Abraham Rudnick

Using a capabilities approach to understand poverty and social exclusion of psychiatric survivors

The purpose of this project is to better understand poverty and social exclusion of psychiatric survivors using a capabilities approach to social justice as part of a larger mixed-methods longitudinal study (N=380) in Ontario, Canada. Using thematic coding, four themes emerged: poverty, ‘You just try to survive’; stigma, ‘People treat you like trash’; belonging, ‘You feel like you don’t belong’; and shared concern and advocacy, ‘Everyone deserves housing’. This analysis provides a deeper understanding of poverty and other social determinants of experiences of psychiatric survivors, including the synergism of poverty and social exclusion.

Peer-Led and Professional-Led Group Interventions for People with Co-occurring Disorders: A Qualitative Study

This pilot study evaluated the experience of people with co-occurring disorders (mental illness and addiction) in relation to peer-led and professional-led group interventions. The study used a qualitative (phenomenological) approach to evaluate the experience of a convenience sample of 6 individuals with co-occurring disorders who participated in up to 8 sessions each of both peer-led and professional-led group interventions (with a similar rate of attendance in both groups). The semi-structured interview data were coded and thematically analyzed. We found 5 themes within and across the 2 interventions. In both groups, participants experienced a positive environment and personal growth, and learned, albeit different things. They were more comfortable in the peer-led group and acquired more knowledge and skills in the professional-led group. Offering both peer-led and professional-led group interventions to people with co-occurring disorders may be better than offering either alone

Client perceptions of the mental health engagement network: a qualitative analysis of an electronic personal health record.

BackgroundInformation technologies such as websites, mobile phone applications, and virtual reality programs have been shown to deliver innovative and effective treatments for mental illness. Much of the research studying electronic mental health interventions focuses on symptom reduction; however, to facilitate the implementation of electronic interventions in usual mental health care, it is also important to investigate the perceptions of clients who will be using the technologies. To this end, a qualitative analysis of focus group discussions regarding the Mental Health Engagement Network, a web-based personal health record and smartphone intervention, is presented here.MethodsIndividuals living in the community with a mood or psychotic disorder (nu2009=u2009394) were provided with a smartphone and access to an electronic personal health record, the Lawson SMART Record, for 12 to 18xa0months to manage their mental health. This study employed a delayed-implementation design and obtained both quantitative and qualitative data through individual interviews and focus group sessions. Participants had the opportunity to participate in voluntary focus group sessions at three points throughout the study to discuss their perceptions of the technologies. Qualitative data from 95 focus group participants were analysed using a thematic analysis.ResultsFour overarching themes emerged from focus group discussions: 1) Versatile functionality of the Lawson SMART Record and smartphone facilitated use; 2) Aspects of the technologies as barriers to use; 3) Use of the Mental health Engagement Network technologies resulted in perceived positive outcomes; 4) Future enhancement of the Lawson SMART Record and intervention is recommended.DiscussionThese qualitative data provide a valuable contribution to the understanding of how smarttechnologies can be integrated into usual mental health care. Smartphones are extremely portable andcommonplace in society. Therefore, clients can use these devices to manage and track mental health issuesin any place at almost any time without feeling stigmatized.ConclusionsAssessing clients’ perspectives regarding the use of smart technologies in mental health care provides an invaluable addition to the current literature. Qualitative findings support the feasibility of implementing a smartphone and electronic personal health record intervention with individuals who are living in the community and experiencing a mental illness, and provide considerations for future development and implementation.

Gender Dysphoria and Dementia: A Case Report

A case of gender dysphoria in a biological male who developed cognitive impairment and subsequent gender confusion is reported. Biographical details and the clinical scenario are described, illustrating a patient who is no longer able to express a consistent gender preference due to moderate dementia. A review of the relevant literature and discussion of how to approach the gender role of this patient is presented.

