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Sammells E, Logan A, Sheppard L. Participant Outcomes and Facilitator Experiences Following a Community Living Skills Program for Adult Mental Health Consumers. Community Ment Health J 2023; 59:428-438. [PMID: 36074286 PMCID: PMC9981707 DOI: 10.1007/s10597-022-01020-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 08/10/2022] [Accepted: 08/11/2022] [Indexed: 11/25/2022]
Abstract
Outcomes from participating in a six-week small-group living skills program, periodically implemented over two years with twelve adult mental health consumers, are reported as a case study. Occupational therapy and recovery-oriented approaches underpinned the development and implementation of the program thus it was important that outcome measures aligned with these perspectives. Data were gathered pre and post program using the Canadian Occupational Performance Measure (COPM) and the Life Skills Profile-16 (LSP-16) in each iteration of the program. Two occupational therapy program facilitators were interviewed about their experience of running the program and using these measurement tools. COPM occupational performance (p = 0.001) and COPM satisfaction (p = 0.004) scores indicated significant change at post-program whereas the LSP-16 total and subscale scores did not (p = 0.132 for total scores). Facilitator insights into the experience of implementing the living skills program and the perceived alignment of the COPM and LSP-16 with recovery-oriented practice are reported.
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Affiliation(s)
- Eliza Sammells
- Occupational Therapist, BOccThy (HONS), Australian Catholic University, Melbourne, Australia
| | - Alexandra Logan
- Occupational Therapy Senior Lecturer, School of Allied Health, Faculty of Health Science, Australian Catholic University, Melbourne, Australia
| | - Loretta Sheppard
- Occupational Therapy, Deputy Head, School of Allied Health, Australian Catholic University, Melbourne, Australia.
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Liang Y, Li Y, Lin G, Cai C, Yuan H, Sheng Q. Effectiveness of Group Patient-Led Life Skills Training on Function and Self-Efficacy for People With Schizophrenia: A Quasi-Experimental Study. J Psychosoc Nurs Ment Health Serv 2023; 61:60-67. [PMID: 36322870 DOI: 10.3928/02793695-20221027-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The current quasi-experimental study evaluated the effectiveness of group patient-led life skills training (LST) on functional recovery and self-efficacy of people with schizophrenia. Two psychiatric units in a mental health center were randomly assigned to intervention (first psychiatric unit) and control (second psychiatric unit) groups. Convenience sampling was used to recruit participants. The intervention group (n = 51) received group patient-led LST, and the control group (n = 53) received routine mental health care services. Outcomes on patients' functional recovery and self-efficacy between groups were compared at baseline, during the intervention (4 weeks), and immediately after the intervention (8 weeks). Repeated measures analysis of variance was used to analyze the data. Results showed that the intervention improved functional recovery and self-efficacy of people with schizophrenia (p < 0.05). Therefore, it is recommended that group patient-led LST be integrated in therapy for people with schizophrenia to facilitate their functional recovery and help them achieve their highest potential for independent living. [Journal of Psychosocial Nursing and Mental Health Services, 61(2), 60-67.].
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John A, Gandhi S, Prasad MK, Manjula M. Effectiveness of IADL interventions to improve functioning in persons with Schizophrenia: A systematic review. Int J Soc Psychiatry 2022; 68:500-513. [PMID: 34802260 DOI: 10.1177/00207640211060696] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND OF THE STUDY Instrumental activities of daily living (IADL) are activities that are needed to live an independent life. Psychotic disorders are associated with deficits in everyday functioning, causing impairment/disability in activities of daily living. Activities play a crucial role to measure functional health or disability. People with Schizophrenia often present difficulties in social and occupational reintegration that may be associated with problems in performing daily activities, including independent living, education, working, and socializing. Activities of daily living and instrumental activities of daily living (life skills training) including leisure and social skills training intended to reintegrate the patient into the community to lead an everyday life. AIM The aim of this review was to identify the effect of skill-based interventions on independent functioning in persons with Schizophrenia. METHODS The authors conducted database searches of Google Scholar, PubMed, Science Direct, ProQuest, EBSCO from 1st January 1992 to 31st December 2020. The researcher extracted data, and the quality of included studies was rated by two authors independently. We used the Cochrane Risk of Bias (ROB) tool for assessing the quality of selected studies. The search identified nine studies that met the inclusion criteria with 655 participants. The outcome measure was independent functioning skills. RESULTS The interventions in the review were multifaceted with different combinations of psychoeducation, cognitive-behavioral methods, training in social skills, and IADL. The interventions resulted in significant improvement in functioning skills and reduction in relapse rates. CONCLUSION Results of this review have revealed moderate to strong evidence for skills training, either behavioral or social skills to improve social and independent functioning, reduce caregiver burden, and improve negative symptoms. The review also supported that interventions could be generalized across settings.
