BackgroundFor people with persisting psychotic disorders, personal recovery has become an important target of mental health services worldwide. Strongly influenced by mental health service consumer perspectives, personal recovery refers to being able to live a satisfying and contributing life irrespective of ongoing symptoms and disability. Contact with peers with shared lived experience is often cited as facilitative of recovery. We aimed to develop and pilot a novel recovery-based digitally supported intervention for people with a psychotic illness.MethodsWe developed a website to be used on a tablet computer by mental health workers to structure therapeutic discussions about personal recovery. Central to the site was a series of video interviews of people with lived experience of psychosis discussing how they had navigated issues within their own recovery based on the Connectedness–Hope–Identity–Meaning–Empowerment model of recovery. We examined the feasibility and acceptability of an 8-session low intensity intervention using this site in 10 participants with persisting psychotic disorders and conducted a proof-of-concept analysis of outcomes.ResultsAll 10 participants completed the full course of sessions, and it was possible to integrate use of the website into nearly all sessions. Participant feedback confirmed that use of the website was a feasible and acceptable way of working. All participants stated that they would recommend the intervention to others. Post-intervention, personal recovery measured by the Questionnaire for the Process of Recovery had improved by an average standardized effect of d = 0.46, 95% CI [0.07, 0.84], and 8 of the 10 participants reported that their mental health had improved since taking part in the intervention.ConclusionIn-session use of digital resources featuring peer accounts of recovery is feasible and acceptable and shows promising outcomes. A randomized controlled trial is the next step in evaluating the efficacy of this low intensity intervention when delivered in conjunction with routine mental health care.
BackgroundIndividuals with psychosis demonstrate positive attitudes towards utilising digital technology in mental health treatment. Although preliminary research suggests digital interventions are feasible and acceptable in this population, little is known about how to best promote engagement with these resources. Candidate predictors include therapist support, sources of motivation and recovery style. Understanding what factors predict engagement will aid more effective design and implementation of digital interventions to improve clinical benefits.ObjectiveThis study aimed to investigate demographic, psychological, and treatment variables that predict overall and type of engagement with a psychosocial, online intervention for individuals with psychosis.MethodsNinety-eight participants with a history of psychosis were given access to a web program containing modules on self-management and recovery, which they were asked to use flexibly at their own pace. Activity was automatically logged by the system. Baseline measures of demographics, recovery style and motivation were administered, and participants were randomised to receive either website access alone, or website access plus weekly, asynchronous emails from an online coach over 12 weeks. Log and baseline assessment data were used in negative binomial regressions to examine predictors of depth and breadth of use over the intervention period. A logistic regression was used to examine the impact of predictor variables on usage profiles (active or passive).ResultsDepth and breadth of engagement were positively predicted by receiving email support, low levels of externally controlled motivations for website use, older age, and having a tertiary education. There was a significant interaction between level of controlled motivation and condition (+/−email) on breadth and depth of engagement: receiving asynchronous emails was associated with increased engagement for individuals with low, but not high, levels of externally controlled motivations. Receiving email support and more autonomous motivations for treatment predicted more active use of the website.ConclusionsAsynchronous email support can promote engagement with online interventions for individuals with psychosis, potentially enabling self-management of illness and improving clinical outcomes. However, those using online interventions due to external motivating factors, may have low levels of engagement with the intervention, irrespective of coaching provided. These findings may guide design and implementation of future online interventions in this population.
This study failed to demonstrate any benefit of adjunctive N-acetyl cysteine in treating autistic disorder. While this may reflect a true null result, methodological issues particularly the lower dose utilised in this study may be confounders.
Autism is a complex developmental disorder with an unknown etiology and without any curative treatment. The mitochondrial electron transfer chains play a major role in the production of ATP, and the generation and management of reactive oxidative stress (ROS). This paper is a systematic review of the role of the mitochondrial electron transport chain in autism, and a consequent hypothesis for treating autism is synthesized. An electronic search with pre-specified inclusion criteria was conducted in order to retrieve all the published articles about the mitochondrial electron transport chain in autism. The two databases of PUBMED and Google Scholar were searched. From one hundred twenty five retrieved titles, 12 (three case control study and 9 case reports) articles met inclusion criteria. All of the included studies indicated dysfunction of electron transport chain in autism. The mitochondrial electron transfer chain seems impaired in some children with autism and ROS production is additionally enhanced. It is hypothesized that interventions involving alternative electron shuttling may improve autism through lowering the production of ROS. In addition, it is expected that this alternative electron shuttling to cytochrome c might enhance the production of ATP which is impaired in the disorder.
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