Caring for a relative with delusional beliefs: a qualitative exploration.

WHAT IS KNOWN ON THE SUBJECT?: Delusions are common experiences in psychosis and this is reflected in the number of studies focused on improving our understanding of their development, impact, and treatments. Many service users with psychosis are in informal caregiving relationships and carers can play an instrumental role in the recovery process. There remains a lack of knowledge and understanding about carer experiences and how they cope when their relative's delusions involve them or close others. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Data drawn from five individual carer interviews, which were subject to interpretative phenomenological analysis, identified the importance of six key themes. In addition to a carer's exposure to their relative's illness symptoms and a reported lack of understanding about their relative's delusions, was a fear of delusion-driven behaviours, and the carer's attempt to conceal the true extent of their caregiving challenges to others. Carers' relationships were fractured and their coping was best described as an ongoing process, mainly developed through trial and error. It extends our understanding of important issues faced by a subgroup of carers and facilitates discussion beyond their levels of stress and burden. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The study, with its limitations, indicates some carers may live in fear of harm from their relatives but also be reluctant to disclose to others the full story of what they are coping with. Health professionals must routinely assess for risks that informal carers may be exposed to as part of their role, and offer tailored support and interventions. ABSTRACT: Background In recent years, there has been a gradual shift towards the study of individual symptom presentations in psychosis, this is particularly found in studies of delusional beliefs. However, the literature remains sparse on informal caregiver experiences of individual symptoms. Aim The study sought to investigate carer experiences of supporting a relative with delusional beliefs, which involve family members. Methods Semi-structured interviews were undertaken with five caregivers and subject to interpretative phenomenological analysis. Results Interviews yielded six superordinate themes highlighting issues concerning a carer's exposure to symptoms of illness; lack of understanding about their relatives' delusional beliefs; concerns over coming to harm from their relative: efforts made by the carer to conceal their relative's delusional beliefs and their consequences; fractured relationships, and a long process of learning how to best cope. Conclusion Caring for a relative with psychosis who experiences delusional beliefs about the carer and family members can be challenging. The results underscore the importance of providing a programme of support to meet the varied needs of informal carers with an explicit aim of assisting carers in their day-to-day problem solving. It should also help to address issues carers may have about causality, including beliefs about self-blame, and identifying effective coping strategies.

Does initiation of an ambulance pre-alert call reduce the door to needle time in acute myocardial infarct?

OBJECTIVES: To assess the effect an ambulance pre-alert call for patients with suspected acute myocardial infarction (AMI) would have on door to needle (DTN) times. METHODS: We carried out back to back audits of DTN times following the initiation of the pre-alert calls. PARTICIPANTS: All patients thrombolysed within the emergency department between July 2003 and April 2004 (inclusive). STATISTICAL ANALYSIS: Mean DTN times and time to ECG pre-change and post-change were compared using the Two sample t test. The Fisher's exact test was used to compare pre-change and post-change proportions of patients seen within guideline times. RESULTS: In total, 73 patients were thrombolysed with 40 of these arriving by ambulance. Eighteen of these 40 were pre-change and 22 were post-change. Four patients were excluded. Fifty per cent of the pre-change group had a DTN time of <30 minutes compared with 91% of the post-change group (p = 0.005, Fisher's exact test). The phase one mean DTN time was found to be significantly greater than that for phase two (Two sample t test, p = 0.016; 95% CI 1.6 to 14.6). CONCLUSIONS: There was a significant reduction in DTN times after the introduction of the pre-alert call.