Overcoming methamphetamine withdrawal syndrome through cognitive behavioural therapy in female correctional inmates

Cognitive-behavioural therapy (CBT) approaches have among the highest level of empirical support for drug and alcohol use disorder treatment. The unbearable impact of withdrawal syndrome such as physical related problems, psychological, social and behavioural can take a long-term impact such as affective and anxiety disorder that can lead to depression. CBT as an intervention that improves coping-skill, and strategy to change a maladaptive mindset should be convenient to reduce withdrawal symptoms. The effect of CBT intervention on the severity of the symptoms of methamphetamine withdrawal syndrome is still narrow. This research is aimed to find out the CBT effect on withdrawal symptoms in both qualitative and quantitative methods on female inmates. This research uses a case study design. Data were conducted using Amphetamine Withdrawal Questionnaire (AWQ) before and after CBT intervention. Data were analyzed using univariate analysis presented as distribution frequency on both before and after the intervention and discussed with single case analysis. The result showed that CBT affects reducing withdrawal syndrome symptoms severity after 4 weeks and 4 session intervention. CBT affects decreasing withdrawal syndrome severity level. Based on these findings, the correctional nurse needs to develop comprehensive nursing care by providing CBT on a rehabilitation program to decrease female inmates’ withdrawal syndrome severity level.

417 - Comparison of prevalence and disturbance of neuropsychic symptoms between institution-dwelling and community-dwelling patients with dementia

ObjectivesTo explore differences in prevalence and disturbance of behavioral and psychological symptoms of dementia (BPSD) between institution-dwelling and community-dwelling patients with dementia.MethodsA cross-sectional survey was conducted. Institution-dwelling (n=112) and community-dwelling patients with dementia (n=157) were enrolled from a nursing home and a tertiary psychiatric hospital located in Guangzhou, China, from March 2019 to September 2019. Neuropsychiatric Inventory (NPI) was used to assess the prevalence and disturbance of BPSDs.ResultsThe community-dwelling patients were older, and having more antianxiety, anticonvulsant, anti- depression, anti-dementia medication use than institution-dwelling patients, while institution-dwelling patients used more antipsychotics than community-dwelling patients. The prevalence of hallucinations (χ2 = 8.55, P = 0.004), agitation (χ2 = 5.38, P = 0.026), depression (χ2 = 22.78, P < 0.001), anxiety (χ2 = 47.17, P < 0.001), aberrant motor behavior (χ2 = 4.72, P = 0.034), and sleep (χ2 = 4.16, P = 0.047) was higher in community-dwelling patients than that in institution-dwelling patients. Moreover, the frequency, severity, and disturbance of almost all of the BPSDs were higher in community-dwelling patients than those in institution-dwelling patients, except for euphoria. High Odds of having hallucination (OR 2.48, 95% CI 1.37-4.49), anxiety (OR 7.36, 95% CI 3.82-14.17), sleep disorder (OR 1.77, 95% CI 1.02-3.10) was observed in community-dwelling patients. Severe dementia was another risk factor for having hallucination (OR 5.48, 95% CI 2.25-13.38), anxiety (OR 2.73, 95% CI 1.22-6.12), sleep disorder (OR 2.61, 95% CI 1.21-5.64), apathy (OR 3.03, 95% CI 1.49-6.19), and irritability (OR 2.6, 95% CI 1.24-5.51). Community-dwelling and severe dementia were two main risk factors for higher NPI scores (adjusted R2 = 0.30), and higher disturbance of anxiety (adjusted R2 = 0.21), sleep disorders (adjusted R2 = 0.15), hallucination (adjusted R2 = 0.12) and irritability (adjusted R2 = 0.11).ConclusionThe prevalence and disturbance of BPSDs were higher in community-dwelling patients with dementia than institution-dwelling patients. Community-dwelling and severe dementia were two main risk factors for higher prevalence and disturbance of BPSDs, especially for anxiety, sleep disorders, and hallucination. Providing community-based BPSDs coping skill training and support for informal caregivers are needed.

