Towards integrated medical and mental healthcare in the inpatient setting: what is the role of psychology?

Congestion, due in large part to hypervolemia, is the primary driver of heart failure (HF) admissions. Relief of congestion has been traditionally achieved through the use of loop diuretics, but there is increasing concern that these agents, particularly at high doses, may be deleterious in the inpatient setting. In addition, patients with HF and the cardiorenal syndrome (CRS) have diminished response to loop diuretics, making these agents less effective at relieving congestion. Ultrafiltration, a mechanical volume removal strategy, has demonstrated promise in achieving safe and effective volume removal in patients with cardiorenal syndrome and diuretic refractoriness. This paper outlines the rationale for ultrafiltration in CRS and the available evidence regarding its use in patients with HF. At present, the utility of ultrafiltration is restricted to selected populations, but a greater understanding of how this technology impacts HF and CRS may expand its use.

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Access, accountability, and the proliferation of psychological therapy: On the introduction of the IAPT initiative and the transformation of mental healthcare

Social Studies of Science ◽

10.1177/0306312719834070 ◽

2019 ◽

Vol 49 (4) ◽

pp. 627-650 ◽

Cited By ~ 3

Author(s):

Martyn Pickersgill

Keyword(s):

Mental Health ◽

Controlled Trial ◽

Mental Healthcare ◽

Public Mental Health ◽

Psychological Therapy ◽

Behaviour Therapy ◽

Psychological Therapies ◽

Treatment Of Depression ◽

Cognitive Behaviour

Psychological therapy today plays a key role in UK public mental health. In large part, this has been through the development of the (specifically English) Improving Access to Psychological Therapies (IAPT) programme. Through IAPT, millions of citizens have encountered interventions such as cognitive behaviour therapy, largely for the treatment of depression and anxiety. This article interrogates how this national response to problems of mental ill-health – and the problematization itself – was developed, accounted for, and sustained. By imbricating economic expertise with accounts of mental ill-health and mechanisms of treatment, IAPT has revivified psychological framings of pathology and therapy. However, it has done so in ways that are more familiar within biomedical contexts (e.g. through recourse to randomized controlled trial studies). Today, the initiative is a principal player in relation to which other services are increasingly developed. Indeed, in many respects IAPT has transformed from content to context within UK public mental health (in a process of what I term ‘contextification’). By documenting these developments, this paper contributes to re-centring questions about the place and role of psychology in contemporary healthcare. Doing so helps to complicate assumptions about the dominance of linear forms of (de)biomedicalization in health-systems.

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741. Impact of Adenovirus Co-detections on Illness Severity

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy210.748 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S266-S266

Author(s):

Varvara Probst ◽

Bhinnata Piya ◽

Laura Stewart ◽

Susan Gerber ◽

Brian Rha ◽

...

Keyword(s):

Medical Condition ◽

Human Adenovirus ◽

Illness Severity ◽

Inpatient Setting ◽

Hospital Inpatient ◽

Respiratory Pathogens ◽

Viral Pathogens ◽

Respiratory Illnesses ◽

Co Detection

Abstract Background Human adenovirus (AdV) is a common pathogen among children with acute respiratory illnesses (ARI) and is often associated with co-detection with other respiratory viral pathogens. We sought to compare demographic and clinical characteristics in children with ARI who had single-AdV vs. AdV-co-detection with other viruses. Methods Children <18 years with fever and/or ARI were enrolled in Vanderbilt Children’s Hospital inpatient setting from 2015 to 2018 and emergency department from 2016 to 2018. Interviews were conducted using standardized case report forms. Nose and throat swab specimens were collected and tested by RT-qPCR for common respiratory pathogens (AdV, RSV, HRV, hMPV, PIV1–4 and Influenza). Results Of 2,740 ARI cases, 174 were positive for AdV [88 (51%) single detection], with 53% male, 47% White, 36% Black, 30% Hispanic and median age of 17.2 months. Co-detected pathogens in AdV-positive specimens were RSV(15%), HRV(14%), influenza(5%), PIV1(1%), PIV2(0.6%), PIV3(1.7%), and PIV4(0.6%), hMPV(3%), >1 co-pathogens(9%). Subjects with single-AdV detection were more likely to have an underlying medical condition (42% vs. 24%, P < 0.05). Table 1 compares clinical presentation and severity of single-AdV and AdV-co-detection cases. Conclusion Patients with single-AdV detection were less likely to present with ARI symptoms and require oxygen, but were more likely to have underlying medical conditions compared with AdV-co-detection. Further studies to type AdV isolates will help elucidate the role of specific adenovirus types associated with co-detections and illness severity and inform epidemiological information for future vaccine initiatives. Disclosures J. V. Williams, Quidel: Board Member, Consulting fee. GlaxoSmithKline: Consultant, Consulting fee. N. B. Halasa, sanofi pasteur: Investigator, Research support. GSK: Consultant, Consulting fee. Moderna: Consultant, Consulting fee.

