Coping, Psychiatric Morbidity and Perceived Care in Patients with Aneurysmal Subarachnoid Haemorrhage

Many patients with an aneurysmal subarachnoid haemorrhage (SAH) exhibit difficulties in rehabilitation, even in cases of a good prognosis. The present project investigates this using qualitative methods and standardised outcome measures. Patients with SAH treated at Uppsala University Hospital between 2002 and 2005 with an expected good prognosis were consecutively included. In addition, nurses working with such patients were interviewed. Outcome was assessed in terms of perception of care, psychiatric health, coping and health related quality of life (HRQoL). Qualitative content analyses revealed eight categories, which were divided into two patterns, Confident or Pessimistic perception of recovery, largely on the basis of the presence or absence of depression. Eighty-three patients were assessed by The Structured Clinical Interview for DSM-IV, Axis I (SCID-I). Forty-one percent fulfilled criteria for any psychiatric disorder seven months after SAH and 45 % presented with a history of lifetime psychiatric morbidity. Logistic regressions indicated that a psychiatric history was related to a higher risk of psychiatric problems seven months after SAH, as well as a lower return to work. SAH patients had lower HRQoL than the general Swedish population; almost entirely in the subgroup with a psychiatric history prior to the SAH. Those with a psychiatric history used more evasive, fatalistic, emotive and palliative coping strategies associated with inability to handle illness. Multiple regressions revealed that a psychiatric history and use of coping were independently associated with HRQoL, albeit more in the mental than the physical domains. Qualitative content analyses revealed that nurses viewed patients’ support needs as a process ranging from technological to emotional care. Shortcomings in the communication between nurses in acute and rehabilitation settings on the subject of support were acknowledged. The results underline the importance of early diagnosis of coexisting psychiatric illness and the need for an intact health care chain

Experiences of long-term benzodiazepine use and addiction amid changes in guidelines for the prescription of narcotic drugs : a qualitative study

Background Addiction to sedative, hypnotic, and anxiolytic drugs (collectively referred to as benzodiazepines), medications commonly used to treat anxiety and sleeping problems, has been described as a hidden epidemic. Growing concerns about addiction and other negative outcomes associated with use of these narcotics have resulted in their regulation and recommendations for more restrictive prescription. However, there are few studies on experiences of long-term benzodiazepine use from the user perspective, and even fewer focusing on people with addiction, who may be the most affected by changing regulations. The aim of this study was to explore experiences of people with long-term use and addiction to benzodiazepines during a time of major changes in guidelines for the prescription of narcotic drugs. Methods This qualitative study included nineteen individual interviews with adults (> 18 years) diagnosed with addiction to benzodiazepines who were undergoing treatment at an urban outpatient clinic in Sweden. The in-depth interviews were pseudonymized, transcribed verbatim, and analyzed using reflexive thematic analysis. Results Two themes highlight the effect of changing prescription guidelines on long-term benzodiazepine users. The first theme, benzodiazepines were not always seen as problematic, but neither were the risks discussed, underscores the absence of psychiatric assessments and conversations about risks at the time of first prescription and highlights the need for clearer communication. The second theme, entangled in continued benzodiazepine use and increasing restrictions on prescribing, illustrates how addiction developed over time and describes how limited contact with prescribers facilitated long-term use, which often persisted until the participants were faced with deprescription. Conclusions This study describes the experiences of individuals with long-term use and addiction to benzodiazepines during a time of shifting attitudes towards prescribing. The results highlight areas for improvement in care for this vulnerable group of patients, including the need for proactive and regular communication about risks of addiction and additional support during deprescription

A comparison of patient ratings and staff ratings of disability using the World Health Organisation Disability Assessment Schedule in individuals with psychotic spectrum disorders who are forensic psychiatric inpatients

