Search

Objective: To describe the perspectives of those with lived experience of stimulant use disorder on methamphetamine-related violence in psychiatric inpatient settings. Method: Eight adult psychiatric inpatients with stimulant use disorder were recruited. Semi-structured interviews were recorded, transcribed and analysed using thematic analysis. Results: Participants reported that traumatic experiences predisposed those using methamphetamine to violent behaviour. Participants were fearful of psychiatric hospitalisation because of loss of autonomy and stigma. Methamphetamine use was associated with mercurial intense emotions. Participants believed these factors led to violence during psychiatric admissions. Conclusions: People with stimulant use disorder have a sophisticated understanding of the complex causal pathways from methamphetamine use to violent behaviour. Their lived experience can make an important contribution to service development. [ABSTRACT FROM AUTHOR]

This perspective paper explores the choice of psychotherapy for psilocybin‐assisted psychotherapy for treatment‐resistant depression. There is evidence to support the use of some psychotherapies in treating 'treatment‐resistant' depression, and emerging evidence for the efficacy of psilocybin. The next step which is the focus of this paper is to identify psychotherapies that are both effective and congruent with the psilocybin experience. The evidence for the efficacy of the psychotherapies is drawn from a Cochrane review and the analysis of their congruence with the psilocybin experience is drawn from a qualitative meta‐synthesis of the experience of psilocybin. The paper will examine whether three one‐to‐one psychotherapies identified as effective in the treatment of treatment‐resistant depression are compatible with the psilocybin experience. Each psychotherapy will be examined in relation to its congruence with the qualitative evidence that suggests the choice of psychotherapy needs to give priority to the subjective experience, facilitate emotional processing, support connectedness with others, acceptance of the self as emotional and support change based on the person's insights into their relationships with others and the world in which they live. We conclude that interpersonal psychotherapy and intensive short‐term dynamic psychotherapy align with that experience, although others are currently being trialled. [ABSTRACT FROM AUTHOR]

There is increasing clinical interest in the use of psilocybin. There is emerging evidence of the efficacy of psilocybin for the treatment of a range of clinical conditions. Mental health nurses have a unique set of skills for caring for people who are hallucinating. To expand these skills to meet the developing clinical interest in the therapeutic use of psilocybin, it is helpful to understand the experience from the perspective of the person being treated with psilocybin. A qualitative meta‐synthesis was conducted to examine how those with psilocybin described their experiences to identify whether its effects are similar across different health conditions. Ten studies were included in the review. The health conditions studied were cancer, depression, HIV, substance use disorder, smoking cessation and trauma. The synthesis of findings identified three themes that were common across the studies despite the health condition: acceptance, connection and transformation. The review provides helpful insights into how people experience psilocybin and its effects on their health condition. [ABSTRACT FROM AUTHOR]

While antidepressants may be effective in treating depression for some people, a third of people do not have an improvement in mood after a trial of two different antidepressants for an adequate duration. These people are diagnosed as having 'treatment‐resistant' depression which situates the problem as part of their biological or psychological makeup. We conducted a search of studies that examined this problem from the perspective of people whose depression did not improve on antidepressants. Nine studies were included in a qualitative meta‐synthesis that identified four themes across these studies: feeling trapped, disconnection, loss of self, and questioning. The participants experienced considerable distress associated with the constant presence of depression in their lives. While antidepressants may help some people, there is a need for more innovative approaches to the treatment of depression. There is a strong argument for trialling appropriate evidence‐based psychotherapy before a person is categorized as having treatment‐resistant depression. It is perhaps better to describe the issue as inadequate efficacy of antidepressants to situate the problem with the treatment provided rather than with the person. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: People with mood disorders often use substances.There are several clinician‐driven hypotheses explaining the relationship. What the paper adds to existing knowledge?: The paper draws together the existing research on the perceptions of those with lived experience of mood disorders on the reasons for using substances.The participants in the studies identified using substances to manage their mood when treatment to manage their mood was not effective or acceptable, and as an escape from trauma and hardship. What are the implications for practice?: Mental health nurses need an understanding of why people with mood disorders may use substances and the impact of this on their treatment.Mental health nurses need to provide trauma‐informed care that emphasizes harm reduction for those who have mood disorders and substance use. Introduction: Substance use is highly prevalent among people with mood disorders. Effective treatment for these people requires a better understanding of the relationship between both mood and substance use from the perspectives of those with lived experience. Question: What are the reasons those with lived experience of mood disorders give for substance use? Method: An integrative review was conducted. The Joanna Briggs Institute suite of critical appraisal tools was used to evaluate the quality of individual studies. Data relevant to the review question were extracted, and the results were synthesized into themes. Results: Eighteen papers met the eligibility criteria. Three themes were identified across the included studies: Managing my mood, More Effective than prescribed medication, and Escape from trauma and hardship. Discussion: This integrative review identified that people with a mood disorder who use substances described choosing to take substances to manage their mood, as an alternative to prescribed medications, and to cope with trauma and social hardships. Implications for Practice: Mental health nurses need to provide care that recognizes why people use substances. They need to understand these reasons to provide a harm reduction and trauma‐informed model of care. Evidence‐based non‐pharmacological interventions for mood disorders need to be available as an alternative to medications or as a supplement. [ABSTRACT FROM AUTHOR]

People would prefer to have psychotherapy as treatment over medication for major depression. There is evidence that psychotherapy does not require in-person delivery to be effective. Other modes of delivery, such as videoconferencing teletherapy, may make it a more accessible treatment. The aim of this review was to identify the characteristics of effective psychotherapy delivered by videoconference for adults in primary care with a primary diagnosis of depression. A quantitative systematic review was conducted and reported according to PRISMA guidelines. There were 8 studies included in the review. The therapies studied were tele problem-solving therapy, behavioural activation and cognitive behavioural therapy. All studies had a medium to high risk of bias. Six were randomized controlled trials, one was a pragmatic retrospective cohort study and one was an open-label design. Four studies found similar outcomes to the in-person comparators, one study found tele problem-solving therapy was more effective than behavioural activation, and one study found cognitive behavioural therapy to be similar to usual care. The search identified only 8 studies. Due to the heterogeneity of outcome measures and comparators, a meta-analysis could not be conducted. No definitive conclusions can be drawn about the effectiveness of teletherapy in primary care based on this review, however, there is emerging evidence to suggest it has similar outcomes to in-person therapy for people with a primary diagnosis of depression. There is no evidence regarding the superiority of one model of therapy over the others. • There is evidence that patients prefer psychotherapy to the use of medication in the treatment of depression in primary care. • The review identified eight studies using three models of psychotherapy. • There is emerging evidence suggesting that teletherapy has similar outcomes to in-person therapy for depression. [ABSTRACT FROM AUTHOR]

