Mediamusic (E-Journal)
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Effect of disease related biases on the subjective assessment of social functioning in Alzheimer's disease and schizophrenia patients
No full textBackground: Questionnaires are the current hallmark for quantifying social functioning in human clinical research. In this study, we compared self- and proxy-rated (caregiver and researcher) assessments of social functioning in Schizophrenia (SZ) and Alzheimer's disease (AD) patients and evaluated if the discrepancy between the two assessments is mediated by disease-related factors such as symptom severity. Methods: We selected five items from the WHO Disability Assessment Schedule 2.0 (WHODAS) to assess social functioning in 53 AD and 61 SZ patients. Caregiver- and researcher-rated assessments of social functioning were used to calculate the discrepancies between self-rated and proxy-rated assessments. Furthermore, we used the number of communication events via smartphones to compare the questionnaire outcomes with an objective measure of social behaviour. Results: WHODAS results revealed that both AD (p < 0.001) and SZ (p < 0.004) patients significantly overestimate their social functioning relative to the assessment of their caregivers and/or researchers. This overestimation is mediated by the severity of cognitive impairments (MMSE; p = 0.019) in AD, and negative symptoms (PANSS; p = 0.028) in SZ. Subsequently, we showed that the proxy scores correlated more strongly with the smartphone communication events of the patient when compared to the patient-rated questionnaire scores (self; p = 0.076, caregiver; p < 0.001, researcher-rated; p = 0.046). Conclusion: Here we show that the observed overestimation of WHODAS social functioning scores in AD and SZ patients is partly driven by disease-related biases such as cognitive impairments and negative symptoms, respectively. Therefore, we postulate the development and implementation of objective measures of social functioning that may be less susceptible to such biases.</p
Participation in Existential Groups Led by Norwegian Healthcare Chaplains-Relations to Psychological Distress, Crisis of Meaning and Meaningfulness
No full textSpirituality groups led by healthcare chaplains have been found to aid patients' recovery processes in US psychiatric units. In Norway, existential groups (EGs) led by healthcare chaplains and co-led by healthcare staff members are offered at psychiatric units; these groups share commonalities with spirituality groups, group psychotherapy, existential therapy and clinical pastoral care, facilitating patients' reflections regarding existential, spiritual and religious issues. The study aimed to examine associations between patients' participation and topics discussed in the EGs and their experiences of psychological distress, crisis of meaning and meaningfulness. A cross-sectional design was applied among 157 patients attending EGs led by healthcare chaplains across Norway. Multivariate regression analyses assessed the strength of possible associations, adjusted for relevant demographical variables. Significant association was found between lengthier EG participation and lower levels of psychological distress, while discussion topics concerning religious and spiritual issues were significantly associated with the experience of meaningfulness.</p
Intranasal midazolam for the sedation of geriatric patients with care-resistant behaviour during essential dental treatment:An observational study
No full textObjectives To describe the efficacy and safety of intranasal midazolam for sedation during essential dental treatment of geriatric patients with major neurocognitive disorder (MND) and care-resistant behaviour (CRB).Background Dental treatment is often impossible in geriatric MND patients with CRB. Intranasal midazolam may provide a non-invasive sedation method, but there is currently no information on its use in geriatric patients.Methods In this observational study, we included geriatric patients with severe MND and CRB needing urgent dental treatment. Each patient received 5 mg midazolam intranasally. Agitation/sedation levels, heart rate, respiration rate and oxygen saturation were recorded at 5-minute intervals.Results Thirty two patients were included. Mean age was 84 (+/- 7) years. Mean (SD) time to treatment start was 13 (+/- 5) minutes, and mean time to maximum sedation 17 (+/- 11) minutes. Sedation was sufficient to enable dental treatment to be completed in 31 (97%) patients. Anxiolysis/light sedation occurred in 16 (50%) patients, and moderate to deep sedation occurred in 16 (50%) patients. No patients suffered from apnoea, although 3 patients required a chin-lift manoeuvre. Hypoxaemia occurred in 1 of these patients and in 2 other patients without airway obstruction. All patients recovered uneventfully. In a regression model, age, weight and other sedative medication use were found not to be associated with maximum sedation depth.Conclusions Of 5 mg intranasal midazolam facilitates treatment of geriatric patients with MND in the comfort of their own environment. More information is needed to guide titration to balance the desired sedation level and patient safety.</p
Medication strategies in first episode psychosis patients:A survey among psychiatrists
