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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 (

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...

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 ...

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

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...

Carol Blixen,1,2 Jennifer B Levin,2 Kristin A Cassidy,2 Adam T Perzynski,1 Martha Sajatovic2–4 1Center for Health Care Research and Policy, MetroHealth Medical Center, 2Department of Psychiatry, 3Department of Neurology, Neurological Institute, 4Department of Biostatistics & Epidemiology, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA Background: Bipolar disorder (BD) is a chronic mental illness associated with reduced quality of life, high rates of suicide, and high financial costs. Evidence indicates that psychosocial stress might play an important role in the onset and course of BD. Objective: The objective of this study was to address the gap between coping theory and the clinical use of coping strategies used to self-manage BD.Methods: In-depth interviews were conducted with a sample of 21 poorly adherent patients with BD. All interviews were audiotaped, transcribed verbatim, and analyzed using content analysis with an emphasis on dominant themes.Results: Transcript-based analysis generated two major domains of coping strategies used to self-manage BD: 1) problem focused (altering eating habits, managing mood-stabilizing medications, keeping psychiatric appointments, seeking knowledge, self-monitoring, and socializing) and 2) emotion focused (distracting activities, denial, isolation, modifying/avoiding, helping others, and seeking social support). Participants used both types of coping strategies to deal with stressful situations brought about by the internal and external demands associated with self-management of BD.Conclusion: This qualitative study provided a first step in evaluating coping strategies as a possible mediator in the self-management of BD and has implications for health care providers. Being able to characterize an individual’s coping behaviors can help patients modify or replace more maladaptive coping with better coping strategies in the self-management of this chronic mental illness. Keywords: bipolar disorder, coping strategies, self-management&nbsp

Schizophrenia is a chronic mental illness which causes significant distress and dysfunction. Yoga has been found to be effective as an add-on therapy in schizophrenia. Modules of yoga used in previous studies were based on individual researcher's experience.This study aimed to develop and validate a specific generic yoga-based intervention module for patients with schizophrenia. The study was conducted at NIMHANS Integrated Centre for Yoga (NICY).A yoga module was designed based on traditional and contemporary yoga literature as well as published studies. The yoga module along with three case vignettes of adult patients with schizophrenia was sent to 10 yoga experts for their validation.Experts (n = 10) gave their opinion on the usefulness of a yoga module for patients with schizophrenia with some modifications. In total, 87% (13 of 15 items) of the items in the initial module were retained, with modification in the remainder as suggested by the experts.A specific yoga-based module for schizophrenia was designed and validated by experts. Further studies are needed to confirm efficacy and clinical utility of the module. Additional clinical validation is suggested.

Kwai Chung Hospital has undergone the deinstitutionalisation process with a number of projects, beginning with a pilot to test the case management model and psycho-education for the care of people with chronic mental illness, followed by a RCT (randomised control trial) study which confirmed the efficacy of case management, and the Intervention for Frequent Readmitters project which confirmed the efficacy of assertive community treatment for a group of patients who had problems living in the community. Since 2010, the hospital has adopted the recovery movement that involves shifting its paradigm, altering its environment, training staff, and developing recovery practices and peer support for the betterment of living for the people it serves.

High rates of early morbidity and mortality in populations with chronic mental illness and addiction, along with the psychosocial risks tobacco use may pose, call for a need to systematically address tobacco in behavioral health settings. While smoke-free policies and other tobacco-related initiatives have faced a variety of barriers, implementing tobacco-free environments remains a vital step in tackling the health discrepancies between persons with chronic mental illness and the general population. This article examines the course of one community mental health center going tobacco-free, along with the challenges facing the initiative and lessons learned in the process. Consistent assessment and treatment of tobacco use, along with an emphasis on overall wellness, were major achievements of the tobacco-free initiative. Despite barriers to policy enforcement and resource integration, the initiative continues to enhance access to person-centered services and promulgate information about tobacco cessation....

In the current consumer age, an analysis of consumers' views about any aspect of life is important. This study examines a person's view of life and quality of life enjoyment and satisfaction. Specifically, we focuses on the view of life and quality of life enjoyment and satisfaction of thirty persons with chronic mental illness living in Asha Half Way Home, located in Bangalore, India, and operated by Richmond Fellowship Society. The tools used in the study were (a) a socio-demographic data sheet, (b) a Patient's View of Life Questionnaire, and (c) the Quality of Life Enjoyment and Satisfaction Questionnaire. The overall findings indicate that residents have a highly positive view about life and that they are highly satisfied with their quality of life in terms of enjoyment and satisfaction. The results validate the modal or approach that is practiced in psychosocial rehabilitation settings such as the Asha Half Way Home.

