Teena M McGuinness

Resilience: Analysis of the concept

Resilience describes a process whereby people bounce back from adversity and go on with their lives. It is a dynamic process highly influenced by protective factors. Protective factors are specific competencies that are necessary for the process of resilience to occur. Competencies are those healthy skills and abilities that the individual can access and may occur within the individual or the interpersonal or family environment. Psychiatric-mental health nursing has always focused on mental-health promotion and attempted to discern positive outcomes from adversity and states of wellness amidst difficult circumstances or severe illness. Defining specific protective factors that facilitate mental health in high-risk groups would enhance our position in todays health care climate.

Successful aging and the epidemiology of HIV.

By 2015, it is estimated that nearly half of those living with HIV in the US will be 50 years of age and older. This dramatic change in the demographics of this clinical population represents unique challenges for patients, health care providers, and society-at-large. Fortunately, because of highly active antiretroviral therapy (HAART) and healthy lifestyle choices, it is now possible for many infected with HIV to age successfully with this disease; however, this depends upon one’s definition of successful aging. It is proposed that successful aging is composed of eight factors: length of life, biological health, cognitive efficiency, mental health, social competence, productivity, personal control, and life satisfaction. Unfortunately, HIV and medication side effects can compromise these factors, thus diminishing one’s capacity to age successfully with this disease. This article explores how HIV, medication side effects from HAART, and lifestyle choices can compromise the factors necessary to age successfully. Implications for practice and research are posited.

How Neuroplasticity and Cognitive Reserve Protect Cognitive Functioning

Overall cognitive status can vary across an individuals life span in response to factors that promote either positive or negative neuroplasticity. Positive neuroplasticity refers to he physiological ability of the brain to form and strengthen dendritic connections, produce beneficial morphological changes, and increase cognitive reserve. Negative neuroplasticity refers to the same physiological ability of t he brain to atrophy and weaken dendritic connections, produce detrimental morphological changes, and decrease cognitive reserve. Factors that promote positive neuroplasticity include physical activity, education, social interaction, intellectual pursuits, and cognitive remediation. Factors that promote negative neuroplasticity include poor health, poor sleep hygiene, poor nutrition, substance abuse, and depression and anxiety. Implications for promoting positive neuroplasticity and avoiding negative neuroplasticity across the life span are emphasized to facilitate optimal cognitive health and ensure successful cognitive aging.

Treating Depression Within the HIV “Medical Home”: A Guided Algorithm for Antidepressant Management by HIV Clinicians

People living with HIV/AIDS (PLWHA) suffer increased depression prevalence compared to the general population, which negatively impacts antiretroviral (ART) adherence and HIV-related outcomes leading to morbidity and mortality. Yet depression in this population often goes undiagnosed and untreated. The current project sought to design an evidence-based approach to integrate depression care in HIV clinics. The model chosen, measurement-based care (MBC), is based on existing guidelines and the largest randomized trial of depression treatment. MBC was adapted to clinical realities of HIV care for use in a randomized controlled effectiveness trial of depression management at three academic HIV clinics. The adaptation accounts for drug-drug interactions critical to ongoing ART effectiveness and can be delivered by a multidisciplinary team of nonmental health providers. A treatment algorithm was developed that enables clinically supervised, nonphysician depression care managers (DCMs) to track and monitor antidepressant tolerability and treatment response while supporting nonpsychiatric prescribers with antidepressant choice and dosing. Quality of care is ensured through weekly supervision of DCMs by psychiatrists. Key areas of flexibility that have been important in implementation have included flexibility in timing of assessments, accommodation of divergence between algorithm recommendations and provider decisions, and accommodation of delays in implementing treatment plans. This adaptation of the MBC model to HIV care has accounted for critical antidepressant-antiretroviral interactions and facilitated the provision of quality antidepressant management within the HIV medical home.

Gender Differences in Adolescent Depression

Depression in adolescents is more common in girls; this gender disparity becomes more apparent during the teen years when girls have close to twice the rate of depression compared with boys. Vulnerability-stress models help explain these differences, and a tendency toward rumination may play a role both in the development and continuation of depressive symptoms. Psychiatric nursing interventions must focus on reappraisal of relationships, challenging rumination, and promoting autonomy.

Poverty, Child Maltreatment, and Foster Care:

Child maltreatment occurs at significantly higher rates among those living in poverty. Children in foster care usually come to the attention of child welfare officials because they are neglected by parents who struggle with conditions associated with poverty: homelessness, history of incarceration, HIV seropositivity, and substance abuse. This article reports the disadvantages experienced by young children in foster care (aged 36 months and younger) via a study of records documenting the multiple risks to their health and development. Low birth weight, prenatal substance exposure, and prematurity were commonly encountered risks. Additionally, the child welfare agency had a low rate of documented screening for early intervention (11% of records surveyed) despite multiple risks and mandates for screening. Implications for nurses are offered. J Am Psychiatr Nurses Assoc, 2007; 13(5), 296-303. DOI: 10.1177/1078390307308421

The effect of antidepressant treatment on HIV and depression outcomes: results from a randomized trial.

