Recovery practice in community mental health teams: national survey.

BACKGROUND: There is consensus about the importance of 'recovery' in mental health services, but the link between recovery orientation of mental health teams and personal recovery of individuals has been underresearched. AIMS: To investigate differences in team leader, clinician and service user perspectives of recovery orientation of community adult mental health teams in England. METHOD: In six English mental health National Health Service (NHS) trusts, randomly chosen community adult mental health teams were surveyed. A random sample of ten patients, one team leader and a convenience sample of five clinicians were surveyed from each team. All respondents rated the recovery orientation of their team using parallel versions of the Recovery Self Assessment (RSA). In addition, service users also rated their own personal recovery using the Questionnaire about Processes of Recovery (QPR). RESULTS: Team leaders (n = 22) rated recovery orientation higher than clinicians (n = 109) or patients (n = 120) (Wald(2) = 7.0, P = 0.03), and both NHS trust and team type influenced RSA ratings. Patient-rated recovery orientation was a predictor of personal recovery (b = 0.58, 95% CI 0.31-0.85, P<0.001). Team leaders and clinicians with experience of mental illness (39%) or supporting a family member or friend with mental illness (76%) did not differ in their RSA ratings from other team leaders or clinicians. CONCLUSIONS: Compared with team leaders, frontline clinicians and service users have less positive views on recovery orientation. Increasing recovery orientation may support personal recovery.

International differences in understanding recovery: systematic review.

AIMS: Mental health policy internationally varies in its support for recovery. The aims of this study were to validate an existing conceptual framework and then characterise by country the distribution, scientific foundations and emphasis in published recovery conceptualisations. METHODS: Update and modification of a previously published systematic review and narrative synthesis of recovery conceptualisations published in English. RESULTS: A total of 7431 studies were identified and 429 full papers reviewed, from which 105 conceptualisations in 115 papers were included and quality assessed using established rating scales. Recovery conceptualisations were identified from 11 individual countries, with 95 (91%) published in English-speaking countries, primarily the USA (47%) and the UK (25%). The scientific foundation was primarily qualitative research (53%), non-systematic literature reviews (24%) and position papers (12%). The conceptual framework was validated with the 18 new papers. Across the different countries, there was a relatively similar distribution of codings for each of five key recovery processes. CONCLUSIONS: Recovery as currently conceptualised in English-language publications is primarily based on qualitative studies and position papers from English-speaking countries. The conceptual framework was valid, but the development of recovery conceptualisations using a broader range of research designs within other cultures and non-majority populations is a research priority.

Measures of the recovery orientation of mental health services: systematic review.

PURPOSE: The review aimed to (1) identify measures that assess the recovery orientation of services; (2) discuss how these measures have conceptualised recovery, and (3) characterise their psychometric properties. METHODS: A systematic review was undertaken using seven sources. The conceptualisation of recovery within each measure was investigated by rating items against a conceptual framework of recovery comprising five recovery processes: connectedness; hope and optimism; identity; meaning and purpose; and empowerment. Psychometric properties of measures were evaluated using quality criteria. RESULTS: Thirteen recovery orientation measures were identified, of which six met eligibility criteria. No measure was a good fit with the conceptual framework. No measure had undergone extensive psychometric testing and none had data on test-retest reliability or sensitivity to change. CONCLUSIONS: Many measures have been developed to assess the recovery orientation of services. Comparisons between the measures were hampered by the different conceptualisations of recovery used and by the lack of uniformity on the level of organisation at which services were assessed. This situation makes it a challenge for services and researchers to make an informed choice on which measure to use. Further work is needed to produce measures with a transparent conceptual underpinning and demonstrated psychometric properties.

[Heart conduction disorders in acute maprotiline poisoning]. / Troubles de la conduction cardiaque lors d'une intoxication aiguë à la maprotiline.

A case is reported of self-poisoning with maprotiline followed by prolonged disorders of intraventricular conduction. The cardiotoxicity of tetracyclic antidepressants was well established, but few cases were reported. Maprotiline pharmacokinetics explained the duration of the cardiovascular side-effects. The severity of maprotiline overdoses should not be underestimated.

[Traumatic myocardial infarct in the sportsman]. / Infarctus du myocarde traumatique chez le sportif.

The authors report the case of a 38 year old sportsman who received a football in the centre of his chest during a football match. Over the following minutes, he experienced a mid-thoracic pain which corresponded to the development of a myocardial infarction which was secondarily complicated by left ventricular failure. Ventriculography revealed a large apical aneurysm and coronary angiography revealed thrombosis of the anterior interventricular artery. Based on this case, the authors discuss the mechanism of cardiac trauma and the type of coronary lesions.