Eating disorders (EDs) are serious mental health illnesses, yet there is a need to better understand the illness experience to improve treatment outcomes. Qualitative research, and narrative approaches in particular, can elicit life stories that allow for the whole illness journey to be explored. This study aimed to explore the experiences of women with a history of an ED, identifying the life events they perceived were relevant to the onset of their ED through to recovery. Interviews were conducted with 18 women with lived experience of an ED. Through structural narrative analysis, an overarching storyline of childhood loss contributing to a belief of conditional acceptance, fear of abandonment and struggle to seek emotional support due to the fear of being a burden was identified. Negative experiences with the health sector were common. These findings have implications for the way medical professionals respond to help seeking and deliver treatment. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Rates of antidepressant prescribing have been increasing.Antidepressants are not effective for many people. What the paper adds to existing knowledge?: Participants described how in order to receive help they had to engage with a medical pathway in which their experiences were constructed as arising from a biochemical deficit.Antidepressant prescribing was identified as being the only option available and was associated with stigma. What are the implications for practice?: Mental health nurses have a role to play in providing treatment options for those experiencing depression.Mental health nurses need to provide evidence‐based information about antidepressants support those experiencing depression to make informed choices. Introduction: There are increased prescribing rates of antidepressants associated with an increase in the diagnosis of depression. However, antidepressants are not effective for many people. There is a gap in the existing literature for a synthesis of the experiences of those with lived experience of antidepressant use to better understand their use and impact given their ubiquitous use in mental health, primary care and other secondary and tertiary care settings. Mental health nurses play direct or indirect roles in both advocating for antidepressant use and monitoring adherence. Aims: To identify how people prescribed antidepressants describe their experiences of the medication including its discontinuation? Method: A meta‐synthesis of qualitative studies examining patients' experiences of antidepressant medication. Ovid MEDLINE, EMBASE, PsychINFO and Cochrane Library databases were searched in May 2021. One reviewer screened titles and abstracts. Two reviewers independently reviewed the retrieved papers for eligibility and data extraction. The data synthesis was conducted using thematic analysis. Two reviewers independently conducted quality appraisals. Results: Twenty‐seven studies with a total of 2937 participants were identified for inclusion in this review. Four themes were identified across the studies: the only option available; stigma associated with 'biochemical deficit' not myself and the vicious cycle. Implications for practice: Those seeking treatment for depression need to be provided with treatment options and evidence‐based information about anti‐depressants to provide them with the opportunity to make informed choices. [ABSTRACT FROM AUTHOR]

This perspective paper aims to present a personal viewpoint on the impact of psychiatric discourse on the principles of recovery in mental health care. Mental health services espouse these principles, yet psychiatric discourse remains the dominant model. A critical analysis will examine how psychiatry maintains this dominance. The aim is to examine how psychiatric discourse constructs both the nature of mental distress and its treatment, and how it maintains its power as the dominant authority and its relationship to recovery principles. The paper concludes that psychiatric discourse is the antithesis of recovery principles and that its authority is perpetuated through co‐opting a medical explanatory model, claiming expertise in the ability to predict social risk, and maintaining a tightly controlled echo chamber. A way forward involves the dismantling of the hierarchical service delivery model based on psychiatric discourse and replacing it with a more horizontal service delivery model in which the lived experience of mental distress is central. Regular audit of services needs to prioritize recovery principles. The implications for mental health nursing are considered. [ABSTRACT FROM AUTHOR]

Social distancing/lockdown policies during the coronavirus (COVID-19) pandemic may alter social rhythms of people through imposition of restrictions on normal daily activities. This may in turn challenge circadian function, particularly in people with mood disorders. Although objective data describing the relationship between circadian disturbances and mood disorders exist, data regarding the subjective experience of circadian challenge is sparse, and its association with mood symptoms is unclear. The present qualitative study was one component of a mixed-methods multi-national project, which took advantage of widespread disruption to daily routines due to Government COVID-related lockdowns during 2020. The Behavior Emotion and Timing during COVID-19 (BEATCOVID) survey study included three open questions generating qualitative data on participants' subjective experience of social disruption due to social distancing/lockdown policies, two of which asked about the barriers and opportunities for stabilizing routines. Responses were coded and analyzed using Thematic Analysis. A total of N = 997 participants responded to at least one of the free-text questions. Four themes were identified: 1) loss of daily timed activities, 2) role of social interaction, 3) altered time perception and 4) disruption to motivation and associated psychological effects. Themes were organized into a provisional heuristic map, generating hypotheses for future research centered on the new concept of 'psychological drift.' [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Aggression and violence are persistent problems in psychiatric inpatient units.Violence preventive factors have been identified from both staff's and patients' perspectives.Violent and aggressive inpatient incidents have not been adequately explained in research and reviews to date. What this paper adds to existing knowledge?: This review is novel in that it provides a comparison of patients' and staff's perspectives and identified that these differ and were influenced by factors attributable to the inpatient culture.The one contributory factor both agreed upon was the role of staff's interpersonal skills in either exacerbating or de‐escalating aggression and violence.The inpatient culture was found to engender differing perceptions of most contributory factors to violence and aggression. What are the implications for practice?: While staff's interpersonal skills were identified as a primary influence on whether their interaction with patients contributed to aggression and violence, this was shaped by the inpatient environment's culture.Patient‐centred interactional skills need to focus on the patients' needs for respect and active participation rather than engendering feelings of disrespect or coercion.Patient‐centred communication skills that demonstrate an understanding of the patient's experience in the inpatient environment need to be core skills for mental health nurses. Introduction: High rates of aggression and violence are a persistent problem in inpatient mental health environments. A comparison of staff's and patients' perceptions of the causes may provide novel insights. Aim: This review aimed to compare patients' and staff's perspectives on the causes of aggression and violence in inpatient environments. Method: An integrative review of the literature was conducted with a search of Ovid (Medline, Embase, PsycINFO) databases and manual searching. Results: Thirty articles met criteria for inclusion. Interactions prior to aggressive or violent incidents were characterized by patients as disrespectful and coercive, and by staff as indicative of the patient's mental state or personality. Both groups identified the importance of patient‐centred communication skills. Discussion: The review identified that patients and staff have differing perspectives on the causes of violence and aggression. There was an interactional dynamic between staff and patients that was shaped by the culture of the inpatient setting. Implications for Practice: Understanding how the inpatient culture plays a role in shaping a dynamic between patients and staff and developing communication skills that acknowledge this may help reduce violence and aggression in inpatient settings. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: There is evidence that the LGBT communities experience greater health disparities, particularly in relation to their mental health needs.The LGBT communities are often faced with stigma and discrimination within mental health services. What the paper adds to existing knowledge?: People within the LGBT communities have identified that their experiences of mental health services reinforce stigma and lack an understanding of their specific needs.Their needs can be addressed by mental health services that challenge heteronormative assumptions and promote self‐acceptance and equity. What are the implications for practice?: The existing heteronormative culture in mental health nursing practice needs to be challenged.Practice needs to demonstrate self-awareness of personal and societal LGBT biases, prejudices, and stigma.Practice needs to demonstrate knowledge of important LGBT health care and psychosocial issues.Practice needs to reflect LGBT clinical skills grounded in professional ethics, guidelines, and standards of care. Introduction: The lesbian, gay, bisexual and transgender (LGBT) communities are a minority population that experience a range of health disparities, including mental health. Because these groups have higher rates of mental disorder than the general population it is, therefore, pertinent to identify their specific mental health needs and their experiences when accessing mental health care. Aim: To identify the mental health needs of the LGBT communities and their experiences of accessing mental health care. Methods: An integrative review of qualitative studies was conducted. Results: A total of fourteen studies were selected for this review. The studies identified that participants' experiences of accessing mental health care were related to (a) experiencing stigma and (b) staff's lack of knowledge and understanding of LGBT people's needs. They identified a need for mental health care that promotes the principles of equity, inclusion and respect for diversity. Discussion: The LGBT communities while not a homogenous group, face unique challenges when dealing with their mental health needs. Services that promote health equity and self‐acceptance are important for this group. Implications for practice: It is vital that mental health nursing education incorporate models that promote equity, inclusion and respect for diversity regarding this group of people. [ABSTRACT FROM AUTHOR]