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Affiliation(s)
- Annie John
- National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Sailaxmi Gandhi
- National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
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Chandran MC, Saji F, Samuel R, Jacob KS. Development and validation of Vellore Inventory of Life Skills among people with severe mental illness. Indian J Psychiatry 2021; 63:15-27. [PMID: 34083816 PMCID: PMC8106431 DOI: 10.4103/psychiatry.indianjpsychiatry_872_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/27/2020] [Accepted: 10/23/2020] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND AND AIM Rehabilitation for people with severe mental illness is incomplete without life skills assessment and intervention. The aim of the study was develop a culturally specific performance-based measure assessing life skills of patients with severe mental illness. MATERIALS AND METHODS The items for the Vellore Inventory of Life Skills (VILS) were drawn after consultation with a reference group and from existing standardized scales. The items were categorized into two sections with six components each, which was further hierarchically arranged into activities at either basic, intermediate, or advanced level. One hundred consecutive clients between 18 and 60 years of age who provided written informed consent were assessed on the Comprehensive Evaluation of Basic Living Skills (CEBLS) and the VILS to evaluate convergent validity and inter-rater reliability. The General Health Questionnaire (GHQ-12) was used to evaluate divergent validity. The assessments were repeated after a week to evaluate test-retest reliability. RESULTS The scale had good inter-rater reliability 0.938 (95% confidence interval [CI] 0.887-0.967) and test-retest reliability 0.907 (95% CI 0.865-0.937). The correlation between total score of VILS and CEBLS (Pearson's correlation coefficient [PCC] = 0.611; P = 0.001) suggested moderate convergent validity. The correlation between total score of VILS and GHQ-12 (PCC = -0.260; P = 0.105) implied good divergent validity. CONCLUSION Preliminary data suggest that the VILS is clinically useful for the Indian population.
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Affiliation(s)
- Meghana C Chandran
- Department of Psychiatry, Christian Medical College, Vellore, Tamil Nadu, India
| | - Febin Saji
- Department of Physical Medicine and Rehabilitation, Christian Medical College, Vellore, Tamil Nadu, India
| | - Reema Samuel
- Department of Psychiatry, Christian Medical College, Vellore, Tamil Nadu, India
| | - K S Jacob
- Department of Psychiatry, Christian Medical College, Vellore, Tamil Nadu, India
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The Optimal Length of Hospitalization for Functional Recovery of Schizophrenia Patients, a Real-World Study in Chinese People. Psychiatr Q 2019; 90:661-670. [PMID: 31327081 DOI: 10.1007/s11126-019-09658-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This study investigated the relationship between the activities of daily living and the length of hospitalization to determine the optimal length of hospitalization for patients with schizophrenia. We collected information from all schizophrenia patients discharged in Peking University Huilongguan Clinical Medical School from January 1, 2015 to December 31, 2015. A total of 1967 patients were enrolled in this study. The Chinese version of the modified Barthel index (MBI-C) was used to assess patients' actual performance on activities of daily living. We used the paired samples t-test to compare MBI-C scores at admission and discharge and performed correlation analysis to find the trend of MBI-C change with length of hospitalization. The average length of hospitalization was 73.3 ± 42.2 days. There were significant differences between the MBI-C scores at the time of discharge from hospital compared with those at the time of admission to the hospital (93.4 ± 11.2 vs. 88.7 ± 11.8; P < 0.001). Taking the length of hospitalization as the grouping boundary value, the correlation analysis of the subgroup found that below a minimum of 20 days, the improvement in the MBI-C scores increased with the increase of length of hospitalization, and above a maximum of 50 days, the improvement in the MBI-C scores decreased with the increase of length of hospitalization. The optimal length of hospitalization for patients with schizophrenia may lie between 20 and 50 days, with regard to the recovery of daily living function.
