Psychological intervention

About: Psychological intervention is a research topic. Over the lifetime, 82654 publications have been published within this topic receiving 2608356 citations.

A review of the effectiveness of agriculture interventions in improving nutrition outcomes

Abstract: Objectives: To review the impact of agriculture interventions on nutritional status in participating households, and to analyse the characteristics of interventions that improved nutrition outcomes. Design: We identified and reviewed reports describing 30 agriculture interventions that measured impact on nutritional status. The interventions reviewed included home gardening, livestock, mixed garden and livestock, cash cropping, and irrigation. We examined the reports for the scientific quality of the research design and treatment of the data. We also assessed whether the projects invested in five types of ‘capital’ (physical, natural, financial, human and social) as defined in the Sustainable Livelihoods Framework, a conceptual map of major factors that affect people’s livelihoods. Results: Most agriculture interventions increased food production, but did not necessarily improve nutrition or health within participating households. Nutrition was improved in 11 of 13 home gardening interventions, and in 11 of 17 other types of intervention. Of the 19 interventions that had a positive effect on nutrition, 14 of them invested in four or five types of capital in addition to the agriculture intervention. Of the nine interventions that had a negative or no effect on nutrition, only one invested in four or five types of capital. Conclusions: Those agriculture interventions that invested broadly in different types of capital were more likely to improve nutrition outcomes. Those projects which invested in human capital (especially nutrition education and consideration of gender issues), and other types of capital, had a greater likelihood of effecting positive nutritional change, but such investment is neither sufficient nor always necessary to effect change.

The expert consensus guideline series. Optimizing pharmacologic treatment of psychotic disorders. Introduction: methods, commentary, and summary.

Abstract: OBJECTIVES: A growing number of atypical antipsychotics are available for clinicians to choose from in the treatment of psychotic disorders. However, a number of important questions concerning medication selection, dosing and dose equivalence, and the management of inadequate response, compliance problems, and relapse have not been adequately addressed by clinical trials. To aid clinical decision-making, a consensus survey of expert opinion on the pharmacologic treatment of psychotic disorders was undertaken to address questions not definitively answered in the research literature. METHOD: Based on a literature review, a written survey was developed with 60 questions and 994 options. Approximately half of the options were scored using a modified version of the RAND 9-point scale for rating the appropriateness of medical decisions. For the other options, the experts were asked to write in answers (e.g., average doses) or check a box to indicate their preferred answer. The survey was sent to 50 national experts on the pharmacologic treatment of psychotic disorders, 47 (94%) of whom completed it. In analyzing the responses to items rated on the 9-point scale, consensus on each option was defined as a non random distribution of scores by chi-square "goodness-of-fit"test. We assigned a categorical rank (first line/preferred choice,second line/alternate choice, third line/usually inappropriate) to each option based on the 95% confidence interval around the mean rating. Guideline tables indicating preferred treatment strategies were then developed for key clinical situations. RESULTS: The expert panel reached consensus on 88% of the options rated on the 9-point scale. The experts overwhelmingly endorsed the atypical antipsychotics for the treatment of psychotic disorders. Risperidone was the top choice for first-episode and multi-episode patients, with the other newer atypicals rated first line or high second line depending on the clinical situation. Clozapine and a long-acting injectable atypical (when available)were other high second line options for multi-episode patients. The expert's dosing recommendations agreed closely with the package inserts for the drugs, and their estimates of dose equivalence among the antipsychotics followed a linear pattern. The experts considered 3-6 weeks an adequate antipsychotic trial, but would wait a little longer (4-10 weeks) before making a major change in treatment regimen if there is a partial response. The experts recommended trying to improve response by increasing the dose of atypical and depot antipsychotics before switching to a different agent; there was less agreement about increasing the dose of conventional antipsychotics before switching, probably because of concern about side effects at higher doses. If it is decided to switch because of inadequate response, risperidone was the expert's first choice to switch to, no matter what drug was initially tried. Although there was some disparity in the expert's recommendations concerning how many agents to try before switching to clozapine, the expert's responses suggest that switching to clozapine should be Clozapine was also the antipsychotic of choice for patients with suicidal behavior. When switching oral antipsychotics,the experts considered cross-titration the preferred strategy. When switching to an injectable antipsychotic, the experts stressed the importance of continuing the oral antipsychotic until therapeutic levels of the injectable agent are achieved. The experts considered psychosocial interventions the first choice strategy for partially compliant patients, with pharmacologic interventions the first choice for patients with clear evidence of noncompliance. However, because it can be difficult to distinguish partially compliant from noncompliant patients, the editors recommended combining psychosocial and pharmacologic interventions to improve compliance whenever possible. When patients relapse because of compliance problems or if there is any doubt about compliance, the experts recommended the use of a long-acting injectable antipsychotic and would select an injectable atypical when this option becomes available. The experts would also consider using an injectable atypical antipsychotic (when available) in many clinical situations that do not involve compliance problems. The experts stressed the importance of monitoring for health problems-especially obesity, diabetes, cardiovascular problems,HIV risk behaviors, medical complications of substance abuse, heavy smoking and its effects, hypertension, and amenorrhea-in patients being treated with antipsychotics. Although many patients are prescribed adjunctive treatments,multiple antipsychotics, and combinations of different classes of drugs (e.g., antipsychotics plus mood stabilizers or antidepressants) in an effort to enhance response, the experts gave little support to any of these strategies, with the exception of antidepressants for patients with dysphoria/depression, antidepressants or ECT for patients with suicidal behavior, and mood stabilizers for patients with aggression/violence. When asked about indicators of remission and recovery, the experts considered acute improvement in psychotic symptoms the most important indicator of remission, whereas they considered more sustained improvement in multiple outcome domains (e.g., occupational/educational functioning, peer relationships,independent living) important in assessing recovery. CONCLUSIONS: The experts reached a high level of consensus on many of the key treatment questions in the survey. Within the limits of expert opinion and with the expectation that future research data will take precedence, these guidelines provide direction for addressing common clinical dilemmas that arise in the pharmacologic treatment of psychotic disorders. They can be used to inform clinicians and educate patients regarding the relative merits of a variety of interventions. Clinicians should keep in mind that no guidelines can address the complexities involved in the care of each individual patient and that sound clinical judgment based on clinical experience should be used in applying these recommendations. Language: en

