Hepatitis C treatment for people with severe mental illness

Over 4 million people in the United States are chronically infected with hepatitis C virus (HCV), and, if untreated, over 20% of these will progress to more serious disease. Persons with severe mental illness (SMI) have markedly elevated rates of HCV infection, but treatment of persons with SMI and HCV has been controversial. Effective antiviral treatment is available, but side effects include depression and other neuropsychiatric symptoms. This article reviews the available data on neuropsychiatric side effects of interferon (IFN) treatment, discusses the limitations of the current research, and makes recommendations regarding HCV treatment in persons with SMI.     

A review of the role of illness models in severe mental illness

The ways in which people think about illness experiences have been associated with a variety of important behaviours and emotional responses in patients, carers, and professionals. Some of these responses have been shown to be related to outcome. Explicit models such as the self-regulation model (SRM) [Leventhal, H., Nerenz, D. R., & Steele, D. F. (1984). Illness representations and coping with health threats. In A. Baum & J. Singer (Eds.), A handbook of psychology and health. Hillsdale, NJ: Erlbaum, 219-252.] have been shown to be useful in highlighting key beliefs across a wide range of different physical illnesses. The specific beliefs about mental illness that have been assessed have been varied and largely without a common theoretical framework. This has resulted in a literature from which it is difficult to draw firm conclusions. The central aim of this paper is to assess the applicability of the SRM to mental illness. To this end, we review studies to date that have examined the beliefs that people with a mental illness have about their experiences. In addition, we review studies that have examined the beliefs of relatives of people with a mental illness and professionals who work with this population. We assess to what extent these studies are consistent with the SRM before suggesting ways in which the model could be further developed and tested. The SRM is presented as a useful framework for more advanced investigations into the function of beliefs about mental illness and how these can be modified in order to effect outcome. Developing psychological theories common to both physical and mental health may eventually result in an integrated approach in which mental illness becomes less stigmatised within the treatment setting.     

Community living assessment for persons with severe and persistent mental illness

Psychiatric rehabilitation has been hampered by the absence of reliable and valid instruments to assess functional skills of persons with severe and persistent mental illness. This article describes the development of the Community Living Assessment Scale (CLAS), which was designed specifically to assess daily living skills of those with mental illness who live in community residences. The scale was found to have good test-retest, split-half, and interrater reliability. Comparison of clients with nonclients revealed significant differences on eight of nine scales. Scale scores were not found to be predictive of type of residential placement; however, many of the scales correlated significantly with perceived level of independence and general well-being 2 years after assessment. The CLAS is recommended as an assessment instrument for use in psychiatric rehabilitation programs and for research with populations with severe and persistent mental illness.     

Affective states and racial identity among African-American women with trichotillomania

Affective correlates of hair pulling were investigated in a sample of 43 African-American women with trichotillomania. The relationship among affective correlates and dimensions of racial identity was also examined. Via phone interview, participants completed the hair-pulling survey on which they rated the intensity of 10 different affective states across three different points in the hair-pulling episode (before, during and after). Participants also completed the Multidimensional Inventory of Racial Identity, which assesses racial identity across the dimensions of centrality, regard and ideology. Univariate analyses identified the feelings of being bored, happy, anxious, guilty and relieved as reflecting a time difference. Negative correlations were found among the racial identity dimension of private regard and the affective correlates of happy and relief that were experienced during and after pulling. Negative correlations were found between the racial identity dimension of humanist ideology and relieved affect as well as humanist ideology and relieved affect during a pulling episode. In light of the results, the importance of understanding and assessing cultural factors in the affective experience of African-American women with trichotillomania is discussed.     

The Hartford study of supported employment for persons with severe mental illness

The authors compared 3 approaches to vocational rehabilitation for severe mental illness (SMI): the individual placement and support (IPS) model of supported employment, a psychosocial rehabilitation (PSR) program, and standard services. Two hundred four unemployed clients (46% African American, 30% Latino) with SMI were randomly assigned to IPS, PSR, or standard services and followed for 2 years. Clients in IPS had significantly better employment outcomes than clients in PSR and standard services, including more competitive work (73.9% vs. 18.2% vs. 27.5%, respectively) and any paid work (73.9% vs. 34.8% vs. 53.6%, respectively). There were few differences in nonvocational outcomes between programs. IPS is a more effective model than PSR or standard brokered vocational services for improving employment outcomes in clients with SMI.     

267名精神卫生专业人员对重性精神病的病耻感认知

精神病患者的病耻感是指因疾病受到的排斥和歧视的态度,其核心概念为刻板印象、偏见和歧视。目前我国相关的研究甚少,为数不多的研究多集中在调查公众对精神疾病的认知和态度上。在中国知网学术文献网络出版总库中以"病耻感"为关键词对1979年以来的文献进行检索,仅检索到29篇文章,其中无一篇针对精神卫生专业人员的研究。本文对来自全国30个省、自治区、直辖市的267名精神卫生专业人员进行了有关病耻感认知和临床工作中态度和行为的初步调查。     

Synaptic and plasticity-associated proteins in anterior frontal cortex in severe mental illness.

