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Taban M, Nooraeen S, Tanha K, Moradi-Lakeh M, Malakouti SK. Effectiveness and cost-effectiveness of community-based mental health services for individuals with severe mental illness in Iran: a systematic review and meta-analysis. BMC Psychiatry 2024; 24:256. [PMID: 38575916 PMCID: PMC10993444 DOI: 10.1186/s12888-024-05666-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 03/07/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Severe mental illness (SMI) imposes a substantial worldwide burden of disability, highlighting the need for comprehensive and adaptable mental health services. This study aims to assess the efficacy and cost-effectiveness of community-based mental health services (CBMHS) in reducing relapse and rehospitalization rates among individuals with SMI in Iran. METHOD A systematic review and meta-analysis were conducted. Medline, EMBASE, ISI, SCOPUS, and ProQuest were searched until December 2022. We focused on randomized controlled trials, quasi-experimental studies, or economic studies related to individuals with SMI. Out of 127 articles, 17 were selected for a full-text review. The primary outcomes were the severity of psychopathology, rehospitalization rates, and the mental health of caregivers. We also examined community-based interventions and their impact on various outcomes. Data extraction and risk of bias assessment were performed, and critical appraisal was conducted using JBI checklists. Meta-analysis was carried out using STATA software. (PROSPERO registration. CRD42022332660). RESULT Rehospitalization rates among patients who received CBMHS were significantly lower, with an odds ratio of 2.14 (95% CI: 1.44 to 3.19), indicating a 2.14 times lower likelihood than those who received treatment as usual. A reduction in psychopathology accompanied this, SMD: -0.31, 95% CI: -0.49 to -0.13, I2 = 40.23%). Moreover, there was a notable improvement in social skills (SMD: -0.7, 95% CI: -0.98 to -0.44, I2 = 0.00%). The burden on caregivers also decreased (SMD: -0.55, 95% CI: -0.99 to -0.1, I2 = 63.2). The Incremental Cost-Effectiveness Ratio (ICER) for QUALY was acceptable, albeit with a wide range of 613 to 8400 Dollars. CONCLUSION CBMHS has demonstrated effectiveness and efficiency in Iran as a developing country. Additionally, it shows promise in mitigating the shortage of acute psychiatry beds. Using multiple data collection tools poses a limitation regarding data consolidation and conducting a meta-analysis.
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Affiliation(s)
- Mozhgan Taban
- Mental Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Sara Nooraeen
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Kiarash Tanha
- Oxford Vaccine Group, Department of Pediatrics, University of Oxford, Oxford, U.K
| | - Maziar Moradi-Lakeh
- Gastrointestinal and Liver Disease Research Center (GILDRC), Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Kazem Malakouti
- Geriatric Mental Health Research Center, School of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Iran.
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Zabihi Poursaadati M, Maarefvand M, Bolhari J, Hosseinzadeh S, Khubchandani J. The design and process of a family and community-based intervention for relapse prevention in people living with schizophrenia in Iran. Int J Soc Psychiatry 2022; 69:587-601. [PMID: 36200283 DOI: 10.1177/00207640221124438] [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] [Indexed: 11/17/2022]
Abstract
BACKGROUND People living with schizophrenia (PLS) suffer frequent relapse accompanied by emergency room visits, premature mortality, lower quality of life and a substantial social and economic burden on families and health systems. There is a dearth of community-based relapse prevention interventions (RPIs) in Iran. AIMS To determine an ideal model for a community-based RPIs for PLS. METHODS A qualitative study with 27 experts in Iran was carried out to understand the ideal RPIs for PLS and the key components of such interventions. RESULTS In 16 semi-structured interviews and 8 group-discussions, the participants identified six major stages of family and community-based RPIs including preparation, social mobilization, local team formation, design an RPI, implementing the RPI, participatory monitoring, and evaluation of the RPI. CONCLUSIONS Given the suboptimal healthcare systems and lack of professionals and services, PLS in Iran may benefit from family and community-based RPIs. Our findings warrant pilot testing of such initiatives across developing communities like Iran to improve health outcomes of PLS.
