Showing papers in "Journal of Psychosocial Nursing and Mental Health Services in 2010"

Interventions to Reduce Cognitive Decline in Aging

Abstract: As the population ages, risks for cognitive decline threaten independence and quality of life for older adults and present challenges to the health care system Nurses are in a unique position to advise older adults about cognitive health promotion and to develop interventions that optimize cognition in older adults A literature review was conducted to provide nurses in mental health and geriatric care with an overview of research related to the promotion of successful cognitive aging for older adults Research evaluating cognitively stimulating lifestyles and the effects on cognitive function in older adults of interventions targeting cognitive training, physical activity, social engagement, and nutrition were reviewed Overall research findings support positive effects of cognitive and physical activity, social engagement, and therapeutic nutrition in optimizing cognitive aging However, the strength of the evidence is limited by research designs Applications for health promotion to optimize cognitive aging and future directions for research are discussed

How neuroplasticity and cognitive reserve protect cognitive functioning.

Abstract: Overall cognitive status can vary across an individual's life span in response to factors that promote either positive or negative neuroplasticity. Positive neuroplasticity refers to he physiological ability of the brain to form and strengthen dendritic connections, produce beneficial morphological changes, and increase cognitive reserve. Negative neuroplasticity refers to the same physiological ability of t he brain to atrophy and weaken dendritic connections, produce detrimental morphological changes, and decrease cognitive reserve. Factors that promote positive neuroplasticity include physical activity, education, social interaction, intellectual pursuits, and cognitive remediation. Factors that promote negative neuroplasticity include poor health, poor sleep hygiene, poor nutrition, substance abuse, and depression and anxiety. Implications for promoting positive neuroplasticity and avoiding negative neuroplasticity across the life span are emphasized to facilitate optimal cognitive health and ensure successful cognitive aging.

Equine-assisted psychotherapy in clinical practice.

Abstract: Equine-assisted psychotherapy (EAP) is an approach in which horses are an integral part of the therapeutic process. This article provides an overview of EAP, including a brief historical perspective, key definitions, and review of pertinent literature. Benefits of the approach are presented, from the standpoint of field observations, client self-reports, and formal research articles. Rather than offer a comprehensive literature review, this article is intended to help non-EAP practitioners become more familiar with the approach.

Caring with comfort rooms. Reducing seclusion and restraint use in psychiatric facilities.

Abstract: The reduction of seclusion and restraint is a national patient safety focus in psychiatric settings. Studies have demonstrated that multisensory or comfort rooms contribute to higher consumer satisfaction and lower rates of seclusion and restraint in general hospitals. As an alternative to the traditionally uncomfortable time-out room, a comfort room was constructed on an acute adult inpatient unit. This space was designed with comfortable furniture, soothing colors, soft lighting, quiet music, and other sensory aids to help reduce unsettled patients' level of stress. The frequency and duration of seclusion and restraint use on the pilot unit was studied before and after implementation of the comfort room. The use of seclusion and restraint was also compared with a similar admission unit without a comfort room. Results supported the hypothesis that the presence of a comfort room significantly reduced seclusion and restraint, and that the use of the comfort room helped reduce patients' stress.

A signature wound of war: mild traumatic brain injury.

Abstract: Improvised explosive devices are the weapons of choice for the insurgent enemy in Iraq and Afghanistan. More soldiers are surviving these blast injuries due to improved torso protection yet are sustaining head and neck wounds in numbers that exceed those from previous wars. Although moderate and severe traumatic head injuries are easily identified and aggressively treated, mild traumatic brain injuries (m-TBIs), or concussions, had previously been deemed inconsequential and often overlooked. Recently, however, the U.S. Department of Defense and Veterans Health Administration have placed emphasis on identifying service members at risk for m-TBI because a select number continue to have disabling symptoms that can negatively affect quality of life. Research regarding the effects and treatment of blasts injury are gaining momentum, but further work needs to be accomplished. This article provides a three-question screening tool that can be used to identify these at-risk veterans.

Use of animal-assisted therapy with psychiatric patients.

Abstract: The use of animal-assisted therapy (AAT) as an adjunct treatment approach in psychiatric settings has received much attention in the literature. This article explores the use of AAT with psychiatric patients. The authors performed a literature review and found that AAT can have a significant effect on the improvement of psychiatric patients' socialization and provides a variety of psychological benefits. Nurses can benefit from learning about the potential benefits of AAT for psychiatric patients.