No full textAim There is an ongoing debate regarding the optimal timing of discontinuation of antipsychotic drugs for patients with first episode psychosis. Although most guidelines recommend maintenance therapy for at least 1 or 2 years after reaching remission, study results indicate that early discontinuation may be beneficial for at least a subsample of patients. To date, little is known about which medication strategies are applied in patients recovering from a first psychotic episode. In this study, we examined the beliefs and practices of clinicians on medication discontinuation.Methods We performed a survey among 50 experienced Dutch psychiatrists to assess how often specific treatment strategies have been applied in the past 12 months, as well as their knowledge and expectations with respect to medication discontinuation.Results Psychiatrists estimated that, after remission, they continued medication at the same dose for at least 12 months in 51.2% of cases, continued in a reduced dose in 33.8% of cases and discontinued medication in 9.1% of cases after 4.4 months of remission on average. Although the medication is discontinued in only a relatively small proportion of patients, almost half of all clinicians (45.9%) used this strategy at least once in the past 12 months.Conclusions There is substantial practice variation in antipsychotic medication strategies after remission from a first psychotic episode. Future research on long-term effects of early medication discontinuation can guide clinicians in making evidence-based decisions when treating first-episode patients.</p
On the role of brain Imaging in drug development for psychiatry
No full textBackground: Over the last decades many brain imaging studies have contributed to new insights in the pathogenesis of psychiatric disease. However, in spite of these developments, progress in the development of novel therapeutic drugs for prevalent psychiatric health conditions has been limited.Objective: In this review we discuss translational, diagnostic and methodological issues that have hampered drug development in CNS disorders with a particular focus on psychiatry. The role of preclinical models is critically reviewed and opportunities for brain imaging in early stages of drug development using PET and fMRI are discussed. The role of PET and fMRI in drug development is reviewed emphasizing the need to engage in collaborations between industry, academia and phase I units.Conclusion: Brain imaging technology has revolutionized the study of psychiatric illnesses and during the last decade neuroimaging has provided valuable insights at different levels of analysis and brain organization, such as effective connectivity (anatomical), functional connectivity patterns and neurochemical information that may support both preclinical and clinical drug development. Since there is no unifying pathophysiological theory of individual psychiatric syndromes and since many symptoms cut across diagnostic boundaries, a new theoretical framework has been proposed that may help in defining new targets for treatment and thus enhance drug development in CNS diseases. In addition, it is argued that new proposals for data-mining and mathematical modelling as well as freely available databanks for neural network and neurochemical models of rodents combined with revised psychiatric classification will lead to validated new targets for drug development
Prevalence, types, and combinations of multiple problems among recipients of work disability benefits
No full textPURPOSE: For persons on disability benefits who are facing multiple problems, active labour market policies seem less successful. Besides health problems, these people perceive personal, social, and environmental problems. Since very little is known about these "non-medical" problems our aim was to explore the prevalence of clients experiencing multiple problems, the types and number of perceived problems, combinations of perceived problems, and associated characteristics in a group of work disability benefit recipients.METHODS: We performed a cross-sectional study, using self-reported data on perceived problems and socio-demographics, and register data from the Dutch Social Security Institute on diagnosed diseases and employment status. A convenient group of labour experts recruited eligible clients on work disability benefit.RESULTS: Of the 207 persons on work disability benefit, 87% perceived having multiple problems. Most reported problems were related to physical (76%) or mental (76%) health. Health problems most frequently occurred together with a mismatch in education, financial problems, or care for family members. Clients with lower education experienced significantly more problems than clients with an intermediate or high educational level.CONCLUSIONS: Clients with multiple problems face severe and intertwined problems in different domains of life, and need tailored multi-actor work disability management.Implications for rehabilitationClients with multiple problems face severe and intertwined problems in different domains of life; therefore, interventions tailored to deal with needs related to specific problems might be more effective than traditional programs.Interventions should match experienced barriers, and involve multi-actor work disability management with all the challenges of mutual cooperation.For persons with multiple problems a focus on pure medical barriers is too narrow, because personal, social, and environmental factors might also obstruct participation in work.</p
Past and Present Intergroup Contact and Conflict Among Inhabitants of Former Mixed Villages of Cyprus:The Role of Individual and Collective Experiences in Predicting Attitudes and Trust