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Affiliation(s)
| | - Masoomeh Maarefvand
- Department of Social Work, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Jafar Bolhari
- Spiritual Health Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Samaneh Hosseinzadeh
- Biostatistics Department, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Jagdish Khubchandani
- Department of Public Health Sciences, New Mexico University, Las Cruces, NM, USA
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Nooraeen S, Javanbakht M, Malakouti SK. The Challenges of Providing Community Psychiatric Services in the COVID-19 Era: The Probability of Soaring Rehospitalization and Caregivers' Burden of People with Severe Mental Illnesses. Med J Islam Repub Iran 2022; 35:181. [PMID: 35706522 PMCID: PMC9168065 DOI: 10.47176/mjiri.35.181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Indexed: 11/09/2022] Open
Affiliation(s)
- Sara Nooraeen
- Mental Health Research Center, School of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Javanbakht
- Mental Health Research Center, School of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Kazem Malakouti
- Mental Health Research Center, School of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Iran
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Moghadam M, Seyedolshohadayi A, Rezvani K, Modaresi S, Saed G. Investigating the effects of post-discharge care services for patients with severe psychiatric illnesses on their caregivers' burnout in Sanandaj. Arch Psychiatr Nurs 2022; 37:61-68. [PMID: 35337440 DOI: 10.1016/j.apnu.2021.08.003] [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: 12/11/2020] [Revised: 07/14/2021] [Accepted: 08/04/2021] [Indexed: 11/30/2022]
Abstract
Family-based caregivers of psychiatric patients are the backbone of the healthcare system and are, in fact, generally considered as patients themselves. Their commitment and obligation to take care of the in-need and disabled patients in the family can lead to their psychological destruction. This paper attempts to investigate the effects of post-discharge care for patients with severe psychiatric illnesses on the burnout of their caregivers in the Qods Hospital of Sanandaj. This before-after study was performed on 72 subjects divided into two groups of 36, all of whom were chosen from the caregivers of the case and control subjects from family members of the psychiatric patients discharged from Qods psychiatric hospital in 2016. The study was effectively conducted with a control group design. The case group included patients who received home-care services after being discharged, and the caregiver group received nothing but regular care. First, using the hospital files, personal characteristics and diagnosis of the patient were recorded, thus the caregivers' characteristics and their burnout and psychological exhaustion severity were collected by caregiver burden inventory. The data were presented using descriptive-analytic indexes. The results represented that most of the caregivers (95.8%) suffered from moderate to severe burdens at the time of discharge. In using the Kolmogorov-Smirnov test, pre-test scores in two groups supported the normal hypotheses of the data (P = 0.55). Also, the level of significance in the covariance test showed the efficacy of intervention after the test (P = 0.000). In this study, most of the patients' caregivers with severe mental illnesses suffered from moderate to a severe burden, which, of course, seems to be more than other similar studies. Differences in social, cultural, and special regional conditions, as well as the type of applied questionnaire, were of significance. However, despite the mentioned difference, as it is true for other similar studies in Iran and other countries, home-care services have a significant effect on reducing the caregivers' burden after one year. Researches could, besides reducing the burnout of caregivers, provide a model which could help patients in the deprived areas without removing cultural and family roots and without diminishing the role of the family.
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Affiliation(s)
- Marzieh Moghadam
- School of Medicine, Neurosciences Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Asrin Seyedolshohadayi
- School of Medicine, Neurosciences Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran.
| | | | - Sara Modaresi
- Mental Health Expert, CMHC, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Golnia Saed
- Kurdistan University of Medical Sciences, Sanandaj, Iran
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Ebrahimi H, Seyedfatemi N, Namdar Areshtanab H, Ranjbar F, Thornicroft G, Whitehead B, Rahmani F. Barriers to Family Caregivers' Coping With Patients With Severe Mental Illness in Iran. QUALITATIVE HEALTH RESEARCH 2018; 28:987-1001. [PMID: 29478404 DOI: 10.1177/1049732318758644] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The broad spectrum of problems caused by caring for a patient with mental illness imposes a high burden on family caregivers. This can affect how they cope with their mentally ill family members. Identifying caregivers' experiences of barriers to coping is necessary to develop a program to help them overcome these challenges. This qualitative content analysis study explored barriers impeding family caregivers' ability to cope with their relatives diagnosed with severe mental illness (defined here as schizophrenia, schizoaffective disorders, and bipolar affective disorders). Sixteen family caregivers were recruited using purposive sampling and interviewed using a semi-structured in-depth interview method. Data were analyzed by a conventional content analytic approach. Findings consisted of four major categories: the patient's isolation from everyday life, incomplete recovery, lack of support by the mental health care system, and stigmatization. Findings highlight the necessity of providing support for caregivers by the mental health care delivery service system.