A Signature Wound of War.

Abstract: Improvised explosive devices are the weapons of choice for the insurgent enemy in Iraq and Afghanistan. More soldiers are surviving these blast injuries due to improved torso protection yet are sustaining head and neck wounds in numbers that exceed those from previous wars. Although moderate and severe traumatic head injuries are easily identified and aggressively treated, mild traumatic brain injuries (m-TBIs), or concussions, had previously been deemed inconsequential and often overlooked. Recently, however, the U.S. Department of Defense and Veterans Health Administration have placed emphasis on identifying service members at risk for m-TBI because a select number continue to have disabling symptoms that can negatively affect quality of life. Research regarding the effects and treatment of blast injury are gaining momentum, but further work needs to be accomplished. This article provides a three-question screening tool that can be used to identify these at-risk veterans.

Psychiatric nursing practice and the recovery model of care

Abstract: This article provides an overview of the national actions by key groups on recovery from psychiatric disability and how a shift is needed to transform health care service delivery in mental health. Fundamental components of recovery are outlined, and examples are provided from the literature in nursing and related disciplines that reflect similar research and evidence-based practice interventions. It is recommended that professional nursing include consumers as active participants in the design of evidence-based practices in all settings.

A Comparison of Multisensory and Traditional Interventions on Inpatient Psychiatry and Geriatric Neuropsychiatry Units

Abstract: Sensory rooms and the use of multisensory interventions are becoming popular in inpatient psychiatry. The empirical data supporting their use are limited, and there is only anecdotal evidence indicating effectiveness in psychiatric populations. The specific aims of this observational pilot study were to determine whether multisensory-based therapies were effective in managing psychiatric symptoms and to evaluate how these interventions compared to traditional ones used in the milieu. The study found that multisensory interventions were as effective as traditional ones in managing symptoms, and participants' Brief Psychiatric Rating Scale scores significantly improved following both kinds of intervention. Medication administration did not affect symptom reduction. This article explores how multisensory interventions offer choice in symptom management. Education regarding multisensory strategies should become integral to inpatient and outpatient group programs, in that additional symptom management strategies can only be an asset.

Potential adverse effects of discontinuing psychotropic drugs: part 2: antidepressant drugs.

Abstract: Understanding the particular pharmacology of different antidepressant drugs can help explain their adverse effects when they are discontinued. For all antidepressant drugs, abruptly stopping them can sometimes result in "rebound" hypomania or mania. Antidepressant drugs having anticholinergic effects often are associated with a discontinuation syndrome characterized by cholinergic rebound, with symptoms of nausea, vomiting, abdominal cramping, sweating, headache, and muscle spasms. Discontinuation of monoamine oxidase inhibitor drugs sometimes results in flu-like symptoms, dysphoria, restlessness, tachycardia, hypertension, and a delirium-like state. Serotonergic antidepressant drugs are sometimes associated with a distinct discontinuation syndrome characterized by dizziness, weakness, nausea, headache, lethargy, insomnia, anxiety, poor concentration, and paresthesias. Adverse discontinuation effects can occur with all types of antidepressant drugs, but only rarely would they be considered serious. To minimize adverse discontinuation effects and to reduce the risk of relapse or recurrence of the underlying treated condition, tapering antidepressant medication is prudent for all patients.

Potential adverse effects of discontinuing psychotropic drugs.

Abstract: For nurses in clinical practice, understanding the pharmacology of drugs their patients take is relevant to understanding their therapeutic uses, side effect profiles, and adverse discontinuation effects. In this article, the last of a four-part series, the discontinuation effects of the following psychotropic drugs are described: benzodiazepine drugs (which have hypnotic, anti-anxiety, and anticonvulsant effects), non-benzodiazepine drugs (used for insomnia), glutamate-modulating drugs, opioid receptor agonist drugs (used as analgesics for the treatment of various pain conditions), and stimulant drugs. Serious adverse effects are likely to occur only after abrupt discontinuation of benzodiazepine drugs, and they should almost always be tapered. Prominent discontinuation effects are seen with opioid and stimulant drugs, but these are usually not serious. Tapering medication, rather than abruptly stopping them, can avoid or minimize the potential adverse discontinuation effects associated with most psychotropic drugs.

An integrated dementia intervention for Korean older adults.

