Motivational and cognitive factors linked to community integration in homeless veterans: study 1 – individuals with psychotic disorders

2020 ◽  
pp. 1-9
Author(s):  
Michael F. Green ◽  
Jonathan K. Wynn ◽  
Sonya Gabrielian ◽  
Gerhard Hellemann ◽  
William P. Horan ◽  
...  

Abstract Background Little is known about the determinants of community integration (i.e. recovery) for individuals with a history of homelessness, yet such information is essential to develop targeted interventions. Methods We recruited homeless Veterans with a history of psychotic disorders and evaluated four domains of correlates of community integration: perception, non-social cognition, social cognition, and motivation. Baseline assessments occurred after participants were engaged in supported housing services but before they received housing, and again after 12 months. Ninety-five homeless Veterans with a history of psychosis were assessed at baseline and 53 returned after 12 months. We examined both cross-sectional and longitudinal relationships with 12-month community integration. Results The strongest longitudinal association was between a baseline motivational measure and social integration at 12 months. We also observed cross-sectional associations at baseline between motivational measures and community integration, including social, work, and independent living. Cross-lagged panel analyses did not suggest causal associations for the motivational measures. Correlations with perception and non-social cognition were weak. One social cognition measure showed a significant longitudinal correlation with independent living at 12 months that was significant for cross-lagged analysis, consistent with a causal relationship and potential treatment target. Conclusions The relatively selective associations for motivational measures differ from what is typically seen in psychosis, in which all domains are associated with community integration. These findings are presented along with a partner paper (Study 2) to compare findings from this study to an independent sample without a history of psychotic disorders to evaluate the consistency in findings regarding community integration across projects.

2020 ◽  
pp. 1-8
Author(s):  
Jonathan K. Wynn ◽  
Sonya Gabrielian ◽  
Gerhard Hellemann ◽  
William P. Horan ◽  
Robert S. Kern ◽  
...  

Abstract Background In an initial study (Study 1), we found that motivation predicted community integration (i.e. functional recovery) 12 months after receiving housing in formerly homeless Veterans with a psychotic disorder. The current study examined whether the same pattern would be found in a broader, more clinically diverse, homeless Veteran sample without psychosis. Methods We examined four categories of variables as potential predictors of community integration in non-psychotic Veterans: perception, non-social cognition, social cognition, and motivation at baseline (after participants were engaged in a permanent supported housing program but before receiving housing) and a 12-month follow-up. A total of 82 Veterans had a baseline assessment and 41 returned for testing after 12 months. Results The strongest longitudinal association was between an interview-based measure of motivation (the motivation and pleasure subscale from the Clinical Assessment Interview for Negative Symptoms) at baseline and measures of social integration at 12 months. In addition, cross-lagged panel analyses were consistent with a causal influence of general psychiatric symptoms at baseline driving social integration at 12 months, and reduced expressiveness at baseline driving independent living at 12 months, but there were no significant causal associations with measures of motivation. Conclusions The findings from this study complement and reinforce those in Veterans with psychosis. Across these two studies, our findings suggest that motivational factors are associated at baseline and at 12 months and are particularly important for understanding and improving community integration in recently-housed Veterans across psychiatric diagnoses.


2021 ◽  
Vol 9 (08) ◽  
pp. 293-299
Author(s):  
S. Benzahra ◽  
◽  
A. Karara ◽  
H. Nafiaa ◽  
A. Ouanass ◽  
...  

Background: Given the higher incidence of psychotic disorders in patients with epilepsy, several neurologists and psychiatrists have attempted to explain this controversial comorbidity. Thus, several hypotheses have been put forward but no link has been established with certainty until today. Objectives: The aim of our work is to draw up a socio-demographic and psychopathological profile of patients with schizophrenia-epilepsy comorbidity as well as to assess the risk of suicide, the management, the reasons for admission and the length of hospitalization. Methodology: we conducted a retrospective cross-sectional study on medical records of patients with schizophrenia and epilepsy who were hospitalized at the Ar-Razi University Psychiatric Hospital in Salé between January 01, 2017 and March 31, 2021. Results: Our study included 56 patients. The average age was 33 + / - 9.83, 55% male. 50% of patients had attempted suicide in the past and 25% had a history of depressive episode, 41.1% had substance use disorder and 26.8% had a family history of psychosis. 85.7% of our patients developed schizophrenia from pre-existing epilepsy the time to onset of schizophrenia compared to epilepsy was 11.08 years +/- 7.71. The mean age of onset of schizophrenia is 23.3 years with a mean duration of progression of 9.18 years, 55.4% of patients were on monotherapy and 8.9% had resistant schizophrenia on clozapine. The average age of onset of epilepsy is 14.73 years, with generalized epilepsy in 84% of cases. The average length of stay is 42 days. The reasons for admission were as follows: hetero-aggression 78.6%, delusional verbalization 85.7% and suicide attempt 23.2%. The majority of our patients have been treated with atypical antipsychotics: Risperidone 30.4%, Amisulpride 21.4% and Aripiprazole 12.5%. Conclusion: The co-occurrence of schizophrenia epilepsy suggests the existence of possible common etiopathogenic factors. The management of this comorbidity requires a multidisciplinary collaboration between neurologist and psychiatrist, in order to confirm the diagnosis, establish a good therapeutic approach and propose a management algorithm taking into account the two pathologies.


