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Polypharmacy is broadly defined as the administration of more than one medication in a single patient, with the most commonly used definition indicating the concurrent use of five or more medications. Polypharmacy occurs in most clinical settings, particularly inpatient settings and treatment settings for persons with chronic illness and the elderly. Reasons for receiving more than one medication include ineffective treatment with monotherapy, targeting specific but varied symptoms, treating two distinct but co-morbid illnesses, addressing unremitting symptoms, and treating extrapyramidal side effects. Research indicates that each medication added to the patient’s regimen increases the likelihood of an adverse outcome, as well as the risk of adverse drug reactions, drug-to-drug interactions, cumulative toxicity, medication errors, patient non-compliance, patient morbidity, and patient mortality. The current study seeks to investigate the rates of polypharmacy and related characteristics predictive of polypharmacy within a forensic psychiatric setting. A total of 182 patients residing in a secure forensic psychiatric hospital were selected. The sample is predominantly male (80.8%, n=147) and majority Caucasian (55.5%, n=101), African American (40.1%, n=73), and Hispanic (2.2%, n=4), with a mean age of 43.5 (SD=13.2). Participants range from persons with at least one mental health disorder (100%, n=182) to persons with at least one chronic illness (74.5%, n=132). Of those currently taking medications, 99.2% have been prescribed more than one type of medication, with 93.1% of those individuals being prescribed four or more. Polypharmacy was observed in 91% of participants. Of those diagnosed with a mood or psychotic disorder, an average of 3.6 different types of psychotropic medications were prescribed. Co-morbidity of mental illness was predictive of polypharmacy trends, F(1,181)=5.28, p<.05. Additionally, individuals with at least one chronic illness also were subjected to polypharmacy practices, with rates increasing for those with more than one chronic illness. As a measure of onset and severity of symptoms, age at first hospitalization and age of onset of aggressive behaviors were measured, and, interestingly, both measures were predictive of polypharmacy within these patients, F(1, 181)=13.45, p<.01. Results indicate that perceived severity of symptomology, aggression, and complex health problems all contribute to polypharmacy practices among prescribing physicians. The high rates of polypharmacy observed are concerning because of the potential for increased aversive health outcomes. Understanding the predictive factors, rates, and trends of polypharmacy has valuable implications for the future treatment and rehabilitation of individuals residing in a forensic psychiatric setting.

Introduction: People who experience mental illness are unlikely to seek help. Research suggests that mental illness stigma negatively impacts help-seeking, yet there is little information about factors that relate to stigma that are positively associated with help-seeking among those with compromised mental health. Emerging research suggests that aspects of the social identity perspective, namely group social identification and perceptions about the group, may provide insights as to how people who experience mental illness navigate help-seeking. Objective: In two studies we aimed to: (1) identify factors (i.e., social identification and perceptions of the group) that relate to stigma that are also associated with the multi-step process of help-seeking; and (2) explore if these factors and aspects of the help-seeking process that occur prior to service utilization (such as illness and symptom recognition) are positively associated with behavioral service utilization. Method: Study 1 employed Amazon's Mechanical Turk to recruit 90 participants who reported being diagnosed with a mental illness and not actively seeking treatment (i.e., medication or seeing a psychologist or psychiatrist). Study 2 employed Facebook to recruit 131 participants who self-reported a mental illness diagnosis. Results: Controlling for symptom severity, mental illness stigma was positively associated with social identification, which in turn positively impacted help-seeking in Study 1. Further, the relationship between social identification and help-seeking was strongest among those with a negative perception of the mental illness group. In Study 2, results indicated that social identification predicted behavioral service utilization, providing support for Study 1. Conclusion: Taken together, these findings suggest that social identification as a person with a mental illness is positively associated with the multi-step process of help-seeking and may be important for those who experience mental illness stigma to get help that enables and facilitates better functioning.

This is a systematic review of the literature on the relationship between internalized stigma and treatment adherence among those diagnosed with a mental illness, with a specific emphasis on identifying gaps in the literature. This review brings together one particular topic in social psychology (e.g., internalized stigma) that may inform clinically relevant work (e.g., treatment adherence among those diagnosed with a mental illness). Self-esteem, hope, self-efficacy, quality of life, social support, shame, insight, and coping were identified as mechanisms of internalized stigma. A theoretical model is proposed to examine these psychosocial mechanisms and identify gaps in relation to the relationship between internalized stigma and treatment adherence. This model provides further understanding of how internalized stigma influences treatment adherence among those diagnosed with a mental illness. Additionally, this review may provide an understanding of not only how internalized stigma relates to treatment adherence, but also advance psychological theory, identify directions for future research and point to avenues for future interventions.

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Abstract Purpose: Mental illness in the United States is a well-documented prevalent health concern. Mental health conditions are extensive and subject to mental illness stigma that negatively impacts client care. Aims: This quality improvement project aims to implement the NAMI In Our Own Voices presentation in conjunction with a ninety-minute anti-stigma educational session to reduce mental illness stigma among nursing students. Methods: This quality improvement project utilizes a pretest-posttest study design to evaluate the implementation of the National Alliance on Mental Illness In Our Own Voices presentation in conjunction with a ninety-minute anti-stigma educational session’s impact on mental illness stigma reduction. The Open Minds Stigma Scale for Health Care providers will be used to determine the level of stigma reduction in undergraduate baccalaureate nursing students. Results: Results are pending project implementation approval from the National Alliance on Mental Illness. Conclusion: No conclusion can be determined at this time as study results are pending.