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Affiliation(s)
- Hossein Ebrahimi
- 1 Department of Psychiatric Nursing, School of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Naeimeh Seyedfatemi
- 2 Nursing Care Research Center. Iran University of Medical Sciences, Tehran, Iran
| | - Hossein Namdar Areshtanab
- 1 Department of Psychiatric Nursing, School of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fatemeh Ranjbar
- 3 Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | | | - Farnaz Rahmani
- 1 Department of Psychiatric Nursing, School of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
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Alzahrani SH, Fallata EO, Alabdulwahab MA, Alsafi WA, Bashawri J. Assessment of the burden on caregivers of patients with mental disorders in Jeddah, Saudi Arabia. BMC Psychiatry 2017; 17:202. [PMID: 28558771 PMCID: PMC5450140 DOI: 10.1186/s12888-017-1368-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 05/23/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Mental disorders are considered important public health problems not only to people with mental illness but also their caregivers. As is the case in many countries, the deinstitutionalization of mental health services in Saudi Arabia, has meant that informal caregivers are shouldering responsibilities for which they are not usually prepared; therefore, the current study was aimed at assessment of the burden on caregivers of people with mental illness. METHODS Through a cross-sectional design, a sample of the caregivers of people with mental illness (n = 377) was selected randomly from a psychiatric hospital in Jeddah. An Arabic version of the Involvement Evaluation Questionnaire (IEQ) was used for collection of data. The data were analyzed on the subscale scores and the 27 items in two ways. First, we used the summed scores for the subscales based on the Likert scale (0-4) for univariate and multivariate statistical analyses, as recommended. We also used parametric statistics (t-tests, one-way ANOVA) because the IEQ subscale scores were fairly normally distributed. RESULTS Males constituted more than one-half of the participating caregivers (55%), with a mean age of 36.6, SD = 11.4 years. As reported by the caregivers, most of the patients were males (62.7%) with a mean age of 33.8, SD = 13.7 years and a range of 17-90 years old. The total mean IEQ burden score of the caregivers was 38.4, SD = 17.5. "Tension" was significantly prominent among younger caregivers aged ≤30 years. "Worrying" was significantly higher among caregivers living with their spouse and children and those living in families with relatively fewer members (<6 members). "Urging" was significantly higher among caregivers who are living with the patient in the same household and those who had been in close contact with the patient for 28 days in the four weeks prior to the study (13.4, SD = 6.8) p < 0.05. Meanwhile, "Urging" was also significantly higher among caregivers caring for mentally ill females (13.5, SD = 6.6) and those not receiving any kind of professional support (12.8, SD = 6.7). The overall burden and the subscale scores were highest among caregivers caring for a close relative such as a parent (44.1, SD = 17.6), son/daughter (39.1, SD = 12.9), sibling (37.1, SD = 18.6), or spouse (37.1, SD = 18.6) p < 0.05. CONCLUSION Care for people with mental illness is burdensome for their caregivers, the magnitude of burden is potentially augmented by factors related to the patients and households. These factors should be considered when planning for preparing caregivers to cope with people with mental illness in Saudi Arabia.
