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Biomedical subjects

K Gournay

Publications and source records attributed to K Gournay.

At least 19 recordsLinked to original sources
PubMed1997

Dual diagnosis of severe mental health problems and substance abuse/dependence: a major priority for mental health nursing.

It is now established that very significant numbers of people with severe mental illness abuse or depend on drugs and/or alcohol. This combination (Dual Diagnosis) leads to increased rates of violence and service use, a reduction in adherence to treatment regimes, an increase in susceptibility to human immunodeficiency virus (HIV) infection and is now found in in-patient populations. Because of their vulnerability to accidents and physical illnesses, dual diagnosis patients are found increasingly in accident and emergency departments, general medical wards and primary care settings. For this reason nurses and other health professionals working in general hospitals should be as aware as their mental health colleagues of the specific needs of this population. There are some excellent models of service organization and training for dealing with dual diagnoses populations in some parts of the USA. However, there is little such development in the UK. There are clear pathways to be followed, but the need for action is urgent.

Humans↗
PubMed1997

Pulling together: multi-disciplinary training for mental health nursing.

In 1995 the Sainsbury Centre for Mental Health commissioned a major review of all specialist mental health training. The current, largely uni-disciplinary approach to training was felt to be failing to equip professionals with the necessary skills for today's multi-disciplinary, integrated, community-based service, where users and their carers expect an equal partnership and sharing of information. Kevin Gournay and Susannah Strong outline the findings and recommendations of the review, and its implications for mental health nurse education, which make a case for its separation from the rest of the nursing profession.

Certification↗
PubMed1996

Body dysmorphic disorder: a cognitive behavioural model and pilot randomised controlled trial.

A cognitive behavioural model of body image is presented with specific reference to body dysmorphic disorder (BDD). We make specific hypotheses from the model for testing BDD patients in comparison with: (i) patients with "real" disfigurements who seek cosmetic surgery; (ii) subjects with "real" disfigurements who are emotionally well adjusted; and (iii) healthy controls without any defect. There have been no randomised controlled trials of treatment for BDD and therefore the model has clear implications for the development of cognitive behavioural therapy. This was evaluated in a pilot controlled trial. Nineteen patients were randomly allocated to either cognitive behaviour therapy or a waiting list control group over 12 weeks. There were no significant pre-post differences on any of the measures in the waiting list group. There were significant changes in the treated group on specific measures of BDD and depressed mood. Cognitive behaviour therapy should be further evaluated in a larger controlled trial in comparison with another psychological treatment such as interpersonal therapy and pharmacotherapy.

Adult↗
PubMed1996

Schizophrenia: a review of the contemporary literature and implications for mental health nursing theory, practice and education.

Contemporary research in the aetiology, neuropsychology and epidemiology of schizophrenia is reviewed. The picture coming from this work is a group of brain diseases of neurodevelopmental origin which manifest themselves in a variety of ways. In turn, there are a range of cognitive deficits associated with the schizophrenias which may, in the extreme, produce major functional handicap. This new knowledge has obvious implications for nurse education and a priority is to place this in undergraduate programmes. However, more importantly, it is argued that we need to alter conceptual frameworks. for example, in some cases we should care for people with schizophrenia in the same way as one would care for an individual suffering the after-effects of a head injury. In the more severe forms of the illness we should take into account the probability that our patients may have significant problems of memory and attention, and thus modify interventions accordingly. It seems clear that our current nursing theories are not underpinned by relevant knowledge of the nature of schizophrenia and this problem warrants urgent attention.

Humans↗
PubMed1996

Body dysmorphic disorder. A survey of fifty cases.

BACKGROUND: Body dysmorphic disorder (BDD) consists of a preoccupation with an 'imagined' defect in appearance which causes significant distress or impairment in functioning. There has been little previous research into BDD. This study replicates a survey from the USA in a UK population and evaluates specific measures of BDD. METHOD: Cross-sectional interview survey of 50 patients who satisfied DSM-IV criteria for BDD as their primary disorder. RESULTS: The average age at onset was late adolescence and a large proportion of patients were either single or divorced. Three-quarters of the sample were female. There was a high degree of comorbidity with the most common additional Axis l diagnosis being either a mood disorder (26%), social phobia (16%) or obsessive-compulsive disorder (6%). Twenty-four per cent had made a suicide attempt in the past. Personality disorders were present in 72% of patients, the most common being paranoid, avoidant and obsessive-compulsive. CONCLUSIONS: BDD patients had a high associated comorbidity and previous suicide attempts. BDD is a chronic handicapping disorder and patients are not being adequately identified or treated by health professionals.

Adult↗
PubMed1995

Mental health nurses working purposefully with people with serious and enduring mental illness--an international perspective.

There has been a world-wide refocus on people with serious and enduring mental health problems. This has provided major challenges for all those involved in mental health care, as the last two decades have produced radical changes in service delivery and a range of new interventions. Mental health nurses are playing a central role as community based clinical case managers and are beginning to use a range of psychosocial interventions. They are also revitalizing skills in the more traditional areas of medication management and residential care. In addition, there are growing problems of substance abuse and violence which needs to be addressed. Mental health nursing is responding in this new era by various training initiatives. However, these programmes need rapid expansion as mental health nurses will continue to play a key role in the services of the future and therefore need these new skills.

Behavior Therapy↗
PubMed1995

The community psychiatric nurse in primary care: an economic analysis.