Abstract: Called dotage in Korea, dementia is primarily characterized by cognitive impairments Secondary manifestations include mental-emotional problems, including depression This study was designed to examine the effects of an integrated dementia intervention for Korean older adults The intervention is composed of cognitive stimulation training, exercise, music, art, and horticultural therapy Participants included 38 older adults with mild dementia Twenty were assigned to the experimental group and 18 to the control group Participants in the experimental group attended 18 program sessions Significant differences were found postintervention between the two groups in measures of cognitive function, depression levels, and mental-emotional health The findings indicate that this integrated dementia intervention can be applied to help older adults with mild dementia

Assessment for and response to adverse childhood experiences.

Abstract: Literature strongly suggests that early exposure to adverse childhood experiences (ACEs) disrupts crucial normal stages of childhood development and predisposes these individuals to subsequent psychiatric sequelae. Even with these data, little is found in nursing literature that discusses ACEs and their impact on adult mental health. Therefore, the purpose of this article is to address how nurses approach communication with clients about and assess for traumatic life experiences. In addition, screening measures for ACEs will be presented, along with discussion about ethical responsibilities of health professionals and researchers in asking about abuse.

Culture is treatment: considering pedagogy in the care of Aboriginal people.

Abstract: This article presents an overview of culture as treatment, by recognizing the impact that culture has on treatment along with the specific rituals, customs, and meanings related to healing. Attention must be given to the Aboriginal heritage, including various concepts of metaphysics, spirituality, medicines, government, oral history, and language. A pedagogical underpinning of illness and healing is better cared for through cultural messaging and learning that is related to the complex historical legacy of Aboriginal societies, and therefore, culture provides important diverse contributions to current treatment and wellness programs.

POSTINCIDENT REVIEW: of Aggression and Violence in Mental Health Settings

Abstract: Management of violence and aggression remains a challenge to mental health care practitioners. It has been acknowledged that for a small number of incidents involving aggression, use of restraint will continue to be a method of containing potentially dangerous situations. The impact of being involved in these procedures remains under-researched, but there is growing acknowledgment that some form of postincident review should take place after restraint use. As part of a larger study, a survey design was used to evaluate whether staff (n = 30) and inpatients (n = 30) had found postincident review helpful after incidents involving restraint. Ninety-seven percent of staff, and 94% of patient participants agreed this approach was useful. This article presents the findings of this survey and discusses the complex factors that should be considered when reviewing the aftermath of restraint for staff and inpatients in acute mental health settings.

Humor as a teaching tool. Use in psychiatric undergraduate nursing.

Abstract: The research and anecdotal literature has suggested therapeutic humor is beneficial in the treatment relationship between nurse and patient; however, the potential effects of therapeutic humor between students and faculty have largely been overlooked. The literature has substantiated that a positive rapport between teacher and student facilitates improved student performance during the clinical experience. The author posits that a teacher's skillful use of humor can be an effective means of establishing and maintaining rapport with a student during potentially stressful clinical experiences. This article discusses the use of appropriate humor and how humor can be leveraged for effective academic and clinical instructional purposes, particularly in high-stress, high-demand settings. The article reflects on the potential for misinterpretation of humor, urging careful consideration of the context for its use.

Cranial electrotherapy stimulation for the treatment of depression.

Abstract: More prevalent in women than men, clinical depression affects approximately 15 million American adults in a given year. Psychopharmaceutical therapy accompanied by psychotherapy and wellness interventions (e.g., nutrition, exercise, counseling) is effective in 80% of diagnosed cases. A lesser known adjunctive therapy is that of cranial electrotherapy stimulation (CES). The major hypothesis for the use of CES in depression is that it may reset the brain to pre-stress homeostasis levels. It is conjectured that the pulsed electrical currents emitted by cranial electrical stimulators affect changes in the limbic system, the reticular activating system, and/or the hypothalamus that result in neurotransmitter secretion and downstream hormone production. While evidence is good for applied research, basic research about the mechanisms of action for CES remains in its infancy. A review of the literature provides an overview of current research findings and implications for clinical mental health practice.

Walking for therapy with Man's best Friend

Abstract: Recent research has shown that older people who walk dogs are more likely than those who walk with a human companion to engage in regular exercise and show more improvement in fitness. Studies with dogs and other animals have suggested new approaches for using animals to enhance both mental and physical health in older adults. With the current intense focus on health care reform, increased use of animals as therapy may serve as a cost-effective strategy for improving and maintaining health in older adults.