Objectives: This review aim was to examine whether psychotherapy is more or less effective in patients with SUD, compared to those without; whether there is a differential effect of a particular psychotherapy in patients with SUD. Methods: A quantitative systematic review following the Cochrane Handbook of Systematic Reviews was used. Results: Five studies of psychotherapy for BD and two studies of an integrated psychotherapy for comorbid BD and SUD were included in the review. Five studies provided a sub‐analysis of the effect of SUD on overall outcomes with only one finding an overall detrimental effect. The results indicated equal, if not better outcomes for individuals with comorbid BD and SUD. Conclusion: There was little evidence that interventions targeted at both BD and SUD may be more efficacious. Further research in to psychotherapeutic treatment for BD should include individuals with comorbid SUD, and analyse substance use as an outcome. Additionally, research into treatments specifically developed for these commonly comorbid disorders is indicated. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to examine participants' experiences of interpersonal and social rhythm therapy, with or without cognitive remediation, and the impact of this intervention on their functioning. Methods: This qualitative study drew data from follow- up interviews of 20 participants who completed the 12-month intervention as part of a randomized controlled trial. The qualitative data were collected through semistructured interviews and were analyzed with thematic analysis. Results: The 20 participants (11 men, 9 women, ages 22-55, median age=32) reported that interpersonal and social rhythm therapy (content and process) as an adjunct to medication, alone or in combination with cognitive remediation, was effective in improving their functioning. They described these improvements as facilitated by a new sense of control and confidence, ability to focus, new communication and problem-solving skills, and better daily routines. Conclusions: Participants with recurrent mood disorders described improved functioning related to therapies that formulate their mood disorder in terms of a model, such as interpersonal and social rhythm therapy with or without cognitive remediation, that provides an understandable and evidence-based rationale, facilitates a sense of control and confidence by supporting the person in undertaking practical routines that can be integrated into daily life, focuses on communication and problem-solving skills, and engenders a sense of hope by working with the person to develop self-management strategies relevant to their specific symptom experiences and the life they choose to live. [ABSTRACT FROM AUTHOR]

Objective: This study compared relapse rates at 18 months among patients with bipolar disorder who, after discharge from publicly funded mental health services, received either adjunctive interpersonal and social rhythm therapy (IPSRT) or treatment as usual (general practice medical care). Methods: Patients diagnosed as having a bipolar I or II disorder who had been discharged from publicly funded mental health services in New Zealand during the previous 3 months were randomly assigned to 18 months of IPSRT or to treatment as usual. The primary outcome measure was the Life Interval Follow-Up Evaluation (LIFE) completed at weeks 26, 52, and 78 of treatment. Secondary measures were scores on the Social Adjustment Scale (SAS) and the Quality of Life- Bipolar Disorder Scale (QoL-BD) and readmission to mental health services. Results: The sample consisted of 88 patients. In this intentionto- treat analysis, no significant differences were observed in rates ofmood episodes between the groups (odds ratio=0.93, 95% confidence interval=0.37-2.17, p=0.86). A statistically significant difference was seen between the intervention and treatment-as-usual groups in scores on the SAS (effect size=0.5) but not on the QoL-BD. A significantly lower readmission rate was observed among the intervention group. Conclusions: This pragmatic clinical effectiveness trial found that a combination of IPSRT and medication management over 18 months did not significantly improve mood relapse but did improve patient functioning. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Medication does not always resolve a serious mood episode, and there is evidence that it needs to be combined with an evidence‐based psychotherapy to promote symptomatic and functional recovery.There is little known about what people with serious mood disorders want from mental health services to manage their mood. What the paper adds to existing knowledge?: Participants in this study wanted a framework other than the medical model for understanding and managing their mood.Their motivation to commence psychotherapy was based on a sense of having hit rock bottom and a need for understanding what was happening in order to better manage their mood. Introduction: There is little known about the motivations for people to participate in psychotherapy for depression. Aim: To explore why people, with a diagnosis of major depressive episode, chose to take part in a psychotherapy study and what they expected it to involve. Method: This was a qualitative study of participants' motivations and understandings of psychotherapy for depression. Data were collected using semi‐structured interviews and analysed using thematic analysis. Findings: Eight females and eight males with an age range from 21 years to 55 years were recruited. Three themes were identified that described why participants chose to participate in psychotherapy: medication was not enough, a turning point and making sense of experience. The participants chose to participate in psychotherapy after finding that medication was insufficient and this combined with a sense of crisis motivated them to engage in psychotherapy in order to learn to manage their mood differently. Discussion: The participants recognized that they wanted a framework other than a medical model with its reliance on medication, in order to make sense of their experiences and develop new self‐management strategies. Implications for Practice: Our study suggests that some people experiencing a serious mood disorder access psychotherapy after "hitting rock bottom" and finding insufficient help from medications. Mental health nurses need to be aware people do not always want a medical model approach to treatment of serious mood disorders and they need to provide the opportunity of engaging in a psychotherapeutic framework in order to better understand and manage their mood. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Recurrent depressive episodes involve significant morbidity, suicide risk and recurrent hospitalizations.In both major depressive disorder and bipolar disorder, there are significant impairments in functioning following resolution of acute symptoms. What this paper adds to existing knowledge?: This paper provides an in‐depth qualitative understanding of the subjective experience of cognitive impairment following a depressive episode in a recurrent mood disorder.It identifies descriptions of two types of experience (being stuck and being preoccupied with one's thoughts) that led to impairments in concentration, memory, organization and decision‐making. What are the implications for practice?: Mental health nurses need to develop an awareness of the impact of cognitive difficulties in the process of recovery from recurrent mood disorders.Mental health nurses need to provide knowledgeable reassurance, information and interventions to people who experience cognitive difficulties to provide a framework of understanding that promotes recovery. Introduction: People who experience recurrent depressive episodes often have ongoing cognitive problems that impact on their functional recovery. These cognitive difficulties have been identified as impacting on social, interpersonal and occupational functioning and can result in vulnerability to relapse. Aim: The aim of this qualitative study was to explore participants' subjective experiences of cognitive impairment after discharge from mental health services following treatment for recurrent depression. Methods: The study was designed as a qualitative study in order to best capture participants' subjective experiences. Data were collected by semi‐structured interviews and were analysed using a process of thematic analysis. Results: Twenty participants took part in this study. All participants described experiences of either 1) "being stuck"; or 2) "being preoccupied with own thoughts"; however, all participants described the experiences in the third theme: "it stops you living to your potential." Implications for practice: In order to promote recovery in a meaningful way, mental health nurses need to provide information about and strategies for managing cognitive difficulties associated with recurrent mood disorders. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this paper was to present Social Rhythm Therapy, which has been modified from Interpersonal and Social Rhythm Therapy, by drawing on implementation science to describe a process that for integrating this into routine clinical practice. Method: On the basis of the principles of user‐centred design, we aimed to modify an existing psychosocial therapy for bipolar disorder to make this readily translatable into a range of clinical practice models which could be further modified based on feedback from end users. Results: Social Rhythm Therapy has been adapted from Interpersonal and Social Rhythm Therapy which has demonstrated efficacy in research settings. The adaptation was developed in order to facilitate implementation of some of the key components in routine clinical practice. It is short, relatively simple, easily learned and intended to be flexible. Conclusions: Social rhythm therapy for bipolar disorder has many characteristics which may make it translatable into clinical practice in different settings. There is a need for studies into the clinical effectiveness of this intervention that has been modified from an evidence‐based intervention. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to conduct a safety analysis among patients with major depressive disorder receiving interpersonal and social rhythm therapy (IPSRT) with and without cognitive remediation. Methods: This preliminary safety analysis of the outcomes of patients with major depressive disorder was part of a larger randomized controlled trial (RCT) in which patients with bipolar disorder and major depressive disorder received IPSRT; half were randomly assigned to receive additional cognitive remediation. The study focused on patients with major depressive disorder because IPSRT had not been trialed with this group; their outcomes were compared with those of patients with bipolar disorder. Data from the first 30 RCT participants were used to examine whether the intervention had adverse effects, whether mood symptoms and functioning improved over 12months, andwhethertherewas a signal ofbenefit. Mood symptoms were measured at baseline and 12months with the Longitudinal Interval Follow-Up Evaluation and the Quick Inventory of Depressive Symptoms-Self-Reported; functioning was measured with the Social Adjustment Scale. Results: A total of 63% (N=19) of participants were diagnosed with bipolar disorder and 27% (N=11) with major depressive disorder. No adverse effects were found for those with major depressive disorder, and improvements were seen in mean depressive and functioning scores at 12 months compared with baseline, with moderate to large effect sizes. Conclusions: IPSRT may be a clinically effective intervention for patients with major depressive disorder. Outcomes related to cognitive functioning and the effects of cognitive remediation will be reported at the end of the trial. [ABSTRACT FROM AUTHOR]