This review begins with an outline of outcome measurement in the country where it has been most thoroughly implemented, namely Australia. There follows a consideration of what constitutes an outcome in mental illness generally, and chronic mental illness in particular. Some instruments, such as the Health of the Nation Outcome Scales (HoNOS), focus primarily on illness severity, and examples of their use in the area of chronic mental illness are presented. Other instruments, such as the Life Skills Profile (LSP), assess personal functioning or disability, and that literature is reviewed. One major area of attention in the chronically mentally ill is quality of life. Another fruitful approach to assessing outcome is to look at needs, especially unmet needs, for which the leading instrument is the Camberwell Assessment of Need; relevant findings are reviewed. The most recent area of interest is recovery. While several scales have been developed, there are as yet relatively few reports of their application with patients with chronic mental illness. The concluding section considers the benefits and weaknesses of using the same standard instruments with all consumers within a service, and shows the utility of outcome results in groups and individuals with generally small overall changes.

This study investigated how people with persistent mental illness who work or study, attend a community‐based activity centre or have no regular activities, experience and describe the meaningfulness of their daily occupations. Data were gathered from 102 randomly selected individuals who were interviewed regarding their daily occupations and perceived meaningfulness using a ‘yesterday activity diary’. Content analysis revealed five main themes of meaningfulness: 1) Connection with others and the world around them, 2) Enjoyment and fun in life, 3) Being productive and having a sense of achievement, 4) Being occupied and having routines and projects in the stream of time and 5) Taking care of oneself to maintain health. Their connections, enjoyment and fun, and taking care of oneself were the aspects of meaningfulness that occurred most frequently. Participants who worked or studied more frequently identified connections, and made fewer statements about taking care of their health. The findings contribute ...

With the growing elderly population, service needs for elders with serious and persistent mental illness (SPMI) will also increase. The current study examines some of the unique challenges and needs faced by the SPMI elderly population. This study describes elders' perceptions of service access, utilization, and satisfaction as well as therapists' perceptions of chronic mental illness among the elderly and their mental health service utilization. The sample consisted of 30 rural-dwelling SPMI elders and their respective service providers (N = 30). Results indicate that elderly participants were utilizing a variety of community and social supports. Further, elderly participants perceived fewer negative effects from their illnesses than did their clinicians. Elderly participants responded more positively than did their clinicians on ratings of interference with functioning, adjustment to living, and social competence suggesting that participants viewed the consequences of their mental illnesses as ...

A model of group psychotherapy for persons with chronic mental illness is organized to provide members with some autonomy regarding treatment dosage and to address, within the group, problematic social relationships. Within this system, the therapist's application of self-psychological theory attends to members' efforts to change and grow (forward strivings) rather than to their repetition of prior traumatic relationships (expectations). Examples from established groups illustrate the therapist's attending to patients' strivings and “testing” to see if patients' cautious efforts to try new experiences are acknowledged and appreciated and, if so, whether there also is evidence of forward movement.

For over three decades, physical abnormalities have been noted in the chronic psychiatric population. Yet, as occupational therapy conceptual models currently emphasize the application of occupation to role performance while minimizing direct focus on component deficits, therapists may be neglecting attention to the sensory motor deficits that many clients exhibit. This article provides a case study, and reports on a series of recent studies that underscore the importance of attending to hand function in the chronic psychiatric population.

Although religious coping has gained acceptance in some spheres of mental health treatment, it has yet to be integrated into the treatment of those suffering from persistent mental illness. In this study, 379 individuals with persistent mental illness who attended 1 of 13 Los Angeles County Mental Health facilities completed a survey consisting of a demographic questionnaire and an adapted version of the Religious Coping Index. More than 81% of the participants reported using religious beliefs or activities to cope, 65% perceived religion as effective, and the majority devoted up to 50% of their total coping time to religion. Participants with more severe symptomatology were more likely to engage in specific religious coping strategies than those with less severe symptoms. These findings suggest that religion may serve as an important coping mechanism for those with persistent mental illness and that such coping could be appropriately incorporated into the treatment and research afforded by mental health ...