Author(s):  
Hee Jung Kim ◽  
Hee-Young Oh ◽  
Hyeon-Joo Lee

Purpose: This study aims to explore the independent housing experiences of people with mental illness who receive supported independent housing services provided by the public sector.Methods: Data were collected through face-to-face interviews using semi-structured interviews. Twelve participants, who had been living independently in the community for around 11 months, were included. A qualitative descriptive method and a content analysis method were applied.Results: Independent housing experiences of people with mental illness were classified into the following four domains: house effect, growth, challenges and limitations, relationships, and support. Eleven categories included the starting point of life, environmental & psychological comfort, inspire independence and confidence, recognition of goals and responsibilities, positive self-awareness, psychological difficulties, immaturity of daily coping, unstable self-protection, relationship improvement, and importance of support resources.Conclusion: For successful community integration of mentally disabled people, continuous legal institutional preparation for stable housing, government active interest, and flexible financial support are needed. In addition to housing support, a recovery-based independent housing case management model needs to be developed for successful maintenance of independent living. We also suggest a study on the effectiveness of independent housing to determine evidence for making a policy.


2020 ◽  
Vol 90 (2) ◽  
pp. 181-192 ◽  
Author(s):  
William P. Horan ◽  
Jonathan K. Wynn ◽  
Sonya Gabrielian ◽  
Shirley M. Glynn ◽  
Gerhard S. Hellemann ◽  
...  

2021 ◽  
pp. 002076402110596
Author(s):  
Girija Sathiaseelan Ramkumar ◽  
Jaimon Plathottathil Michael ◽  
Anvar Sadath

Background: Clinical and psychosocial profiles of persons living with mental illness (PMI) in non-hospital settings in India have not been adequately studied. Aim: This study describes the profile of PMI living in non-hospital settings by focussing on variables like functioning and social networks. Method: Residents of all available residential facilities in one district area were surveyed and descriptive data was obtained. Socio occupational functioning was assessed using the Social and Occupational Functioning Scale (SOFS) and social network was measured by modified Lubben Social Network Scale-6 (LSNS-6). Results: A total of nine centres housing 491 residents (7–128) were surveyed via field visits. The mean age of the residents was 49 ± 14.0 years. Fifty per cent of them were never married, 22% were separated or widowed. Almost half of the people had psychotic disorders, while diagnosis could not be delineated in a quarter of the population. Almost half the people reached the facilities with the help of their families, while 40% were brought by police or volunteers who found them wandering. Impairment in socio-occupational functioning was only mild in 90% of residents, while 60% did not contact relatives or friends in the past 3 months. Conclusion: PMI living in non-hospital residential facilities were on average in their middle age and were deficient in marital bonds and other social support. They had reached the centres with the help of extended family or by police/volunteers who rescued them from wandering status. Nevertheless, most of them had only mild to moderate levels of impairment, and their functional capacity was good for independent living in the community with support. Hence, newer models of supported housing that provide greater community reintegration, like independent shared housing within regular neighbourhoods, can be tried. In persons with residual family ties, providing continuous community-based support may help re-establish family integration.


2021 ◽  
Vol 9 ◽  
Author(s):  
Christine Nguyen ◽  
Abigail Leung ◽  
Andrea Lauzon ◽  
Mark T. Bayley ◽  
Laura L. Langer ◽  
...  

