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In India, more than 90% of the patient with chronic mental illness stayed with their family members. Approximately 77.4% of caregivers experience moderate to severe levels of aggression. The purpose of this study was to evaluate the effectiveness of caregiver-training program on knowledge in managing aggressive behavior of mentally ill at home. Research design was pre-experimental. Seventy two caregivers were recruited using purposive sampling technique. The caregivers knowledge was assessed at 3 time points with regard to training program; before, immediately (post-test 1), and after 1 month (±1 week; post-test 2). The baseline knowledge was reflective of the deficiencies existing in the management of aggression of the mentally ill by caregivers. The knowledge of caregivers regarding the management of aggressive behavior of mentally ill, increased after caregiver training program, from the pre-test score of 17.63 ± 3.3 to post-test 1 score of 23.26 ± 2.9, and slightly decreased post-test 2 score of 21.01 ± 3.3 at p

Abstract. In Switzerland, assisted suicide (AS) may be granted on the basis of a psychiatric diagnosis. This pilot study explored the moral attitudes and beliefs of nurses regarding these practices through a quantitative survey of 38 psychiatric nurses. The pilot study, which serves to inform hypothesis development and future studies, showed that participating nurses supported AS and valued the reduction of suffering in patients with severe persistent mental illness. Findings were compared with those from a previously published study presenting the same questions to psychiatrists. The key differences between nurses’ responses and psychiatrists, may reflect differences in the burden of responsibility, while similarities might capture shared values worth considering when determining treatment efforts. More information is needed to determine whether these initial findings represent nurses’ views more broadly.

Objective: Research and study the Lebanese employers’ attitudes, toward recruiting candidates with a mental illness and toward their employees who suffer chronic mental illnesses (A CMI) and the factors that may play a role in affecting it. Methods: A combined cross sectional and retrospective study. Interviews conducted with a mix of 63 human resource managers and high executive employees to assess the integration of people with A CMI at the workplace, and the attitudes toward them. Results: Primarily, the engagement of an occupational physician or a social worker in the process, was associated with a reduction in stigma surrounding the subject matter. Moreover, hiring a candidate with A CMI was perceived as a social image improvement of the hiring company. However, A CMI employees were perceived as having lower efficiency and self-esteem, as well as a greater vulnerability to dismissal. Conclusion: The presence and engagement of an occupational physician, and/or a social worker, has been found to be the main positive stigma modulator against mental illness, in a corporate setting.

This study aimed to investigate the effect of selected sports games in leisure on mindfulness skills, anxiety and depression of chronic mental patients. This is a quasi-experimental study and its participants consisted of women with chronic mental illness aged 20-30 years hospitalized in Atef Rehabilitation Centre of Mashhad in 2022. The statistical sample was selected as a total of 46 people, i.e., the entire statistical population. The samples were randomly divided into control and experimental groups. Data collection tools included the Kentucky Mindfulness Skills Questionnaire (2004), the Beck Depression Inventory (1961), and the Zung Anxiety Inventory (1971). In the pre-test, both groups filled out the questionnaires. The subjects of the experimental group played selected sports games for eight weeks, three days a week and every day for 60 minutes, and the control group continued their daily activities. Then, the two experimental and control groups participated in the post-test and filled out the questionnaires again. SPSS software version 24 was used for data analysis. Findings indicate that the mean of depression and anxiety decreased after the post-test, but the mean increased for mindfulness. Although there was a significant difference between the control and experimental groups in the variables of mindfulness, depression, and anxiety after selected sports games, the components of describing mindfulness and physical symptoms of anxiety were not significant. The results showed that considering that playing sports games in the leisure time of chronic mentally ill people improves their level of mental health, it is recommended that selected sports games be included in the leisure program of these patients; Therefore, spending sports leisure time while creating positive effects on the physical and mental dimensions of patients can be a good alternative to the same and inflexible daily programs of this group of society.

Background: Patients with chronic mental illness are frequently hospitalized and discharged from psychiatry wards. This situation is referred to as the “revolving door phenomenon” (RDP). In addition to factors related to the patient and the disease, limited number of beds leading to shortened hospital stay are among the reasons associated with frequent hospitalization. This study aims to compare patients with RDP and patients with single hospitalization in terms of clinical, sociodemographic, and treatmentoriented characteristics in order to evaluate the risk factors causing frequent hospitalization. Subjects and methods: In this study, patients who were admitted and hospitalized between May 1, 2011 - May 1, 2016 were retrospectively evaluated from patient records. The RDP group consisted of 74 patients and the single-hospitalization group consisted of 59 patients who met inclusion criteria. Results: The RDP group had significantly higher rates of male gender, ECT history, past suicide attempts, multiple drug treatment, clozapine use, legal incidents, and noncompliance to follow up following discharge compared to the single hospitalization group (p

Background: Individuals with mental illness, as they are stigmatized by society, are also stigmatized themselves, and this process is internalized. This may adversely affect the recovery process. Aims: This study was conducted to investigate the relationship between internalized stigmatization and subjective recovery in patients with schizophrenic. Method: This research was performed for patients with schizophrenia at rehabilitation centers registered with the community mental health center. The survey was performed out with 94 patients in the recovery phase who met the inclusion criteria and who going to the center. Sociodemographic information form, internalized stigmatization scale and subjective recovery assessment scale were used in the collection of data. Results: In the study it was found that there is a relationship between internalized stigmatization and subjective recovery. Increased levels of internalized stigma patient outcome would decrease the level of recovery. Conclusion: It is recommended that nurses perform intervention programs to reduce internalized stigmatization in patients with schizophrenia.

