Objectives Severe mental illness is a debilitating condition affecting a wide range of functioning of an individual. Identification of signs and symptoms is part of clinical assessment which aids case formulation, making diagnosis, determine treatment planning and outcome. How the symptoms are documented in case record undoubtedly affect the decision and communication among mental health professionals, treatment protocol, potential outcome and prognosis. This is the first study in Hong Kong mental health service to overview the symptom dimensions documented by clinicians in case records. Currently, there is no clinical practice guideline to guide clinicians on symptom documentation. This study attempts to explore the symptom dimensions as documented in the first interview records of people with first episode psychosis in EASY clinic in a local hospital. The result will serve as preliminary reference material or the development of an appropriate documentation guideline or audit in future. Method A retrospective review of case records was conducted to evaluate the symptom documentation by clinicians. All first interview notes of patients suffering from schizophrenia spectrum disorder who attended the EASY clinic in 2012 were included.90 case records were identified. The symptoms characteristics were recorded into a template and categorized with reference to the domains of psychopathology in DSM-5, SAPS and SANS. A total of 29 items of symptom characteristics and related clinical features were identified and measured with descriptive statistics. Results All symptom characteristics and clinical features were reported in percentage. It was found that majority of interview notes(62%)had documented a range of 22-26items out of 29 items(76-90%) of symptom characteristics and clinical features observed from case records. Clinicians had demonstrated high proficiency in documenting a comprehensive range of psychiatric symptoms. Conclusion This paper aims to increase the awareness of clinicians on continuous evaluation of current practice on symptom documentation; to identify good practice or area for improvement; and initiate the development of standardized documentation guideline to guide future symptom documentation practice for betterment of quality patient care and service planning for people with first episode psychosis. / published_or_final_version / Psychological Medicine / Master / Master of Psychological Medicine

Programs providing interventions for early psychosis are becoming commonplace in the United States (US); however the terrain of existing services within programs remains undocumented. Unlike other countries, the US does not have a systematic approach to defining and treating this population. We examined program characteristics, clinical services, and treatment population parameters for early intervention programs across the US. A semi-structured telephone interview was conducted with program directors between July 2013 and April 2014. Content analysis was used to identify the presence or absence of 32 evidenced based practices recently recommended for early intervention programs (Addington, et al., 2013). Frequent client requests were identified and functional definitions of the population served were assessed. A total of 34 eligible programs were identified; 31 (91.2%) program representatives agreed to be interviewed. Of the 32 essential components, the most prevalent were individual psychoeducation and outcomes tracking; the least prevalent were outreach services and communication with inpatient units. The population was most frequently defined by age restrictions, and restrictions on the duration of psychosis. Emergent themes of client requests included functional and social recovery as well as help meeting practical needs. Findings have the ability to assist researchers and policy-makers in determining best practice models and creating measures of fidelity. This study provides critical feedback on services for the early psychosis population and identifies research to practice gaps and areas for improvement moving forward.

Indiana University-Purdue University Indianapolis (IUPUI) / This study investigates differences between Veterans and non-Veterans with severe mental illness (SMI) regarding perceptions of their illness, themselves, and treatment. I compare patient interviews (using the Indiana Psychiatric Illness Interview, IPII) of Veterans (N=20) and non-Veterans (N=26). Modified grounded theory and qualitative coding software Atlas-TI were used to develop codebooks for each group, and these were compared for differences. I examined differences in both code frequency and meaning. Statistically, more Veterans were male, employed, married, had higher income, and had higher education. Statistical differences in code frequency included: more Veterans discussing boredom, regret/guilt/loss, and wanting to be “normal.” More non-Veterans had codes of pessimism and religion/spirituality, wanting a different future, bringing up mental health, family, future: no change, life goals, and relapse. Key differences in narrative themes included: (1) Veterans’ “military mindset”/discussion of anger as part of mental illness, (2) non-Veterans’ focus on mental-illness, (3) differing attitudes regarding stigma, (4) active versus passive attitudes toward treatment, and (5) degree of optimism regarding the future. Differences are described and then potential relationships and interactions are proposed. Veterans appear to have several protective factors (i.e., finances, employment, marriage). Additionally, Veterans’ military-mindset seems to encourage greater stigma-resistance, and thereby also facilitate Veterans being more active and optimistic toward treatment and recovery. By contrast, non-Veteran focus on mental illness may be related to increased self-stigma, passive and pessimistic attitudes. I propose that Veteran identity can serve as an additional protective factor against stigma, pessimism, and passivity. Veteran-identity may also be a useful framework clinically, to help promote active approaches to treatment (e.g., “fighting symptoms”). Further, Veterans emphasized issues relating to anger as important and part of their mental health. It may be that Veterans are more comfortable discussing mental health in the language of “anger,” given stigma. Finally, findings suggest that helping individuals in both groups engage in meaningful, non-mental illness-related life activities may help shape self-perception, and thereby responses to stigma, attitudes toward treatment, and hope for the future.