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Affiliation(s)
- Sami H. Alzahrani
- 0000 0001 0619 1117grid.412125.1Family and Community Medicine Department, Faculty of Medicine, King Abdulaziz University, PO Box 80205, Jeddah, 21589 Saudi Arabia
| | | | | | - Wesam A. Alsafi
- Department of Psychiatry, Mental Health Hospital, Jeddah, Saudi Arabia
| | - Jamil Bashawri
- 0000 0001 0619 1117grid.412125.1Family and Community Medicine Department, Faculty of Medicine, King Abdulaziz University, PO Box 80205, Jeddah, 21589 Saudi Arabia
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Gurung D, Upadhyaya N, Magar J, Giri NP, Hanlon C, Jordans MJD. Service user and care giver involvement in mental health system strengthening in Nepal: a qualitative study on barriers and facilitating factors. Int J Ment Health Syst 2017; 11:30. [PMID: 28428815 PMCID: PMC5395761 DOI: 10.1186/s13033-017-0139-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 04/11/2017] [Indexed: 11/10/2022] Open
Abstract
Background Service user and caregiver involvement has become an increasingly common strategy to enhance mental health outcomes, and has been incorporated in the mental healthpolicies of many developed nations. However, this practice is non-existent or fragmented in low and middle income countries (LMICs). Instances of service user and caregiver involvement have been rising slowly in a few LMICs, but are rarely described in the literature. Very little is known about the context of user and caregiver participation in mental health system strengthening processes in a low-income, disaster- and conflict-affected state such as Nepal. Methods This study explores (a) the extent and experiences of service user and caregiver involvement in policy making, service planning, monitoring, and research in Nepal; (b) perceived barriers to such involvement; and (c) possible strategies to overcome barriers. Key Informant Interviews (n = 24) were conducted with service users and caregivers who were either affiliated to a mental health organization or receiving menta health care integrated within primary care. Purposive sampling was employed. Data collection was carried out in 2014 in Chitwan and Kathmandu districts of Nepal. Data analysis was carried out in NVivo10 using a framework approach. Results The involvement of service users affiliated to mental health organizations in policy development was reported to be ‘tokenistic’. Involvement of caregivers was non-existent. Perceived barriers to greater involvement included lack of awareness, stigma and discrimination, poor economic conditions, the centralized health system, and lack of strong leadership and unity among user organizations. Increased focus on reducing public as well as self-stigma, improved policy frameworks and initiatives, and decentralization of care are some strategies that may facilitate service user and caregiver involvement. Conclusion The study highlighted need for user and caregiver networks free from competing interests and priorities. Improved policy frameworks and decentralization of care may support meaningful service user and caregiver involvement. Electronic supplementary material The online version of this article (doi:10.1186/s13033-017-0139-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Dristy Gurung
- Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar, GPO Box 8974, Kathmandu, Nepal
| | - Nawaraj Upadhyaya
- Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar, GPO Box 8974, Kathmandu, Nepal.,HealthNet TPO, Amsterdam, The Netherlands
| | - Jananee Magar
- Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar, GPO Box 8974, Kathmandu, Nepal
| | - Nir Prakash Giri
- Nepal Mental Health Foundation (NMHF), Lazimpat, GPO Box 557, Kathmandu, Nepal
| | - Charlotte Hanlon
- Institute of Psychiatry, Psychology and Neuroscience, Centre for Global Mental Health, King's College London, London, UK.,Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, PO 9086, Addis Ababa, Ethiopia
| | - Mark J D Jordans
- Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar, GPO Box 8974, Kathmandu, Nepal.,Institute of Psychiatry, Psychology and Neuroscience, Centre for Global Mental Health, King's College London, London, UK.,War Child Holland, Helmholtzstraat 61-G, 1098 LE Amsterdam, The Netherlands
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Ahmadi M, Khalili H, Abbasian L, Ghaeli P. Effect of Valerian in Preventing Neuropsychiatric Adverse Effects of Efavirenz in HIV-Positive Patients: A Pilot Randomized, Placebo-Controlled Clinical Trial. Ann Pharmacother 2017; 51:457-464. [PMID: 28478716 DOI: 10.1177/1060028017696105] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Several neuropsychiatric adverse effects of efavirenz are known. Preventing these adverse effects may improve patients' adherence to antiretroviral therapy (ART). OBJECTIVES To evaluate the efficacy and safety of valerian in preventing neuropsychiatric adverse effects of efavirenz in HIV-positive patients. METHOD In this pilot randomized, double-blinded, placebo-controlled, clinical trial, 51 HIV-positive patients who were receiving efavirenz were recruited into the valerian (n = 25) or placebo (n = 26) group. Patients received valerian (530 mg) or placebo nightly 1 hour before sleep for 4 weeks. The neuropsychiatric status (sleep, anxiety, depression, suicidal thought, and psychosis) of patients was assessed at baseline and week 4 using validated questionnaires. RESULTS Sleep ( P ≤ 0.001) and anxiety ( P = 0.001) significantly improved in the valerian group compared with the placebo group. Dizziness was the most common complaint of patients in first days of the intervention. In the valerian and placebo groups, 92% and 84.6% of patients experienced dizziness, respectively ( P = 0.35). Nausea was the second common adverse effect that 84% and 76.9% of patients in the valerian and placebo groups experienced ( P = 0.39). CONCLUSION In the first 4 weeks of ART including efavirenz, valerian significantly improved sleep and anxiety in HIV-positive patients. Valerian may be considered as a potential option in preventing neuropsychiatric adverse effects of efavirenz in HIV-positive patients.