Māori have high rates of bipolar disorder (BD) and mental health service use. Despite the high prevalence and the impact on functioning and whānau (family), there is limited research on treatment interventions for Māori with bipolar disorder and indeed on Māori and indigenous mental health generally. A qualitative study combining individual interviews and focus groups was conducted with the aim to explore mental health clinicians' and Māori mental health workers' perspectives of effective treatment for Māori with BD. Sixteen participants took part in either individual interviews, focus groups or both. The study found the importance of a Māori worldview; tikanga Māori (rituals); understanding the whānau context, whakawhanaugatanga (connection), the powhiri (introduction) process, and whakarongo (listening) were key to working effectively with Māori who had BD. Both the interviews and focus groups identified similar concepts. The concept of whakawhanaungatanga (connection) captures the themes from the individual interviews and focus groups. The participants in this study identified the person and their culture rather than the psychiatric diagnosis as crucial to providing effective care to Māori with BD. Without a foundation in whakawhanaungatanga, engagement, diagnosis, treatment adherence, and the process of recovery are unlikely to be as effective for Māori with BD. It was evident from the findings that it was the person not the diagnosis that was central to therapeutic engagement. [ABSTRACT FROM AUTHOR]

To determine the clinical effectiveness (glycemic control, other biological measures, cost-effectiveness and patient satisfaction) of primary care nurse-led interventions for diabetes. A systematic review following methods described for complex interventions and using PRISMA guidelines for reporting was undertaken. Nurse-led care for diabetes can be regarded as a complex intervention requiring the measurement of more than one outcome and for this reason we chose a range of outcomes clinical (symptoms), patient-centred (experiences) and organisational (cost-effectiveness). An extensive literature search using MEDLINE (PubMed) EMBASE, and CINAHL was conducted. Primary studies with adults in primary care with both quantitative (comparison with physician-led care and cost-effectiveness) and qualitative (patient experiences of nurse-led care) methodologies from 2003 until June 2018. All studies were appraised using the Cochrane Collaboration's tool for assessing risk of bias. The appraisal involved evaluation of the degree of risk of bias in selection, performance, detection, attrition and reporting. Because of the complexity of multiple outcomes (quantitative and qualitative) a narrative synthesis was undertaken. The search generated 18 published studies that met our eligibility criteria. Three randomized controlled trials and one historical control trial found statistically significant differences in glycemic levels in favour of the nurse-led interventions. Two cluster randomized trials, two randomized pragmatic trials and two randomized controlled trials found no differences between groups. The three open-label studies found statistically significant improvements in HbA1c levels. The audit identified that more patients had lower HbA1c levels after the initiation of a nurse-led intervention. Three randomized controlled trials found significant improvements in biological outcomes and one did not. The four studies measuring cost-effectiveness found the nurse-led intervention was associated with less costs. Four studies examined patient satisfaction with nurse-led care and found this was very good. This review which incorporated a broad range of studies to capture the complexity of nurse-led interventions has identified that there is evolving evidence that nurse-led interventions for community treatment of diabetes may be more clinically effective than usual physician-led care. [ABSTRACT FROM AUTHOR]

Objectives: (1) To examine the differences between interpersonal and social rhythm therapy (IPSRT) and specialist supportive care (SSC) in the longer term impacts of IPSRT and SSC on cumulative depression and mania symptoms over a further 78‐week follow‐up period post treatment. (2) To calculate the survival time before recurrence of a new mood episode over the 3‐year period. Methods: One hundred young people with bipolar disorder aged between 15 and 36 years who had been randomized to treatment with either IPSRT or SSC for 78 weeks were followed up for a subsequent 78 weeks. The Longitudinal Interval Follow‐up Evaluation was completed at 26‐week intervals. A Mann‐Whitney U test was used to determine if there were significant differences between therapy types and a Kaplan‐Meier survival analysis was used to determine time to recurrence. Cox regression was used to assess the association between time to relapse and therapy type. Results: There were no significant differences between therapies at each of the data points for either depression or mania scores. The mean change in depression and mania in both groups was significantly different for all three follow‐up data points. The actuarial cumulative recurrence rates were 53% for IPSRT and 49% for SSC. There was no significant difference between the groups in time to recurrence. Conclusions: While there were no significant differences between the two therapies, there was an overall reduction in symptoms in both therapies. There may be sustained benefits in providing intensive psychotherapies in conjunction with pharmacotherapy for young people with bipolar disorder. [ABSTRACT FROM AUTHOR]

Background: Monitoring clinical response to treatment in depressed inpatients, particularly identifying early improvement, may be sub-optimal. This may impact adversely on patients through longer admissions and sub-optimal pharmacotherapy. Psychomotor speed is a prominent neuropsychological function which changes as recovery occurs. This study examines simple techniques used to quantify psychomotor change and their potential to contribute to monitoring recovery. Methods: Activity levels were continuously monitored in patients diagnosed with a major depressive episode from four acute psychiatric wards using two actigraphs (commercial and scientific) for 3 weeks and linear regression used to calculate a gradient to express rate of change. Psychomotor speed was assessed using the simple Coin Rotation Task. Mood and functioning were rated using the Quick Inventory of Depressive Symptoms, Clinical Global Impression Scale and Functioning Assessment Short Test. The assessments were completed at baseline and follow-up (3 weeks), and correlations were calculated for all change measures. Results: In all, 24 inpatients were recruited but not all completed baseline and follow-up measures. Change in activity count (N = 16) and psychomotor speed (N = 13) correlated significantly with improvement in clinical measures of depressive symptoms. Actigraphs were acceptable to hospital inpatients. Limitations: The limited size of this pilot study precludes the analysis of predictive power or the influence of other variables such as depression subtypes, age, gender or variations related to medications. Conclusion: Early change in simple activity and psychomotor speed warrant further investigation for utility in measuring treatment response in depressed inpatients. [ABSTRACT FROM AUTHOR]