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“Like I’m Talking to a Real Person”: Exploring the Meaning of Transference for the Use and Design of AI-Based Applications in Psychotherapy

Frontiers in Psychology ◽

10.3389/fpsyg.2021.720476 ◽

2021 ◽

Vol 12 ◽

Author(s):

Michael Holohan ◽

Amelia Fiske

Keyword(s):

Mental Healthcare ◽

Human Interaction ◽

Conceptual Approach ◽

Psychotherapeutic Practice ◽

Healthcare It ◽

Psychotherapeutic Relationship ◽

Therapeutic Encounter ◽

Real Person ◽

Development Trajectories

AI-enabled virtual and robot therapy is increasingly being integrated into psychotherapeutic practice, supporting a host of emotional, cognitive, and social processes in the therapeutic encounter. Given the speed of research and development trajectories of AI-enabled applications in psychotherapy and the practice of mental healthcare, it is likely that therapeutic chatbots, avatars, and socially assistive devices will soon translate into clinical applications much more broadly. While AI applications offer many potential opportunities for psychotherapy, they also raise important ethical, social, and clinical questions that have not yet been adequately considered for clinical practice. In this article, we begin to address one of these considerations: the role of transference in the psychotherapeutic relationship. Drawing on Karen Barad’s conceptual approach to theorizing human–non-human relations, we show that the concept of transference is necessarily reconfigured within AI-human psychotherapeutic encounters. This has implications for understanding how AI-driven technologies introduce changes in the field of traditional psychotherapy and other forms of mental healthcare and how this may change clinical psychotherapeutic practice and AI development alike. As more AI-enabled apps and platforms for psychotherapy are developed, it becomes necessary to re-think AI-human interaction as more nuanced and richer than a simple exchange of information between human and nonhuman actors alone.

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The Persistence of Child and Adolescence Mental Healthcare: Results from Registry Data

10.21203/rs.2.16858/v1 ◽

2019 ◽

Author(s):

Hermien Dijk ◽

Roel Freriks ◽

Rob Alessie ◽

Jochen Mierau

Keyword(s):

Mental Healthcare ◽

Child And Adolescent ◽

Individual Characteristics ◽

Registry Data ◽

Direct Care ◽

Sudden Increase ◽

Policy Reforms ◽

Lagged Dependent Variable ◽

Time Invariant

Abstract Background: Previous studies on the persistence of child and adolescent mental healthcare do not consider the role of time-invariant individual characteristics. Estimating persistence of healthcare using standard linear models yields biased estimates due to unobserved heterogeneity and the autoregressive structure of the model. This study provides estimates of the persistence of child and adolescent mental healthcare taking these statistical issues into account. Methods: We use registry data of more than 80,000 Dutch children and adolescents between 2000 and 2012 from the Psychiatric Case Registry Northern Netherlands (PCR-NN). In order to account for autocorrelation due to the presence of a lagged dependent variable and to distinguish between persistence caused by time-invariant individual characteristics and a direct care effect we use Arellano-Bond estimation. In further analyses we assess the robustness of our results to policy reforms, different definitions of care and diagnosis decomposition. Results: All estimation results for the direct care effect (true state-dependence) show a positive coefficient smaller than unity with a main effect of 0.215 ( p < 0.01), which indicates that the process is stable. Persistence of care is found to be 0.065 ( p < 0:05) higher for females. Additionally, the role of time-invariant characteristics in the persistence of care appears to be large. Further analyses indicate that (1) policy reforms only slightly affected persistence of care, (2) results are robust to different definitions of care and (3) persistence of care does not differ significantly across subgroups. Conclusions: The results indicate that a substantial part of persistence is due to time-invariant individuals characteristics. Additionally, we find that in the absence of further shocks a sudden increase of 10 care contacts in the present year is associated with approximately 3 additional care contacts at some point in the future. This result provides essential information about the necessity of budget increases for future years in the case of exogenous increases in healthcare use.