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Semrau M, Lempp H, Keynejad R, Evans-Lacko S, Mugisha J, Raja S, Lamichhane J, Alem A, Thornicroft G, Hanlon C. Service user and caregiver involvement in mental health system strengthening in low- and middle-income countries: systematic review. BMC Health Serv Res 2016; 16:79. [PMID: 26931580 PMCID: PMC4774091 DOI: 10.1186/s12913-016-1323-8] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Accepted: 02/17/2016] [Indexed: 11/15/2022] Open
Abstract
Background The involvement of mental health service users and their caregivers in health system policy and planning, service monitoring and research can contribute to mental health system strengthening, but as yet there have been very few efforts to do so in low- and middle-income countries (LMICs). Methods This systematic review examined the evidence and experience of service user and caregiver involvement in mental health system strengthening, as well as models of best practice for evaluation of capacity-building activities that facilitate their greater participation. Both the peer-reviewed and the grey literature were included in the review, which were identified through database searches (MEDLINE, Embase, PsycINFO, Web of Knowledge, Web of Science, Scopus, CINAHL, LILACS, SciELO, Google Scholar and Cochrane), as well as hand-searching of reference lists and the internet, and a snowballing process of contacting experts active in the area. This review included any kind of study design that described or evaluated service user, family or caregiver (though not community) involvement in LMICs (including service users with intellectual disabilities, dementia, or child and adolescent mental health problems) and that were relevant to mental health system strengthening across five categories. Data were extracted and summarised as a narrative review. Results Twenty papers matched the inclusion criteria. Overall, the review found that although there were examples of service user and caregiver involvement in mental health system strengthening in numerous countries, there was a lack of high-quality research and a weak evidence base for the work that was being conducted across countries. However, there was some emerging research on the development of policies and strategies, including advocacy work, and to a lesser extent the development of services, service monitoring and evaluation, with most service user involvement having taken place within advocacy and service delivery. Research was scarce within the other health system strengthening areas. Conclusions Further research on service user and caregiver involvement in mental health system strengthening in LMICs is recommended, in particular research that includes more rigorous evaluation. A series of specific recommendations are provided based on the review. Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1323-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Maya Semrau
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Heidi Lempp
- King's College London, Faculty of Life Sciences and Medicine, Academic Rheumatology, Clinical Trials Group, Weston Education Centre, 10, Cutcombe Rd., London, SE5 9RJ, UK
| | - Roxanne Keynejad
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Sara Evans-Lacko
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, 16 De Crespigny Park, London, SE5 8AF, UK
| | - James Mugisha
- Butabika National Referral and Teaching Hospital, Kampala, Uganda
| | - Shoba Raja
- Special Advisor, BasicNeeds, 158A Parade, Leamington Spa, Warwickshire, CV32 4AE, UK
| | | | - Atalay Alem
- Department of Psychiatry, Addis Ababa University, College of Health Sciences, School of Medicine, Addis Ababa, Ethiopia
| | - Graham Thornicroft
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Charlotte Hanlon
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, 16 De Crespigny Park, London, SE5 8AF, UK. .,Department of Psychiatry, Addis Ababa University, College of Health Sciences, School of Medicine, Addis Ababa, Ethiopia.
