Psychiatric Partial Hospitalization Programs: Following World Health Organization Guidelines with a Special Focus on Women with Delusional Disorder
Abstract
:1. Introduction: Delusional Disorder
2. Methods
3. Community-Based Mental Health Models in the Treatment of Delusional Disorder
- (a)
- address the needs of a specific population, with accessibility viewed as a crucial element;
- (b)
- harness the goals and strengths of persons with mental illness through rehabilitation, leading to recovery;
- (c)
- promote a network of adequate support, services, and resources via multidisciplinary teamwork;
- (d)
- emphasize services that are evidence-based and recovery-oriented [18].
3.1. The Role of Community Treatment in Delusional Disorder
3.1.1. Primary Care in Delusional Disorder
3.1.2. Community Mental Health Centers and DD
- (1)
- Rapid identification of emergencies and crises, thus avoiding decompensation and hospital admission.
- (2)
- Availability of psychological therapy, such as cognitive–behavioral, systemic family, group, and occupational therapy, all of which improve insight and prevent relapse, readmission, and secondary symptoms such as anxiety.
- (3)
- Ready access and support to family members.
- (4)
- Rehabilitation and supportive work opportunities.
3.2. The Concept of Empowerment in DD
- (1)
- (2)
- Promote patients’ personal self-help and support processes through their social networks [36].
- (3)
- Support the development of practical problem-solving and decision-making with respect to treatment and other aspects of life [36].
- (4)
- Establish a non-paternalistic relationship framework that favors consensus [37].
- (5)
- Offer sufficient information to enable patients to make knowledgeable decisions [36].
4. Core Strategies of the Mental Health Action Plans Designed for Patients with Delusional Disorder
4.1. Theme 1: Promotion of Mental Health and Prevention in Delusional Disorder
4.1.1. Objective 1: Promotion of Mental Health and Prevention of Mental Disorders
4.1.2. Objective 2: Prevention of Suicidality and Substance Use
4.1.3. Objective 3: Anti-Stigma and Discrimination Actions
4.2. Theme 2: Improvement of Quality, Equity, and Continuity of Care
Objective 4: Improving Quality, Equity, and Continuity of Care (Including Physical Health) in DD
4.3. Theme 3: Coordination and Cooperation across Different Levels of Care (Measuring Health and Social Outcomes)
4.4. Theme 4: Specific Training for Mental Health Professionals
5. Partial Hospitalization Programs for Women with Delusional Disorder: Targets and Actions
5.1. Health Promotion in Women with DD
5.2. Prevention of Suicide, Substance Use Disorders, and Other Risk Factors in Women with Delusional Disorder
5.3. Coordination and Cooperation
5.4. Training
5.5. Research
6. Discussion and Conclusions: Planning the Future
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Functions of the CMHC |
---|
Providing biological and psychosocial interventions for individuals with severe mental health problems |
Cooperating closely with primary health care and hospital units |
Providing psychoeducation and focused support to families |
Coordinating with other institutions and community service organizations |
Sustaining social functioning and increasing the time individuals spend in the community |
Contributing to the reduction of mental illness stigma |
Theme 1 |
Promotion of mental health |
Prevention of mental health |
Theme 2 |
Improvement of quality, equity, and continuity of care |
Theme 3 |
Integration of health and social models of care |
Theme 4 |
Appropriate training for health workers |
Health Promotion and Prevention of Mental and Physical Ill-Health | |
---|---|
Nurses | |
Individual assessment and therapy | Medication management Psychopathological monitoring Health promotion (cancer screening and adherence to psychiatric, medical, and gynecological appointments) Patient and family support |
Group therapies | Lifestyle intervention: motivation, learning, empowerment strategies, and behavioral skills Psychoeducation Sleep hygiene |
Psychologists | |
Individual assessment and therapy | Psychopathological assessment and behavioral monitoring Identification of psychotic exacerbation and emotional responses to delusional ideas Encouraging adherence Cognitive–behavioral therapy for insomnia, smoking cessation, and psychotic symptoms |
Group therapies | CBT for psychopathological symptoms CBT for insomnia and smoking cessation Psychoeducation Family therapy |
Moderator | Potential Intervention | Mediator | Potential Intervention | Behaviors |
---|---|---|---|---|
Substance use disorders Social isolation | Psychotherapy Pharmacological treatment Psychosocial intervention | Hostility | Antipsychotics Antidepressants (when needed) Psychotherapy | Aggressive behaviors |
Aggressivity | ||||
Impulsivity | ||||
Depressive symptoms | Suicide attempts | |||
Paranoid symptoms |
Aims | |||
To determine and compare the prevalence of DD in two neighborhoods of Barcelona, Spain (La Mina, Verneda) and describe psychosocial risk factors | |||
Methods | |||
Cross-sectional study of cases of DD included in the electronic Case Registry of the La Verneda–La Mina Community Mental Health Unit. | |||
Results | |||
Total Sample | La Verneda | La Mina | |
Cases of DD | N = 209 | N = 145 | N = 64 |
Prevalence of DD | 20.17/10,000 inhabitants | 18.13/10,000 inhabitants | 27/10,000 inhabitants |
Employment Situation | Inactive: 115 (62.2%) Active: 70 (37.8%) | Inactive: 75 (60.0%) Active: 51 (40%) | Inactive: 40 (78.8%) Active: 19 (32.2%) |
Conclusions | |||
Prevalence of DD in this community-based sample is higher than the prevalence reported in hospital-based studies | |||
Prevalence of DD is higher in neighborhoods with high frequency of psychosocial and socioeconomic risk factors |
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González-Rodríguez, A.; Alvarez, A.; Guàrdia, A.; Penadés, R.; Monreal, J.A.; Palao, D.J.; Labad, J.; Seeman, M.V. Psychiatric Partial Hospitalization Programs: Following World Health Organization Guidelines with a Special Focus on Women with Delusional Disorder. Women 2021, 1, 80-96. https://doi.org/10.3390/women1020008
González-Rodríguez A, Alvarez A, Guàrdia A, Penadés R, Monreal JA, Palao DJ, Labad J, Seeman MV. Psychiatric Partial Hospitalization Programs: Following World Health Organization Guidelines with a Special Focus on Women with Delusional Disorder. Women. 2021; 1(2):80-96. https://doi.org/10.3390/women1020008
Chicago/Turabian StyleGonzález-Rodríguez, Alexandre, Aida Alvarez, Armand Guàrdia, Rafael Penadés, José Antonio Monreal, Diego J. Palao, Javier Labad, and Mary V. Seeman. 2021. "Psychiatric Partial Hospitalization Programs: Following World Health Organization Guidelines with a Special Focus on Women with Delusional Disorder" Women 1, no. 2: 80-96. https://doi.org/10.3390/women1020008