The promotion of the self‐managing capacities of people has become a marker of contemporary mental health practice, yet self‐management remains a largely uncontested construct in mental health settings. This discourse analysis based upon the work of Foucault investigates self‐management practices for bipolar disorder and their action upon how a person with bipolar disorder comes to think of who they are and how they should live. Using Foucault's framework for exploring the ethical self and transcripts of interviews with people living with bipolar disorder, this discourse analysis finds that the discursive practices of self‐management for bipolar disorder are prescribing a restricted regime for living based upon the quintessential neo‐liberal subject using practices that are focused upon managing an unreliable and problematic self. The article concludes with the proposition that the problem of bipolar disorder (for which self‐management is an answer) is less about the object itself and more about how we construct the nature of the self. A Māori indigenous ontology is used here as an example of an alternative discursive resource through which people make sense of the self and which allows ways of thinking about self‐management that engage with ambivalence and ambiguity rather than restriction and regulation. [ABSTRACT FROM AUTHOR]

Abstract: Suicide is a major concern for mental health nurses because of its clear correlation with mental illness. In New Zealand, coroners investigate all deaths that appear to be a result of suicide, and provide reports to mental health services (MHS). The aim of the present study was to investigate coronial recommendations to MHS in relation to suicide prevention and to examine clinical and family responses to these. The present study was a three‐phase design: (i) analysis of coroners’ recommendations related to suicide in MHS; (ii) interviews with clinicians for their response to the recommendations; and (iii) interviews with individuals working with families of consumers of MHS for their responses in relation to family‐related recommendations. A qualitative content analysis was conducted on the recommendations from coroners, the interviews with clinical leaders, and the focus group for family workers. Coroners recommended that MHS should implement suicide‐prevention strategies that would facilitate improved communication, risk containment, service delivery, and family involvement. Clinicians agreed with most recommendations, apart from those related to risk containment. Family workers endorsed the coronial perspective that family inclusion in MHS was suboptimal. Coroners, MHS, and mental health nurses need to consider the latest clinical evidence for suicide prevention. However, given the complexity of factors that influence suicide, it is important to be realistic about MHS role in preventing suicide, but ensure that MHS provide interventions for which there is evidence, including facilitating family participation and providing access to psychotherapies. [ABSTRACT FROM AUTHOR]

Abstract: Psychoeducation has become a common intervention within mental health settings. It aims to increase people's ability to manage a life with a long‐term illness. For people with bipolar disorder, psychoeducation is one of a range of psychosocial interventions now considered part of contemporary mental health practice. It has taken on a ‘common sense’ status that results in little critique of psychoeducation practices. Using a published manual on psychoeducation and bipolar disorder as its data, Foucauldian discourse analysis was used in the present study for a critical perspective on psychoeducation in order to explore the taken‐for‐granted assumptions on which it is based. It identifies that the text produces three key subject positions for people with bipolar disorder. To practice self‐management, a person must: (i) accept and recognize the authority of psychiatry to know them; (ii) come to see that they can moderate themselves; and (iii) see themselves as able to undertake a reflexive process of self‐examination and change. These findings highlight the circular and discursive quality to the construct of insight that is central to how psychoeducation is practiced. Using Foucault's construct of pastoral power, it also draws attention to the asymmetrical nature of power relations between the clinician and the person with bipolar disorder. An effect of the use of medical discourse in psychoeducation is to limit its ability to work with ambivalence and contradiction. A critical approach to psychotherapy and education offers an alternate paradigm on which to basis psychoeducation practices. [ABSTRACT FROM AUTHOR]

Background The increasing prevalence of diabetes is well-documented along with the findings that some ethnic minorities have a higher prevalence than non-minority individuals. Along with possible biological differences between ethnicities, access to economic, social, cultural and symbolic capital may impact on the success of managing type-2 diabetes. Objectives To examine how people from ethnic minorities in Western countries describe their experiences of managing type-2 diabetes mellitus. Data sources PubMed and Ovid Medline databases. Eligibility criteria Studies between 1946 and July 2016 were included if they were qualitative in design and presented findings in relation to adults from ethnic minorities and their descriptions of self-managing type-2 diabetes mellitus. Study appraisal and synthesis The CASP evaluation for qualitative studies was used for quality appraisal and synthesis involved thematic analysis and evaluation of evidence using GRADE-CERQual approach. Findings Twenty-seven papers were included in the review. The primary studies were all conducted in middle-high income western countries with people from diverse ethnicities, although the majority were Black American. There was high confidence in the evidence that a sense of powerlessness, issues of treatment accessibility and acceptability, and the culturally defined roles within families impacted on how some participants managed their diabetes. There was moderate confidence in the evidence in relation to the cultural significance of food and for the cultural effect of stigma. Conclusion The potential for a sense of powerlessness to manage diabetes, the acceptability and accessibility of treatment, the significance of food, the impact of cultural roles and stigma needs to be pivotal to diabetes education for people from ethnic minorities in Western countries. [ABSTRACT FROM AUTHOR]

Aim To examine the relationship of the pain severity scores with demographic variables (age, gender, and ethnicity) and with the frequency of falls, fatigue, and depression in a very large New Zealand sample of people over 65 years assessed using the Home Care International Residential Assessment Instrument. Background Pain is reported to be highly prevalent in older people yet it is poorly correlated with tissue damage. There is convincing evidence that it is related to depression and some evidence of its relationship with fatigue and falls. Design This is a cross-sectional study examining a national cohort assessed on referral for a needs assessment for access to publicly funded service provision or support. Method Participants were 45,418 adults aged over 65 years referred for a mandatory needs assessment between 2012-2014. All variables analysed were drawn from the Home Care International Residential Assessment Instrument. Univariate descriptive statistics were used to characterize the sample in relation to the association of severe pain with age, gender, and ethnicity and with the key variables of interest: falls, fatigue, and depression. Logistic regression models were used to examine the relationship of the presence or not of severe pain with the other key health-related variables: falls, fatigue, and depression, respectively, after controlling for the presence of age, gender, and ethnicity. Odds ratios are reported to quantify the difference in risk with increasing severity of falls, fatigue, and depression. Results The mean age of the cohort was 82.48 years ( SD 7.48) and 48.5% of the sample reported experiencing daily pain. The rates of severe daily pain were 12%-18% with those in the 65-74 years group having the highest reported rate of severe pain (18%) and a gradual decrease in severe pain with age. After co-varying for age, ethnicity, and gender, the presence of severe daily pain was predicted by increasing frequency of falls and fatigue and having current depression. While two-thirds reported their pain control was adequate, a third reported that their pain control was not adequate despite adhering to a therapeutic regime. Conclusion The study highlights how pervasive pain is in this group and its correlation with falls, fatigue, and depression. While the effect sizes were relatively small the results may be clinically significant and it may be clinically important that the presence of pain in older people could indicate the need for further nursing assessment in relation to falls, fatigue, and depression. [ABSTRACT FROM AUTHOR]