Background: Many individuals with cerebral palsy (CP) or acquired brain injury (ABI) are at higher risk of lowered psychosocial functioning, poor mental health outcomes and decreased opportunities for community integration (CI) as they transition to adulthood. It is imperative to understand the characteristics of those at highest risk of dysfunction so that targeted interventions can be developed to reduce the impact.Methods: This quantitative, cross-sectional study examines current patients of the Living Independently Fully Engaged [(LIFEspan) Service], a tertiary outpatient hospital-based clinic. The Patient Health Questionnaire-4 (PHQ-4) and the Community Integration Questionnaire (CIQ) were administered to participants. Personal health information was also collected from participants' health charts, and participant interviews. Associations of sex and condition with the outcomes of screening for further assessment of depression, screening for further assessment of anxiety, and CI were calculated using t-tests and Chi-square tests.Results: 285 participants completed standardized screening tools for depression and anxiety (PHQ-4) and 283 completed the Community Integration Questionnaire (CIQ). Mean age was 23.4 (4.2) years; 59% were diagnosed with CP, 41% diagnosed with ABI, and 56% were male. A moderate proportion of the sample screened positive for further assessment of anxiety (28%) and depression (16%), and the overall mean score on the CIQ for the sample was 15.8 (SD 5.1). Participants that screened positive for further assessment of depression and anxiety on the PHQ-4 had lower scores on the Social Integration subscale of the CIQ (p = 0.04 and p = 0.036, respectively). Females were found to have significantly higher community integration than males (p = 0.0011) and those diagnosed with ABI were found to have significantly higher community integration than those with CP (p = 0.009), respectively. A weak negative association was found between age for the total sample and overall PHQ-4 score (p = 0.0417). Presence of an intellectual or learning disability/challenge was associated with a lower CIQ score (p = 0.0026).Conclusions: This current study, highlights the need for further research to explore the unique needs and barriers faced by this population. This study may inform assessments and interventions to support the mental health and community integration of this population.


Author(s):  
Seyedeh Bentolhoda Mousavi ◽  
Peter Higgs ◽  
Negar Piri ◽  
Ensieh Sadri ◽  
Matina Pourghasem ◽  
...  

Objective: Although comorbidity of psychotic disorders and substance use can lead to increase in mortality, less is known about the outbreak and predictors. Psychotic patients tend to be overlooked during assessment; hence, the possibility of an undertreated or missed condition such as increasing substance use. This investigation aimed to measure the prevalence of substance use in psychotic patients and to survey the powerful predictors. Method: In a 1-year cross-sectional study, 311 psychotic patients were assessed using the Structured Interview Based on DSM-5 for diagnostic confirmation as well as questions surveying prevalence and possible predictors of substance use. Results: Prevalence of substance use among psychotic patients was 37.9%. Several variables were identified as factors associated with drug abuse among the psychotic patients. These included male gender, younger age, being currently homeless, a history of imprisonment, and having family history of drug use. The strongest predictors of substance use, however, were family history of drug use, male gender, and being currently homelessness. Conclusion: Policymakers should note the importance of substance use among psychotic patients. Developing active screening strategies and comprehensive preventive plans, especially in the high-risk population, is suggested.


2017 ◽  
Vol 2017 ◽  
pp. 1-8 ◽  
Author(s):  
Pawan Kumar Sharma ◽  
Clareann H. Bunker ◽  
Tushar Singh ◽  
Enakshi Ganguly ◽  
P. Sudhakar Reddy ◽  
...  

Aim. Falls are an important contributor to loss of function, morbidity, and mortality in elders. Little is known about falls in Indian populations. The objective of this cross-sectional report was to identify the prevalence and correlates of falls in a cohort of 562 rural southern Indian men and women. Methods. Risk factors included demographics, anthropometrics, self-reported health, medical history, physical function, vision, depression, and lifestyle. Odds ratios were calculated using logistic regression. Results. 71 (13%) subjects reported at least 1 fall in the past year. Prevalence was higher among women (17%) than men (8%), P=0.003. Sex and age showed significant interaction (P=0.04) whereby falls prevalence increased with age among women but decreased among men. Correlates of falls among men included a history of osteoarthritis (OA) (odds ratio (OR): 6.91; 95% CI: 1.4–33.1), depression (OR:9.6; 3.1–30.1), and greater height (OR per 1 standard deviation increase: 2.33; 1.1–5.1). Among women, poor physical performance (OR: 3.33; 1.13–9.86) and history of cardiovascular disease (CVD) (OR: 2.42; 1.01–5.80) were independently associated with falls. Implications. Prevalence of falls in elderly South Indians was lower than published reports from western countries and likely reflects low exposure to fall risks. Patterns with age differed in men and women and may reflect sex differences in the accuracy of age recall. Presence of comorbidities specifically OA, CVD, and depression was independent correlate of falling.