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Jalali F, Hashemi SF. Group life skills training for promoting mental health in women after released from prison: A randomized pilot efficacy trial. Health Care Women Int 2019; 40:314-327. [DOI: 10.1080/07399332.2018.1547385] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Farzad Jalali
- Negahe Mosbat Social Health Institute, Mashhad, Iran
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Morris K, Reid G, Spencer S. Occupational therapy delivered by specialists versus non-specialists for people with schizophrenia. Cochrane Database Syst Rev 2018; 10:CD012398. [PMID: 30293234 PMCID: PMC6516954 DOI: 10.1002/14651858.cd012398.pub2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Schizophrenia is a severe mental health condition that is characterised by positive symptoms, such as hallucinations and delusions; negative symptoms, such as flattened affect, thought disorder (disrupted speech), and lack of motivation; and cognitive symptoms, such as problems with memory and attention. Schizophrenia can occur as an isolated episode, or as a recurring cycle of remission and relapse, and is associated with impairment in psychosocial and occupational functioning.Although antipsychotic drugs are the main treatment for people with schizophrenia, in most countries mental health services usually provide a range of add-on interventions, including occupational therapy. This is a complex intervention designed to support and enable continued participation in daily life through engagement in activities and occupations meaningful to the individual. Occupational therapists are professionals trained to deliver therapy where the emphasis is on improving occupational function and participation rather than treating symptoms, and uses a wide range of methods based on the needs of individuals. However, similar interventions may also be delivered by staff not trained as occupational therapists. OBJECTIVES To examine the effects of occupational therapy delivered by occupational therapists compared to occupational therapy delivered by any other person for people with schizophrenia. SEARCH METHODS We searched the Cochrane Schizophrenia Group's Study-Based Register of Trials (including trial registers) on 4 November 2016 and 26 July 2018. SELECTION CRITERIA All randomised controlled trials evaluating the functional or clinical outcomes of occupational therapy, or both, for people with schizophrenia delivered by occupational therapists compared with occupational therapy for people with schizophrenia delivered by anyone other than occupational therapists. DATA COLLECTION AND ANALYSIS Review authors independently inspected citations, selected studies, extracted data, and appraised study quality. MAIN RESULTS The search yielded 1633 records. Of these, we retrieved 17 full-text reports (14 studies) for further scrutiny, which we subsequently excluded as they did not meet our inclusion criteria. AUTHORS' CONCLUSIONS Currently there are no randomised controlled trials comparing delivery of occupational therapy for people diagnosed with schizophrenia by occupational therapists with delivery of similar interventions by anyone other than occupational therapists. Research studies employing methodologically robust trial designs are needed to establish whether or not there are better outcomes for people with a diagnosis of schizophrenia with occupational therapy that is delivered by trained occupational therapists.
