develop an organisational ...patient safety strategy, one Trust engaged with service users, carers and senior clinicians and managers in order to understand how they define harm.
Aim: To explore the meaning of harm in a mental health and learning disabilities setting.
Method: This paper describes the outcome of service improvement work with service users, carers, senior clinicians and managers at one Trust to determine what harm meant to them.
Results: Harm is a concept which is broader than elements currently seen within organisational patient safety metrics and clinical risk assessments.
Conclusions: Taking into account the diverse feedback received about what constitutes harm, a more inclusive definition emerges which could be incorporated into a new framework for risk management, balancing risk of harms across multiple dimensions. This approach has the potential to bring together consideration of the risk and recovery agendas.
Celotno besedilo
Dostopno za:
BFBNIB, DOBA, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Aims
To evaluate the cost‐effectiveness of a specialist smoking cessation package for people with severe mental illness
Design
Incremental cost‐effectiveness analysis was undertaken from the UK ...National Health Service and Personal Social Services perspective over a 12‐month time horizon. Total costs, including smoking cessation, health‐care and social services costs and quality‐adjusted life years (QALYs), derived from the five‐level EuroQol 5‐dimension (EQ‐5D‐5 L), collected from a randomized controlled trial, were used as outcome measures. The bootstrap technique was employed to assess the uncertainty.
Setting
Sixteen primary care and 21 secondary care mental health sites in England.
Participants
Adult smokers with bipolar affective disorder, schizoaffective disorder or schizophrenia and related illnesses (n = 526).
Intervention and comparator
A bespoke smoking cessation (BSC) package for people with severe mental illness offered up to 12 individual sessions with a mental health smoking cessation practitioner versus usual care (UC). Of the participants who were randomized, 261 were in UC group and 265 were in BSC group.
Measurements
BSC intervention cost was estimated from the treatment log. Costs of UC, health‐care and social services and EQ‐5D‐5 L were collected at baseline, 6‐ and 12‐month follow‐ups. Incremental costs and incremental QLAYs were estimated using regression adjusting for respective baseline values and other baseline covariates.
Findings
The mean total cost in the BSC group was £270 95% confidence interval (CI) = –£1690 to £1424 lower than in the UC group, while the mean QALYs were 0.013 (95% CI = –0.008 to 0.045) higher, leading to BSC dominating UC (76% probability of cost‐effective at £20 000/QALY).
Conclusions
A bespoke smoking cessation package for people with severe mental illness is likely to be cost‐effective over 12 months compared with usual care provided by the UK's National Health Service and personal social services.
Articles published in The Journal of Humanistic Counseling from 2000 to 2019 were analyzed to determine trends over time in article content (e.g., topical content, research methodology, participant ...characteristics, research design, statistics used, reporting standards) and author characteristics (e.g., leading contributors and institutions, gender, work setting, domicile).
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