NewAccess is a low-intensity cognitive behavioural program which was recently trialled for the first time in Australia for clients aged under 18. Given that accessing support earlier tends to result in better outcomes for people with mild-to-moderate mental health issues, having NewAccess available for young people has the potential to reduce the likelihood of mild-to-moderate mental health concerns developing into more serious, or chronic mental illness over time for some clients, while also freeing up resources for those with more severe support needs. This mixed methods approach presents the findings of an independent evaluation of the program delivered out of two regional headspace centres in 2017-2019. From an initial sample of 165 young participants aged between 12 and 25, 109 completed the program. Of those who completed the program 60 were under the age of 18. The standardised assessment and outcome measures indicated a very good response to the program, with the majority showing significant improvements in their depression, anxiety and psychological distress scores. The overall 'reliable improvement' and 'recovery rates' were 64.2% and 72.3% respectively. Overall, the results indicated this program was an acceptable and efficacious intervention for young people in rural settings, when delivered in a 'youth-friendly' service environment.

The aim of study is to determine how caregivers of individuals with chronic mental illnesses evaluate their care experience. A qualitative type study with phenomenologic method was made. A sampling group of totaly 12 individuals who caregivers of individuals with chronic mental illnesses at least 10years, was formed with purposeful sampling method. The data were collected through in-depth interviews with personal information form and semi structured interview form. Data analysis was carried out with content analysis and written as raw data. Average age of caregivers was 51.98±2.6 and care time average was 18.25±2.06 years. Seven theme for caregivers of individuals with chronic mental illness; emotional tension, burnout, deterioration from family functions, stigma, restrictions in daily life and social activities, deterioration in body and mental health and economic difficulties. Caregivers should be supported by carrying out intervention studies on the difficulties experienced by those who care for individuals with chronic mental illness. It is recommended that more experimental and qualitative studies specific to diseases are carried out in order to understand in detail what the caregivers of individuals with chronic mental illness experience.

Background Patriarchy exposes women to various forms of discrimination and oppression. Women are more often blamed for mental illness, which can result in social isolation and stigma. Method Case Study. Results Psycho-social intervention aided in empowering women by giving them voices to speak as well as by utilizing their strengths and available community resources to develop a sense of self-efficacy, coping strategies, and support system. Conclusion Women with chronic mental illness have unique needs and challenges. Mentally ill women face sexual coercion in childhood or adulthood. The factors related to help-seeking in the context of abuse were family reactions, social support, and stigma. Our findings highlight the need to conduct risk assessments and provide community-based and coordinated services during follow-up visits. Key messages Trauma-focused intervention should be culturally appropriate and should focus on reducing emotional distress, restoring self-adaptation, and enhancing social support.

Introduction: Psychosocial rehabilitation is the process that facilitates opportunities for persons with chronic mental illness to reach their optimal level of independent functioning in society and for improving their quality of life. However, such psychosocial rehabilitation centers are limited in India. Aims: The present study assesses psychosocial rehabilitation centers (of urban day-care and rural residential rehabilitation center) operated by Ashadeep Charitable Foundation, a civil service organization and its effect on health outcomes of patients living with chronic mental illness. Materials and Methods: Records of 170 cases were retrieved for secondary analysis of demographic information, diagnosis, duration of stay, and health outcomes. Results: Rehabilitation activities included yoga, light physical exercises, group discussion, training for daily living skills, social skills, life skills, vocational training, individual, and family counseling. In addition, extensive outreach activities, mental health camps were also integral part of the rehabilitation activities. Patients who have accessed rehabilitation services were diagnosed with schizophrenia, psychosis, bipolar disorder, depression, and intellectual disability. The average duration of rehabilitation of patients (other than persons with intellectual disability) was ranged from three to four months. Out of those rehabilitated, 69% of them were successfully re-integrated with the family. Conclusion: Combination of pharmacological and psychosocial interventions are effective for re-integrate patients with mental illness to the family. This model of community-based rehabilitation has potential for scale-up.

Excoriation disorder or skin picking disorder (SPD) is a chronic mental illness. It is defined by recurrent skin picking, scratching, rubbing and digging or urges to do so that goes on for extended periods of time, resulting in skin lesions and behaviour that interferes with functioning in other areas of life. The skin-picked area of the body can be smooth and healthy, and the anomaly invisible to the naked eye. Commonly, individuals with SPD seek aesthetic procedures to address perceived self-defects or to remedy their self-inflicted scarring. It is important for aesthetic practitioners to identify SPD because continuing with aesthetic interventions could worsen the illness for the sufferer. In response to this issue, aesthetic practitioners can identify individuals with SPD by administering a screening questionnaire and appropriately providing referrals to mental health professionals.