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Affiliation(s)
- Karen Morris
- University of CumbriaDepartment of Health, Psychology & Social StudiesFusehill StreetCarlisleUKCA1 2HH
| | - Graeme Reid
- North West Boroughs Healthcare NHS Foundation TrustWakefield HouseGuardian StreetWarringtonUKWA5 1UD
| | - Sally Spencer
- Edge Hill UniversityPostgraduate Medical InstituteSt Helens RoadOrmskirkLancashireUKL39 4QP
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Inchausti F, García-Poveda NV, Ballesteros-Prados A, Ortuño-Sierra J, Sánchez-Reales S, Prado-Abril J, Aldaz-Armendáriz JA, Mole J, Dimaggio G, Ottavi P, Fonseca-Pedrero E. The Effects of Metacognition-Oriented Social Skills Training on Psychosocial Outcome in Schizophrenia-Spectrum Disorders: A Randomized Controlled Trial. Schizophr Bull 2018; 44:1235-1244. [PMID: 29267940 PMCID: PMC6192494 DOI: 10.1093/schbul/sbx168] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
A pilot study of the effects of metacognition-oriented social skills training (MOSST) on social functioning in patients with schizophrenia spectrum disorders (SSDs) reported promising results. The main purpose of the current trial was to compare the effectiveness and potential benefits of MOSST vs conventional social skills training (SST). Single-blind randomized controlled trial with 2 groups of patients aged 18-65 with SSDs on partial hospitalization. Participants were randomly assigned (1:1) to receive 16 group sessions with MOSST or conventional SST, both in addition to standard care, over 4 months, with a 6-month follow-up. Psychosocial functioning, metacognition, and symptom outcomes were measured by blind assessors. Statistical analyses used mixed models to estimate treatment effects in each postrandomization time point. Thirty-six patients were randomly assigned to the MOSST group and 33 patients to the conventional SST group. Between-group differences were significant in favor of MOSST on Social and Occupational Functioning Assessment Scale (SOFAS) and Personal and Social Performance Scale (PSP) total scores at post-treatment and follow-up. Concerning PSP subscales, there were significant between-group differences in favor of MOSST at follow-up on socially useful activities, personal and social relationships, and disturbing and aggressive behaviors. Metacognition only improved following MOSST group. For people with SDDs, MOSST appears to have short- and long-term beneficial effects on social functioning and symptoms. Further studies are required to replicate the current results in other samples.
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Affiliation(s)
- Felix Inchausti
- Complejo Hospitalario of Navarra, CSM Ermitagaña, Pamplona, Spain,School of Medicine, University of Navarra, Pamplona, Spain,To whom correspondence should be addressed; Complejo Hospitalario of Navarra, CSM Ermitagaña, Pamplona, Spain; tel: 948-198-590, fax: 948-198-179, e-mail:
| | | | | | | | | | - Javier Prado-Abril
- Complejo Hospitalario of Navarra, CSMIJ Natividad Zubieta, Sarriguren, Spain,Research Network on Preventive Activities and Health Promotion (REDIAPP) (RD12/0005), Aragon Health Sciences Institute (IACS), Zaragoza, Spain
| | | | - Joe Mole
- Oxford Institute of Clinical Psychology Training, University of Oxford, Oxford, UK
| | | | - Paolo Ottavi
- Centro di Terapia Metacognitiva Interpersonale, Rome, Italy
| | - Eduardo Fonseca-Pedrero
- Department of Educational Sciences, University of La Rioja, La Rioja, Spain,P3 Prevention Program of Psychosis, Oviedo, Spain
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Norman R, Lecomte T, Addington D, Anderson E. Canadian Treatment Guidelines on Psychosocial Treatment of Schizophrenia in Adults. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2017; 62:617-623. [PMID: 28703017 PMCID: PMC5593243 DOI: 10.1177/0706743717719894] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE It is generally recognised that psychosocial interventions are essential components of the effective treatment of schizophrenia in adults. A considerable body of research is being published regarding the effectiveness of such interventions. In the current article, we derive recommendations reflecting the current state of evidence for their effectiveness. METHODS Recommendations were formulated on the basis of a review of relevant guidelines, particularly those formulated by the Scottish Intercollegiate Guideline Network (SIGN) and National Institute for Health and Care Excellence (NICE). RESULTS There is evidence strongly supporting the use of family interventions, supported employment programs, and cognitive-behavioural therapy. There are also reasons to recommend the use of cognitive remediation, social skills training, and life skills training under specified circumstances. It is important that all patients and families be provided with education about the nature of schizophrenia and its treatment. Several recent innovative psychosocial approaches to treatment are awaiting more thorough evaluation. CONCLUSIONS There continues to be strong evidence for the effectiveness of several psychosocial interventions in improving outcomes for adults with schizophrenia. In the past decade, innovative interventions have been described, several of which are the subject of ongoing evaluative research.