Smart Mother Classes Toward Coping Skill Ability, and Anxiety Level among Pregnant Women

Background: Antenatal education is considered standard care for pregnant women. Unfortunately, this class does not provide sufficient skills for women to cope with stress during pregnancy and delivery. In the other side, study literature claims that coping skill is truly essential for the mother to cope with and minimize the anxiety which leads to a serious risk for both mother and baby. Objective: This study aims to prove the impact of smart mother classes to improve coping skills ability and decrease anxiety levels among pregnant women. Methods: This study used a randomized pre-test post-test control group design in which the ages of pregnancies were 28-35 weeks in Semarang City Region. The mothers were randomly assigned to be members of an experiment group (n=50) and a control group (n=50). The experiment group was given smart mother classes that did perform antenatal classes and coping skills, while the control group was given standard classes, antenatal education only. The data analysis employed a dependent sample t-test and independent sample t-test. Results: There is a significant change over coping skill ability for the intervention group (p<.01), but not in the control group. Furthermore, there is also a significant change in the decrease in anxiety levels in the intervention group (p<.01). Conclusion: Smart mother classes are predominantly effective to reduce anxiety levels and enhance coping skill ability among pregnant women. Thus, pregnant women need to join smart mother classes during pregnancy. Keywords: smart mother classes; coping skill, anxiety level, antenatal classes

Exploring the ideal practice for occupational therapists on assertive community treatment teams

Introduction Canadian occupational therapists are employed as case managers on assertive community treatment (ACT) teams to support community living for individuals with severe and persistent mental illnesses. In this position, occupational therapists act primarily as generalists, typically attending appointments with clients, supervising medication adherence, supporting basic living needs, and managing client crises. Occupational therapists may also provide psychotherapy and coping skill groups, as well as profession-specific practices, such as skills training. Exploring how ACT occupational therapists describe their perceived ideal practice may support transformation in long-standing, occupational therapy practices on ACT teams. Method This qualitative, interpretive description study involved 11 Canadian ACT team occupational therapists in one individual, semi-structured in-depth interview using an interview guide containing open-ended questions. Interview transcripts were analyzed to identify themes pertaining to therapists’ descriptions of their perceived ideal occupational therapy practice on ACT teams. Results Three themes emerged: (a) Engaging in practice “with intention”; (b) Finding the space for occupational therapy practice; and (c) Supporting clients in their recovery to find their best occupational self. Conclusions The findings highlight practice possibilities for occupational therapist working on ACT teams and provide a foundation for advocating for better use of specific occupational therapy practices within community mental health settings.

Case Report: Cognitive Work Hardening for Return-to-Work Following Depression

The growing number of mental health disability claims and related work absences are associated with a magnitude of human, economic and social costs with profound impact on the workplace. In particular, absences due to depression are prevalent and escalating. There is a need for treatment interventions that address the unique challenges of people returning to work following an episode of depression. Occupational functioning often lags depression symptom improvement which necessitates targeted treatment. Cognitive work hardening (CWH) is a multi-element, work-oriented intervention with empirical research supporting its role in return-to-work following a depressive episode. This case report details the use of CWH to prepare an individual to return to work following a disability leave due to depression. It illustrates how CWH bridges the functional gap between being home on disability and returning to competitive employment. The client presented is a 50 year old divorced woman who had been off work for approximately 2 years for depression precipitated by the terminal illness of her mother. She participated in a 4 week CWH program which addressed fatigue and decreased stamina, reduced cognitive abilities, outdated computer skills, and heightened anxiety. Work simulations enabled the rebuilding of cognitive abilities with concomitant work stamina; task mastery bolstered self-confidence and feelings of self-efficacy; and coping skill development addressed the need for stress management and assertive communication strategies. By program completion, the client's self-reported work ability had increased and both fatigue and depression symptom severity had decreased. Clinical markers of work performance indicated that the client was ready to return to her pre-disability job. Three months after completion of CWH, the client reported that she was at work, doing well and working full days with good stamina and concentration. This report provides insight into how CWH can be applied to return-to-work preparation following depression with positive outcomes.

Predicting the Coping Skills of Older Drivers in the Face of Unexpected Situation