Background: One of the most important aspects of receiving medical care is access to that care. For people with mental illness who have greater healthcare needs and are at risk for poor health outcomes, reduced access to care constitutes a crisis. While the COVID-19 (coronavirus disease 2019) pandemic continues to affect the United States, specifying what it means to have access to mental healthcare is more critical than ever. Aims: The aims of this concept analysis are to review definitions and descriptions of access to mental healthcare in the literature and to synthesize the relevance of these findings to inform future research, theory development, policy, and practice. Methods: The concept of access to mental healthcare was analyzed using Rodgers’s evolutionary concept analysis method. CINAHL, PsycINFO, and MEDLINE were queried for peer-reviewed articles about access to mental healthcare published from January 2010 to April 2020 ( n = 72). Data were reviewed for concept antecedents, attributes, consequences, surrogate, and related terms. Results: Five models of access to mental healthcare were identified, with several antecedents and consequences: utilization, economic loss/gain, incarceration, and patient/provider satisfaction. Cross-sectional and predictive studies highlighted three interrelated attributes: clinical management, healthcare delivery, and connectedness. Conclusions: The concept of access to mental healthcare is often used stagnantly across disciplines to create health policies, yet the concept is transformative. Future research requires up-to-date operational definitions of access to mental healthcare to target interdisciplinary approaches.

Severe mental illness (SMI) is associated with a reduced life expectancy of up to 20 years. One possible contributor to this fact is dysregulation of the hypothalamus-pituitary-adrenal (HPA)-axis. Looking at the morphology of effector organs, such as the adrenal glands themselves, could reveal insights into organ function and response to possible HPA-dysregulation. This forensic autopsy-based study investigated if there were any morphological changes in adrenal glands between decedents who had previously been submitted to a psychiatric hospital with a diagnosis of schizophrenia (

Background: Schizophrenia is a chronic mental illness that strongly affects not only the patients with schizophrenia, but also their families and close relatives. So far, family research on patients with schizophrenia has mainly focused on parents, but has neglected siblings. Aim: This study aims to evaluate the well-being of 103 siblings of patients with schizophrenia within the Lazarus and Folkman’s Transactional Coping and Stress Model. Materials: A Sociodemographic Information Form, Subjective Well-being Scale, Zarit Caregiver Burden Scale, Multidimensional Perceived Social Support Scale, Ways of Coping Scale and Shortened Perceived Parental Rearing Styles Form were administered to the siblings of patients with schizophrenia. Results: The results of this study revealed that well-being was associated with perceived mother overprotection, perceived social support, problem-focused coping and indirect coping. Social support moderated the relationship between burden and well-being as a buffering factor. Conclusion: Therefore, siblings of patients with schizophrenia should be given access to social support and their problem-focused coping strategies should be strengthened. Besides, parents should be supported to provide suitable care for the siblings of patients with schizophrenia.

Background: Schizophrenia is a chronic mental illness affecting the social and occupational lives of the sufferers and posing a considerable burden on the patients and their families. Furthermore, negative societal reactions and the internalization of these attitudes exacerbate the difficulties encountered. This study examines the perspectives of Turkish people with schizophrenia on how they view the impact of the illness on their lives, the societal reactions and attitudes to schizophrenia and whether they agree with these reactions. Methods: Twenty-three adult participants, all members of two schizophrenia associations in Ankara, capital of Turkey, were recruited. Semistructured interviews were used to find out their perspectives on how the illness affected their lives, how the society reacts to them and their views on these reactions. Interviews were recorded, transcribed and thematic analysis was used to capture the general and the subthemes. Results: The findings suggest that causal attributions for the illness, the impact of illness on various life domains, challenges of living with the illness and finally stigmatization are general categories that capture the perspectives of the participants. Conclusion: People diagnosed with schizophrenia experience the impacts and burdens of their illness in various domains of their lives and negative societal reactions heighten these burdens. It seems important to consider the challenges faced by people with schizophrenia in living with their illness and the impacts of negative societal behaviors and attitudes in offering psychosocial interventions programs for supporting this group. Furthermore, combating negative societal attitudes also seems to be necessary.

Background: Schizophrenia is a devastating and chronic mental illness. Considering the nature of illness along with routine psychiatric care, various supportive therapies are recommended. Family psychoeducational approach has been developed to increase patients' as well as their caregivers' knowledge and insight into their illness. It is postulated that this increased knowledge and insight will enable people with schizophrenia and their caregivers to cope in a more effective way with the consequences of their illness, thereby improving prognosis. Aim: The aim of this study is to assess the efficacy of family psychoeducation intervention on the caregivers of schizophrenia patients with respect to their perceived quality of life. Materials and Methods: A total of 30 caregivers of male schizophrenia patients were selected through purposive sampling technique. Patients were divided into two groups, namely, experimental and control group. Family psychoeducation intervention was given on twice-monthly basis for 6 months to the experimental group caregivers. Baseline assessment was carried out with the help of WHO Quality of Life-BREF followed by intervention and then posttherapeutic assessment was done with same tool. Results: Most of the caregivers were above 40 years of age group, married, and male. Following family psychoeducation, significant improvement in overall quality of life scores was observed in experimental group caregivers compared to control group caregivers where no such intervention was provided. Conclusion: Family psychoeducation is feasible and useful in our clinical population.