Rationale, aims and objectives Diabetes mellitus is associated with significant morbidity, mortality, and escalating health care costs. Research has consistently demonstrated the importance of glycaemic control in delaying the onset, and decreasing the incidence, of both the short-term and long-term complications of diabetes. Although glycaemic control is difficult to achieve and challenging to maintain, it is key to reducing negative disease outcomes. The aim of this study was to determine whether a nurse-led educational intervention alone or a nurse-led intervention using education and acceptance and commitment therapy (ACT) was effective in reducing hemoglobin A1c (HbA1c) in people living with uncontrolled type 2 diabetes compared to usual care. Methods Adults over the age of 18 years, with a confirmed diagnosis of type 2 diabetes and HbA1c outside of the recommended range (4%-7%, 20-53 mmol/mol) for 12 months or more, were eligible to participate. Participants were randomised to either a nurse-led education intervention, a nurse-led education plus ACT intervention, or a usual care. One hundred and eighteen participants completed baseline data collection (N = 34 education group, N = 39 education plus ACT, N = 45 control group). An intention to treat analysis was used. Results A statistically significant reduction in HbA1c in the education intervention group was found ( P = .011 [7.48, 8.14]). At 6 months, HbA1c was reduced in both intervention groups (education group −0.21 and education and ACT group −0.04) and increased in the control group (+0.32). A positive change in HbA1c (HbA1c reduced) was noted in 50 participants overall. Twice as many participants in the intervention groups demonstrated an improvement as compared to the control group (56% of the education group, 51% education plus ACT, and 24% control group. Conclusions At 6 months post intervention, HbA1c was reduced in both intervention groups with a greater reduction noted in the nurse-led education intervention. [ABSTRACT FROM AUTHOR]

Aim To synthesize qualitative descriptions of the experience of chronic pain across conditions. Background Chronic pain is a transdiagnostic symptom in that while somatic pathology plays a role in activating pain pathways, psychological and social factors contribute to the experience of pain over time. The treatment of the underlying condition may require both biomedical intervention and biopsychosocial approaches. Design Qualitative meta-synthesis using Confidence in the Evidence from Reviews of Qualitative Research ( CERQual) developed by Grading of Recommendations Assessment Development and Evaluation ( GRADE) working group to evaluate the strength of the evidence. Data sources PubMed and Ovid Medline from 2000-2015. Review methods Following a systematic search strategy all papers were assessed in relation to inclusion criteria and quality. Themes were extracted from each study and a meta-synthesis conducted before completing an evaluation of confidence in the findings. Results Forty-one papers exploring the experience of chronic pain were included in the review. Five meta-themes were identified across the studies: 1) the body as obstacle; 2) invisible but real; 3) disrupted sense of self; 4) unpredictability; and 5) keeping going. There was high confidence in the evidence for three themes: 'the body as obstacle'; 'disrupted sense of self' and 'keeping going'; and moderate confidence in the evidence for 'invisible but real' and 'unpredictability'. Conclusions The findings in this review suggest there are similarities in the experience of chronic pain across a range of conditions that have implications for the development of transdiagnostic pain management strategies and interventions. [ABSTRACT FROM AUTHOR]

Rationale, aims and objectives Self-management of type 2 diabetes through diet, exercise and for many medications, are vital in achieving and maintaining glycaemic control in type 2 diabetes. A number of interventions have been designed to improve self-management, but the outcomes of these are rarely explored from a qualitative angle and even fewer through a process evaluation. Method A process evaluation was conducted using a qualitative design with participants randomized to an intervention. Seventy-three people living with type 2 diabetes and hyperglycaemia for a minimum of 1 year, randomized to one of two interventions (n = 34 to an education intervention and n = 39 to an education and acceptance and commitment therapy intervention) completed stage one of the process evaluation, immediately following the intervention through written feedback guided by open-ended questions. A purposive sample of 27 participants completed semi-structured interviews at 3 and 6 months post intervention. Interview data were transcribed and data analysed using a thematic analysis. Results The majority of participants described an increase in knowledge around diabetes self-management and an increased sense of personal responsibility. Participants also described changes in self-management activities and reflected on the challenges in instigating and maintaining change to improve diabetes management. Conclusion The complexities of implementing change in daily life to improve glycaemic control indicate the need for ongoing support post intervention, which may increase and maintain the effectiveness of the intervention. [ABSTRACT FROM AUTHOR]

Background There is evidence that chronic pain is not recognised or managed effectively in older people. It is important to examine how older people cope with this because of the impact it can have on their quality of life and mortality. It will also enable nurses to work with older people to support effective coping skills and provide information on other useful coping strategies. Objectives To examine how older people cope with non-malignant chronic pain. Design This is a qualitative meta-synthesis using Confidence in the Evidence from Reviews of Qualitative Research developed by Grading of Recommendations Assessment Development and Evaluation working group to evaluate the strength of the evidence. Data sources PubMed and Ovid Medline from 1995 to 2015. Review methods Following a systematic search strategy all papers were assessed in relation to inclusion criteria and quality. Only qualitative studies were included. Themes were extracted from each study and a meta-synthesis conducted before completing an evaluation of confidence in the findings. Results Seventeen primary studies were included in the meta-synthesis. Three meta-themes were identified: ‘adjusting to the inevitable’, ‘doing it my way without medication’ and ‘the importance of support in managing the struggle’. There was high confidence in the evidence for ‘doing it my way without medication’ and moderate confidence in the evidence for the other two meta-themes. Conclusion Given that the participants in the primary studies were generally wary of health professionals and stoic in their response to pain, it is important for nurses to communicate in ways that engage older people and ensure their independence and sense of control remains intact. Identification of current coping strategies will enable the nurse and the older person to work together to assess their effectiveness and to adapt these if more effective coping is required. [ABSTRACT FROM AUTHOR]

Aim The aim of this study was to explore the experiences of diagnosis and education for people living with Type 2 diabetes who have sub-optimal glycaemic control. Background The increasing prevalence of Type 2 diabetes is a global concern. Many people have difficulty maintaining optimal glycaemic control with up to 50% having HbA1c levels higher than recommended. A range of factors that have been suggested as possibly contributing to this, however, little is known about how their experience of diagnosis, education and support to attempt to understand the context of their self-management practices. Design A qualitative thematic analysis of interviews conducted with people with sub-optimal glycaemic control prior to their participation in an intervention study. Method Thirty participants taking part in a psychosocial/educational intervention for people with sub-optimal glycaemic control were interviewed in 2012 before the intervention commenced. These interviews explored each participant's experience of the diagnosis and associated education. The interviews were transcribed and a thematic analysis was conducted. Findings Almost all the participants had been shocked at receiving the diagnosis and felt it had been a moral indictment on their lifestyle. Many had been given the impression that they had a mild form of diabetes and most had been given very little information on self-management that they had found useful. Conclusion The findings suggest that for the participants there was a considerable gap between the rhetoric of person-centred services and the reality of the experiences of diagnosis and education for the self-management of Type 2 diabetes. [ABSTRACT FROM AUTHOR]

Aim The aim of this study was to evaluate the clinical effectiveness (improvement in health status and/or functioning and use of health services) of transdiagnostic health management interventions for people aged 65 years and older. Background The care of older people with multimorbidity is of increasing concern for nurses. A transdiagnostic approach to health management interventions (promote self-management or lifestyle) may be apposite for providing older people with the skills to manage symptoms that may or may not be disease-specific. Design Quantitative systematic review. Review methods Cochrane methods using Cochrane's Effective Practice and Organization of Care Methods ( EPOC) for assessing risk of bias and the Grading of Recommendations, Assessment, Development and Evaluation ( GRADE) for assessing the weight of evidence. Data sources Medline, CINAHL, PubMed and Psyc INFO 1999-2014. Results Twelve studies were included in the review ( n = 10,393). All 12 studies provided results for health outcomes (health status and functioning) and six provided results for health outcomes and health service utilization. Ten studies reported statistically significant improvements in health outcomes but of these studies only two were of low risk of bias. Three studies identified some statistically significant reductions in health service utilization. The weight of evidence for the health management interventions included in the review, were low/moderate for improvements in health status and low for improvements in health service utilization. Conclusion While there is some very preliminary evidence suggesting that structured transdiagnostic health management interventions may be clinically effective for older people with multimorbidity the effect sizes are small and the quality of this evidence is generally low. [ABSTRACT FROM AUTHOR]

The article explores the issues associated with the use of Internet video conferencing in delivering Interpersonal and Social Rhythm Therapy (IPSRT) for people discharged from mental health services with mood disorder during the COVID-19 pandemic. Topics discussed include the positive aspects of using the Zoom platform such as continuity of care, and the invasion of privacy issue cited by some patients due to the perception that using Zoom means therapists are entering their house.