Bakgrund Psykisk ohälsa och suicid är ett stort folkhälsoproblem globalt. Det finns förebyggande insatser mot suicid och i det arbetet har sjuksköterskan en stor roll.​​ Syfte Syftet var att beskriva allmänsjuksköterskors erfarenheter av möten med suicidnära patienter.​ Metod ​​ Litteraturöversikt grundad på nio vetenskapliga artiklar. Databaserna CINAHL Complete och PubMed användes. Artiklarna analyserades genom Fribergs analysmodell.​ Resultat Sjuksköterskornas erfarenheter visade att det saknas utbildning och kunskap om psykisk ohälsa och suicid. Det fanns organisatoriska brister som avsaknad av verktyg, riktlinjer och tid. Sjuksköterskorna poängterade vikten av samarbete mellan och utanför professionen. Attityder mot suicid var generellt negativa men mer positiva hos de sjuksköterskorna med mer arbetserfarenhet.​ Sammanfattning Sammanfattningsvis visade resultatet på flertalet hinder som i vissa fall gjorde att sjuksköterskorna inte kunde ge patienterna den omvårdnad de hade behövt. Resultatet diskuterades med fokus på huvudområdena kunskap, erfarenhet och organisatoriska brister som framkom efter kategoriseringen av artiklarnas innehåll.​ / Background Mental illness and suicide are huge public health problems worldwide. There are preventive actions against suicide and nurses have an important role​. Aim The aim was to describe the general nurses' experiences of meetings with suicidal patients.​ Method ​​Literature review based on nine scientific articles. The databases CINAHL Complete and PubMed were used. The articles were analyzed using Friberg‘s model.​ Results The nurses' experiences were that there was a lack of education and knowledge about mental illness and suicide. There was organizational deficiency such as a lack of tools, guidelines and time. The nurses pointed out the importance of coordination within and      between the disciplines. Attitudes towards suicide were generally negative but slightly more positive amongst the more experienced nurses.​ Summary In conclusion, the result shows that there exist several obstacles which in some cases made the nurses provide insufficient psychiatric care. The result was discussed with a focus on the main areas contained knowledge, experience and organizational deficiencies that emerged from the articles.​

Police and family members often serve as the first responders in times of crisis for individuals living with mental illness. Research that focuses on families examines the burden of caring for loved ones with mental illness (e.g., subjective burden such as emotional impact and objective burden such as physical or financial impact). Police responses to individuals with mental illness have been shown to focus primarily on post-contact decisions (e.g., arrest, diversion, use of force, and peace keeping) as well as implementation of policy responses (e.g., critical incident teams). This dissertation contributes to the existing literature by examining factors that impact police responses to individuals with mental illness, including the role of power, as seen from both the police and family perspectives. Utilizing the theoretical frameworks of collective consciousness, bureaucracy, and power, a more comprehensive understanding of police responses to mental health calls is gained. Using a phenomenological approach, semi-structured, in-depth interviews were conducted with police officers (n = 34) and family members of individuals living with mental illness (n=5). Creswell’s (2013) five steps to phenomenological data analysis were followed. NVivo data software was used to assist with coding and data management. The data from this study provide insight into the complex contextual landscape of police responses to individuals with mental illness. Such responses are influenced by personal, bureaucratic, community, and systemic factors. The family experience and perspective is also impacted by personal, community, and systemic influences. Data further revealed evidence of another dimension of power, a shift in responsibility for action (e.g., giving some measure of choice to another in the response or outcome). A new model detailing the complex landscape of police responses to individuals living with mental illness was developed and recommendations for appropriate forms of intervention were outlined. Building on and strengthening current models, opportunities for social work at this intersection are presented, including a focus on social justice and partnership with agencies and organizations.

Women are more susceptible to a range of detrimental diseases surrounding autoimmunity and inflammation, but the causes of this are largely unknown. Much of the current research investigating these patterns focus on a microscopic view of cellular and/or hormonal processes, but holistic perspectives incorporating sociology, psychology, physiology, and evolution are rarely considered. Through investigating interactions between a history of neglecting women’s research, evolutionary origins of sex differences in the immune system, and the impacts of society’s influences on stress, some sex-biased patterns of disease may emerge. The existing SS-SH-SS theory by Brown et al. (2022) describes the complex environmental, psychological, and biological mechanisms that interact to create a female sensitivity to stress-based inflammatory diseases. Using the foundations of this theory, in this study we used global disease and stress exposure data from the World Bank and Global Health Data Exchange project to investigate how the relationships between exposure to stress and prevalence of diseases differ by sex. Using principal component analysis and generalized linear mixed models, we demonstrated a complex relationship between certain stress factors and inflammatory diseases. Particularly, we found that levels of poverty, alcohol use and drug use had distinct, sex-specific impacts on rates of diseases that we studied. Female rates of disease were particularly sensitive to the changes in substance use and poverty, with an inverse relationship with poverty and a direct relationship with substance use. This study can serve as an example for investigating the correlates of sex-biased diseases and mental disorders, particularly about the role of sex-biased experiences of social stress in the origin of sex-biased mental illnesses. / Thesis / Master of Science (MSc) / Throughout history, women's health has been overlooked in research, leading to a lack of understanding regarding sex-related health disparities. Our project addresses this gap by exploring how stress impacts inflammation and its connection to the prevalence of diseases like rheumatoid arthritis and depression. We analyze data from international repositories, revealing that males and females respond differently to specific stressors, which may help explain why certain diseases are more prevalent among women. This insight strengthens our understanding of sex-based health outcomes and may lead to improved healthcare for women everywhere.