Abnormalities of proteins involved in neurotransmission and neural plasticity at synapses are reported in schizophrenia, and may be markers of dysregulated neural connectivity in this illness. Studies of brain development and neural regeneration indicate a dynamic interplay between neural and oligodendroglial mechanisms in regulating synaptic plasticity and axonal sprouting. In the present study, markers of synapses (synaptophysin), plasticity (growth-associated protein-43) and oligodendrocytes (myelin basic protein) were investigated in anterior frontal cortex homogenates from individuals with schizophrenia and depression. Synaptophysin immunoreactivity was reduced in schizophrenics who died of natural causes relative to controls. Myelin basic protein immunoreactivity was decreased in both schizophrenics and depressed individuals who died by suicide. Overall, no changes were observed in growth-associated protein-43 immunoreactivity. However, a slight increase in immunoreactivity in depressed suicides relative to control was observed. These findings support the hypothesis that synaptic abnormalities are a substrate for disordered connectivity in severe mental illness, and suggest that synaptic-oligodendroglial interactions may contribute to the mechanism of dysregulation in certain cases.     

Quality of life of persons with severe mental illness living in an intermediate care facility

This study examined resident characteristics, clinical factors, and mental health service utilization associated with quality of life (QOL) for residents living in an Intermediate Care Facility (ICF). This study also utilized published literature to compare the QOL of ICF residents to persons with psychiatric disorders living in other residential settings. Chart review and interviews were used to study 100 randomly selected residents living in an ICF with a chart diagnosis of schizophrenia. Multivariate analyses suggest that higher levels of QOL are associated with reports that psychological problems did not interfere with work and activities and with lower levels of being a danger to others. Also, a comparison of the QOL scores reported by ICF residents to other published mentally ill populations suggests that residents of the ICF report somewhat higher QOL scores than state hospital patients, but lower scores as compared to other community samples. Data provide insight into the types of problems faced by residents of an intermediate care facility. These findings have implications for understanding the importance of mental health service utilization on QOL.     

Trauma exposure and posttraumatic stress disorder in adults with severe mental illness: a critical review

There is a great deal of research on the prevalence, correlates, and treatment of PTSD in the general population. However, we know very little about the manifestation and consequences of PTSD in more complicated patient populations. The purpose of the current paper is to provide a comprehensive review of PTSD within the context of severe mental illness (SMI; i.e., schizophrenia spectrum disorders, mood disorders). Extant data suggest that trauma and PTSD are highly prevalent among individuals with SMI relative to the general population, and both are associated with adverse clinical functioning and increased healthcare burden. However, trauma and PTSD remain overlooked in this population, with low recognition rates in public-sector settings. Additionally, there are few data on the clinical course and treatment of PTSD among individuals with SMI. Particularly lacking are longitudinal studies, randomized controlled treatment trials, and studies using ethno-racially diverse samples. Furthermore, there is a need to better understand the interplay between trauma, PTSD, and severe forms of mental illness and to further develop and disseminate evidence-based PTSD treatments in this population. The current state of the literature and future directions for practice are discussed.     

Struggling and enduring with God, religious support, and recovery from severe mental illness

Objectives: People with severe mental illnesses may achieve varying degrees of recovery, including symptom reduction and community integration. Research also indicates that religiosity facilitates coping with psychological disorders. In this study, we assessed the relationship between religiosity and recovery from severe mental illnesses. Design: Self‐report data were collected from 81 participants with severe mental illnesses. We measured recovery, religious support, and participants' struggle or endurance with faith. Results: Religious support and enduring with faith were positively associated with recovery. Struggling was negatively associated with recovery, and that relationship was mediated by religious support. Conclusions: Religious variables, including religious support and spiritual struggle, might affect recovery from severe mental illnesses. © 2011 Wiley Periodicals, Inc. J Clin Psychol 67:1–16, 2011.     

HIV risk behavior among adults with severe mental illness: a systematic review

Adults with severe mental illness (SMI) have been disproportionately affected by the HIV/AIDS epidemic. This systematic review of the empirical literature on SMI documents the prevalence and correlates of HIV risk behaviors, discusses clinical implications for HIV prevention, and recommends directions for future research. Prevalence rates of HIV risk behaviors were estimated using weighted means, and findings on correlates were synthesized. Across reviewed studies (N=52), the majority of adults with SMI were sexually active, and many engaged in risk behaviors associated with HIV transmission (e.g., unprotected intercourse, multiple partners, injection drug use). HIV risk behaviors were correlated with factors from the following domains: psychiatric illness, substance use, childhood abuse, cognitive-behavioral factors, and social relationships. A proposed model illustrates the multiple pathways linking these domains to HIV risk behavior. Further research using improved methodologies (e.g., longitudinal designs, standardized measures, multivariate analyses) is needed to examine the broader social context in which HIV risk behavior occurs and identify underlying processes. HIV prevention efforts targeting adults with SMI must occur on multiple levels (e.g., individual, group, community, structural/policy), address several domains of influence (e.g., psychiatric illness, trauma history, social relationships), and be integrated into existing services (e.g., psychotherapy, substance abuse treatment, housing programs).     