Context: Recently, research community of certain domain showing their eagerness towards the use of social media networks to gain constructive knowledge in decision making and automation, such as aid to perform software development activities, crypto-currencies usage, network community detection and recommendation and so on. Recently, besides other domains of eHealth, the use of social media and big data analytics has become hot topic to predict the patient of mental illness involved in either depression, schizophrenia, eating disorders, anxiety or addictive behaviors. Problem: Traditional methods either need enough historic data or to keep the regular monitoring on patient activities for identification of a patient associated with a mental illness disease. Method: In order to address this issue, we propose a methodology to classify the patients associated with chronic mental illness diseases (i.e. Anxiety, Depression, Bipolar, and ADHD (Attention Deficit Hyperactivity Disorder) based on the data extracted from the Reddit, a well-known network community platform. The proposed method is employed through Co-training (type of semi-supervised learning approach) technique by incorporating the discriminative power of widely used classifiers namely Random Forrest (RF), Support Vector Machine (SVM), and Naïve Bayes (NB). We used Reddit API to download posts and top five associated comments for construction of a feature space. Results: The experimental results indicate the effectiveness of Co-training based classification rather than the state of the art classifiers by a margin of 3% on average in par with every state of art technique. In future, the proposed method could be employed to investigate any classification problem of any domain by extracting date from the social media.

Bipolar disorder is a chronic mental illness that has significant morbidity and mortality implications globally. Increasingly, as with many mental health disorders, patients are being identified in primary care settings. In this overview, we discuss screening and case identification, making the case for judicious use of screening tools coupled with follow-up clarifying questions. We review the main modalities of treatment including pharmacother-apy and the evidence for non-pharmacotherapy adjunctive approaches. We discuss recommendations and cautions regarding the use of antidepressants in this population. Finally, we explore the role of new models of care and pharmacogenetic testing. As primary care providers play a critical role in the care of patients with bipolar disorder there are a number of important considerations both in the identification of patients as well as initiating and monitoring treatment.

A esquizofrenia é uma doença mental crônica, caracterizada por distorções do pensamento e da percepção e do afeto, com frequência associados a comportamentos sociais inadequados. O objetivo desta pesquisa foi realizar um mapeamento de fatores sociodemográficos e clínicos de pacientes atendidos em um ambulatório de esquizofrenia e outras psicoses de um hospital público do sul do Brasil. Trata-se de uma pesquisa descritiva e correlacional em uma amostra por conveniência de 108 pacientes (59,3% masculino e 40,7% feminino), com idade média de 36 anos (mediana = 36, IIQ = 27,0 - 46,0). A coleta dos dados sociodemográficos e clínicos foram realizado por meio de um questionário e dos instrumentos Mini International Neuropsychiatric Interview (MINI), MINI Plus e Positive and Negative Syndrome Scale (PANSS-BR). Apenas 16% dos participantes tinham emprego remunerado. Os sintomas típicos do transtorno mostraram-se dentro do esperado (sintomas positivos, mediana = 13, IIQ = 9,25 – 16; sintomas negativos, média = 18,3, DP ± 6,3). O medicamento mais utilizado é a clozapina, um antipsicótico atipico, que possui evidências de eficácia em sintomas positivos e negativos e para modulação de comportamentos suicidas.Palavras-chave: Esquizofrenia. Perfil clínico. Variáveis sociodemográficas. ABSTRACT: Schizophrenia is a chronic mental illness characterized by distortions in thinking, perception and affection, frequently associated with inappropriate social behavior. The objective of this research was to map sociodemographic and clinical factors related to schizophrenia in patients attended at a public hospital in southern Brazil. It is a descriptive and correlational research in a convenience sample of 108 patients (59.3% male and 40.7% female), with a mean age of 36 years (median = 36, IIQ = 27.0-46, 0). The sociodemographic and clinical data were collected through a questionnaire and the Mini International Neuropsychiatric Interview (MINI), MINI Plus and Positive and Negative Syndrome Scale (PANSS-BR) instruments. Only 16% of the participants had paid employment. The typical symptoms of the disorder were within the expected (positive symptoms, median = 13, IIQ = 9.25 - 16, negative symptoms, mean = 18.3, SD ± 6.3). The most commonly used drug is clozapine, an atypical antipsychotic, which has evidence of efficacy in positive and negative symptoms and modulation of suicidal behavior.Keywords: Schizophrenia. Clinical profile. Sociodemographic variables.

Adults with serious and persistent mental illnesses, such as schizophrenia, schizoaffective disorder, and bipolar disorder, who are under guardianship/conservatorship, may experience health care, s...

