The assessment of depression in patients following a stroke is complex with the consequence that there are few well validated tools to aid identification. The aim of this thesis was to examine a range of approaches to detecting depression in people who have suffered a stroke. A series of three studies was performed ( casenote review, feasibility study and main study) exploring the effectiveness of different strategies for diagnosing and screening for depression in hospitalised stroke patients. The casenote review included 159 patients; median age 74 years (IQR 68-79), 86 (54.1 %) were male. The Psychology Assistant assessed patients using a clinical interview, and found 78 (55%) patients were depressed. The MDT often identified depression in patients who were not depressed (sensitivity 96.6%; specificity 15.2%). It was also apparent that there was no systematic assessment or recording of depression following a stroke. The feasibility study piloted validation of the Geriatric Mental State [GMS-AGECAT] and the Montgomery Asberg Depression Rating Scale (MADRS) as diagnostic interviews when performed by the research nurse in comparison to the "gold standard" the Psychiatrist. In addition the utility of an observational screening tool, the Signs of Depression Scale [SODS] for mood problems in people who have had a stroke, including those with cognitive and communication problems, was explored. The feasibility study informed some minor changes to the main study, which was undertaken. Seventy-four patients were seen by both the research nurse and by the Psychiatrist and were therefore included in the main analysis. The median age was 70 (IQR, 59-78) and 40 (54%) were male. Nearly half (49%) had abnormal communication with only 10% having normal memory function. According to the Psychiatrist, 27 (36%) patients were depressed. According to the research nurse, the GMS AGECAT and the MADRS classified 32/74 (43%) and 38/71 (54%) patients respectively as depressed. Relative to the psychiatric interview, the GMS-AGECA T had a sensitivity of 66. 7% and a specificity of 70.2%. The MAD RS had a sensitivity of 80.8% and a specificity of 62.2%. Seventy-one patients had the SODS completed by a ward nurse, 55 by a therapist and 31 by a carer.

Thesis--St. John's University, N.Y. / Vita. Includes bibliographical references.

Thesis--St. John's University, N.Y. / Vita. Includes bibliography.

Aims: The aims of this thesis were focused on the social climate of inpatient forensic mental health settings. Firstly, the study reviewed the literature of qualitative studies of staff and patient experiences of social climate. Secondly, the utility of a case study methodology to examine innovations to practice in forensic mental health settings are discussed. Thirdly, a longitudinal case study aimed to examine the impact of a Mentalization based treatment (MBT) training and case consultation intervention on the functioning of a low secure ward. Method: A systematic review and qualitative synthesis of social climate in forensic mental health settings was completed using the ‘best-fit’ framework approach. Secondly, a critical analysis of case study methodology was presented based on key decision points. A longitudinal ward case study with staff (n=37) and patient (n=7) participants examined the impact of staff MBT training and MBT based case consultation sessions. MBT based case consultation sessions ran on the ward over an eight month period. Data was collected through a range of methods including questionnaires, semi-structured interviews, ward observations and routinely reported data. The case study data was tested through a pattern matching approach with reference to rival explanations. Results: The systematic review identified 20 papers that met the inclusion criteria. The framework synthesis identified 22 themes related to social climate, which were organised in a conceptual model. Ten themes were seen to represent the experience of social climate. Consideration of the applicability of the case study method to forensic settings found the method to be feasible and acceptable to staff though a limitation is that outcomes are tentative and open to rival explanations. Positive impacts of the training and case consultation intervention included an increase in enthusiasm for working with patients with a personality disorder diagnosis and evidence of some increased team cohesion. The main rival explanation identified was the impact of changes to the composition of the staff and patient group. Conclusions: The systematic review findings highlight that current quantitative measures of social climate may not fully represent the construct. The conceptual model developed allows for generation of potential interventions to improve social climate. In the case study, staff reported positive perspectives of both MBT training and the case consultation sessions. The intervention did not appear to impact on patient motivation, though patients reported positive changes in staff behaviour. The case study method was seen as applicable to forensic mental health settings and provided interpretable data useful for analytical generalisations, and clinically in considering innovations to practice.

Implementation of a Protocol to Improve Quality and Use of Existing Crisis Safety Plan Kaitlynn Earls, Dr. Jo-Ann Marrs, Dr. Judy Rice, Dr. Beth Schreiner. College of Nursing, East Tennessee State University. Crisis safety plans are an important tool for decreasing suicide attempts if a crisis situation arises. Pre-implementation data found that only approximately 20% of clients with schizophrenia/schizoaffective disorder in medication services only had a up to date crisis safety plan in place. The purpose of this quality improvement project is to implement and evaluate a protocol to increase the use of an already established crisis safety plan in the outpatient setting within the electronic medical record. Aim is to increase imitating and updating crisis safety plans for clients with schizophrenia/schizoaffective disorder. Participants include clerical and nursing and providers. Target population are patients diagnosed with schizophrenia/schizoaffective disorder with appointments in medication services clinic. Clerical staff will identify those in the target population who do not have updated safety plan. Those without an updated plan will meet with the LPN and/or nurse practitioner who will document it in the electronic medical record. Outcome goal of 75% or more would be completed by the end of the 12 week implementation period, with approximately 45 of 60 safety plans will be up to date by the end of the implementation period. Preliminary findings include an increase in recognition of absent safety plans, as well as more awareness about the importance of crisis safety plans among staff.

No description available.

No description available.

People with lung cancer are at a high risk of developing anxiety and depression during cancer treatments. Previous research has shown physical activity to be effective in improving psychological symptoms in people with cancer, however, the majority of studies have focused on female breast cancer survivors. The purpose of this literature review was to determine if physical activity interventions can effectively and feasibly reduce anxiety and depression in people with lung cancer who are undergoing treatment. A database search was conducted in CINAHL Plus, MEDLINE, APA PsycInfo, and SPORTDiscus. The search resulted in 265 articles and 9 were selected for inclusion in this review. Four studies showed significant improvements in anxiety and depression, six studies showed significant improvements in only anxiety, and the remaining studies showed no effect. The studies that improved both anxiety and depression used multimodal physical activity programs that included the use of supplemental psychological and health promoting interventions. Limitations included high drop-out rates, small sample sizes, and using different physical activity programs in a portion of the studies. Multimodal physical activity programs are safe and feasible and should be recommended to reduce anxiety and depressions in people with lung cancer undergoing treatment.

The conclusions of Sarikoc, Ozcan, and Elcin (2017) had weaknesses. An uncontrolled variable (time spent in training) could account for the results. The difference in the control and experimental groups was not statistically significant. Acceptance of the hypothesis that video with interviews is more effective than videos alone is premature.

No description available.