Use of feeding tubes in patients with advanced dementia: are we doing harm?

Abstract: The decision to place a feeding tube in a patient with advanced dementia is difficult for both family members and health care professionals. There is increasing evidence that the use of feeding tubes in these patients does not improve survival, prevent aspiration pneumonia, prevent or heal decubitus ulcers, or improve other clinical outcomes. Yet, despite this evidence, more than one third of nursing home residents with advanced dementia have feeding tubes, and many of these individuals have feeding tubes inserted on hospital admission for an acute care problem. Health care professionals need to examine the evidence carefully to identify practices that provide patients and families with information to make informed choices and respect their rights and dignity at end of life.

Use of endocrine hormones for treating depression.

Abstract: Disturbances in some endocrine hormones have been implicated in the pathophysiology of depression. Some of these hormones (and drugs that affect hormone function) have been used as therapeutic agents for the treatment of depression, especially adrenal, thyroid, and gonadal axis hormones. Open-label and controlled studies of various drugs that directly suppress or inhibit adrenal axis function have shown some benefit for the treatment of major depression, including treatment-resistant depression. Thyroid hormone augmentation is effective for nonresponders to antidepressant agents, although it has not been studied extensively. Estrogen may improve mild mood symptoms in perimenopausal women but may not be effective alone for major depression. Evidence of the antidepressant effects of testosterone in men is inconsistent, with mixed results from controlled studies. The adrenal steroid hormone dehydroepiandrosterone has an important role in mood regulation and may have significant antidepressant effects.

Potential adverse effects of discontinuing psychotropic drugs. Part 3: Antipsychotic, dopaminergic, and mood-stabilizing drugs

Abstract: Abrupt discontinuation of antipsychotic drugs in patients with schizophrenia is associated with earlier, and often more severe, illness episodes than are seen with gradual discontinuation. Antipsychotic drugs can cause various abnormal motor syndromes, but abruptly stopping them has been associated with the seemingly paradoxical development of similar motor syndromes, such as withdrawal dyskinesias, parkinsonian symptoms, dystonias, and neuroleptic malignant syndrome. Dopamine-releasing and dopamine-agonist drugs are used to treat some of the motor syndromes caused by antipsychotic drugs, but their abrupt discontinuation can also be associated with abnormal syndromes. When antipsychotic drugs, lithium, or certain anticonvulsant drugs are used for treatment of bipolar disorder, rapid versus gradual discontinuation is more likely to lead to greater mood instability and manic relapse. If necessary, these medications should be gradually tapered to minimize all types of adverse discontinuation effects. Patients should be educated about the possible adverse effects of abrupt medication discontinuation.

Potential adverse effects of discontinuing psychotropic drugs. Part 1: Adrenergic, cholinergic, and histamine drugs.

Abstract: Understanding drug pharmacology and mechanism of action can help explain not only therapeutic effects and side effects, but also potential adverse effects when drugs are discontinued. This series of articles will broadly review the potential adverse effects associated with the discontinuation of various psychotropic drugs. This first article focuses on adrenergic, cholinergic, and histamine drugs. After chronic use, abruptly stopping adrenergic receptor drugs can cause rebound anxiety, restlessness, and heart palpitations. Abruptly stopping anticholinergic drugs can lead to an anticholinergic discontinuation syndrome characterized by cholinergic rebound, symptoms of which include nausea, sweating, and urinary urgency. Discontinuation of acetylcholinesterase enzyme inhibitor drugs may be associated with mild anticholinergic-like effects such as dry mouth, constipation, and blurred vision. Abrupt discontinuation of histamine-blocking drugs can be associated with activation, insomnia, and a mild anticholinergic withdrawal syndrome. Tapering, rather than abruptly discontinuing, medication can avoid or minimize medication discontinuation effects.

Receiving Difficult News: Views of Patients in an Inpatient Setting

Abstract: For this quantitative study, a cross-sectional design was used to assess patients' ratings regarding receiving difficult news pertaining to their psychiatric illness, such as deleterious lifestyle consequences and lifelong medications. One hundred inpatients were interviewed and completed the survey. Nearly all agreed they had a legal or moral right to information about their diagnosis, and most agreed they should be told their diagnosis. The majority believed the doctor was the best person to tell them their diagnosis, and more than half indicated that not providing a diagnosis was more concerning than be ing told. Approximately two fifths of patients indicated they would prefer to hear difficult news in the presence of key family members or over several sessions, and more than three quarters thought providing hope, regardless of circumstances, was important. The highest response rates were for staff to provide accurate and reliable information, be honest and answer patients' questions, and inform patients of their treatment options and side effects. These results indicate the importance of communicating accurate and timely information to patients in an empathic and understanding manner.