Community psychiatric nurses (CPNs) in the United Kingdom are increasingly working in primary health care settings with less serious mental health problems. This paper describes an economic evaluation of their work using a randomized controlled trial in which 231 patients were assigned to continuing general practitioner care or one of two conditions of CPN intervention. This is only the third systematic economic analysis of community mental health nursing in the UK and the first carried out by mental health nurses. Various costs to patients, their families and the health care system were determined. Results showed that patients receiving CPN intervention experienced less absence from work and that this resulted in a net benefit. However, the cost per quality adjusted life year for intervening with this group of patients was probably several times more than for intervening with the seriously mentally ill. Therefore, if one considers both the clinical and economic results of the study, taken together with the recent results of the review of mental health nursing, there seems little justification for CPNs continuing to work in this area.

Absenteeism↗
PubMed1995

The report of the clinical standard advisory group: standards of care for people with schizophrenia in the UK and implications for mental health nursing.

The Clinical Standards Advisory Group Schizophrenia Committee has spent two years (1993-1995) developing a standards protocol to assist all Purchasers and Providers with the task of producing optimum services for people with schizophrenia and other serious and enduring mental illnesses. This work has been underpinned by research that included visits to a representative sample of services throughout the UK. The report of this initiative, which was published in the summer of 1995, has many implications for mental health nursing. These include the continuing necessity to focus on serious mental illness; more effort to develop multidisciplinary working and the use of the Care Programme Approach; an increased focus on relevant training in case management and psychosocial interventions; the need to recognize physical health problems; the importance of medication management; and, as the Review of Mental Health Nursing emphasized, the issue of leadership should be targeted as a priority for action.

Clinical Protocols↗
PubMed1995

Community psychiatric nursing with non-psychotic patients: relating process to outcome.

The aim of this study was to investigate the community psychiatric nursing (CPN) process with non-psychotic patients and to relate various constructs of the initial assessment interview to final patient outcome. The overall purpose of the research was to provide future directions for CPN training. This study used a repeated measures design, assessing patients at pre- and post-intervention on various scales to obtain outcome data. These clients were referred by general practitioners to community psychiatric nurses working in primary health care settings. The first contact session was video recorded (n = 8). Process measures were derived from these recordings using two independent expert raters using several process measures. Anxiety, depression and 'psychiatric caseness' indices all related to various process constructs (R(s) > or = 0.69). These results are based on correlations of a small sample, and the evidence suggests that a poor initial interview has a negative weighting on patient outcomes. This first interview may be related to the CPN skill base. CPN training may need to incorporate a module on structured assessment techniques. This study concludes that it is possible to conduct action research successfully within this field.

Community Health Nursing↗
PubMed1994

British nurses in behavioural psychotherapy: a 20-year follow-up.

A postal survey was carried out of all nurse behaviour therapists trained on the English National Board for Nursing, Midwifery and Health Visiting course in adult behavioural psychotherapy (ENB 650) since its inception at Maudsley Hospital London, in 1972. All trained therapists currently in practice in the UK were surveyed, and 113 of 142 eligible respondents returned questionnaires. These were examined to elicit the professional profiles and working practices of the therapists, and to identify similarities and differences between therapists trained in the four training centres in the UK. It was found that the majority of nurse therapists remain in clinical practice after training, and continue to further their education and clinical expertise. There has been a general shift towards cognitive and short-term interventions, and towards practice based on primary care, with general practitioners providing most referrals. There were significant differences between the centres in terms of a number of the therapeutic techniques used, diagnostic categories of clients seen, and several elements of working practice, including referral source and numbers of clients seen and treated. The implications of the findings for clinical practice and for nursing in behaviour therapy are discussed.

Behavior Therapy↗
PubMed1994

Community psychiatric nurses in primary health care.

BACKGROUND: Community psychiatric nurses (CPNs) are increasingly working in primary health care with non-psychotic patients. This study was designed to test the efficacy of this work. METHOD: The study was carried out in six health centres in north London with a total of 36 participating general practitioners (GPs) and 11 CPNs. Using a randomised controlled trial, 177 patients were referred by their GP and randomly allocated to continuing GP care, immediate community psychiatric nursing intervention, or placed on a 12-week waiting-list, after which time the patient was offered CPN intervention. A range of measures of symptoms and social function were used, and ratings were carried out at assessment and at 24 weeks. RESULTS: Patients improved on all measures over time (P < 0.001 for all measures). However, there was no difference between the group of patients receiving GP care and patients seen by the CPN. Improvements seemed to be independent of the amount of contact. Drop-out rates from CPN intervention were high (50%). CPN drop-outs were more disabled to start with, but did as well as CPN treatment completers. Patients were more likely to drop out with trained than untrained CPNs. There was no evidence that referral to a CPN saved GP time. CONCLUSIONS: The results add weight to the argument that CPNs should refocus their activity on people with serious mental health problems, and indicate that CPN education should focus on skill acquisition and interventions of proven effectiveness.

Adult↗
PubMed1987

Construction and constriction in agoraphobia.

A formulation of agoraphobia is presented in personal construct theory terms. It is hypothesized that the construing of agoraphobics and their spouses is characterized by low cognitive awareness of constructs concerning interpersonal conflict and lack of tenderness; by dilemmas in which the ability to go out implies possible infidelity; and by low self-esteem in the agoraphobic and high self-esteem in their spouse. Evidence in support of these hypotheses is provided by a repertory grid study comparing agoraphobics, non-agoraphobic neurotics, spouses of both client groups, and normal subjects. Features of construing of agoraphobic and spouse are shown to be predictive of the agoraphobic's response to behaviour therapy, and therapeutic improvement to be associated with some reconstruction in the above areas. The role of mutual validation of constructions between agoraphobic and spouse in the maintenance of agoraphobic behaviour is discussed, as are implications for the treatment of agoraphobia.

Adult↗