Discovering the impact of psychotherapeutic hospital treatment for adults with serious mental illness

Allen, Jon G.; Fowler, J. Christopher; Madan, Alok; Ellis, Thomas E.; Oldham, John M.; Frueh, B. Christopher

doi:10.1521/bumc.2017.81.1.1

Cited by 8 publications

(8 citation statements)

References 62 publications

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“…Described as an integrative treatment approach (Allen et al, 2017), the core treatment interventions focus on improving emotion regulation, symptom severity, and functional capacity by enhancing attachment security and mentalizing, that is, attending to and understanding mental states in self and others (Allen et al, 2008; Fonagy et al, 2018). Mentalizing, developed by Fonagy and colleagues (Bateman & Fonagy, 2012; Fonagy et al, 2018), provides an integrative bridge between the psychodynamic and cognitive-based approach.…”

Section: Methodsmentioning

confidence: 99%

Personality trait domains predict psychiatric symptom and functional outcomes.

Fowler¹,

Lamkin²,

Allen³

et al. 2022

Psychotherapy

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A review of high intensity, high dose mentalization-based inpatient psychiatric treatment indicated large effect-size reductions in symptoms of depression, anxiety, somatization, and improving emotion-regulation functioning (Allen et al., 2017). This study examined the impact of pathological personality traits has on baseline symptoms and functioning, as well as their impact on the longitudinal course in a large cohort of adult inpatient psychiatric sample (N = 804). The Personality Inventory for DSM-5 (PID-5; Krueger et al., 2012) was used to assess trait domains impact on longitudinal outcomes (anxiety, depression, somatic symptoms, and functional impairment) using hierarchical repeated measures modeling. Results indicate Negative Affectivity and Detachment were related to higher admission severity in all four outcome domains. Psychoticism was related to somatic symptoms, while Antagonism and Disinhibition were related to functional impairment. Paradoxically, when symptoms were plotted over 2-week intervals during hospitalization, patients with higher admission PID-5 trait scores exhibited greater improvement over time. The PID-5 appears to contribute to prediction of treatment outcome response above and beyond demographic and burden of illness. Importantly, the findings add to a growing body of literature indicating that impairments in personality traits do not preclude positive treatment response, particularly when treatments target pathological personality features.

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Section: Methodsmentioning

confidence: 99%

Personality trait domains predict psychiatric symptom and functional outcomes.

Fowler¹,

Lamkin²,

Allen³

et al. 2022

Psychotherapy

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“…The Houston Methodist Behavioral Health FR program was designed to address the existing barriers described in the previous section of this article. It is the latest iteration of previously developed models of care at our institution 14,42,44–47…”

Section: Functional Rehabilitationmentioning

confidence: 99%

Functional Rehabilitation: An Integrated Treatment Model for Patients With Complex Physical and Psychiatric Conditions

Orme

Fowler

Bradshaw

et al. 2022

Journal of Psychiatric Practice

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The health care delivery system in the United States, structured to provide single-disease care, presents unique challenges for patients with complex physical and psychiatric comorbidities. Patients in these populations are often referred to multiple specialty clinics, encounter little continuity of care or collaboration among their providers, incur high health care costs, and experience poor treatment outcomes. Given these barriers, questions remain about the extent to which siloed and fragmented care, as opposed to the complex nature of the illnesses themselves, contribute to poor outcomes. If given the opportunity to receive well-integrated, consistent, and personalized care, can patients with historically difficult-to-treat comorbid medical and mental illnesses make progress? This article describes an innovative model of care called functional rehabilitation that is designed to address existing barriers in treatment. The functional rehabilitation program seeks to disrupt the escalating effects of interacting comorbidities by offering highly collaborative treatment from a small team of clinicians, personalized interventions using a shared decision-making framework, multipronged treatment options, colocation in a large hospital system, and significant 1:1 time with patients. The article includes a case example with longitudinal outcome data that illustrates how progress can be made with appropriate programmatic supports. Future research should examine the cost-effectiveness of this model of care.

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“…Data mining for research purposes evolved (for reviews of this project’s discoveries, see Allen et al, 2017; Ellis, 2017) with early studies addressing basic questions of pre–post change and global effectiveness of the treatment model (Latini et al, 2009) and describing pilot results from a suicide-specific treatment approach (Ellis, Green, Allen, Jobes, & Nadorff, 2012). These early investigations helped establish benchmarks for rates of remission and provided the first systematic evidence of effectiveness of the programs and hospital-wide treatment model; however, the results were too general to yield actionable practice improvements.…”

Section: Lessons Learnedmentioning

confidence: 99%

Lessons learned while integrating patient-reported outcomes in a psychiatric hospital.

Fowler¹,

Madan²,

Frueh

et al. 2019

Psychotherapy

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In today's world of smart-device monitoring systems, clinicians may be lulled into the assumption that we can download software to monitor our patients' psychological and behavioral functioning with little or no effort or follow-up. This belief is as erroneous as it is tempting; in fact, implementing effective and efficient systems for utilizing patient-reported outcomes (PROs) in daily practice and research takes a virtual village of stakeholders, clinicians, developers, analysts, and clinical researchers. Here, we describe the iterative processes required for designing, implementing, and updating a large-scale inpatient psychiatric quality improvement/research platform that provides real-time feedback to clinicians and patients. During the past 10 years, many surprises and counterintuitive discoveries have emerged from this project, not the least of which is how difficult it is to establish and maintain "buy-in" and the utilization of PROs with busy clinicians and administrators. Methods for prioritizing and structuring data for different uses, including examining the effectiveness of treatment programs, identifying moderators of change, and improving treatment planning by developing algorithms to alert clinicians to adverse outcomes, are highlighted. The authors conclude by describing a new venture to integrate biological data and between-visit PROs monitoring to enhance well-being and reduce emergency department and hospital admissions for high-risk patients. Clinical Impact StatementQuestion: This article describes the process, challenges, and pitfalls of making patient-reported outcomes (PROs) in daily practice and research a high-value proposition. Findings: Lessons learned from this 10-year project provide broad guidelines to clinical researchers planning to implement PROs in practice. Meaning: Although PRO platforms are driving toward fully automated systems, clinical systems will be best served by a counterbalance of human engagement in the feedback process. Next Steps: Future directions for integrated PROs platforms will include physiological data and ecological momentary assessments between office visits to optimize patient care.

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Discovering the impact of psychotherapeutic hospital treatment for adults with serious mental illness

Cited by 8 publications

References 62 publications

Personality trait domains predict psychiatric symptom and functional outcomes.

Personality trait domains predict psychiatric symptom and functional outcomes.

Functional Rehabilitation: An Integrated Treatment Model for Patients With Complex Physical and Psychiatric Conditions

Lessons learned while integrating patient-reported outcomes in a psychiatric hospital.

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