ABSTRACT
Background: Providing community-based mental health services is crucial and is an agreed plan between the Iranian Mental Health Office and the Regional Committee for the Eastern Mediterranean [affiliated with WHO]. The aim of this study was to determine the effectiveness of home-visit clinical case-management services on the hospitalization rate and other clinical outcomes in patients with severe mental illness
Methods: A total of 182 patients were randomly allocated into three groups, namely, home-visit [n=60], telephone follow-up [n=61] and as-usual care [n=61] groups. Trained nurses as clinical case-managers provided home-visit services and the telephone follow-up tasks. Hospitalization rate as a measure of recurrence, as well as burden, knowledge, general health condition of caregivers with positive/negative symptoms, satisfaction, quality of life, and social skills of the consumers were assessed as the main and secondary outcomes, respectively
Results: Most clinical variables were improved in both intervention groups compared with the control group. During the one year follow-up, the rate of rehospitalization for the telephone follow-up and as-usual groups were respectively 1.5 and 2.5 times higher than the home-visit group
Conclusion: Trained clinical case-managers are capable of providing continuous care services to patients with severe mental illness. The telephone follow-up services could also have beneficiary outcome for the consumers, their caregivers, and the health system network
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Nurses , Telephone , Patient Outcome Assessment , Hospitalization , CaregiversABSTRACT
Psychiatric stigma refers to systemic and internalized stereotypical negative attitudes against individual with mental illness. This article describes the level of self stigma, stereotype endorsement and perceived discrimination experienced by patients with Bipolar- I disorder in Tehran. Data were collected from a total of 126 patients with Bipolar- I disorder who responded to acute phase treatment using the Internalized Stigma of Mental Illness scale. The ISMI scale has five. Alienation, Stereotype Endorsement, Perceived Discrimination, Social Withdrawal and Stigma Resistance. In this study 26.7% of participants reported moderate to high levels of self stigma, 57.49% moderate to high levels of stigma resistance and 18.3% moderate to high levels of Perceived discrimination. The results suggest that, self stigma appears in over one fifth of individuals with Bipolar-I disorder in Iran. The symptoms of Bipolar- I disorder have profound impacts on the quality of life of affected patients. Psychosocial functioning and self-esteem is impaired in people with Bipolar-I disorder. Interventions are required to reduce the negative effects of internalized stigma in this group
ABSTRACT
Psychosocial factor is considered as intermediate social determinant of health, because it has powerful effects on health especially in women. Hence deeper understanding of the mental-health process needed for its promotion. The aim of this study was to explore women's experience of the mental-health problem and related action-interactions activities to design the appropriate interventions. In-depth interviews with women 18-65 years were analyzed according to the grounded theory method. The selection of Participants was based on purposeful and theoretical sampling. In this study, a substantive theory was generated; explaining how female with the mental-health problem handled their main concern, which was identified as their effort to achieve comfort [core variable]. The other six categories are elements in this process. Daily stress as a trigger, satisfaction is the end point, marriage is the key point and action-interaction activities in this process are strengthening human essence, Developing life skills and help seeking. Better understanding the mental-health process might be useful to design the interventional program among women with mental-health problems
ABSTRACT
Community-based health programs [CBHPs] with participatory approaches has been recognized as an important tool in health promotion. The goal of this study was to understand the nature of participation practice in CBHP and to use the data to advocate for more participation-friendly policies in the community, academy and funding organizations. In this qualitative study, 13 CBHPs, which were active for last 5 years have been assessed using semi-structural in-depth interviews with programs principal and managers and focus group discussions with volunteers and service users. Data analysis was based on the deductive-inductive content analysis considering the participatory approaches in these programs. The results show that, the main category of participation was divided to community participation and intersectional collaboration. The community participation level was very different from "main," "advisory" or "supporting" level. The process of recruitment of volunteers by the governmental organization was centralized and in non-governmental organizations was quite different. According to respondents opinion, financial and spiritual incentives especially tangible rewards, e.g., learning skills or capacity building were useful for engaging and maintaining volunteers' participation. For intersectional collaboration, strong and dedicated partners, supportive policy environment are critical. It seems that maintaining partnership in CBHP takes considerable time, financial support, knowledge development and capacity building
ABSTRACT
In Iran, more than 25% of women suffer from mental disorders. Mental disorders and subclinical problems are associated with socioeconomic problem .At the community level, mental health promotion can reduce social damage. The aim of this study as a part of community based mental health promotion intervention was to explore how mental health in Iranian women is viewed. According to a qualitative method in 2012, participants were selected by purposeful sampling from married women 18 to 65 years who are residents in Tehran. Fifteen in depth individual interviews were conducted with regard to the concept of mental health, causal pathway and help-seeking behavior according to explanatory model. Mental health was perceived as the same of emotional well-being. It conceptualized not only lack of mental disorder but also sense of satisfaction and healthy functioning. According to participant`s view, the causal pathway of mental health problems were classified to individual, familial and social factors. Physical and behavioral problems were related to individual factor, Lack of marital adjustment was one of the most important issues in familial item and in social factor, cultural context and socio- economic problems were extracted .In help seeking process, all of the participants believed that the religion has important effect in mental health. Marital adjustment is an important stage in process of mental health in women
ABSTRACT
Psychotropic drug use in the elderly with chronic schizophrenia is an important issue in the field of psychiatry. The main goal of this study was to clarify the pattern of such drug use in these patients, in order to consider such therapy plan and focus on its cost attributing measures, for a more reasonable quality of care program. In this descriptive study, participants included 52 elderly patients at Tehran's Razi Mental Hospital who had chronic schizophrenia in the residual phase. Selected patients were taking at least two psychotropic drugs equivalent to 500mg Chlorpromazine. We prepared the list of the drugs used by completing the pre-designed questionnaire charts. Data were analyzed with SPSS 17. In one case [1.92%] the entries were Risperidone, Chlorpromazine, Fluphenazine Decanoate, and Thiothixene]. In 11 cases [21.2%] there were three entries and in 40 cases [76.8%] there were two. The Chlorpromazine equivalent dose in each group ranged from the lowest dose [750. mg] to the highest [5600. mg]. The highest Chlorpromazine dose [5600. mg] equivalent per milligram belonged to the four entries of [Risperidone, Chlorpromazine, Fluphenazine Decanoate and Thiothixene]. The lowest Chlorpromazine dose [750. mg] was seen in 3 entries of Risperidone, Chlorpromazine and Fluphenazine Decanoate. There was a high prevalence of using more than two psychotropic medications from the first atypical antipsychotic category. Less frequently, the second and the third typical antipsychotics were used. We recommend further research into more feasible patterns of psychotropic prescriptions, lowering the amount of medication use and considering their cost-benefits in the elderly with chronic schizophrenia