In recent years, when an older driver who cannot immediately recognize, judge, and operate properly faces an unexpected situation, they often panic, which may cause a traffic accident. However, there has not yet been enough discussion about the coping skills of older drivers in the face of this unexpected situation. Therefore, this study discusses the coping skills of older drivers in the face of unexpected situations. Moreover, we propose a coping skills prediction system (CP system). The CP system predicts coping skills from the tilt angle and angular velocity of the left foot when an older driver is driving or preparing to start a car. The experiment carried out two phases, a phase of driving a car and a phase of preparing to start the car. In the driving phase, the young and older driver drive the car in a driving simulator. The average age of the young driver group was ± standard deviation = 20.6 ± 0.7 years, and the age of the older driver group was 78.5 ± 5.1 years. The driving route included 15 cases in which collision accidents are likely to occur. We analyzed the experimental results of the driving phase and clarified the predictors of coping skills. Moreover, we analyzed the correlation between the left foot movement in driving and the left foot movement during preparing to start the car. As a result of the experiment, there was a 0.84 correlation between the tilt angle of the left foot of the older driver in driving and the tilt angle of the left foot of the older driver in preparing to start the car. The result shows that the coping skills can be predicted from the tilt angle of the left foot of the older driver during preparing to start the car. We showed that the coping skill can be predicted with an accuracy of 92% or 94% on average from the tilt angle and the angular velocity of the left foot while driving or preparing to start the car. Moreover, we clarified that the tilt angle of the left foot of a driver without coping skills is perpendicular to the ground compared to a driver with coping skills. This study is expected to contribute to the prevention of traffic accidents that occur in the face of an unexpected situation.

QOLP-20. A FEASIBILITY STUDY UTILIZING MINDFULNESS MEDITATION DURING CONCOMITANT CHEMORADIATION IN MALIGNANT GLIOMA PATIENTS: HEALTH-REPORTED QUALITY OF LIFE (HRQOL) RESULTS

BACKGROUND Primary brain tumor patients experience high levels of distress due to their diagnosis and treatment leading to changes in their health-related quality of life (HRQoL). Even with the standard treatment of 6 weeks of radiation with concurrent temozolomide for malignant gliomas, the prognosis remains poor. We sought to provide a new intervention and coping skill for our patients during chemoradiation to alleviate some of their stress and anxiety. Mindfulness meditation is a mind-body therapy used in many other cancer groups which can alleviate stress and improve fatigue, cognition, and sleep. METHODS 15 newly diagnosed malignant glioma subjects started 1-hour weekly phone mindfulness sessions during the 6 weeks of chemoradiation. They completed an in-person mindfulness session and interview upon return to the clinic with a final follow up survey 2 months later. Patient reported outcomes questionnaires were collected at each time point. RESULTS 0/15 subjects completed their post-chemo/in-person visit, and 9 completed their final follow-up surveys 2 months later. Scores for perceived cognition, fatigue, sleep, anxiety, spiritual-well being and mindfulness improved over these time points. Completed HRQoL patient-reported outcome questionnaires with positive trends noted from the mean (SD) post-chemo/in-person visit change from baseline and the follow-up change from baseline were: FACT-Cog perceived Cognitive Impairments subscale 4.11(13.55), 9.14(16.77); FACT-G total -5.48(16.02), 7.02(13.44); FACT-Br total -3.15(24.76), 13.17(23.37); FACIT-F -5(7.68), 0(7.92); and the FACIT-Sp12 -1.38(7.6), 2.17(4.88). Trail making Part A completion times from baseline to follow up decreased over time in 8/9 subjects and 7/9 subjects in Part B. Per the final follow up survey, 7/9 subjects continued their meditation practices after the training sessions and subjectively noted benefits with their stress and anxiety. Conclusion: Despite this small sample size, this mindfulness meditation intervention did positively impact patient-report outcomes of HRQoL in this patient population, thereby larger randomized studies are warranted.

Psychosocial profile of women reporting with breast related symptoms and their association with time taken for presentation, a hospital based study

Background: The paper aims to study psycho-socio- demographic factors of women presenting with breast symptoms, find their correlations with (TTP).Methods: This cross sectional study was conducted in the Breast diagnostic clinic of a tertiary care hospital over a period of 2 months with the aim to approach all those women attending the breast diagnostic clinics and who had not started any treatment so far. The data collection was done using self-administered questionnaire and interview based questionnaire as required for a period of 2 months. 80 patients were included in the study. Their socio-demographic data, health seeking behaviour were collected and personality traits, life orientation and coping styles were assessed using the standardized tests. Descriptive, correlation analysis and stepwise linear regression followed by logistic regression, using SPSS20 software.Results: TTP was long with mean 6months. It was found to be negatively associated with size of the lump and education and positively with awareness about risk of cancer. Life orientation styles and personality traits showed no correlation. Pessimism was the seen in the majority of women.Conclusions: Education and increasing awareness about risk of cancer in the women can help them to report for treatment without delay. The understanding of coping skill, life orientation and personality domains and their relationship with TTP in the pre-diagnostic stage can help in future planning strategies during the course of treatment for breast cancer.