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Affiliation(s)
- Ross Norman
- 1 Departments of Psychiatry and Epidemiology & Biostatistics, Western University, London, Ontario.,2 Prevention & Early Intervention Program for Psychoses (PEPP), London Health Sciences Centre, London, Ontario
| | - Tania Lecomte
- 3 Department of Psychology, University of Montreal, Montreal, Quebec.,4 Centre de recherche de l'Institute universitaire en santé mentale de Montréal, Quebec
| | - Donald Addington
- 5 Hotchkiss Brain Institute and Department of Psychiatry, University of Calgary, Calgary, Alberta
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Dickson K, Sutcliffe K, Rees R, Thomas J. Gaps in the evidence on improving social care outcomes: findings from a meta-review of systematic reviews. HEALTH & SOCIAL CARE IN THE COMMUNITY 2017; 25:1287-1303. [PMID: 26500053 PMCID: PMC5484323 DOI: 10.1111/hsc.12300] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/15/2015] [Indexed: 06/05/2023]
Abstract
Adult social care continues to be a central policy concern in the UK. The Adult Social Care Outcomes Framework (ASCOF) is a range of measures nationally available to drive forward improvement on outcomes and quality in local councils. While there is an emphasis on improving transparency, quality and outcomes, drawing on research evidence to achieve these aims is often difficult because the evidence is not easily identifiable, is disparate or of variable quality. We conducted a meta-review to analyse and summarise systematic review-level evidence on the impact of interventions on the four outcomes set out in the ASCOF: quality of life, delaying and reducing the need for services, satisfaction with services and safeguarding of vulnerable adults. This paper focuses on the availability of review-level evidence and the presence of significant gaps in this evidence base. A range of health and social care databases were searched, including MEDLINE, ASSIA and The Cochrane Library in January and February 2012. All systematic reviews evaluating the efficacy of social care interventions for improving ASCOF outcomes for older people, people with long-term conditions, mental health problems or physical and/or learning disabilities were eligible. Two reviewers independently screened systematic reviews for quality and relevance and extracted data; 43 systematic reviews were included, the majority of which examined the impact of interventions on quality of life (n = 34) and delaying and reducing the need for support (n = 25). Limited systematic review-level evidence was found regarding satisfaction with services and safeguarding. There were also significant gaps in relation to key social care interventions and population groups. Research priorities include addressing these gaps and the collation of data on interventions, outcomes and populations more closely related to social care. Overall, a more relevant, comprehensive and robust evidence base is required to support improvement of outcomes for recipients of adult social care.
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Affiliation(s)
- Kelly Dickson
- Evidence for Policy and Practice Information and Co‐ordinating Centre (EPPI‐Centre)Social Science Research UnitUCL Institute of EducationLondonUK
| | - Katy Sutcliffe
- Evidence for Policy and Practice Information and Co‐ordinating Centre (EPPI‐Centre)Social Science Research UnitUCL Institute of EducationLondonUK
| | - Rebecca Rees
- Evidence for Policy and Practice Information and Co‐ordinating Centre (EPPI‐Centre)Social Science Research UnitUCL Institute of EducationLondonUK
| | - James Thomas
- Evidence for Policy and Practice Information and Co‐ordinating Centre (EPPI‐Centre)Social Science Research UnitUCL Institute of EducationLondonUK
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Moriana JA, Gálvez-Lara M, Corpas J. Psychological treatments for mental disorders in adults: A review of the evidence of leading international organizations. Clin Psychol Rev 2017; 54:29-43. [PMID: 28384513 DOI: 10.1016/j.cpr.2017.03.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 03/24/2017] [Accepted: 03/27/2017] [Indexed: 11/18/2022]
Abstract
Most mental health services throughout the world currently regard evidence-based psychological treatments as best practice for the treatment of mental disorders. The aim of this study was to analyze evidence-based treatments drawn from RCTs, reviews, meta-analyses, guides, and lists provided by the National Institute for Health and Care Excellence (NICE), Division 12 (Clinical Psychology) of the American Psychological Association (APA), Cochrane and the Australian Psychological Society (APS) in relation to mental disorders in adults. A total of 135 treatments were analyzed for 23 mental disorders and compared to determine the level of agreement among the organizations. The results indicate that, in most cases, there is little agreement among organizations and that there are several discrepancies within certain disorders. These results require reflection on the meaning attributed to evidence-based practice with regard to psychological treatments. The possible reasons for these differences are discussed. Based on these findings, proposals to unify the criteria that reconcile the realities of clinical practice with a scientific perspective were analyzed.