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Person-centred care in psychiatry: a clinical and philosophically informed approach

BJPsych Advances ◽

10.1192/bja.2021.75 ◽

2021 ◽

pp. 1-9

Author(s):

Gerrit Glas

Keyword(s):

Residency Training ◽

Healthcare Workers ◽

Core Curriculum ◽

Healthcare Reform ◽

Mental Healthcare ◽

Regulatory Role ◽

The Core ◽

Way Of Thinking

SUMMARY After many years of mental healthcare reform there is still a lot of unease among patients about healthcare workers’ lack of attention to their daily needs and to the tensions and ambiguities that accompany their attempts to integrate their condition into their lives. Person-centred care is often presented as a solution, but the term refers to many differing approaches and needs further specification depending on the problem it aims to resolve. This article presents and discusses a clinical and philosophically informed approach that flexibly focuses on the person- and context-bound aspects of the patient's condition and on the co-regulatory role of the clinician in the patient's attempt to regulate their condition. This approach is a way of thinking, rather than yet another model. It will be shown how this approach can be integrated in the core curriculum of specialty (residency) training in psychiatry.

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The role of the outer setting in implementation: associations between state demographic, fiscal, and policy factors and use of evidence-based treatments in mental healthcare

Implementation Science ◽

10.1186/s13012-019-0944-9 ◽

2019 ◽

Vol 14 (1) ◽

Cited By ~ 11

Author(s):

Eric J. Bruns ◽

Elizabeth M. Parker ◽

Spencer Hensley ◽

Michael D. Pullmann ◽

Philip H. Benjamin ◽

...

Keyword(s):

Behavioral Health ◽

Multilevel Models ◽

Mental Healthcare ◽

Mental Health Program ◽

Evidence Based ◽

Structural Factors ◽

Stakeholder Relationships ◽

Outer Setting ◽

Per Capita

Abstract Background Despite consistent recognition of their influence, empirical study of how outer setting factors (e.g., policies, financing, stakeholder relationships) influence public systems’ investment in and adoption of evidence-based treatment (EBT) is limited. This study examined associations among unmodifiable (e.g., demographic, economic, political, structural factors) and modifiable (e.g., allocation of resources, social processes, policies, and regulations) outer setting factors and adoption of behavioral health EBT by US states. Methods Multilevel models examined relationships between state characteristics, an array of funding and policy variables, and state adoption of behavioral health EBTs for adults and children across years 2002–2012, using data from the National Association for State Mental Health Program Directors Research Institute and other sources. Results Several unmodifiable state factors, including per capita income, controlling political party, and Medicaid expansion, predicted level of state fiscal investments in EBT. By contrast, modifiable factors, such as interagency collaboration and investment in research centers, were more predictive of state policies supportive of EBT. Interestingly, level of adult EBT adoption was associated with state fiscal supports for EBT, while child EBT adoption was predicted more by supportive policies. State per capita debt and direct state operation of services (versus contracting for services) predicted both child and adult EBT adoption. Conclusions State-level EBT adoption and associated implementation support is associated with an interpretable array of policy, financing, and oversight factors. Such information expands our knowledge base of the role of the outer setting in implementation and may provide insight into how best to focus efforts to promote EBT for behavioral health disorders.

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More than Pills and Beds

Advances in Human Services and Public Health - Evidence Discovery and Assessment in Social Work Practice ◽

10.4018/978-1-4666-6563-7.ch006 ◽

2014 ◽

pp. 113-129

Author(s):

Sebastian Rosenberg ◽

Fiona McDermott

Keyword(s):

Mental Health ◽

Social Work ◽

Social Workers ◽

Mental Healthcare ◽

Theory And Practice ◽

Mental Health Recovery ◽

Social Work Theory ◽

Integral Element ◽

The Way

Contemporary models of mental healthcare emphasise the importance of multi-disciplinary approaches in supporting recovery for consumers. There is growing evidence of the key role to be played by social workers derived from both the principles of recovery and those underpinning social work theory and practice, particularly a focus on person-in-environment. However, pressures on the way mental healthcare is provided in Australia are threatening this confluence. These pressures are much more concerned with the needs of funders than professionals, consumers, and their families. The aim of this chapter is to explore the evidence to support social work as an integral element in mental health recovery and to better understand these emerging challenges. The role of social work in good mental healthcare is too important to become marginalized; yet this prospect is real. Better understanding of the contemporary landscape of social work can help ensure this does not occur.

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