Peer influence in children and adolescents: crossing the bridge from developmental to intervention science.

Abstract: Considerable evidence supports the hypothesis that peer relationships influence the growth of problem behavior in youth. Developmental research consistently documents the high levels of covariation between peer and youth deviance, even controlling for selection effects. Ironically, the most common public interventions for deviant youth involve segregation from mainstream peers and aggregation into settings with other deviant youth. Developmental research on peer influence suggests that desired positive effects of group interventions in education, mental health, juvenile justice, and community programming may be offset by deviant peer influences in these settings. Given the public health policy issues raised by these findings, there is a need to better understand the conditions under which these peer contagion effects are most pronounced with respect to intervention foci and context, the child's developmental level, and specific strategies for managing youth behavior in groups.

Mental Health Literacy: Past, Present, and Future.

Abstract: Mental health literacy (MHL) is a construct that has arisen from the domain of health literacy (HL) and must be understood in that context. The development of HL was initially informed by observations that low functional literacy was associated with numerous poor health outcomes. In its early definition, HL was considered primarily within the health care environment, focusing on the ability of people to be able to understand and make effective use of medical information, particularly to better understand and better adhere to medication treatments. For example, the American Medical Association defined HL as the ‘‘ability to read and comprehend prescription bottles, appointment slips and other essential health-related materials required to successfully function as a patient.’’ In 1998, the World Health Organization (WHO) expanded the definition of HL to include ‘‘the cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand, and use information in ways which promote and maintain good health.’’ The Canadian Public Health Association has used these historical developments to inform their own and more expanded HL definition, noting that HL is ‘‘the ability to access, understand, evaluate and communicate information as a way to promote, maintain and improve health in a variety of settings across the life-course.’’ More recently, understanding of HL has evolved into a broader construct that is considered fundamental to improving a person’s health outcome, decreasing health inequities in populations, and enhancing the operation of health systems and the development of health policy. Thus it is now recognized as necessary to improve health outcomes at both the individual and population levels. For example, Kanj and Mitic proposed a tiered HL model comprising functional HL (generic skills applied by people within health care environments), conceptual HL (generic skills applied in social contexts), and HL as empowerment for people in social and political contexts. The Wagner Chronic Care Model, and other current approaches to chronic illnesses require the enhancement of HL as a core competency for people receiving health care to enhance the likelihood of provision and receipt of effective and collaborative health care. In this context, HL has evolved from a risk factor for poor health outcomes as a result of inadequate treatment adherence to an asset that can be enhanced through educational strategies. Recent research continues to demonstrate that poor HL is related to numerous negative health and social outcomes, including but not limited to: increased rates of chronic illness; decreased use of health services; increased health care costs; and early mortality. The WHO has identified that HL is perhaps the most important component of the social determinants of health, noting that it is ‘‘a stronger predictor of an individual’s health status than income, employment status, education and racial or ethnic group.’’ p 7 Currently, HL is understood to include the following components: the competencies needed by people to help obtain and maintain health and identify illness; understanding how and where to access and how to evaluate health information and health care; understanding how to properly apply prescribed treatments; and, obtaining and applying skills related to social capital, such as understanding rights related to health and health care and understanding how to advocate for health improvements. Further, HL is understood necessarily to be developmentally appropriate; contextually applied; involving multiple related stakeholders; and, available through existing institutional and

Family Interventions for Schizophrenia

Abstract: This article reviews the existing evidence for the efficacy and effectiveness of psychoeducational family interventions in the treatment of persons with schizophrenia. There is substantial evidence that psychoeducational family interventions reduce the rate of patient relapse. There is suggestive, though not conclusive, evidence that these interventions improve patient functioning and family well-being. Interventions with multifamily groups that include the patient may be of superior benefit for subgroups of patients. More research is necessary to determine the critical ingredients of family interventions, to expand the groups of patients included in these studies, and to evaluate a broader range of outcomes.