In humans, the incident rate of mental illness is gradually rising due to various causes. Schizophrenia is one of the chronic mental illness and its happing rate also rising in the current era. The patient with Schizophrenia will experience a confused mental condition and a timely recognition and treatment is essential to reduce the risk. The proposed work aims to implement a methodology to support the automated detection of Schizophrenia from the brain MRI slices of T1 modality (T1W). The assessment of brain MRI is executed using the pre-trained VGG16 system and the deep-features extracted are optimized with the Slime-Mould-Algorithm (SMA) and the reduced features are then considered to train, test and validate the binary classifiers employed in this work. This research is implemented using 500 images of each case (healthy/abnormal) and the attained result with the SVM-Cubic is superior compared to other classifiers considered in the automated disease detection system.

Personal recovery is a process of developing new meaning and purpose in life beyond the catastrophic effects of mental illness. Benefit finding (BF) is conceptualized as finding positive changes or benefits through experiences in adversity. Sense of coherence (SOC) focuses on how people can stay healthy and maintain well-being, even in adversity. This study aimed to examine the relationships among the initial levels and longitudinal changes in personal recovery, BF, and SOC among people with chronic mental illness in Japan. In this longitudinal study, a two-wave self-report questionnaire survey was conducted for service users aged 20 or older with mental illness using convenience sampling method in 2014 and 2015. We applied the Latent Change Score approach. Model fit was evaluated according to the CFI and RMSEA. Among 373 eligible participants at baseline, valid responses in both T1 and T2 from 195 respondents were included in the study (valid response rate = 52.3%). Among them, 65.6% were male, with average age of 45.6. The model of the three constructs at the two time points had good to reasonable fit to the data. The initial levels and changes in personal recovery, BF, and SOC were significantly and positively related to each other.

International audience; Using French longitudinal register data, we compare the evolution of employment rates of persons with severe chronic mental illness, before and after the first medico-administrative recognition of the illness by the Statutory Health Insurance (SHI), with that of people without recognised mental illness. The study focuses on persons of working age having a work history before recognition. Our empirical approach relies on a double difference method with coarsened exact matching. Before illness recognition subjects had lower employment rates than those without mental illness but relatively high, reflecting their initial employment attachment. Results indicate that employment rates decrease sharply after recognition. A large employment rate gap between persons with and without severe mental illness develops during the four years following recognition. We examine whether the magnitude of the decrease is sensitive to the macroeconomic context. Findings show that the decline in employment rates was significantly more pronounced during the Great Recession compared with the pre-crisis period, amongst women. As a conclusion, this study points out that implementing coordinated early health and labour policies in the phase of the entry into the chronic-illness insurance scheme of the SHI might play a key role in preventing the detrimental effects of illness on economic and social conditions of persons with severe mental illnesses.

This chapter focuses on the efficacy of cognitive behavioral therapy (CBT) in the treatment of pediatric anxiety disorders. The chapter will first outline the presentation of anxiety disorders in youth, which are among the most common mental disorders in pediatric populations. It will then describe the core components of CBT, which has been demonstrated to be an efficacious treatment for youth anxiety, with lower dropout and fewer adverse events compared to other treatment options. Key supporting evidence will then be reviewed, along with important treatment considerations such as treatment format, treatment intensity, and comorbidity. CBT can also be applied to many neurodevelopmental conditions and challenges. Given the potential for chronic mental illness and associated risk of adverse outcomes in adulthood, it is imperative that pediatric anxiety be properly diagnosed and treated.

The article examines the legislation of the Kingdom of the Netherlands regulating the main issues of euthanasia. The author examines the various types of euthanasia and assisted suicide that exist in the Netherlands, the procedures for their implementation provided for by law, as well as the approach to the most difficult issues, such as the euthanasia of newborns and people suffering from chronic mental illness.

Bipolar disorder (BD) is a serious and chronic mental illness that may result in disability. We evaluated effect of the duration of untreated of bipolar (DUB) (manic episodes) on clinical outcomes, including episode severity, residual symptoms, duration of hospitalization, and suicide attempts, and on socioeconomic status of patients.A total of 216 participants who had bipolar I disorder (manic state) recruited from November 2017-December 2019 from an inpatient psychiatric unit. Patients divided into 2 groups based on DUB: Group A, with DUB4 months; and Group B, with DUB ≥4 months. All participants had evaluation for demographic and clinical features, Socioeconomic scale, Young mania rating scale (YMRS) at admission and discharge.Group A participants were more often male, urban residents, married, literate and educated, professionally employed. Group A had a younger age of onset, less duration of illness, less frequency of episode, less suicide attempts, less duration in hospital, high mean of socioeconomic, lower mean of YMRS at admission and discharge in compared to Group B.A longer DUB (manic episodes)was associated with negative clinical outcomes (more frequent episode, more symptoms severity, longer hospital admission, more suicide severity, more residual symptoms) and low socioeconomic state of patients with BDI (manic episodes).