Objectives: Given the sensitivity of individuals with mood disorders to circadian disruption, transmeridian travel would likely be a high-risk endeavour leading to onset or relapses in mood. A systematic review was undertaken to identify the evidence of the impact of transmeridian travel on people with mood disorders. Methods: Databases search included the following: CINAHL, MEDLINE, PsycINFO and manual searching using the keywords jetlag, transmeridian travel, circadian rhythm disruption, mood disorder, bipolar, major depression, seasonal affective disorder, depression, mania and hypomania. Results: Only three studies were identified that related to transmeridian travel and jetlag in people with mood disorders. There is some suggestion that transmeridian travel does appear to precipitate mood episodes with an increased rate of episodes of depression with westward compared with an increased rate of manic/hypomanic episodes with eastward travel. Individuals with a previous history of mood disorder appear to be more vulnerable if adherence to medication is compromised. Conclusion: Given the limited evidence that transmeridian travel precipitates mood episodes, this poses difficulties in identifying suitable ways to mitigate the effects of transmeridian travel in mood disorders. However, in the absence of mood-specific guidelines, some guidance can be given based on our current understanding of the relevance of circadian disruption to both jetlag and mood disorders. Further research is required to identify more focused strategies to mitigate the impact of transmeridian travel for individuals with mood disorders. [ABSTRACT FROM AUTHOR]

Objective: Bipolar disorder is a chronic relapsing disorder associated with high rates of suicide, suicide attempts and nonsuicidal self-injury. The study aimed to prospectively identify the rates of suicide attempts and nonsuicidal self-injury in young people participating in an adjunctive randomised controlled psychotherapy for bipolar disorder and to identify differences in individuals who engaged in nonsuicidal self-injury, made suicide attempts or did both. Method: In all, 100 participants aged 15–36 years with bipolar disorder received 78 weeks of psychotherapy and were followed up for a further 78 weeks. Data were collected using the Longitudinal Interval Follow-up Evaluation. Results: Suicide attempts reduced from 11% at baseline to 1% at the end of follow-up (week 156). Similarly, self-harm reduced from 15% at baseline to 7% at the end of follow-up. Individuals who engaged in both nonsuicidal self-injury and made suicide attempts differed from those with who only made suicide attempts, engaged in nonsuicidal self-injury or did neither. They were characterised by a younger age of illness onset and higher comorbidity. Conclusion: Adjunctive intensive psychotherapy may be effective in reducing suicide attempts and nonsuicidal self-injury and warrants further attention. Particular attention needs to be paid to individuals with early age of onset of bipolar disorder. [ABSTRACT FROM AUTHOR]

Objective: To identify whether mindfulness-based stress reduction is effective in improving physical health outcomes for long-term physical conditions. Method: A systematic review of the literature (retrieved from MEDLINE, PubMed and PsycINFO). Results: Fifteen studies were included in the review. None of the studies assessed as having a low risk of bias demonstrated significant improvements in physical health status although there was some emerging evidence that mindfulness-based stress reduction may be useful in pain conditions. There was some preliminary evidence that it may also be effective in improving primary insomnia and irritable bowel syndrome. Small to moderate effect sizes were also found for asthma, pain, tinnitus, fibromyalgia and somatization disorders. Conclusion: Although there is some preliminary support for the use of mindfulness-based stress reduction in physical health conditions, further research is required before it could be considered an effective intervention for improving physical health outcomes. [ABSTRACT FROM AUTHOR]

Little is known about the factors that contribute to a positive psychotherapy outcome. There is still considerable debate as to whether specific factors (e.g. severity of symptoms, comorbidity) or nonspecific factors (e.g. alliance, therapy process) are most important in influencing outcome. This study examined the additional contribution that therapeutic process and alliance made to previously identified specific predictors of response to CBT and IPT for depression over the course of therapy. The previously identified specific factors were belief that childhood reasons caused the depression, recurrent depression, perceptions about how logical therapy was and comorbid personality disorder symptoms. One hundred and sixty five adult outpatients with major depression were treated for depression in a randomised clinical trial examining predictors of response to Cognitive Behavior Therapy and Interpersonal Psychotherapy. All therapy sessions were audiorecorded to enable objective ratings of therapeutic process and alliance. Process factors – patient psychic distress, patient participation and patient alliance had the strongest associations with outcome. The early and middle stage of therapy process did not account for any additional variance other than that previously identified by the patient predictors, however, at the end stage of therapy process contributed a further 14%. [ABSTRACT FROM AUTHOR]

Objective: The objective of this paper is to describe two methods of qualitative analysis - thematic analysis and content analysis - and to examine their use in a mental health context. Method: A description of the processes of thematic analysis and content analysis is provided. These processes are then illustrated by conducting two analyses of the same qualitative data. Transcripts of qualitative interviews are analysed using each method to illustrate these processes. Results: The illustration of the processes highlights the different outcomes from the same set of data. Conclusion: Thematic and content analyses are qualitative methods that serve different research purposes. Thematic analysis provides an interpretation of participants' meanings, while content analysis is a direct representation of participants' responses. These methods provide two ways of understanding meanings and experiences and provide important knowledge in a mental health context. [ABSTRACT FROM AUTHOR]

The article presents a study on non-pharmacological interventions for treating moderate to severe inpatient depression. It discusses the need to improve care given in acute inpatient depression treatment services amid concerns such as lack of people to talk to, over-reliance on medication and boredom, some non-pharmacological approaches that led to enhanced outcomes including cognitive behavioural therapy, interpersonal psychotherapy and behavioural activation. Also noted is chronotherapeutics.