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Affiliation(s)
- Juan Antonio Moriana
- Department of Psychology, University of Cordoba, Spain; Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), Spain; Reina Sofia University Hospital, Spain.
| | - Mario Gálvez-Lara
- Department of Psychology, University of Cordoba, Spain; Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), Spain; Reina Sofia University Hospital, Spain
| | - Jorge Corpas
- Department of Psychology, University of Cordoba, Spain
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Brooke-Sumner C, Petersen I, Asher L, Mall S, Egbe CO, Lund C. Systematic review of feasibility and acceptability of psychosocial interventions for schizophrenia in low and middle income countries. BMC Psychiatry 2015; 15:19. [PMID: 25886524 PMCID: PMC4382830 DOI: 10.1186/s12888-015-0400-6] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 01/26/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In low and middle income countries there is evidence to suggest effectiveness of community-based psychosocial interventions for schizophrenia. Many psychosocial interventions have however been conceptualized in high income countries and assessing their feasibility and acceptability in low and middle income countries is pertinent and the objective of this review. METHODS Six databases were searched using search terms (i) "Schizophrenia"; (ii) "Low and middle income or developing countries" and (iii) "Psychosocial interventions". Abstracts identified were extracted to an EndNote Database. Two authors independently reviewed abstracts according to defined inclusion and exclusion criteria. Full papers were accessed of studies meeting these criteria, or for which more information was needed to include or exclude them. Data were extracted from included studies using a predesigned data extraction form. Qualitative synthesis of qualitative and quantitative data was conducted. RESULTS 14 037 abstracts were identified through searches. 196 full articles were reviewed with 17 articles meeting the inclusion criteria. Little data emerged on feasibility. Barriers to feasibility were noted including low education levels of participants, unavailability of caregivers, and logistical issues such as difficulty in follow up of participants. Evidence of acceptability was noted in high participation rates and levels of satisfaction with interventions. CONCLUSIONS While there is preliminary evidence to suggest acceptability of community-based psychosocial interventions for schizophrenia in low and middle income countries, evidence for overall feasibility is currently lacking. Well-designed intervention studies incorporating specific measures of acceptability and feasibility are needed.
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Affiliation(s)
- Carrie Brooke-Sumner
- School of Applied Human Sciences, Discipline of Psychology, University of KwaZulu-Natal, Durban, South Africa.
| | - Inge Petersen
- School of Applied Human Sciences, Discipline of Psychology, University of KwaZulu-Natal, Durban, South Africa.
| | - Laura Asher
- Department for Population Health, Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK.
- Department of Psychiatry, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Sumaya Mall
- Department of Psychiatry and Mental Health, Alan J Flisher Centre for Public Mental Health, University of Cape Town, Cape Town, South Africa.
| | - Catherine O Egbe
- School of Applied Human Sciences, Discipline of Psychology, University of KwaZulu-Natal, Durban, South Africa.
| | - Crick Lund
- Department of Psychiatry and Mental Health, Alan J Flisher Centre for Public Mental Health, University of Cape Town, Cape Town, South Africa.