Throughout their lives, chronic mentally ill people go through a series of disruptive events and periods of suffering. In general, the literature suggests that people with long-standing mental illnesses are extremely vulnerable and cannot maintain themselves without assistance. When old age is added to this mix, the result is a heavy burden for both the patient and the caregiver. While the negative consequences, for both patient and caregiver, of suffering chronic illness during old age must not be ignored, neither should the positive periods in these people's lives. There are times when the mutual identification between cold and young yields vivid examples of the latter's ability to reconstitute a social self. In this paper I look at chronic illness in old age as a struggle on the part of the sufferer to reconcile her/his experiences of suffering in the light of approaching death. I attempt to show that the process of aging with a chronic mental illness involves not only decay and suffering, but also resilience and vitality.

The purpose of this research was to study the impact of horticulture, a purposeful activity, on group participants in a clubhouse facility. This impact was analyzed according to Zhan's (1992) conceptual model of quality of life (QOL) which includes: (a) life satisfaction, (b) self-concept, (c) health and functioning, and (d) socio-economic factors. Ten members diagnosed with chronic mental illnesses participated in this 6-week study. This investigation interpreted the description of the horticulture experience from the participants' perspective. The researchers immersed themselves in this experience by interacting with participants throughout the duration of the study. The 7 themes that emerged included the impact of the horticulture activities on group experiences, sharing, learning, sensory stimulation, creativity, emotions and memories. The results suggested that horticulture, when used in a group-based setting, has an immediate and positive effect on life satisfaction, well being, and self-co...

Within the mental health field, there is an increased attention to issues of diversity. However, this awareness has not yet been applied to racially and culturally diverse gays and lesbians who are chronically mentally ill. Some of the reasons for this include the long history of homogeneity of American institutions; the underutilization of mental health services by minority groups; the stigmatization of the mentally ill; and homophobia, within both the psychiatric community and society at large. As a result, there is a need for mental health professionals to acknowledge minority gays and lesbians with chronic mental illness, and begin to provide programs that affirm their sexual orientation, race, and cultural identities.

Women inmates in Nebraska have demographic similarities and differences which are often at odds with contradicting national data. Over the past fifteen years, the demographics of women incarcerated at the Nebraska Center for Women have experienced substantial change. The number of inmates incarcerated for violent offenses has increased by 8 percent and now constitutes 42 percent of the overall inmate population. The number of inmates incarcerated for drug related offenses has similarly increased and now comprises 36 percent of the population, while 85 percent of all inmates have been identified as having a substance abuse problem. Unfortunately, the inpa-tient treatment program can only handle nineteen of those identified with drug problems, while another seventy remain on the waiting list. The number of inmates who are identified with chronic mental illness has increased and a request to house these individuals has been recommended. As in most prisons, the inmate population has continued to incr...

In occupational therapy, a fundamental belief is that a healthy lifestyle reflects the adapted balance between work, play/leisure, self-care and rest activities, which promotes occupational function. Adolph Meyer (1922) stated that our existence is structured through occupation. The occupational balance may be disrupted when an individual experiences a mental health problem. Mental health problems vary in terms of diagnosis, but more importantly, they vary in the amount of occupational dysfunction. In this study, the type of environmental support needed to function with a mental health problem is an indicator of differences in abilities to perform daily activity patterns. This study describes this balance of occupations as the temporal adaptation between two comparison groups. The effects of gainful employment and mental health status on the activity patterns for work, play/leisure, self-care and rest are discussed in terms of hours utilized, and the perceived competence, importance and enjoyment...

This article is a first person account of wrestling with spiritual questions and issues by an individual who has lived with a chronic mental illness since the age of 17. Writing about her own life story and struggle with mental illness, she brings to the fore issues of what we pray for and how; the meaning of suffering; a closer examination of the sometimes frivolous ways we ask God to intervene in our lives; and a struggle to understand the meaning of healing, and its place in the life of a person with a chronic mental illness.

Relatives of adults with chronic mental illness are recognised as an important provider of care for this vulnerable population. Carers, alongside service users, are being encouraged to be more involved in developing plans for care and treatment in the community for people with severe and long term mental health problems through arrangements such as the care programme approach. However, many relatives continue to express dissatisfaction with mental health services in terms of information and advice. This study compares relatives' satisfaction with two groups established by neighbouring Community Mental Health Teams. Despite some broad similarities, notable differences were apparent between the groups in terms of the profile of the relatives and the orientation of the groups. Both groups were found to meet the needs of participants and were rated highly on providing information and emotional support. The ratings by the ‘drop-outs’ of each group differed, with only one set being dissatisfied with th...