Metacognitive disturbances in persons with severe mental illness: Theory, correlates with psychopathology and models of psychotherapy

Metacognition refers to the ability to think about thinking, both one's own and that of others. In this introduction to the special issue on this subject, the editors summarize preceding literature on the nature and extent of metacognitive disturbances in severe mental illness. They then summarize the proceeding seven pieces that explore models of metacognitive disturbance in severe mental illness, its correlates with psychopathology, and emerging models of psychotherapy.     

HIV risk differences between African-American and white men who have sex with men

African-American men who have sex with men remain at disproportionately greater risk for contracting human immunodeficiency virus (HIV) infection. While high HIV seroincidence has been documented among homosexual African-American men, behavioral research has rarely studied the HIV risk issues confronting these men. This study assessed a sample of 253 men who have sex with men to determine if African-American (n = 79) and white (n = 174) men report different rates of HIV risk behaviors and differ in characteristics indicative of risk. African-American men who have sex with men were more likely to be HIV-seropositive, to report past treatment for gonorrhea and syphilis, and to have a recent unprotected sex partner known or believed to be HIV-seropositive. Multivariate analyses of covariance, controlling for group differences in age, education, and income, revealed that African-American men who have sex with men were less open about their sexual orientation, scored lower in HIV risk behavior knowledge, had more female sexual partners, and more frequently used cocaine in association with sex relative to white men who have sex with men. Human immunodeficiency virus prevention programs tailored to the needs and risk issues of African-American men who have sex with men are needed.     

Racial differences in hepatitis B and hepatitis C and associated risk behaviors in veterans with severe mental illness

Racial differences in the seroprevalence of and risks for hepatitis B (HBV) and hepatitis C (HCV) were examined in military veterans with severe mental illnesses (SMI). Participants (376; 155 Caucasian, 221 African American) were inpatients at a Veterans Affairs (VA) psychiatric unit in Durham, N.C., from 1998 to 2000. Prevalence rates of HBV and HCV were 21.3% and 18.9%, respectively. African Americans had a higher HBV seroprevalence than did Caucasians: 27.6% versus 12.3%; odds ratio (OR) 2.73; 95% confidence interval (CI)=1.55, 4.79. Although not statistically significant, HCV seroprevalence was also higher for African Americans than it was for Caucasians: 21.3% versus 15.5%; OR=1.47; 95% CI=0.86, 2.53. No racial difference was observed for injection drug use (IDU), the strongest risk indicator for both HBV and HCV. Multivariable analyses indicated that African-American race, IDU, and multiple sex partners in the past six months were related to an increased risk of HBV, whereas IDU and smoking crack cocaine were both independently related to an increased risk of HCV. Thus, veterans with SMI--particularly African-American veterans--have high rates of HBV and HCV infection. African-American veterans have significantly higher rates of HBV than do Caucasian veterans, which persist after controlling for prominent risk behaviors.     

Roots of prostate cancer in African-American men

To fully understand the role of genetics and environment (biotic, abiotic and sociocultural) in the prostate cancer disparity experienced by African-American men, this paper examined the rates of prostate cancer among African-American men and one of their ancestral populations in west Africa. Data sources were from the World Health Organization (WHO) and reported hospital records in the literature. Based on the WHO's worldwide cancer data, west African men have much lower prostate cancer incidence and mortality compared to African-American men. For example, compared to Nigerian men, African-American men are >10 times likely to develop prostate cancer and 3.5 times likely to die from the disease. However, contrary to the global ranking by WHO, there is documented evidence in the literature indicating that prostate cancer in at least one west African country is similar to rates found in the United States and in Caribbean Islands. To better address prostate cancer disparity, future studies should study populations and subgroups from central and west Africa, the original source population for African Americans.     

A randomized controlled trial comparing two vocational models for persons with severe mental illness

The authors compared 2 approaches to vocational rehabilitation for individuals with severe mental illness: the individual placement and support (IPS) model of supported employment and the diversified placement approach (DPA), which emphasizes work readiness and offers a range of vocational options, including agency-run businesses and agency-contracted placements with community employers. In all, 187 unemployed participants with severe mental illness were randomly assigned to IPS or DPA. Over 2 years, IPS had significantly better competitive employment outcomes than DPA. Competitive employment rates over the 2-year follow-up were 75.0% for IPS and 33.7% for DPA. However, IPS and DPA did not differ on paid employment outcomes. The authors conclude that IPS is more effective than DPA in achieving competitive employment, but not paid employment.