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Brooke-Sumner C, Lund C, Petersen I. Perceptions of psychosocial disability amongst psychiatric service users and caregivers in South Africa. Afr J Disabil 2014; 3:146. [PMID: 28730007 PMCID: PMC5443050 DOI: 10.4102/ajod.v3i1.146] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 09/19/2014] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND In many parts of South Africa there is little support for people with psychosocial disability caused by schizophrenia, beyond provision of psychotropic medications. Appropriate community-based psychosocial rehabilitation interventions are a crucial element of mental health service development. OBJECTIVES This study aimed to use an explanatory model of illness framework to document experiences of illness, disability and recovery amongst service users with schizophrenia and their caregivers in a poorly resourced area in the North West Province. Data were used to provide recommendations for a contextually appropriate non-specialist facilitated group psychosocial rehabilitation intervention. METHOD Eighteen in-depth individual interviews were conducted: nine with schizophrenia service users and nine with caregivers. Interviews were conducted by two trained field researchers; both clinical psychologists fluent in the first language of participants. All interviews were recorded, translated and transcribed. Data were thematically analysed using NVivo 9. RESULTS Participants linked the illness to witchcraft, poverty and stress. Family conflict was recognised in the course of the illness, causing stress and challenges for emotional well-being. Knowledge of diagnosis and biomedical treatment was minimal. Key factors recognised by service users as promoting recovery were the ability to work, and the support of traditional healers and religious structures. CONCLUSION Based on the findings of this study, a group psychosocial rehabilitation intervention emerged as a recommendation, with the incorporation of psycho-education, adherence support, coping skills, and opportunities for income generation and productive activity. The importance of also enlisting the support of religious leaders and traditional healers in supporting recovery is emphasised.
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Affiliation(s)
- Carrie Brooke-Sumner
- School of Applied Human Sciences, Discipline of Psychology, University of KwaZulu-Natal, South Africa
| | - Crick Lund
- Alan J. Flisher Centre for Public Mental Health Department of Psychiatry and Mental Health, University of Cape Town, South Africa
| | - Inge Petersen
- School of Applied Human Sciences, Discipline of Psychology, University of KwaZulu-Natal, South Africa
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Kauppi K, Hätönen H, Adams CE, Välimäki M. Perceptions of treatment adherence among people with mental health problems and health care professionals. J Adv Nurs 2014; 71:777-88. [PMID: 25394750 DOI: 10.1111/jan.12567] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2014] [Indexed: 12/31/2022]
Abstract
AIMS To explore patients' and mental healthcare professionals' perceptions of supportive and restrictive indicators of adherence to treatment in patients with mental health problems. BACKGROUND People with mental health problems may have difficulties adhering to their treatment, causing relapses and hospitalizations. It is, therefore, important to learn more about how patients' treatment adherence can be supported and what jeopardizes adherence. DESIGN A descriptive qualitative study. METHODS Nine focus groups and semi-structured interviews were conducted in Finland during 2010-2011. The patients (n = 19) were recruited from patient associations and the healthcare professionals (n = 42) from healthcare organizations. The data were analysed using inductive content analysis. FINDINGS Participants agreed that treatment adherence can be supported. Suggestions focused on treatment planning mindful of both patient involvement and needs. A structured daily routine helps patients manage their everyday issues and further facilitates adherence. On the other hand, patients found that their adherence was affected by factors related to the mental health system, including arrangements for follow-up care, access to services, the receptiveness of providers to meet patient needs and a disconnect time between hospital and community life. CONCLUSION Patient adherence should already be taken into account when treatment is planned. The content of treatment should be individually designed according to the patient's activities of daily life. In addition, stressing the importance of medication and listening to the patient's opinions and experiences of taking medication may improve the patient's willingness to adhere.