The South African Mental Health Act of 2002 advocates the de-institutionalization of treatment of patients with mental disorders, so that the mental health care users or patients are treated in their communities. Although this approach is often used to discharge patients from hospital, no feasibility assessments are conducted to ascertain adequate care for these patients. The objective of the study was to explore the experiences of family members who provide home care for patients with serious mental disorders. A qualitative explorative design was used to interview 20 primary caregivers whose family members were readmitted to a public psychiatric hospital in Pretoria. Data were analysed using NVivo version 11. The findings are that caring for patients with serious mental illness at home is difficult, sometimes unbearable, because the families have to deal with violence perpetrated by the patients, safety concerns, financial difficulties and emotional turmoil, and wish that the patients would be kept in institutions. The absence of required skills and resources to care for the mentally ill at home exposes the patients and their families to emotional, financial and social difficulties, and results in unfavourable outcomes for both the patients and their families.

The rates of obesity and type 2 diabetes (T2D) are much higher in patients with chronic mental illness compared to the general population1. Second-generation antipsychotic medications (SGA) are clearly contributory to these adverse metabolic phenotypes2. Thus, annual monitoring of fasting plasma glucose (FPG) levels is recommended to screen for T2D in patients on SGA3. Of note, FPG, and also HbA1c, have poor sensitivities in detecting T2D early, with nearly 50% of cases being missed using either of the above tests when compared to oral Glucose Tolerance Testing (oGTT,4). We thus screened patients with schizophrenia, schizoaffective or bipolar disorder on SGA per oGTT. We hypothesized that we would identify more patients with T2D per oGTT compared to FPG or HbA1c testing alone. To identify risk factors for T2D, we also assessed BMI, waist/hip ratio, blood pressure, dietary habits (UKDDQ = UK Diabetes and Diet Questionnaire), physical activity records (3d pedometer records), measures of psychopathology, cognition (PHQ-9 = Patient Health Questionnaire, SLUMS = Saint Louis University Mental Status exam) as well as HOMA IR (Homeostatic Model Assessment of Insulin Resistance), Matsuda index and lipid profile. Data were analyzed using SPSS, comparing normal and prediabetic patients to patients with T2D (per oGTT criteria). Thus far, we screened 22 patients per oGTT and newly identified 5 patients with T2D (23%), only one patient had T2D per HbA1c criterion, 4 were identified per elevated FPG, 3 patients had elevated 2h plasma glucose levels. Patients with T2D had significantly lower Matsuda indices (p

PURPOSE To identify factors influencing the hopes of mental health nurses and to explore their experiences with a sense of hope. DESIGN AND METHODS A descriptive research survey was conducted with 113 nurses at three closed psychiatric wards in South Korea. FINDINGS Nurses' hope, interpersonal skill competence, and professional self-concept were all found to have statistically significant correlations (r = 0.60-0.73, p

The purpose of the current descriptive qualitative study was to reveal experiences of family caregivers of individuals with chronic psychiatric illness. Family caregivers who provided care to 16 individuals with chronic mental illness were interviewed. Three themes emerged from the interviews: Illness Management , The Caregiver's World: Changes and Effects , and Coping From the Caregiver's Point of View . Understanding the experiences of family caregivers contributes to content development of family intervention programs. [ Journal of Psychosocial Nursing and Mental Health Services, 58 (3), 38–46.]

A case report is employed that illustrates the need for residential mental health treatment (RT) and the need for continuation of support post RT. Children and youth with moderate-to-severe mental ...

There is a relative paucity of literature in the field of spirituality among people who have a lived experience of severe mental illness from Australia. Sixteen individuals with a severe mental illness were interviewed on their experiences of spirituality. The three themes that emerged from the data were concepts of spirituality, benefits of intentional spiritual practices and perceived spiritual benefits of recreational pursuits and physical activity. This paper adds to the relatively sparse literature on spirituality among persons with a mental illness in Australia.

BACKGROUND: Further exploration of the practice roles of psychiatric mental health (PMH) advanced practice registered nurses (APRNs) is warranted. OBJECTIVE: In March of 2016, the American Psychiatric Nurses Association (APNA) conducted a national survey to gather data on the demographics, practice roles, and activities of certified PMH APRNs. DESIGN: The e-mail survey contained 46 questions consistent with minimum data set requirements of the Forum of State Nursing Workforce Centers. RESULTS: The data indicate that PMH APRNs are a clinically active workforce; the majority deliver a wide variety of mental health services including diagnosis and management of both acute and chronic mental illness, prescribing, and providing psychotherapy. CONCLUSION: PMH APRNs are delivering care to clients dealing with a range of serious mental illnesses across the life span in a variety of roles. It will be critical to monitor the activities and outcomes of this expanding behavioral health care workforce.

