Peter J. J. Goossens

Alone together: A grounded theory study of experienced burden, coping, and support needs of spouses of persons with a bipolar disorder

Bipolar disorder is a chronic and severe mental disorder. Little is known about the experiences of the spouses of such patients. A grounded theory study was undertaken to examine the burden for spouses living with a partner with a bipolar disorder and to explore how they cope and what support they need. Fifteen spouses and ex-spouses were interviewed; they experienced heavy burden and found themselves to be alone together. Their coping process is found to involve appraisal of the situation and attempts to achieve a balance between self-effacement and self-fulfilment. While support can clearly reduce experienced burden, the spouses surprisingly receive virtually no professional support. A theory is developed that constitutes a starting point for the development of adequate support for spouses.

Prevalence of interpersonal trauma exposure and trauma-related disorders in severe mental illness

Background Interpersonal trauma exposure and trauma-related disorders in people with severe mental illness (SMI) are often not recognized in clinical practice. Objective To substantiate the prevalence of interpersonal trauma exposure and trauma-related disorders in people with SMI. Methods We conducted a systematic review of four databases (1980–2010) and then described and analysed 33 studies in terms of primary diagnosis and instruments used to measure trauma exposure and trauma-related disorders. Results Population-weighted mean prevalence rates in SMI were physical abuse 47% (range 25–72%), sexual abuse 37% (range 24–49%), and posttraumatic stress disorder (PTSD) 30% (range 20–47%). Compared to men, women showed a higher prevalence of sexual abuse in schizophrenia spectrum disorder, bipolar disorder, and mixed diagnosis groups labelled as having SMI. Conclusions Prevalence rates of interpersonal trauma and trauma-related disorders were significantly higher in SMI than in the general population. Emotional abuse and neglect, physical neglect, complex PTSD, and dissociative disorders have been scarcely examined in SMI.

Self-reported psychopathological symptoms and quality of life in outpatients with bipolar disorder

PURPOSEnPatients with bipolar disorder in a euthymic mood state can suffer from subsyndromal or residual symptoms of depression or hypomania. This study was undertaken to gain insight into the broader spectrum of psychopathological symptoms and quality of life.nnnDESIGN AND METHODSnParticipants (n = 157) completed the Symptoms Checklist-90, the World Health Organization Quality of Life Assessment Instrument-Bref, and a questionnaire addressing demographic and clinical characteristics.nnnFINDINGSnOutpatients with bipolar disorder reported fewer symptoms of psychopathology than psychiatric outpatients in general, but relative to the general population, a significantly lower quality of life was reported. The number of symptoms showed consistently negative correlations with the quality of life.nnnPRACTICE IMPLICATIONSnThe results of this study urge nurses to not settle for treatment response in terms of reduced manic or depressive episodes, but instead to strive for full remission of all symptoms.

Recognising prodromes of manic or depressive recurrence in outpatients with bipolar disorder: a cross-sectional study

BACKGROUNDnThere is some evidence that teaching patients to recognise prodromes of manic and depressive episodes improved time to recurrence and hospitalization, social function, and performance in employment. Little information is available about which prodromal symptom patients with bipolar disorder recognise as being the very first symptom of recurrence.nnnOBJECTIVESnThe aims of this study were to describe the very first symptoms in manic or depressive recurrence reported by patients with bipolar disorder and to explore associations between the ability to recognise these prodromal symptoms and the clinical characteristics of these patients.nnnDESIGNnA cross-sectional, descriptive design.nnnSETTINGSnFive psychiatric outpatient clinics in the Netherlands.nnnPARTICIPANTSn111 outpatients diagnosed with bipolar disorder, currently not in an episode.nnnMETHODSnData were obtained through a face-to-face interview with open ended questions and a questionnaire for demographic and clinical characteristics. Reported prodromes were categorised in an instrument inductively constructed and based on literature review and expert opinion. Associations were calculated with chi squares.nnnRESULTSnThe first recognised symptom of recurrence in mania was change in energy level (21%), sleep (17%), and social functioning (16%). In depression it was change in thought (15%), mood stability (12%), energy level (12%), social functioning (11%), and sleep (10%). Twenty-eight percent of the patients were not able to recognise prodromes of recurrence in mania. Also 28% was not able to recognise prodromes of depression, and 12% was not able to recognise either of them. A significant association (p=0.033) was found between the ability to recognise prodromes of depression and the lifetime number of depressive episodes.nnnCONCLUSIONSnThe majority of euthymic patients with bipolar disorder are able to recognise prodromes of recurrence. These warning signs often emerge early in the process of recurrence. Our results suggest that patients learn to recognise prodromes of recurrence rather by experience than from therapeutic interventions. Talking to patients and their relatives closely after recovered from an episode to construct the early phase of recurrence can be important to improve recognition and prevent future episodes of mania or depression.

Factors Influencing Attitudes of Nurses in General Health Care Toward Patients with Comorbid Mental Illness: An Integrative Literature Review

An estimated 40% of patients in general health care settings suffer from a comorbid mental illness. A literature review was conducted to elucidate the factors underlying the different attitudes of nurses in general health care toward the nursing care of these patients. Although lack of knowledge, skills, and additional training with respect to dealing with patients with comorbid mental illness were frequently mentioned as a cause of negative attitudes, their exact relationships remained unclear. A holistic nursing vision, support, and older age were described as having a positive influence on a positive attitude, and workload was described as having a negative influence.

