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- Koskuvi, Marja, et al.
(author)
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Lower complement C1q levels in first-episode psychosis and in schizophrenia
- 2024
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In: Brain, Behavior, and Immunity. - : Elsevier. - 0889-1591 .- 1090-2139. ; 117, s. 313-319
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Journal article (peer-reviewed)abstract
- Recent evidence has implicated complement component (C) 4A in excessive elimination of synapses in schizophrenia. C4A is believed to contribute to physiological synapse removal through signaling within the C1q initiated classical activation axis of the complement system. So far, a potential involvement of C1q in the pathophysiology of schizophrenia remains unclear. In this study, we first utilized large-scale gene expression datasets (n = 586 patients with schizophrenia and n = 986 controls) to observe lower C1QA mRNA expression in prefrontal cortex tissue of individuals with schizophrenia (P = 4.8x10-05), while C1QA seeded co-expression networks displayed no enrichment for schizophrenia risk variants beyond C4A. We then used targeted liquid chromatography-mass spectrometry (LS-MS) to measure cerebrospinal fluid (CSF) levels of C1qA in 113 individuals with first-episode psychosis (FEP), among which 66 individuals was later diagnosed with schizophrenia, and 87 healthy controls. CSF concentrations of C1qA were lower in individuals diagnosed with FEP (P = 0.0001), also after removing subjects with a short-term prescription of an antipsychotic agent (P = 0.0005). We conclude that C1q mRNA and protein levels are lower in schizophrenia and that further experimental studies are needed to understand the functional implications.
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- Ali, Lilas, 1981, et al.
(author)
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Person-centred psychosis care in the inpatient setting:Staff experiences of an educational intervention.
- 2016
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In: International Forum on Quality and Safety in Health Care. Gothenburg, Sweden 12-15 April 2016.
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Conference paper (other academic/artistic)abstract
- Introduction: The key component in this research project is to test and implement a person-centred psychosis care approach that leads to an active partnership between health professionals and patients. Only by transforming the relationship between the patient and the care provider from the present state of dependency into an equal partnership can we achieve a more effective care model with enhanced financial efficacy and patient self-efficacy. Person-centred psychosis care means to shift away from a model in which the patient is the passive target of a medical intervention to a model where a contractual arrangement is made involving the patient as an active part in the care and the decision-making process. The patient illness narrative is the starting point for building a collaborative, equalitarian health professional-patient partnership that confirms capacities in patients. The patient narrative is the patient´s account of his/her illness, symptoms, and the impact on life. Finally the narrative and agreed partnership needs to be documented in order to secure further care. Methods: The person centered care intervention will be implemented at all four in-patient wards at the Psychosis clinic. An implementation group has been formed and representatives from the four wards are included in this group (section leaders, heads of the wards, and senior ward psychiatrists). The implementation group makes decisions regarding the organization and content of the staff education sessions. The research process has a participatory design which is structured by the foundation pillars in the gPCC model and composes of four workshops together with 33% of the staff in the psychosis care wards, at the department of psychosis, Sahlgrenska University Hospital. All workshops focus on person-centred care and how to implement this care approach at all four in-patient wards at the Psychosis clinic. Now that the educational intervention has been completed it is in our belief that the care offered on the ward is more person-centred. This project will explore this with a simple “before” and “after” design. The primary outcome will be patient empowerment as measured by the “Making Decisions Empowerment Scale”. This scale been validated and used internationally in studies involving persons with severe mental ill-health. Results: All the participants in this project have completed the second phase of the gPCC implementation model and they have agreed on person-centred tasks to implement in their units. Our hypothesis is that persons who receive inpatient treatment after the implementation of the intervention will score higher on ratings of empowerment and consumer satisfaction than those on the “pre-intervention” wards. Further, we hypothesize that shorter hospital stays and less use of involuntary treatments will be observed on the post-intervention wards. Discussion: A person-centered care approach can increase partnership between mental health service users and providers. A basic tenant of person-centered care is that the patient is seen as a capable person who has self-respect and self-esteem. A key element in person-centred care is the dialogue between the professional and the patient, a dialogue with the person, rather than talking to (or informing) a person. The staff education package in itself provides us with an excellent opportunity for transfer of research findings into the care setting. The members of the teaching staff are used as active researchers who will incorporate results from ongoing of the teacher’s results from our ongoing clinical projects on cognition, adherence, and stigma.
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- Ali, Lilas, 1981, et al.
(author)
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Personcentrering vid psykisk ohälsa
- 2020
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In: Personcentrering inom hälso- och sjukvård. Från filosofi till praktik.. - 9789147129676 ; , s. 299-318
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Book chapter (other academic/artistic)
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- Allerby, Katarina, et al.