David W Morris,1 Subroto Ghose,1,2 Ella Williams,1,2 Kevin Brown,1,2 Fuad Khan1,2 1Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA; 2Department of Psychiatry, Parkland Memorial Hospital, Dallas, TX, USA Introduction: Hospital emergency departments (EDs) around the country are being challenged by an ever-increasing volume of patients seeking psychiatric services. This manuscript describes a study performed to identify internal and external factors contributing to repeated psychiatric patient admissions to the hospital main ED. Methods: Data from ED visits of patients who were admitted to the Parkland Memorial Hospital ED (the community hospital for Dallas County, TX, USA) with a psychiatric complaint more than once within a 30-day period were evaluated (n=202). A 50-item readmission survey was used to collect information on demographic and clinical factors associated with 30-day readmission, as well as to identify quality improvement opportunities by assessing related moderating factors. An analysis of acute readmission visits (occurring within 3 days of previous discharge) was also performed. Results: Patients readmitted to the ED commonly present with a combination of acute psychiatric symptoms, substance use (especially in the case of acute readmission), and violent or suicidal behavior. The vast majority of cases reviewed found that readmitted patients had difficulties coordinating care outside the ED. A number of moderating factors were identified and targeted for quality improvement including additional support for filling prescriptions, transportation, communication with family and outside providers, drug and alcohol treatment, intensive case management, and housing. Conclusion: Many of the resources necessary to reduce psychiatric patient visits to hospital EDs are available within the community. There is no formal method of integrating and insuring the continuity of community services that may reduce the demand for psychiatric and related services in the ED. While agreements between community service providers may be challenging and require considerable vigilance to maintain equitable agreements between parties, this route of improving efficiency may be the only available method, given the current and projected patient care needs. Keywords: chronic mental illness, psychiatric readmission, emergency psychiatry, public mental health

David W Morris,1 Subroto Ghose,1,2 Ella Williams,1,2 Kevin Brown,1,2 Fuad Khan1,2 1Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA; 2Department of Psychiatry, Parkland Memorial Hospital, Dallas, TX, USA Introduction: Hospital emergency departments (EDs) around the country are being challenged by an ever-increasing volume of patients seeking psychiatric services. This manuscript describes a study performed to identify internal and external factors contributing to repeated psychiatric patient admissions to the hospital main ED. Methods: Data from ED visits of patients who were admitted to the Parkland Memorial Hospital ED (the community hospital for Dallas County, TX, USA) with a psychiatric complaint more than once within a 30-day period were evaluated (n=202). A 50-item readmission survey was used to collect information on demographic and clinical factors associated with 30-day readmission, as well as to identify quality improvement opportunities by assessing related moderating factors. An analysis of acute readmission visits (occurring within 3 days of previous discharge) was also performed. Results: Patients readmitted to the ED commonly present with a combination of acute psychiatric symptoms, substance use (especially in the case of acute readmission), and violent or suicidal behavior. The vast majority of cases reviewed found that readmitted patients had difficulties coordinating care outside the ED. A number of moderating factors were identified and targeted for quality improvement including additional support for filling prescriptions, transportation, communication with family and outside providers, drug and alcohol treatment, intensive case management, and housing. Conclusion: Many of the resources necessary to reduce psychiatric patient visits to hospital EDs are available within the community. There is no formal method of integrating and insuring the continuity of community services that may reduce the demand for psychiatric and related services in the ED. While agreements between community service providers may be challenging and require considerable vigilance to maintain equitable agreements between parties, this route of improving efficiency may be the only available method, given the current and projected patient care needs. Keywords: chronic mental illness, psychiatric readmission, emergency psychiatry, public mental health

The spiral phenomenon of homelessness and mental ill-health are major growing epidemic in both developed and developing countries. Viewing from a socio-economic-political dimension, homelessness and mental ill-health cause detrimental effects on the individuals' lives as well as the nation-building process. The condition of women seems to be complex, as the gender perspectives are often described in terms of patriarchy and powerlessness. The bi-directionality of mental illness and homelessness creates a vicious cycle, and many women seem to end up in shelter care homes. The scenario of homeless women with chronic mental illness reflects the lack of community-based rehabilitation efforts and gender-sensitive policy level initiatives.

Relying on records of veterans’ hospital admissions, and service and pension files of the Canadian Expeditionary Force, this paper explores authoritative accounts of First World War veterans’ mortality attributed to suicide and accidental causes among veterans treated as mental cases at the Ontario Military Hospital at Cobourg, Ontario. Military and pension officials invariably ascribed veterans’ suicide attempts and deaths to moments of temporary insanity or chronic mental illness, which were in turn attributed to hereditary or personal failing. Veterans’ own statements within these files reveal discrepancies between the storylines authored by and about veterans, emphasizing the impact of war and the “tension of agency” in veteran deaths by suicide.

Objectives: The objective of the current study was to examine the pathology test utilisation of 25-hydroxyvitamin D (25(OH)D) within an Australian inpatient psychiatric setting. Method: A retrospective audit of 300 random hospital files of those admitted as inpatients between Nov 2014 and Nov 2015 was undertaken. Data was quantitatively analysed and described. Results: The number of inpatients who had a vitamin D determination during their admission was 37/300 (12.33%). The mean vitamin D level of those tested was 51.63 nmol/l. Of those that were tested, 18/37 (48.6%) were mildly to moderately deficient. There was a statistically significant difference in age and length of stay between those that were and were not tested for vitamin D levels, p-value Conclusion: This audit highlights vitamin D screening inadequacy. More research is recommended to establish tangible benefits of supplementation, while local practice provides valuable data for education and policy purposes.