A group therapy model for chronic mental patients based on existential principles is described. Focusing on the existential dilemmas of chronically ill patients accesses their inner life and acknowledges their immense strengths in tolerating the illness. These effects can improve the patients' motivation for and compliance with treatment and lower distressing secondary conditions such as shame, hopelessness, and suicidality. The model uses the methods of (a) linking, (b) differentiating the therapy team, and (c) addressing the core issues to counteract the negative processes of derealization, powerlessness and irrelevance that hinder group therapy with these patients. Therapists attempt to highlight divergent perspectives of irresolvable dilemmas, offering patients the opportunity to experience and to communicate the courage, tolerance and love required to carry the burden of chronic mental illness.

SUMMARY This paper explores the efficacy of on-going weekly psychodynamic group music therapy with those with chronic mental illness in a therapeutic-community setting. Co-improvised music-making was the primary medium of communication and connection in the group, combined with a period for verbal reflection. Central to the therapist's thesis is that the shared music medium primarily acts as a way of expressing, organising and containing the experience of individual members and of the group. It allows for contact between members at a pre-verbal, preconscious level. For this particular patient group, contacts made at this level can be critical to their further ability to tolerate and integrate feelings in a more verbal and conscious way. The music-therapy setting is seen as aiding the process of linking together these two areas of experience, thus providing patients with a potentially freer, less restricted, way of relating to themselves and each other.

A pilot study is reported of non-hospital residential care for people with chronic mental illness. The Needs for Care Assessment (NFCA) was used to ascertain the clinical and social functioning of six patients who transferred from a long-term psychiatric ward to a high-support community hostel. Standardised interviews were conducted with patients and care-staff before re-location, during the settling-in period and one year later. Results indicate improvements in social and clinical functioning. Unmeetable needs in the hospital became meetable in the hostel. Residents expressed a preference for hostel accommodation.Staff and participants’ opinions regarding improvements in functioning appeared to differ. This study provided a first step to further explorative, but empirically-based analyses concerning hostel accommodation for people with chronic psychiatric disabilities.

This article describes a newsletter, Chronic Mental Illness and Aging, designed to encourage excellence in writing and to provide undergraduate students with an opportunity to publish scholarly papers. The papers are based on topics assigned in a Psychology of Aging course. The newsletter is published three times a year and consists of 12 pages (six back to back) in a black and white format. Students are responsible for the layout of the material, word-processing articles, maintaining the mailing list, and sending the issues out. Featured papers consist of up-to-date information on a mental health issue involving elderly persons. The newsletter is sent to mental health professionals who work with elders and who have difficulty in keeping up with current developments in the field. The cost of publishing the newsletter is minimal, less than $150 a year. The only cost factors, presumind duplication services are available, are postage and paper. Suggestions for other gerontological newsletters are provided.

Evaluates how a child's subjective perceptions of a mentally ill parent's psychiatric symptoms and parenting skills relate to the child's psychological adjustment. In this study, 57 children and their mothers, half of whom were mothers with a severe and chronic mental illness, participated in a research protocol that included a directed observation of mother-child dyads and measures of parenting style, parent psychopathology, child behavior, and child's self-perceptions. The results indicated that children's subjective perceptions of parents' behavior are important variables in a child's adjustment.

Informal caregiving by relatives is an important component of the daily environment for many sufferers from chronic mental illness. This paper considers some possible reasons for the uncomfortable relations which often seem to occur between the family and the professional caregivers. Some of the barriers to an effective therapeutic alliance may be system-wide inadequacies in resources for an area of health care which is still somewhat stigmatized. However, other barriers seem to be attitudinal in nature. This paper proposes several ways in which the mental health professionals and family caregivers may work together more constructively as co-therapists. These are issues which require explicit consideration in the initial and continuing education which mental health professionals receive.

To assess the impact of chronically mentally ill patients on the primary health care team, a case-control comparison of patient contact recorded in general practitioner notes was conducted in seven general practices within the catchment area of a community mental health centre over a 12-month period. Patients with chronic mental illness registered with the centre had more recorded total contact with the primary care team (median 12 vs 2 contacts) and more recorded face to face contact with their general practitioner (median 5 vs 1 contacts) than had controls (not in psychiatric care). Chronically mentally ill patients had been on their current practice list for a shorter period than controls (median 66 vs 154 months), and received more items of medication on repeat prescription (median 2 vs 0). Patients with chronic mental illness living outside hospital make greater demands on the primary health care team than patients not currently receiving specialist psychiatric care.

