Michelle Cleary

Psychosocial Treatments for People with Co-occurring Severe Mental Illnesses and Substance Use Disorders (Dual Diagnosis): A Review of Empirical Evidence

&NA; Considerable research documents the health consequences of psychosis and co‐occurring substance use disorders. Results of randomized controlled trials assessing the effectiveness of psychosocial interventions for persons with dual diagnoses are equivocal but encouraging. Many studies are hampered by small, heterogeneous samples, high attrition rates, short follow‐up periods, and unclear description of treatment components. The treatments available for this group of patients (which can be tailored to individual needs) include motivational interviewing, cognitive‐behavioral therapy, contingency management, relapse prevention, case management, and skills training. Regardless of whether services follow integrated or parallel models, they should be well coordinated, take a team approach, be multidisciplinary, have specialist‐trained personnel (including 24‐hour access), include a range of program types, and provide for long‐term follow‐up. Interventions for substance reduction may need to be further developed and adapted for people with serious mental illnesses. Further quality trials in this area will contribute to the growing body of data of effective interventions.

Prevalence of comorbid substance use, anxiety and mood disorders in epidemiological surveys, 1990–2014: A systematic review and meta-analysis

BACKGROUND Comorbidity is highly prevalent between substance use disorders (SUDs), mood and anxiety disorders. We conducted a systematic review and meta-analysis to determine the strength of association between SUDs, mood and anxiety disorders in population-based epidemiological surveys. METHODS A comprehensive literature search of Medline, EMBASE, CINAHL, PsychINFO, Web of Science, and Scopus was conducted from 1990 to 2014. Sources were chosen on the basis that they contained original research in non-clinical populations conducted in randomly selected adults living within defined boundaries. Prevalence of comorbid SUDs, mood and anxiety disorders and odds ratios (ORs) were extracted. RESULTS There were 115 articles identified by electronic searches that were reviewed in full text which yielded 22 unique epidemiological surveys to extract lifetime and 12-month prevalence data for psychiatric illness in respondents with an SUD. Meta-analysis indicated the strongest associations were between illicit drug use disorder and major depression (pooled OR 3.80, 95% CI 3.02-4.78), followed by illicit drug use and any anxiety disorder (OR 2.91, 95% CI 2.58-3.28), alcohol use disorders and major depression (OR 2.42, 95% CI 2.22-2.64) and alcohol use disorders and any anxiety disorder (OR 2.11, 95% CI 2.03-2.19). ORs for dependence were higher than those for abuse irrespective to diagnoses based on lifetime or 12-month prevalence. CONCLUSIONS This review confirms the strong association between SUDs, mood and anxiety disorders. The issue has now been recognised worldwide as a factor that affects the profile, course, patterns, severity and outcomes of these disorders.

Stigma in mental health: clients and professionals

Stigmatising attitudes are not uncommon among mental health professionals who may be less than optimistic about outcomes for people with long-term mental health problems. These perceptions are probably related to the professionals’ experiences, such as those working in the public sector dealing with clients in the most disturbed phases of mental illness. We provide an overview of stigma and some contemporary stigma conceptualisations and then explore some stigma-reducing strategies for mental health professionals. The way that mental health professionals work with patients can have an important effect on their recovery.

Identifying and addressing bullying in nursing

Bullying activities can be overt and intimidating or comparatively invisible to others. Nurses who work in a culture of bullying may experience job dissatisfaction and physiological and psychological consequences. Failure to adhere to professional responsibilities and engage in acceptable interpersonal behaviours sets the scene for unhealthy workplaces. Bullying is also costly to organisations due to increased leave and nurse attrition and decreased nurse productivity, satisfaction, and morale. This review provides an overview of bullying, how this impacts on nursing staff, and ways to reduce bullying incidents to cultivate a more positive work environment.

Psychosocial treatments for people with co‐occurring severe mental illness and substance misuse: systematic review

AIM This study is a report of a systematic review to assess current evidence for the efficacy of psychosocial interventions for reducing substance use, as well as improving mental state and encouraging treatment retention, among people with dual diagnosis. BACKGROUND Substance misuse by people with a severe mental illness is common and of concern because of its many adverse consequences and lack of evidence for effective psychosocial interventions. DATA SOURCES Several electronic databases were searched to identify studies published between January 1990 and February 2008. Additional searches were conducted by means of reference lists and contact with authors. REVIEW METHODS Results from studies using meta-analysis, randomized and non-randomized trials assessing any psychosocial intervention for people with a severe mental illness and substance misuse were included. RESULTS Fifty-four studies were included: one systematic review with meta-analysis, 30 randomized controlled trials and 23 non-experimental studies. Although some inconsistencies were apparent, results showed that motivational interviewing had the most quality evidence for reducing substance use over the short term and, when combined with cognitive behavioural therapy, improvements in mental state were also apparent. Cognitive behavioural therapy alone showed little consistent support. Support was found for long-term integrated residential programmes; however, the evidence is of lesser quality. Contingency management shows promise, but there were few studies assessing this intervention. CONCLUSION These results indicate the importance of motivational interviewing in psychiatric settings for the reduction of substance use, at least in the short term. Further quality research should target particular diagnoses and substance use, as some interventions may work better for some subgroups.

