Service User Experiences of Integrating a Mobile Solution (IMPACHS) Into Clinical Treatment for Psychosis.

Innovative technological solutions are increasingly being introduced into psychotherapy. Understanding service user perspectives is a key aspect in adapting this technology to treatment. This study investigated service users' personal experience of the utility, challenges, and rewards of using an mHealth solution in cognitive behavioral therapy for psychosis (CBTp). People participating in an early intervention program for psychosis (n = 16) utilized the mHealth solution for up to 6 months. Semi-structured qualitative interviews were conducted to capture participant experiences, and quantitative data were collected on psychopathology, usage, and quality of the solution. The solution was widely accepted and utilized in treatment. Four dominant themes were constructed from the interviews: (a) Accessibility and supporting recall, (b) Promotion of dialogue with the therapist, (c) Encouraging reflection, and (d) Factors that affected engagement with the solution. The mHealth solution was perceived as facilitating psychotherapeutic processes and supported underlying CBTp treatment principles.

Adult cognitive ability and educational level in relation to concussions in childhood and adolescence: a population study of young men.

OBJECTIVE: To investigate the relationship of concussion(s) suffered through childhood and adolescence with completed level of school education and cognitive ability in young adulthood. METHODS: Educational level and scores on a test of cognitive ability were obtained for a cohort of 130,298 young men processed by the Danish draft board. Of these, 6146 had, at some age from birth onwards, been briefly admitted to hospital with a main discharge diagnosis of concussion. A further 402 had two such concussions and 48 had three or more. RESULTS: Educational level and cognitive ability test scores were negatively associated with the number of concussions and the age at concussion(s). Most markedly, compared to the 123,684 non-concussed men, those with two or more concussions had lower educational levels (OR = 0.48; 95% CI = 0.26-0.89), as also did those sustaining one concussion between the age of 13 up to the time of testing (OR = 0.47: 0.42-0.52). CONCLUSIONS: Since concussions do not generally have long-term effects, the results suggest that lower educational level is primarily a risk factor for sustaining a concussion at all ages, but in particular in adolescence more than in childhood and in the case of multiple concussions. It should, however, be recognized that, in some proportion of cases, the educational deficits have probably arisen as a consequence of the persistent symptoms of a lengthy post-concussional syndrome.

Cognitive ability and educational level in relation to concussion: a population study of young men.

OBJECTIVES: To investigate the association of concussion with cognitive ability (CA) and educational level (EL). DESIGN: Epidemiological-cross-linkage of national computer registers. SETTING: Denmark. PARTICIPANTS: 130 420 young men appearing before the Danish draft board during the period 2006-2010. PRIMARY AND SECONDARY OUTCOME MEASURES: CA test scores, EL and occurrence of concussion during the period 2004-2009, treated either in an A&E unit or upon admission to a hospital ward. RESULTS: The 3067 men who had suffered a concussion had lower CAs (mean=96.5, SD=15, 95% CI 95.0 to 97.0) than the total cohort and they were lower for 1452 who were admitted to a hospital ward (mean CA=95.8, SD=15, 95% CI 95.1 to 96.6) than for 1615 who were treated only at an A&E unit (mean CA=97.1, SD=15, 95% CI 96.3 to 98.0). Multiple logistic regressions revealed that the effects for EL were stronger than those for CA. Among 127 353 men not sustaining a concussion, 48% attended a 'gymnasium' (sixth-form college), among men treated for a concussion at an A&E unit, this falls to 36% and among men hospitalised for a concussion to 30%. Transfer to a gymnasium, if it happens, almost invariably does so before the 18th birthday. Among 701 men suffering a concussion and admitted to a hospital department after this date, only 26% (n=182) were previously transferred to a gymnasium. Among the 804 men treated at an A&E unit after their 18th birthday, 33% (n=265) had done so. These two percentages are significantly below the corresponding non-concussed population (48%). CONCLUSIONS: Taken together, the results suggest that lower CA and, in particular, lower EL are risk factors for sustaining a concussion, the risk increasing with the severity of the injury.