Background Psychosocial rehabilitation in forensic psychiatric services requires sound measurement of patient and staff perceptions of psychosocial function. The recommended World Health Organisation Disability Assessment Schedule 2.0 (WHODAS), designed for this, has not been examined with offender patients. Aims To examine patient and staff WHODAS ratings of secure hospital inpatients with psychosis, any differences between them and explore associations with other clinical factors. Methods Seventy-three patients self-rated on the WHODAS after 3 months as inpatients. An occupational therapist interviewed the patient's primary nurse and care team at about the same time (staff ratings). Scores were calculated according to the WHODAS manual. WHODAS scores and interview-rated symptom severity, cognitive measures, daily antipsychotic dose and duration of care were compared. Results Patient ratings indicated less disability than staff ratings for total score and for the domains of understanding and communicating, getting along and life activities. Self-care and participation ratings were similar. Patients were more likely to rate themselves as disabled in getting around (mobility). Only one-fifth of patient- and staff- ratings (16, 22%) were similar, while for nearly a third of the patients (23, 32%) self-ratings were higher than staff ratings. More severe positive symptoms were associated with higher self-rated WHODAS disability after accounting for treatment duration, negative symptoms, cognitive score and antipsychotic dose. No variable accounted for the staff/patient differences in ratings. Conclusion Our mean WHODAS score findings echoed those in other patient samples-of patient underestimation of disability, linked to severity of symptoms. In this study using the WHODAS for the first time in a forensic mental health secure inpatient service, however, we found that, by comparing individuals, half of the patients reported equivalent or greater disability than did staff. Future research should focus on elucidating from patients what contributes to their self-ratings. Understanding their thought processes in rating may enhance rehabilitation planning

Comparison of two instruments for measurement of quality of life in clinical practice - a qualitative study

Background: The study aimed to investigate the meaning patients assign to two measures of quality of life: the Schedule for Evaluation of Individual Quality of Life Direct Weighting (SEIQoL-DW) and the SEIQoL-DW Disease Related (DR) version, in a clinical oncology setting. Even though the use of quality of life assessments has increased during the past decades, uncertainty regarding how to choose the most suitable measure remains. SEIQoL-DW versions assesses the individual's perception of his or her present quality of life by allowing the individual to nominate the domains to be evaluated followed by a weighting procedure resulting in qualitative (domains) as well as quantitative outcomes (index score). Methods: The study applied a cross-sectional design with a qualitative approach and collected data from a purposeful sample of 40 patients with gastrointestinal cancer. Patients were asked to complete two measures, SEIQoL-DW and the SEIQoL-DR, to assess quality of life. This included nomination of the areas in life considered most important and rating of these areas; after completion patients participated in cognitive interviews around their selections of areas. Interviews were audiotaped and transcribed verbatim which was followed by analysis using a phenomenographic approach. Results: The analyses of nominated areas of the two measures resulted in 11 domains reflecting what patients perceived had greatest impact on their quality of life. Analysis of the cognitive interviews resulted in 16 thematic categories explaining the nominated domains. How patients reflected around their quality of life appeared to differ by version (DW vs. DR). The DW version more often related to positive aspects in life while the DR version more often related to negative changes in life due to having cancer. Conclusions: The two SEIQoL versions tap into different concepts; health-related quality of life, addressing losses and problems related to having cancer and, quality of life, more associated with aspects perceived as positive in life. The SEIQoL-DR and the SEIQoL-DW are recommended in clinical practice to take both negative and positive aspects into account and acting on the problems of greatest importance to the patient

At the tipping point : Patient experiences of addiction to benzodiazepines and motivation to seek treatment

Introduction: Addiction to benzodiazepines is a serious problem, and it is important to better understand how individuals can be motivated to quit. Few studies have investigated patients' perceptions and experiences of addiction to benzodiazepines and there is a need to better understand the influence of motivational factors on treatment seeking. Methods: In this qualitative study, nineteen adults undergoing treatment for addiction to benzodiazepines participated in semi-structured individual interviews which were analyzed using reflexive thematic analysis. Results: Participants both defined addiction in relation to and found motivation to quit using benzodiazepines in the negative effects they experienced. Three themes were identified relating to a patient's journey towards a "tipping point" where they were motivated to seek treatment. Participants described that as their addiction grew, benzodiazepine use became a constant mental preoccupation resulting in the need to procure more medication. Participants faced a crossroads as their benzodiazepines became less effective, and many entered a negative cycle of dose escalation and withdrawal symptoms. Participants also described many negative impacts on psychosocial and practical aspects of their daily lives as they lost control to benzodiazepines. Conclusions: The results of this study provide insight to patient perspectives on benzodiazepine addiction and suggests that patients find motivation to quit when the consequences related to benzodiazepine use reach a tipping point. Motivation is of clinical importance in the decision to seek treatment, and by working to identify and cultivate individual motivational factors, healthcare providers may be able to help more patients recover from addiction to benzodiazepines