2019 ◽  
Vol 14 (1) ◽  
pp. 29-32
Author(s):  
Md Abdul Wahab ◽  
Md Mustafizur Rahman ◽  
Md Abdur Razzak ◽  
Md Habibur Rahman ◽  
Farzana Zafreen

Introduction: The prevalence of cardiovascular diseases (CVDs) is rapidly increasing at an alarming rate worldwide and is currently considered as the leading cause of death. List of both modifiable and non-modifiable risk factors for CVDs are long and no particular group of people is immune from it. Objectives: To determine the prevalence of CVDs risk factors among the Border Guard Bangladesh (BGB) personnel. Materials and Methods: This descriptive cross-sectional study was conducted from January to December 2017 among 1225 BGB personnel aged over forty years and working in Chattogram Hill Tracts (CHT) of Bangladesh. Respondents’ socio-demographic characteristics, health history and physical activities were collected in a pre-tested questionnaire. Blood pressure (BP), anthropometric and laboratory parameters were measured and categorized as per the standard procedure. Results: Study subjects’ positive family history of hypertension (HTN), ischemic heart disease, diabetes mellitus and bronchial asthma was 9.6%, 1.8%, 7.9% and 14.2% and positive personal history was 11.5%, 2.5%, 9.7% and 5.6% respectively. A positive history of smoking, using Jorda, Gull and extra salt was 20.4%, 8.9%, 3.5% and 16.3% respectively. Among the respondents by systolic BP; elevated BP, stage1 and stage2 HTN was found 41.5%, 17.6% and 5.7% and by diastolic BP it was 20.9%, 10.3% and 6.8% respectively. Nutritional status by body mass index was; obese 1.2% and overweight 52.5% but by waist-hip ratio only 1.7% was obese. Diabetic and pre-diabetic by ‘Fasting plasma glucose’ was 7.5% and 16% in contrary to ‘Oral glucose tolerance test’ was 8.7% and 17.5% subjects respectively. Very high, high and borderline high total cholesterol was found among 5.5%, 15.1% and 37.8%; triacylglycerol was 2.2%, 32.7% and 29.6% and LDL-cholesterol was 6.5%, 8.5% and 22.7% respondents respectively. HDL-cholesterol was found low in 12.9% study subjects. Conclusion: High prevalence of both modifiable and non-modifiable risk factors of CVDs was found among BGB members. Targeted interventions are needed to reduce modifiable risk factors and prevent CVDs. Journal of Armed Forces Medical College Bangladesh Vol.14(1) 2018: 29-32


2018 ◽  
Vol 18 (1) ◽  
Author(s):  
M. Fata Fatihuddin ◽  
Khairina Khairina ◽  
Lilik Djuari