OBJECTIVES The objective of this study was answer to the question: to what extent are the anger of the caregivers of patients diagnosed with schizophrenia and their perceived level of burden are related? METHOD The study is a descriptive and correlational study. The information form prepared by the researchers which questions the socio-demographic information of the individuals along with the “Caregiving Burden Inventory” which examines the burden of the caregiver as well as “Trait Anger and Anger Expression Style Scale (TAAES)” which determines the anger levels of the caregivers were used. RESULTS The caregiving burdens of the caregivers according to the score averages were determined as 11.88 ± 9.78 for time and dependency burden, 11.93 ± 8.46 for developmental burden, 8.47 ± 6.63 for physical burden, 5.61 ± 5.26 for social burden, 6.29 ± 5.25 for emotional burden and the total burden score was determined as 44.19 ± 26.75. According to the trait anger and anger expression style scale score averages; trait anger was determined as 15.12 ± 5.95, anger expression as 9.70 ± 3.43, anger-in as 15.22 ± 4.02, anger control as 28.05 ± 5.57 and anger total score average as 68.11 ± 9.97. CONCLUSION According to the results obtained from this study, caregivers of schizophrenia patients experience developmental, physical, social and emotional burdens in addition to trait anger. The caregivers of schizophrenia patients need knowledge and support in order to control the burden and the anger they experience during the caregiving process.

Worldwide, there has been a dominant belief that the deinstitutionalisation of the mentally ill is a cost-saving approach, leading health authorities to embark on such initiatives without adequate community-based health and social service resources and supports. These have resulted in disaster, even in high-income countries, when insufficient planning and preparation have been effected. The recent experience in South Africa that saw the deaths of approximately 100 people with chronic mental illness within 1 year of being moved from a mental health facility is further evidence of the need for more concerted and deliberate planning and resourcing of mental health care services. The article examines various issues relating to deinstitutionalisation and urges authorities to re-examine their approach to mental health care and especially the priority accorded to this marginalised group.

Obsessive-compulsive disorder (OCD) is a chronic mental illness affecting 2%–3% of the population worldwide. Scrupulosity (an OCD dimension) is centered on religious and/or moral intrusive thoughts...

This research is a semi-empirical study aiming to examine the effect of family trainings and life skills among the families, if Mashhad with chronic mental disorders. In doing this research, a sample of 300 subjects has been chosen in the stratified random and systematic approach from the families of chronic mental disorders who have been admitted in round the clock centers in Mashhad and who have been in the waiting list and these subjects have been divided to two groups of experiment and control randomly and we introduce family trainings and life skills to the experiment group. There was no training to control group. These two groups were tested in period to the beginning of trainings and post training with instruments such as taking care and mental disorders attitude questionnaire, life skills attitude questionnaire, California social adjustment? questionnaire, Rosenberg self-esteem, general health questionnaire and epidemiological mental disorders questionnaire. The result indicated that training had no effect on the attitude of families toward taking care of mental disorder, but family member’s attitude toward mental disorder had been changed. These trainings have been influential on changing family member’s attitude toward life skills, social adjustment, self-esteem, mental health increase and reducing mental disorders.

Background Family expressed emotions had been shown to be predictive of outcome in mental illnesses in variety of cultural settings. Distressed caregivers who provide care to mentally ill relatives are at risk for developing mental health disorders. Methods A hospital based cross sectional study was conducted among 85 caregivers of chronic mental illness using purposive sampling technique. Caregivers were interviewed using Family Questionnaire (FQ) and Kessler Psychological Distress Scale (K10) to assess expressed emotions and psychological distress of caregivers respectively. Results More than half (55.3%) of the caregivers had low expressed emotions while 44.7% had high expressed emotions. More than half (55.3%) of the caregivers had low psychological distress, followed by medium risk (31.8%) and high risk (12.9%). Study revealed significant association between caregiver’s expressed emotion with caregiver’s relationship to patient, area of residence, socioeconomic status, age and gender of patients. Caregiver’s psychological distress had a significant association with their relationships with patient and educational qualification of patient. There was positive correlation between caregiver’s expressed emotions and psychological distress. Discussion This study illustrated that more than half (55.3%) of the caregivers had low expressed emotions and 44.7% had high expressed emotions while caring their patients with chronic mental illness. This finding is contradictory to the findings of a study conducted in India which depicts that most of the caregivers were designated as high EE (56%) as compared to low EE (44%). Another study conducted in Thailand indicated that large number of caregivers have high expressed emotion (87.5%).Another descriptive quantitative exploratory study done in Saudi Arabia had shown that majority of caregivers had low EE (85%). This differences in the results related to expressed emotions could be possibly due to variations in the sample size and tools used for data collection among these studies.

Mental disorders are an important cause of long-term disability and dependency. It accounts for over 15% of the disease burden in developed countries, which is more than the disease burden caused by all cancers. Mental illness is a leading cause of suffering, economic loss and social problems. The burden of mental disorders is likely to have been underestimated because of inadequate appreciation of the connectedness between mental illness and other health conditions. Mental disorders increase risk for communicable and non-communicable diseases, and contribute to unintentional and intentional injury, and comorbidity complicates help-seeking, diagnosis, and treatment, and influences prognosis. Consequently, health professionals have trivialized the issue of mental illness. It is essential that researchers and public health professionals work together to resolve the enormous public health crisis presented by mental disorders. In short, we must “mainstream” mental health.