Objective This randomized, controlled clinical trial compared the effect of interpersonal and social rhythm therapy ( IPSRT) to that of specialist supportive care ( SSC) on depressive outcomes (primary), social functioning, and mania outcomes over 26-78 weeks in young people with bipolar disorder receiving psychopharmacological treatment. Methods Subjects were aged 15-36 years, recruited from a range of sources, and the patient groups included bipolar I disorder, bipolar II disorder, and bipolar disorder not otherwise specified. Exclusion criteria were minimal. Outcome measures were the Longitudinal Interval Follow-up Evaluation and the Social Adjustment Scale. Paired-sample t-tests were used to determine the significance of change from baseline to outcome period. Analyses of covariance were used to determine the impact of therapy, impact of lifetime and current comorbidity, interaction between comorbidity and therapy, and impact of age at study entry on depression. Results A group of 100 participants were randomized to IPSRT (n = 49) or SSC (n = 51). The majority had bipolar I disorder (78%) and were female (76%), with high levels of comorbidity. After treatment, both groups had improved depressive symptoms, social functioning, and manic symptoms. Contrary to our hypothesis, there was no significant difference between therapies. There was no impact of lifetime or current Axis I comorbidity or age at study entry. There was a relative impact of SSC for patients with current substance use disorder. Conclusions IPSRT and SSC used as an adjunct to pharmacotherapy appear to be effective in reducing depressive and manic symptoms and improving social functioning in adolescents and young adults with bipolar disorder and high rates of comorbidity. Identifying effective treatments that particularly address depressive symptoms is important in reducing the burden of bipolar disorder. [ABSTRACT FROM AUTHOR]

The present study aims to review the quality of open-access nursing journals listed in the Directory of Open Access Journals that published papers in 2013 with a nursing focus, written in English, and were freely accessible. Each journal was reviewed in relation to their publisher, year of commencement, number of papers published in 2013, fee for publication, indexing, impact factor, and evidence of requirements for ethics and disclosure statements. The quality of the journals was assessed by impact factors and the requirements for indexing in Pub Med. A total of 552 were published in 2013 in the 19 open-access nursing journals that met the inclusion criteria. No journals had impact factors listed in Web of Knowledge, but three had low Scopus impact factors. Only five journals were indexed with PubMed. The quality of the 19 journals included in the review was evaluated as inferior to most subscription-fee journals. Mental health nursing has some responsibility to the general public, and in particular, consumers of mental health services and their families, for the quality of papers published in open-access journals. The way forward might involve dual-platform publication or a process that enables assessment of how research has improved clinical outcomes. [ABSTRACT FROM AUTHOR]

The article presents research which examined the use of adjunctive interventions to treat mania in admitted patients. Topics covered include the assessments of non-psychopharmacological treatments such as Group Cognitive Behavioral Therapy (G-CBT), Interpersonal and Social Rhythm Therapy (IPSRT) and dark room therapy. Also mentioned is the analysis of sleep-wake times of patients.

A number of recent, highly-publicized, perceived health-care service failures have raised concerns about health professionals' accountabilities. Relevant to these concerns, the present study sought to examine how mental health nurses understood clinical responsibility and its impact on their practice. A descriptive, qualitative design was used, and a convenience sample of 10 mental health nurses was recruited from specialist inpatient and outpatient mental health settings in Canterbury, New Zealand. Data were collected using semistructured interviews, and the transcriptions were analysed using an inductive, descriptive approach. Three major themes were identified: being accountable, fostering patient responsibility, and shifting responsibility. Being accountable involved weighing up patients' therapeutic needs against the potential for blame in an organizational culture of risk management. Fostering patient responsibility described the process of deciding in what situations patients could take responsibility for their behaviour. Shifting responsibility described the culture of defensive practice fostered by the organizational culture of risk aversion. The present study highlighted the challenges mental health nurses experience in relation to clinical responsibility in practice, including the balancing required between the needs of patients, the needs of the organization, and the perceived need for self-protection. [ABSTRACT FROM AUTHOR]

An editorial is presented on the addressing cognitive impairment in mood disorders a role for the mental health nurse. Topics inlcude the Journal examined how thirty people with depression associated with either Major Depressive Disorder or Bipolar Disorder described their experiences in cognitive functioning, the participants in that study has described either being stuck, and the paucity of thoughts while preoccupied with their own thoughts' has described having too many ruminative thoughts.

crowe m., burrell b. & whitehead l. (2011) Lifestyle risk management - a qualitative analysis of women's descriptions of taking hormone therapy following surgically induced menopause. Journal of Advanced Nursing 68(6), 1814-1823. Abstract Aim. This article is a report of a study that examined how women describe their decisions in relation to the use of menopausal hormone therapy following surgical menopause. Background. Women who have had a surgically induced menopause generally experience more intense menopausal symptoms than natural menopause and are regularly prescribed menopausal hormone therapy. Since 2002 the risks associated with this therapy have been widely reported. Method. This study is a qualitative analysis of semi-structured interviews between March and May 2009 with 30 participants who had experienced surgical menopause and were, or had in the past, taken menopausal hormone therapy. This was a community sample recruited in Christchurch, New Zealand. A risk management theoretical approach underpinned the analysis. Findings. The womens' descriptions of managing the risks associated with menopausal therapy fell into two main themes: Life has to go on and Waiting for someone to tell me. All these women had either made an active decision to continue on treatment because of the impact of menopausal symptoms or took their doctor's advice to continue. A less dominant theme but one that was also evident was Relying on my body to get me through in which the women had decided to discontinue treatment because they regarded it as unnatural. Conclusion. The study provided insights into how women utilize an experiential reasoning process to manage the health and lifestyle risks associated with taking menopausal hormone therapy. Nurses need to be aware of how this process influences women's reasoning processes when working with women following surgical menopause. [ABSTRACT FROM AUTHOR]

Objective: To identify interventions that improve medication adherence in bipolar disorder.Method: A review of the literature from 2004 to 2011 was conducted using Medline and manual searching.Results: Eleven studies were identified as meeting inclusion criteria. Five studies demonstrated improved medication adherence. No characteristics of the interventions, clinical characteristics of the groups or methodological factors distinguished those psychosocial interventions that demonstrated improvement from those that did not.Conclusions: While only a few interventions improved adherence, most improved clinical outcomes. Issues were also identified about the way in which adherence is defined. It is proposed that incorporating patient preferences into measures of adherence within the context of a disorder-specific psychosocial intervention may provide an approach that demonstrates both improved adherence and improved clinical outcomes. However this requires further research. [ABSTRACT FROM PUBLISHER]

Abstract: Background: The age of the first episode of illness in Bipolar Disorder has been shown to be an important predictor of outcome with early onset, particularly onset before puberty, associated with greater comorbidity, a poorer quality of life and greatest impairment in functioning. Methods: Baseline data from a psychotherapy study was used to examine the prevalence of other comorbid psychiatric conditions and the impact of onset at an early age on both self harming behaviour and suicide attempts in young people with Bipolar Disorder. Results: This study of 100 adolescents and young adults (aged 15–36years) with Bipolar Disorder showed that comorbid conditions were very common, even at the start of their bipolar illness. Comorbidity increased as the age of onset decreased with very early onset (<13years) patients bearing the greatest burden of disease. Greater comorbidity also significantly increased the risk of having self harmed and attempted suicide with high lethal intent. Self harming behaviour was predicted by having a lifetime diagnoses of Borderline Personality Disorder and Panic Disorder along with an early age of onset of Bipolar Disorder. In contrast, previous suicide attempts were predicted by greater comorbidity and not by very early (<13years) age of onset. [Copyright &y& Elsevier]

There is considerable interest in understanding and augmenting the process of change in psychotherapy. In this study qualitative and quantitative analyses were used to examine patient processes associated with change in recorded psychotherapy sessions from the Christchurch Psychotherapy for Depression Study. The sample consisted of 177 outpatients with a primary diagnosis of major depressive disorder randomized to receive weekly therapy sessions of Cognitive Behavior Therapy or Interpersonal Psychotherapy. Qualitative analyses identified four main themes associated with patient change. From these themes a 10-item rating scale, the Patient Psychotherapy Process Scale (PPPS), was developed. Analyses indicated the PPPS is a reliable and valid measure of important patient change processes, with higher scores associated with a better response to psychotherapy. [ABSTRACT FROM PUBLISHER]