Evidence Base and Components of Brief Admission as an Intervention for Patients With Borderline Personality Disorder: A Review of the Literature

PURPOSEnTo review the available evidence-based literature on the components of brief inpatient psychiatric hospital admission as an intervention for patients with borderline personality disorder.nnnDESIGN AND METHODnSystematic literature search, narrative literature review. Content analysis.nnnFINDINGSnFive key components of brief admission as an intervention were identified: discussion of goals; organization of Brief Admission; clear admission procedure; specification of any other interventions during Brief Admission; and stipulation of conditions for premature (i.e., forced) discharge.nnnRESEARCH AND PRACTICE IMPLICATIONSnBrief Admission can be effectively used to prevent self-harm and suicide in patients with borderline personality disorder. During the Brief Admission, psychiatric nurses can support these patients achieving an active coping in dealing with their symptoms.

Everyday life consequences of substance use in adult patients with a substance use disorder (SUD) and co-occurring attention deficit/hyperactivity disorder (ADHD) or autism spectrum disorder (ASD): a patient's perspective

BackgroundAlthough the prevalence of substance use disorder (SUD) with co-occurring attention deficit/hyperactivity disorder (ADHD) or autism spectrum disorder (ASD) is relatively high in adult patients, there is hardly any knowledge about these dual diagnoses. A recent study reported met- and unmet needs for several life domains regarding these patient groups. To improve treatment, it is necessary to identify the everyday life consequences of SUD and co-occurring ADHD or ASD in adult patients.MethodsQualitative study using in-depth interviews. 11 SUD + ADHD and 12 SUD + ASD patients participated in the study. The interview transcripts were coded and analysed according to the seven steps for descriptive phenomenology by Colaizzi.ResultsBoth patients with ADHD and patients with ASD can get caught in a jumble of thoughts and emotions which can often lead to agitation and impulsivity in the case of ADHD or passivity and melancholia in the case of ASD with co-occurring SUD in both cases. Initially substance use ameliorates the symptoms and related problems, but both patient groups can later experience even greater problems: difficulties with the structuring of daily life due to a lack of planning (SUD + ADHD) or due to a lack of initiative (SUD + ASD). Both groups indicate that structure helps them function better. They also recognize that substance use disorganizes their lives and that an absence of structure contributes to substance use in what becomes a vicious circle which needs to be broken for effective treatment and care.ConclusionsThis study provides insight into the daily life consequences of SUD with a co-occurring ADHD or ASD. Substance use is reported to solve some ADHD- or ASD-related problems in the short run but have negative consequences in the long run (i.e., contribute to already impaired cognitive functioning). Insight is provided into what clinicians can do to break this vicious circle and thus help ADHD patients to refrain from action and ASD patients to take action.

Experiences of patients with borderline personality disorder with the brief admission intervention: A phenomenological study

Brief admission is a crisis intervention for patients with borderline personality disorder (BPD), and refers to a clinical admission at a psychiatric hospital for a period of 1-5 nights. Patients formulate a treatment plan together with their community mental health nurse about the maximum frequency allowed for these brief admissions. The purpose of the study was to describe the lived experiences of patients with BPD with use of the brief admission intervention. The study used a phenomenological approach. Inclusion criteria were a diagnosis of BPD, according to the Diagnostic and Statistical Manual of Mental Disorders-IV criteria; experience with brief admission, and sufficient understanding of the Dutch language. A total of 16 female patients and one male patient participated in the study. Thematic analysis of the transcripts of the interviews revealed four major meaning units: (i) organization of the brief admission; (ii) contact with a nurse; (iii) time out from daily life; and (iv) experienced value for the patient. Patients highlighted the quality of the contact with a nurse as the most important aspect of the brief admission. Nurses should be aware of the importance of connecting with patients who have BPD during a brief admission, particularly in light of the interpersonal hypersensitivity that characterizes these patients.

Attitude disentangled: a cross-sectional study into the factors underlying attitudes of nurses in Dutch rehabilitation centers toward patients with comorbid mental illness

In rehabilitation centers, many patients suffer a comorbid mental illness. Nurses have different attitudes toward these patients. A cross-sectional, questionnaire-based study among nurses in Dutch rehabilitation centers was undertaken to clarify the factors that underlie attitudes toward patients with comorbid mental illness. The main factors associated with attitudes were feelings of competence and experiences with dealing with patients with mental illness. Other associations were perceived support; frequency of caring for patients with comorbid mental illness; work experience in mental health care; additional psychiatric training; and the personality traits “extraversion,” “emotional stability,” and “openness to experience.” Perceived support had the strongest association with feelings of competence.

Mental Health Nursing and First Episode Psychosis

The purpose of this literature review is to identify mental health nursings contribution to the care and treatment of patients with a first episode of psychosis; A systematic literature review was undertaken, with 27 articles selected for study. Five domains were identified: development of therapeutic relation, relapse prevention, enhancement of social functioning, stimulation of medication adherence, and support of family members. The level of evidence of mental health nursings contribution to the care and treatment of those undergoing their first episode of psychosis was low. Our review suggests that mental health nurses should reflect upon their own daily practices within the five domains.