Nurse-Patient Interaction in Acute Adult Inpatient Mental Health Units: a Review and Synthesis of Qualitative Studies

Mental health nurses work with acutely unwell patients, and the busy setting is characterised by unpredictable events. This paper is a report of a review conducted to identify, analyse and synthesize research in adult acute inpatient mental health units, which focused on nurse-patient interaction. Several electronic databases were searched using relevant keywords to identify studies published from 1999-present. Qualitative studies published in English were included if they specifically investigated nurse-patient interaction in acute inpatient care in adult settings. Eighteen studies were included (23 papers). Findings were grouped into the following six categories: 1) sophisticated communication; 2) subtle discriminations; 3) managing security parameters; 4) ordinary communication; 5) reliance on colleagues; and 6) personal characteristics. These studies of acute inpatient mental health units reveal that nurse communication involves interpersonal approaches and modalities that exemplify highly developed communication and personal skills designed specifically for this challenging setting. Further quality research should focus on the conditions that enable the development of therapeutic interactional skills and the relationship of these skills to the nuanced context in which they are practiced.

Psychiatry and the Hirsch h-index: The Relationship Between Journal Impact Factors and Accrued Citations

&NA; There is considerable debate on the use and abuse of journal impact factors and on selecting the most appropriate indicator to assess research outcome for an individual or group of scientists. Internet searches using Web of Science and Scopus were conducted to retrieve citation data for an individual in order to calculate nine variants of Hirschs h‐index. Citations to articles published in a wide range of psychiatric journals in the periods 1995–99 and 2000–05 were analyzed using Web of Science. Comparisons were made between journal impact factor, h‐index of citations from publication to 2008, and the proportion of articles cited at least 30 or 50 times. For up to 14 years post‐publication, there was a strong positive relationship between journal impact factor and h‐index for citations received. Journal impact factor was also compared to the percentage of articles cited at least 30 or 50 times—a comparison that showed wide variations between journals with similar impact factors. This study found that 40%–50% of the articles published in the top ten psychiatry journals ranked by impact factor acquire 30 to 50 citations within ten to fifteen years. Despite certain flaws and weaknesses, the h‐index provides a better way to assess long‐term performance of articles or authors than using a journals impact factor, and it provides an alternative way to assess a journals long‐term ranking.

What patients and carers want to know: an exploration of information and resource needs in adult mental health services

OBJECTIVE The objectives of this study were to: (i) obtain baseline data on the extent of carer involvement across a representative sample of hospital and community patients within an integrated area health service; and (ii) examine perspectives on discharge planning and community care among patients and their carers to identify information and resources they consider important. METHOD Over a 4-month period, inpatients before discharge and patients accessing community mental health services participated in face-to-face interviews. Information was collected about carer involvement and, with the patients consent, the identified carer was sent a similar survey to determine demographics and information needs. This resulted in a representative sample of patients and carers accessing inpatient and community settings across a metropolitan mental health service. Support needs and carer burden were also assessed but are not reported here. RESULTS A total of 407 interviews were completed, 207 in inpatient settings and 200 in the community. An inpatient response rate of 70% and a community response rate of 75% was achieved. Across both settings, 67% of patients identified a carer and a carer response rate of 28% was then obtained. We found carers and patients have different priorities regarding the information they want and information is often not provided to carers. Furthermore, patients were more confident in their ability to manage their mental health in the community than carers. CONCLUSIONS This study yielded important baseline data about the number of patients who have a carer. We were also able to determine that routine clinical information provided to patients and carers is inadequate from their perspective. It is anticipated that this initiative will assist ongoing service planning and improve partnerships with patients and their carers.

Psychosocial Treatment Programs for People With Both Severe Mental Illness and Substance Misuse

Over 50% of people with a severe mental illness also use illicit drugs and/or alcohol at hazardous levels. This review is based on the findings of 25 randomized controlled trials which assessed the effectiveness of psychosocial interventions, offered either as one-off treatments or as an integrated or nonintegrated program, to reduce substance use by people with a severe mental illness. The findings showed that there was no consistent evidence to support any one psychosocial treatment over another. Differences across trials with regard to outcome measures, sample characteristics, type of mental illness and substance used, settings, levels of adherence to treatment guidelines, and standard care all made pooling results difficult. More quality trials are required that adhere to proper randomization methods; use clinically valuable, reliable, and validated measurement scales; and clearly report data, including retention in treatment, relapse, and abstinence rates. Future trials of this quality will allow a more thorough assessment of the efficacy of psychosocial interventions for reducing substance use in this challenging population.

Mental health nurses' views of recovery within an acute setting

How the principles of a recovery-oriented mental health service are incorporated in the day-to-day nursing practice of mental health nurses in inpatient settings is unclear. In this study, we interviewed 21 mental health nurses working in acute inpatient mental health units about a range of recovery-focused topics. Three overlapping themes were identified: (i) the perception of recovery; (ii) congruent humanistic approaches; and (iii) practical realities. Only four interviewees had some formal training about recovery. Most respondents recognize that positive attitudes, person-centred care, hope, education about mental illness, medication and side-effects, and the acknowledgement of individual recovery pathways are necessary to prevent readmission, and are central to a better life for people who live with a mental illness. This research supports the view that ideas and practices associated with the recovery movement have been adopted to some degree by nurses working at the acute end of the services continuum. However, most saw the recovery orientation as rhetoric rather than as an appropriately resourced, coordinated, and integrated program. These nurses, however, speak of much more detailed aspects of working with patients and being required to prepare them for the exigencies of living in the community post-discharge.