Background:Depression is a major barrier to HIV treatment outcomes. Objective:To test whether antidepressant management decision support integrated into HIV care improves antiretroviral adherence and depression morbidity. Design:Pseudo-cluster randomized trial. Setting:Four US infectious diseases clinics. Participants:HIV-infected adults with major depressive disorder. Intervention:Measurement-based care (MBC) – depression care managers used systematic metrics to give HIV primary-care clinicians standardized antidepressant treatment recommendations. Measurements:Primary – antiretroviral medication adherence (monthly unannounced telephone-based pill counts for 12 months). Primary time-point – 6 months. Secondary – depressive severity, depression remission, depression-free days, measured quarterly for 12 months. Results:From 2010 to 2013, 149 participants were randomized to intervention and 155 to usual care. Participants were mostly men, Black, non-Hispanic, unemployed, and virally suppressed with high baseline self-reported antiretroviral adherence and depressive severity. Over follow-up, no differences between arms in antiretroviral adherence or other HIV outcomes were apparent. At 6 months, depressive severity was lower among intervention participants than usual care [mean difference −3.7, 95% confidence interval (CI) −5.6, −1.7], probability of depression remission was higher [risk difference 13%, 95% CI 1%, 25%), and suicidal ideation was lower (risk difference −18%, 95% CI −30%, −6%). By 12 months, the arms had comparable mental health outcomes. Intervention arm participants experienced an average of 29 (95% CI: 1–57) more depression-free days over 12 months. Conclusion:In the largest trial of its kind among HIV-infected adults, MBC did not improve HIV outcomes, possibly because of high baseline adherence, but achieved clinically significant depression improvements and increased depression-free days. MBC may be an effective, resource-efficient approach to reducing depression morbidity among HIV patients.

Risky recreation: synthetic cannabinoids have dangerous effects

Use of synthetic marijuana (also known as spice, K2, aroma, and eclipse) is often viewed by young people as harmless recreation. Until recently, the substance was freely available in U.S. convenience stores and head shops, and it is still available via the Internet. Emerging evidence shows a wide range of responses to the drug, including paranoia, aggressive behavior, anxiety, and short-term memory deficits. Synthetic cannabinoids are not currently detectable via standard toxicology tests. Recognition and management of synthetic cannabinoid use are discussed.

Improvements in depression and changes in quality of life among HIV-infected adults

Improving quality of life (QOL) for HIV-infected individuals is an important objective of HIV care, given the considerable physical and emotional burden associated with living with HIV. Although worse QOL has been associated with depression, no research has quantified the potential of improvement in depression to prospectively improve QOL among HIV-infected adults. We analyzed data from 115 HIV-infected adults with depression enrolled in a randomized controlled trial to evaluate the effectiveness of improved depression care on antiretroviral drug adherence. Improvement in depression, the exposure of interest, was defined as the relative change in depression at six months compared to baseline and categorized as full response (≥50% improvement), partial response (25–49% improvement), and no response (<25% improvement). Multivariable linear regression was used to investigate the relationship between improvement in depression and four continuous measures of QOL at six months: physical QOL, mental QOL, HIV symptoms, and fatigue intensity. In multivariable analyses, physical QOL was higher among partial responders (mean difference [MD] = 2.51, 95% CI: −1.51, 6.54) and full responders (MD = 3.68, 95% CI: −0.36, 7.72) compared to individuals who did not respond. Mental QOL was an average of 4.01 points higher (95% CI: −1.01, 9.03) among partial responders and 14.34 points higher (95% CI: 9.42, 19.25) among full responders. HIV symptoms were lower for partial responders (MD = −0.69; 95% CI: −1.69, 0.30) and full responders (MD = −1.51; 95% CI: −2.50, −0.53). Fatigue intensity was also lower for partial responders (MD = −0.94; 95% CI: −1.94, 0.07) and full responders (MD = −3.00; 95% CI: −3.98, −2.02). Among HIV-infected adults with depression, improving access to high-quality depression treatment may also improve important QOL outcomes.

Reducing HIV risk among people with serious mental illness.

The rate of HIV infection among U.S. citizens who live with serious mental illness (SMI) is significantly higher than among the general population. Research on the determinants of risk behavior is limited. The purpose of this article is to explore the effects of HIV-related health disparities on people with SMI by analyzing the multiple determinants, or domains of risk, and describing issues related to tailoring HIV primary prevention risk reduction strategies to people with SMI. According to the model proposed by Meade and Sikkema, domains of risk include psychiatric illness, substance use, cognitive-behavioral factors, social relationships, and demographics. The majority of people with SMI are sexually active and engage in behaviors that place them at high risk for HIV/AIDS. Mental illness may affect HIV risk through interacting domains that influence sexual behavior. HIV risk reduction strategies must consider psychiatric illness and comorbidities, social relationships, and trauma history. In addition, these efforts should be integrated into existing services.