In an epidemiologic case-finding study of 341 persons diagnosed as having “long-term functional psychosis”, 7 persons with schizophrenia had committed suicide during a follow-up period of 3 years. Data about the seven cases were retrospectively gathered through studies of medical case records and through interviews with significant others and care personnel/psychotherapists. All seven persons had been chronically ill. Most of them were in a state of remission from their illness before the suicide and even showed signs of lasting improvement. The individuals had premorbidly been functioning rather well, with normal ambitions. Late in their illness they expressed a sense of loss of a former self and feelings of being hopelessly handicapped and separated from what they considered to be normal life. All seven persons had also experienced negative life events shortly before the suicide. The time perspective of having lived with a chronic mental illness for many years seems to have been of major importance in t...

The article reports a wellness education program developed to enhance and promote healthy life-style behaviors for individuals with chronic mental illness living in the community. Theoretical concepts from health promotion, wellness, and social learning were used in the development of this program. The program comprised three components: wellness education sessions, exercise/activity sessions, and a smoking reduction course.

This article presents a summary of the author's study of the lived experiences of homeless women diagnosed with chronic mental illness. Strategies found to be effective in the conduct of the study are highlighted. Issues and problems related to population access, sampling, data generation, and difficult situations in the field are discussed with proposed solutions. The resolution of nurse helper/nurse researcher role conflicts is addressed.

The individual with a chronic illness frequently experiences a variety of environmental settings throughout the illness and treatment process. Although it is congruent with current nursing theory development to view environment in a broad context, nurses may fail to appreciate the continuity of environments experienced by their clients. This article argues for a reconceptualization of the environment that explicitly considers the continuity of environments experienced by the client with a chronic mental illness. This will assist nurses in determining the supportive and nonsupportive aspects of their clients' environments.

(1998). Social psychiatry research and the elderly with chronic mental illness. Aging & Mental Health: Vol. 2, No. 3, pp. 165-166.

People who suffer chronic mental illness tend to become progressively more disadvantaged. Problems related to work, family, health, and the use of leisure time increase while physical vitality and mental acuity diminish. As difficulties compound, social functioning becomes marginal and tenuous. About half of the mental patients released from hospitals are readmitted within a year of discharge. The patient's sojourn in the community has been eloquently described by Bassuk &

Chronic mental illness, especially schizophrenia, can lead to long-term disability, largely consequent upon the negative symptoms that persist. More than half of all patients with schizophrenia will suffer from residual disability. Depressing though this is, it is encouraging to note that in half of all patients, the mental symptoms decrease over time, and the patients are able to achieve some semblance of a normal life sometimes even a complete cure. A variety of factors seem to be implicated in the extent to which patients remain with deficits. Although genetics may play a part, it is recognized that social factors and periods of institutionalization may cause negative symptoms. This has important implications for rehabilitation and the prevention of relapse. It is especially important that community support programs and long-term rehabilitation efforts help to remedy or compensate for deficits in social skills. Even where institutionalization is uncommon, there are other psychosocial factors that produce the same effects. In many developing countries, a person is ostracized and stigmatized following an episode of ' 'madness, ' ' even if all symptoms have disappeared and the patient' s behavior has returned to normal. Expectations with regard to the person's role in society, a lack of trust in his judgment, and a generally negative attitude by others in the community can cause the former

Deinstitutionalization as a social change phenomenon has had a profound affect on both hospital andcommunity psychia- try and on the almost 2 million chronically ill, their families, and the communities in which they now live. Two individuals, Gail and James, were subjects for a study which asked three research ques- tions. First, how have these individuals with a chronic mental illness functioned as deinstitutionalized persons; second, did participation in a fifteen-week occupational therapy program affect performance of skills in work, play, and self care; and, finally, what is a model for the occupational therapis1 as case manager with the chronically mentally ill? Descriptive case study methodology revealed previous rehabilitation efforts over ten years were fragmented and time lim- ited and demonstrated that the subjects made periodic gains in self- care skills; but that these were not maintained in the absence of treatment. Pre- and post-testing of the subjects during the fifteen week occupational t...

Much work has been done to prepare people with a history of chronic mental illness for vocational placement. Evaluation tools can select some who are likely to be successful in competitive or sheltered work. Many whose psychiatric disability is so severe it interferes seriously with their capacity for work have need for more pre-vocational or vocational skills training. A literature survey shows many programs designed to help this population but little specific outcome data. Other articles state the need for empirical research. With limited funds and a large underserved population, further research is important.