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Affiliation(s)
- Kaisa Kauppi
- Department of Nursing Science, University of Turku, Finland
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Ottavi P, D'Alia D, Lysaker P, Kent J, Popolo R, Salvatore G, Dimaggio G. Metacognition-oriented social skills training for individuals with long-term schizophrenia: methodology and clinical illustration. Clin Psychol Psychother 2013; 21:465-73. [PMID: 23754780 DOI: 10.1002/cpp.1850] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Revised: 05/02/2013] [Accepted: 05/03/2013] [Indexed: 11/07/2022]
Abstract
PURPOSE There is much evidence indicating the presence of social deficits in schizophrenia and the detrimental effect of these deficits on global functioning in this population. As a result, social skills training (SST) has emerged as a legitimate psychosocial treatment, although effectiveness research has revealed small effect sizes and limited generalizability regarding the benefits of this treatment. METHODS In light of the strong evidence of metacognitive deficits in schizophrenia and the importance of metacognition to successful social functioning, we propose a novel therapeutic intervention wherein metacognitive remediation is integrated into SST: metacognition-oriented social skills training (MOSST). In the current paper, we present MOSST, an adapted SST programme wherein clients are also encouraged to have mindful contact with their own thoughts and to better consider and understand the mental states of others as well as the connection between mental states and behaviour. RESULTS We present a case wherein an individual with schizophrenia successfully completed the MOSST programme. CONCLUSION We outline directions for future research, starting with the logical next step of empirically testing the efficacy of MOSST. KEY PRACTITIONER MESSAGE Currently social skills training is considered to be the elected psychosocial treatment for people affected by schizophrenia, although evidence indicates limited benefits. People with schizophrenia have metacognitive deficits, which interfere with proper social functioning. A metacognitive-oriented social skills training (MOSST) intervention has been developed by the authors.A treatment such as MOSST, which integrates social skills training and metacognitive training, promises to improve social skills through improving the metacognition.
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Affiliation(s)
- Paolo Ottavi
- Centro di Terapia Metacognitiva Interpersonale, Rome, Italy
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Chien WT, Leung SF, Yeung FK, Wong WK. Current approaches to treatments for schizophrenia spectrum disorders, part II: psychosocial interventions and patient-focused perspectives in psychiatric care. Neuropsychiatr Dis Treat 2013; 9:1463-81. [PMID: 24109184 PMCID: PMC3792827 DOI: 10.2147/ndt.s49263] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Schizophrenia is a disabling psychiatric illness associated with disruptions in cognition, emotion, and psychosocial and occupational functioning. Increasing evidence shows that psychosocial interventions for people with schizophrenia, as an adjunct to medications or usual psychiatric care, can reduce psychotic symptoms and relapse and improve patients' long-term outcomes such as recovery, remission, and illness progression. This critical review of the literature was conducted to identify the common approaches to psychosocial interventions for people with schizophrenia. Treatment planning and outcomes were also explored and discussed to better understand the effects of these interventions in terms of person-focused perspectives such as their perceived quality of life and satisfaction and their acceptability and adherence to treatments or services received. We searched major health care databases such as EMBASE, MEDLINE, and PsycLIT and identified relevant literature in English from these databases. Their reference lists were screened, and studies were selected if they met the criteria of using a randomized controlled trial or systematic review design, giving a clear description of the interventions used, and having a study sample of people primarily diagnosed with schizophrenia. Five main approaches to psychosocial intervention had been used for the treatment of schizophrenia: cognitive therapy (cognitive behavioral and cognitive remediation therapy), psychoeducation, family intervention, social skills training, and assertive community treatment. Most of these five approaches applied to people with schizophrenia have demonstrated satisfactory levels of short- to medium-term clinical efficacy in terms of symptom control or reduction, level of functioning, and/or relapse rate. However, the comparative effects between these five approaches have not been well studied; thus, we are not able to clearly understand the superiority of any of these interventions. With the exception of patient relapse, the longer-term (eg, >2 years) effects of these approaches on most psychosocial outcomes are not well-established among these patients. Despite the fact that patients' perspectives on treatment and care have been increasingly concerned, not many studies have evaluated the effect of interventions on this perspective, and where they did, the findings were inconclusive. To conclude, current approaches to psychosocial interventions for schizophrenia have their strengths and weaknesses, particularly indicating limited evidence on long-term effects. To improve the longer-term outcomes of people with schizophrenia, future treatment strategies should focus on risk identification, early intervention, person-focused therapy, partnership with family caregivers, and the integration of evidence-based psychosocial interventions into existing services.
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Affiliation(s)
- Wai Tong Chien
- School of Nursing, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
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