No full textPositive attitudes and trust towards former adversaries facilitate reconciliation and peacebuilding. Both historical and current intergroup experiences such as intergroup contact and conflict predict intergroup attitudes and trust but no previous research has investigated the joint effects of these experiences. Therefore, we study the interplay of positive intergroup contact preceding conflict, negative experiences of the conflict, and positive intergroup contact following conflict. Drawing on social representations theory and using a multilevel design, we highlight the importance of both individual and collective experiences. We examine the effects of such experiences on intergroup attitudes and trust among a large sample of Greek Cypriots (N = 802) and Turkish Cypriots (N = 718) from 54 formerly ethnically mixed villages in the context of a protracted and frozen conflict in Cyprus. Present-day individual contact related to more positive attitudes and higher trust regardless of past experiences of conflict or contact. Furthermore, past collective contact experiences predict more positive attitudes and higher trust, whereas past collective conflict experiences predicted more negative attitudes and lower trust. Finally, present-day contact closes the gap in trust between respondents with low and high past contact. Overall, both current and historical, and individual and collective experiences matter
Beyond Platform Capitalism:Critical Perspectives on Facebook Markets from Melanesia
No full textThis article argues for a need to move beyond studies of platform capitalism and inter-capitalist struggles to also account for inter-economic struggles, the platformization of longstanding primarily non-capitalist societies, the same kind of societies that have conceptually inspired discussions of platforms as hi-tech gift economies. Based on longitudinal ethnographic fieldwork on digital transformations among the horticulturalist Lau of Malaita, Solomon Islands, we analyse horticulturalist adoptions and adaptations of Facebook. Specifically, we consider how informal bush markets are being digitized through online Buy and Sell groups. We show how Solomon Islanders use Buy and Sell Facebook groups to continue moral economic practices that emphasize the accumulation of wealth not in a capitalist, but in a relational sense, where economic activity primarily serves the creation and affirmation of relationships. Our findings, thus, challenge universalizing claims about the nature of platforms as one that is necessarily about the commodification, in a capitalist sense, of all social relations. Simultaneously, they call for more research on experiences of platformization at the margins of global capitalism and the ways in which not-so-average users are making platforms their own
Later-Life Migration in The Netherlands:Propensity to Move and Residential Mobility
No full textAs the populations age, there is a growing potential for later-life migration. In this study, the residential moving behavior of older adults in the Netherlands is examined. On the basis of pooled data from the Housing Research Netherlands (HRN) survey, we were able to reveal which factors are likely to influence considerations about moving and actual mobility. The results support the premise that residential mobility decreases with age. The strongest predictors of actual mobility were factors associated with the dwelling, while the neighborhood, particularly the extent of social cohesiveness, played a substantial role in explaining the older adults’ propensity to move
Participants' unspoken thoughts and feelings negatively influence the therapeutic alliance; a qualitative study in a multidisciplinary pain rehabilitation setting
No full textPURPOSE: This study aimed to explore factors that influence participants' perceptions of the therapeutic alliance with healthcare professionals; their participation in the alliance; and their commitment to treatment in a multidisciplinary pain rehabilitation setting.MATERIALS AND METHODS: A qualitative research-design was used and 26 participants in a multidisciplinary pain rehabilitation program were interviewed in-depth.RESULTS: Initially, participants reported to be satisfied with their healthcare professionals. After deeper reflection on the therapeutic alliance, several unspoken thoughts and feelings and relational ruptures emerged. Almost all participants mentioned a history of disappointing and fragmented healthcare, and they reported on how this affected their cognitions, perceptions, and beliefs about the current program. Participants felt insufficiently empowered to voice their concerns and regularly chose to avoid confrontation by not discussing their feelings. They felt a lack of ownership of their problems and did not experience the program as person-centered.CONCLUSIONS: Several factors were found that negatively influence the quality of therapeutic alliance (agreement on bond) and efficacy of the treatment plan (agreement on goals and tasks). To improve outcomes of pain rehabilitation, healthcare professionals should systematically take into account the perceptions and needs of participants, and focus more on personalized collaboration throughout the program offered.Implications for rehabilitationDifferences in perceptions and experiences of pain, together with differences in beliefs about the causes of pain, negatively influence the therapeutic alliance.When participants and healthcare professionals operate from different paradigms, it is important that they negotiate these differences.From the perspective of participants, a clear-cut organization of healthcare that encourages collaboration is required.It is important to focus on personalized collaboration from the start and during treatment, and to recognize and discuss disagreement on diagnosis and treatment plans.During this collaboration, healthcare professionals should systematically take into account the perceptions and needs of the participants.</p