Serendipity and psychopharmacology.

Abstract: This article describes several examples where the development of drugs and devices for use in psychiatry followed from initial serendipitous observations. The potential psychotropic properties of chlorpromazine (Thorazine(®)) were first noted in surgical patients when the drug was being investigated as a potentiator of anesthesia. Similar findings were noted with iproniazid (Marsilid(®)), developed for the treatment of tuberculosis, and the drug was later released for clinical use as an antidepressant agent. The development of meprobamate (Miltown(®)), an approved treatment for anxiety, evolved from initial efforts to find a chemical that would inhibit the enzymatic destruction of the antibiotic drug penicillin. The psychiatric uses of lamotrigine (Lamictal(®)) and vagus nerve stimulation were prompted by initial observations that epilepsy patients receiving these treatments had positive mood effects. Nurses should be familiar with the concept of serendipity, as they often are in the best position to observe, record, and report on unexpected clinical effects in patients taking any kind of prescription or nonprescription medication.

Keeping in touch. Cell phone use in people with schizophrenia disorders.

Abstract: There is limited research exploring telephone intervention for psychiatric clients; no studies specific to cell phone use have been conducted. This pilot study examined the feasibility and acceptability of cell phone use in individuals with schizophrenia spectrum disorders (SSDs). Ten outpatients with SSDs were provided with previously activated cell phones for 5 months; trained nurses contacted participants weekly. Seven participants completed the 5-month follow-up period. A minority of participants reported difficulty retrieving messages and answering or charging their phone. These preliminary findings indicate the majority of individuals with SSDs are willing to use this method of communication and are able to do so with few problems. Possible barriers to the use of cell phones with this group include lifestyle factors and poor decision making. Future investigations should examine the use of cell phone access to foster personal safety, gain a sense of connectedness to others, and enhance quality of life.

When Is a "Generic" Medication not Really a Generic?

Abstract: The distinction between pharmaceutical equivalent and pharmaceutical alternative drug products can lead to considerable confusion, especially with the proliferation of various branded, alternative, and generic medications that contain the same active ingredient. To illustrate this problem, four examples of medication products containing the active ingredients paroxetine, venlafaxine, bupropion, and valproate will be described. Understanding these differences is important for nurses providing patient care. Only generic drugs can be freely substituted for a brand-name product. Switching to a pharmaceutical alternative requires a change in prescription. Finally, the use, labeling, and cost of branded, alternative, and generic medications may be different.

Are generic medications safe and effective

Abstract: Because multiple branded, alternative, and generic medications contain the same active ingredient, controversies sometimes arise regarding generic substitution. For patients, physicians, and nurses, the critical issue is whether generic medications are safe and effective. This article addresses the issue with regard to several anti-depressant, anticonvulsant, and antipsychotic medications. There is no consistent evidence that generic substitutes are less safe or effective than brand-name equivalents. Uncontrolled reports are subject to many confounding factors and biases. Relapses temporally associated with medication switches could be due to the change but are difficult to distinguish from the natural history of the treated condition. Adverse effects temporally associated with medication switches could also be attributable to the change, but they might also be explained as a type of "nocebo" effect. Randomized controlled blinded studies are necessary to evaluate causality; however, such studies typically have not supported uncontrolled reports that the safety or effectiveness of brand-name and generic drugs differ. It is still clinically prudent to monitor a patient whose medication has been switched.

Psychosocial adjustments following weight loss surgery.

Abstract: Recent interest in weight loss surgery has increased dramatically, largely due to the rising prevalence of severe obesity and the use of less invasive laparoscopic surgical procedures. Physiological postoperative outcomes are easily measured and have been well documented in the literature. The impact of weight loss surgery on psychosocial, behavioral, and psychological function is less clearly understood. Few long-term studies of postoperative weight loss surgery patients in the literature measure emotional health and quality of life. This article discusses some of the psychosocial, behavioral, and psychiatric issues and challenges patients commonly encounter following weight loss surgery.