What is a Psychiatric Disability

This article aims to clarify the notion of a psychiatric disability. The article uses conceptual analysis, examining and applying established definitions of (general) disability to psychiatric disabilities. This analysis reveals that disability as inability to perform according to expectations or norms is related to impairment as deviation from the (statistical) norm, while disability as inability to achieve (personal) goals is related to impairment as deviation from the (personal) ideal. These two views of impairment and disability are distinct from the self-organization view of impairment as disrupted self-creation or disrupted self-repair and of disability as disrupted whole person self-compensation (in relation to an impairment). All these three views of disability pertain to psychiatric disability. Although there is nothing necessarily psychiatric about psychiatric disability other than the psychiatric impairment related to it, the life course and life circumstances typical of many people with (severe) psychiatric disorders may lead to disability and may thus confer some (psychiatric) specificity on this disability. This analysis may facilitate research on specific psychiatric disabilities and a broader scope for psychiatric rehabilitation.

Humour-Related Interventions for People with Mental Illness: A Randomized Controlled Pilot Study

AbstractnThis study explored the feasibility and effects of humour-related interventions for mentally ill adults. Twelve, randomly assigned, participated in each of 3 arms—stand up comedy training (the experimental arm), discussing comedy videos (the active control arm), and no humour-related intervention (the passive control arm). Quantitative and qualitative data were collected at baseline, end of interventions (3xa0months) and follow up (after another 3xa0months). Scale comparisons were largely negative, although self-esteem marginally increased in the experimental arm. Interview responses indicated benefits for the interventions, including improved self-esteem in the experimental arm. These results, though mixed, justify further study.n

Toward a Vision for the Development, Study, and Use of Electronic Health Technology for and by People With Psychiatric and/or Substance Use Disorders: A Strengths, Weaknesses, Opportunities, and Threats Analysis and Illustration

The world is rapidly transforming into a global village, mostly because of communication becoming increasingly accessible and fast. This is having a profound impact on our dayto-day experiences and lives and changing many long-standing assumptions and ways of doing things in many areas, even beyond what Alvin Toffler radically predicted a few decades ago (Toffler, 1970). Just like our children have a hard time believing we once waited eagerly for the postal worker to bring a letter from a family member living in a far-away country, it may not be long before our students will find it difficult to imagine lengthy face-to-face therapeutic sessions as the only available intervention. Nostalgia aside, in this commentary we wish to look ahead and focus on future possibilities that electronic health technology (e-health) enables and will likely continue to do so. This issue focuses on innovations and opportunities of technology-based assessments and interventions targeting psychiatric and substance use disorders. In this commentary we present a broader global perspective, beyond specific topics addressed in this issue, in order to envision the larger picture in relation to the development, study, and use of e-health in the mental health and substance use system, recognizing that e-health easily crosses borders and is applicable in many if not most or all countries. We especially focus on patient/consumer-level applications of e-health (such as website–

Risperidone for Individuals with Refractory Schizophrenia

Background: Risperidone has been shown to be as effective as other atypical antipsychotic medications in the treatment of psychotic symptoms, but its effectiveness in refractory psychotic symptoms is unclear. nObjective: In this paper, we aim to review the available evidence related to the use of risperidone in refractory schizophrenia. n nMethods: English language articles ranging from 1985 to 2009 (inclusive) were retrieved from Pubmed in December 2009 using the search terms ‘schizophrenia’, ‘refractory’, ‘resistant’, ‘risperidone’, ‘atypical’, ‘combination’ and ‘antipsychotic’. n nResults: The available literature is conflicting on the use of risperidone as an augmentation of clozapine or of other antipsychotics and methodological problems make drawing firm conclusions difficult. Studies using Risperidone Long Acting Injection have included both individuals with recent-onset schizophrenia and those with refractory schizophrenia, which makes it difficult to interpret its effectiveness specifically for those with refractory schizophrenia. Risperidone may reduce potentially disabling cognitive symptoms of schizophrenia, but these effects do not differ significantly from that of other typical and atypical antipsychotic medications. n nConclusion: Further and more rigorous research is required on risperidone for refractory schizophrenia.