Abstrak. Setiap makhluk hidup mempunyai kebutuhan, tidak terkecuali manusia.  Kebutuhan tersebut menjadi dasar dan syarat untuk keberlangsungan hidup manusia. Adanya penyakit didalam tubuh dapat menyebabkan perubahan pemenuhan kebutuhan, baik secara fisiologis maupun psikologis. Karena beberapa fungsi organ tubuh memerlukan pemenuhan kebutuhan lebih besar dari biasanya. Tujuan utama dari terapi pada skizofrenia adalah pemulihan. Pemulihan dapat dicapai baik dari segi fungsi mental maupun fisik. Terdapat empat faktor penilaian dalam menentukan terapi pemulihan termasuk diantaranya hilangnya gejala, fungsi pekerjaan, kehidupan mandiri, dan relasi yang perlu melibatkan peran pasien skizofrenia sendiri, pelaku rawat, maupun masyarakat (Lieberman dan Murray, 2001). Penelitian ini bertujuan untuk mengetahui gambaran kebutuhan hidup pasien skizofrenia dan gangguan psikotik lainnya menurut dirinya sendiri dan menurut pelaku rawatnya. Dan membandingkan gambaran kebutuhan hidup pasien skizofrenia dan gangguan psikotik lainnya menurut dirinya dan pelaku rawatnya.Subjek penelitian mencakup 30 pasien skizofrenia dan pelaku rawatnya yang berobat jalan di poli jiwa RSUD. Dr. Soetomo pada bulan November-Desember 2017. Pemilihan subjek dilakukan secara konsekutif menggunakan kriteria inklusi dan eksklusi. Penelitian ini mengambil data dari wawancara dan kuesioner dari instrumen Camberwell Assessment of Need Short Appraisal Schedule (CANSAS). Penelitian ini menggunakan studi analitik observasional cross-sectional dan chi square untuk mengolah datanya.Perbandingan jenis kelamin laki-laki dan perempuan pada pasien skizofrenia dan gangguan psikotik lainnya adalah 1,1:1. Umur pasien skizofrenia dan gangguan psikotik lainnya (73,3%) berkisar antara 19-39 tahun. Sebagian besar pasien skizofrenia dan gangguan psikotik lainnya belum menikah (53,33%). Pasien skizofrenia dan gangguan psikotik lainnya memiliki pekerjaan menjadi ibu rumah tangga (30%) bagi yang perempuan dan (16,7%) tidak bekerja. 50% dari pasien skizofrenia dan gangguan psikotik lainnya terdiagnosa skizofrenia paranoid, dan sudah menyandang lama sakit lebih dari 5 tahun (63,3%). Hubungan kekerabatan dari pelaku rawat pasien skizofrenia dan gangguan psikotik lainnya sebesar 56,7% adalah orang tua. Didapatkan beberapa kebutuhan pasien skizofrenia dan gangguan psikotik lainnya yang tidak terpenuhi dalam penelitian ini menurut pasien skizofrenia dan gangguan psikotik lainnya dan menurut pelaku rawatnya. Dari 22 pertanyaan CANSAS, kebutuhan pasien skizofrenia dan gangguan psikotik lainnya yang dilaporkan pelaku rawatnya lebih tinggi daripada menurut pasien skizofrenia. Pasien skizofrenia dan gangguan psikotik lainnya dan pelaku rawatnya menilai adanya masalah akomodasi, perawatan rumah, telefon/alat komunikasi, aktivitas sehari-hari dan kesehatan fisik yang dinilai tinggi dalam pemenuhan kebutuhan hidup pasien skizofrenia dan gangguan psikotik lainnya. Tidak adanya hasil yang bermakna (p0,05) dalam penelitian ini yang berarti tidak adanya perbedaan dalam menilai kebutuhan hidup menurut pasien skizofrenia dan gangguan psikotik lainnya dan menurut pelaku rawatnya. Diharapkan instrumen ini bisa digunakan untuk pemantauan kebutuhan pasien skizofrenia apakah pasien skizofrenia mempunyai masalah dalam memenuhi kebutuhan hidupnya ke depannya. Kata Kunci: Skizofrenia, Kebutuhan hidup, Pelaku asuh, Instrumen CANSAS Abstract. Background: Every human being has a need that becomes the basis and conditions for the sustainability of his life. The presence of disease in the body can cause changes in the needs, both physiological and psychological. The main goal of therapy in schizophrenia is restoration. Recovery can be achieved both in term of mental and physical function. There are four assessment factors in determining revobertu including loss of symptoms, occupational function, independent living, and relationships that need to involve the role of self-schizophrenic, caregiver, and community. And the recovery is related to the needs of people with schizophrenia.Objective: To determine the description of the needs schizophrenia and other psychotic disorders according to theirself and according to their caregiver. And to compare the description of the needs of a schizophrenic person and other psychotic disorders according to theirself and according to their caregiver.Materials and Method: The subjects include 30 people with schizophrenia and 30 their caregiver(S). who went to the hospital in RSUD. Dr. Soetomo in November-Desember 2017. Subject selection is done consecutively and use inclusion and exclusion creteria. This study takes data from interviews and questionnaires from the Camberwell Instrument assessment of need short appraisal schedule (CANSAS). Used the analitic observasional study cross-sectional and chi square descriptibe study to process the data.Result: The male and female sex ratioin schizophrenia patient and other psychotic disorders is 1.1: 1. Schizophrenia and other psychotic disorders age is ranged from 19-39 years (73.3%). Most of the schizophrenia and other psychotic disorders are unmarried (53.33%). People with schizophrenia and other psychotic disorders have a job of being housewives (30%) for women and (16.7%) not working. 50% of schizophrenic outcomes and other psychotic disorders are diagnosed with paranoid schizophrenia, and have been sick for more than 5 years (63.3%). The relationship of caregiver of schizophrenia and other psychotic disorder is parent (56,7%). Some needs of schizophrenic and other psychotic disorders are not met in this study according to schizophrenia and other psychotic disorders and according to their caregiver.Conclusion: From 22 CANSAS questions, the need of people with schizophrenia and other psychotic disorders reported by caregivers is higher than according to schizophrenics. People with schizophrenia and other psychotic disorders and their caregiver(s) assess the problem of accommodation, home care, telephones / communication devices, daily activities and physical health are highly rated in the needs of people with schizophrenia and other psychotic disorders. The absence of significant results (p 0.05) in this study meant that there was no difference in viewpoints in assessing the schizophrenic needs of the schizophrenic life according itself and according to the caregiver. In addition, It is expected that this instrument can be used to monitor the needs of people with schizophrenia whether people with schizophrenia have problems in their future life needs. Keywords: Schizophrenia, life needs, caregiver, CANSAS instrumen


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