(author)
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Increasing person-centeredness in psychosis inpatient care: care consumption before and after a person-centered care intervention
- 2023
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In: Nordic Journal of Psychiatry. - 0803-9488 .- 1502-4725. ; 77:6, s. 600-607
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Journal article (peer-reviewed)abstract
- Background: Patients with psychotic disorders often need hospitalization with long stays. Person-centered care (PCC) has been shown to improve care quality and decrease the length of hospital stay in non-psychiatric settings. We carried out an educational intervention for inpatient staff, aiming to increase person-centeredness at a major Swedish psychosis clinic. The aim of this study was to test if the intervention could be associated with decreased length of hospital stay (LoS), involuntary stay (LoIS), and reduction in rapid readmissions. Methods: Data from the clinic’s administrative registry were compared for patients with a discharge diagnosis within the schizophrenia-spectrum treated during the one-year periods before and after the PCC intervention. Results: Contrary to our hypotheses, a quantile regression estimated longer LoS post-intervention, median difference 10.4 d (CI 4.73–16.10). Neither age, sex nor diagnostic category were associated with LoS. Of all inpatient days, ∼80% were involuntary. While LoIS was numerically longer post-intervention, the difference did not reach significance in the final regression model (median difference 7.95 d, CI −1.40 to 17.31). Proportions with readmission within 2 weeks of discharge did not differ (7.7% vs 5.2%, n.s.). Conclusions: Increased length of inpatient care was observed after the PCPC intervention. This could reflect an increased focus on the unmet needs of persons with serious psychotic conditions, but it needs to be explored in future research using a more rigorous study design. Trial registration: This study is part of a larger evaluation of Person-Centered Psychosis Care (PCPC), registered during data collection (after the study start, before analysis) at clinicaltrials.gov, identifier NCT03182283.
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| 8. |
- Allerby, Katarina, 1980, et al.
(author)
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Increasing person-centeredness in psychosis inpatient care: staff experiences from the Person-Centered Psychosis Care (PCPC) project
- 2022
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In: BMC Health Services Research. - : Springer Science and Business Media LLC. - 1472-6963. ; 22:1
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Journal article (peer-reviewed)abstract
- Background: Interventions to increase person-centeredness in hospital care for persons with psychotic illness are needed. Changing care delivery is however a complex venture, requiring staff to reconsider their mindsets and ways of working. A multidisciplinary educational intervention for hospital staff at four wards was launched to increase person-centeredness in the care of patients with schizophrenia and similar psychoses. This study aims to explore staff experiences of working to increase person-centeredness. Methods: A heterogenic sample of staff (n = 23) from all participating wards were recruited for six focus group interviews. Semi-structured questions covered staff perceptions of person-centered care and the process of increasing person-centeredness. Transcribed data was analyzed using thematic analysis according to Braun and Clarke. Results: Staff viewed person-centered care as an approach rather than a method. They described central aspects of person-centered care, such as recognizing the patient as a capable person who can participate in her/his care. Statements further showed how these core features were put into practice. Changes related to the intervention were presented in terms of evolving patient and staff roles, improved contact with patients, more flexible care routines, and a more positive ward climate. Neither psychotic symptoms nor involuntary status were considered barriers for person-centered care, but organizational factors beyond staff control seemed to impact on implementation. Conclusions: After implementation, participants displayed good understanding of the core concepts of person-centered care in both thinking and action. They attributed several improvements in the care milieu to an increased level of person-centeredness. Psychotic behavior and involuntary treatment did not present major barriers to person-centered care. Findings suggest person-centered care is feasible in the psychosis inpatient setting and could improve quality of care.
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| 10. |
- Allerby, Katarina, 1980, et al.
(author)
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Person-Centered Psychosis Care (PCPC) In An Inpatient Setting : Ward Level Data And Staff Workload
- 2019
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In: Schizophrenia Bulletin. - : Oxford University Press. - 0586-7614 .- 1745-1701. ; 45:Supplement 2, s. S304-S304
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Journal article (peer-reviewed)abstract
- Background: The person-centered care approach has been little tested in inpatient settings for persons with schizophrenia. An intervention, PersonCentered Psychosis Care (PCPC), was created to increase person-centered care through an educational intervention for staff. The education had a participatory approach where participants were involved in shaping the education and creating projects aimed at care development. The PCPC intervention focused on the patient’s narrative, the creation of a partnership between the patient and staff, and on coming to an agreement between the patient and staff concerning the care. The present study aims to compare staff experienced workload and ward level data before and after implementation of the intervention.Methods: The study was carried out on 4 hospital wards (43 beds) at the Psychosis Clinic, Gothenburg, Sweden. Data was collected during a 6-month pre-intervention period, followed by an implementation period of 3 years, and finally a post intervention data collection period (9 months). During both data collection periods, one nurse per ward filled out a measure of daily subjective workload (a VAS scale with 0 indicating no burden at all and 10 indicating the highest imaginable burden). Additional ward level data (length of hospital stay, involuntary interventions, rehospitalization rates) were collected via the clinic’s electronic monitoring system.Results: The pre-intervention ratings (n=505) showed a mean subjective workload of 5.48 (SD=1.94). The post intervention workload (n=465) showed a mean of 4.51 (SD=2.08) which represents a significant reduction of experienced workload (t (968) = p <.0005). Analyses regarding length of hospital stay, involuntary interventions, and rehospitalization rates are underway and will be presented.Discussion: The findings indicate an improvement in the work environment for hospital staff and provide a quantitative result in line with staff experiences previously reported in our focus group study. The before and after design has its limitations, but the positive findings motivate further testing with a more rigorous design such as a cluster randomized study.
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