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Malakouti SK, Nojomi M, Mirabzadeh A, Mottaghipour Y, Zahiroddin A, Kangrani HM. A Comparative Study of Nurses as Case Manager and Telephone Follow-up on Clinical Outcomes of Patients with Severe Mental Illness. IRANIAN JOURNAL OF MEDICAL SCIENCES 2016; 41:19-27. [PMID: 26722141 PMCID: PMC4691265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2013] [Revised: 02/10/2014] [Accepted: 02/23/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Providing community-based mental health services is crucial and is an agreed plan between the Iranian Mental Health Office and the Regional Committee for the Eastern Mediterranean (affiliated with WHO). The aim of this study was to determine the effectiveness of home-visit clinical case-management services on the hospitalization rate and other clinical outcomes in patients with severe mental illness. METHODS A total of 182 patients were randomly allocated into three groups, namely, home-visit (n=60), telephone follow-up (n=61) and as-usual care (n=61) groups. Trained nurses as clinical case-managers provided home-visit services and the telephone follow-up tasks. Hospitalization rate as a measure of recurrence, as well as burden, knowledge, general health condition of caregivers with positive/negative symptoms, satisfaction, quality of life, and social skills of the consumers were assessed as the main and secondary outcomes, respectively. RESULTS Most clinical variables were improved in both intervention groups compared with the control group. During the one year follow-up, the rate of rehospitalization for the telephone follow-up and as-usual groups were respectively 1.5 and 2.5 times higher than the home-visit group. CONCLUSION Trained clinical case-managers are capable of providing continuous care services to patients with severe mental illness. The telephone follow-up services could also have beneficiary outcome for the consumers, their caregivers, and the health system network.
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Affiliation(s)
- Seyed Kazem Malakouti
- Mental Health Research Centre, Department of Psychiatry, Iran University of Medical Sciences, Tehran, Iran
| | - Marzieh Nojomi
- Department of Community Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Arash Mirabzadeh
- Health Research Center, Department of Psychiatry and Social Determinants, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Yasaman Mottaghipour
- Department of Psychiatry, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Zahiroddin
- Behavioral Science Research Center, Department of Psychiatry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamed Mohammadi Kangrani
- Department of Psychiatry, Razi Hospital, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Yesufu-Udechuku A, Harrison B, Mayo-Wilson E, Young N, Woodhams P, Shiers D, Kuipers E, Kendall T. Interventions to improve the experience of caring for people with severe mental illness: systematic review and meta-analysis. Br J Psychiatry 2015; 206:268-74. [PMID: 25833867 DOI: 10.1192/bjp.bp.114.147561] [Citation(s) in RCA: 165] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Informal caregiving is an integral part of the care of people with severe mental illness, but the support needs of those providing such care are not often met. AIMS To determine whether interventions provided to people caring for those with severe mental illness improve the experience of caring and reduce caregiver burden. METHOD We conducted a systematic review and meta-analyses of randomised controlled trials (RCTs) of interventions delivered by health and social care services to informal carers (i.e. family or friends who provide support to someone with severe mental illness). RESULTS Twenty-one RCTs with 1589 carers were included in the review. There was evidence suggesting that the carers' experience of care was improved at the end of the intervention by psychoeducation (standardised mean difference -1.03, 95% CI -1.69 to -0.36) and support groups (SMD = -1.16, 95% CI -1.96 to -0.36). Psychoeducation had a benefit on psychological distress more than 6 months later (SMD = -1.79, 95% CI -3.01 to -0.56) but not immediately post-intervention. Support interventions had a beneficial effect on psychological distress at the end of the intervention (SMD = -0.99, 95% CI -1.48 to -0.49) as did problem-solving bibliotherapy (SMD = -1.57, 95% CI -1.79 to -1.35); these effects were maintained at follow-up. The quality of the evidence was mainly low and very low. Evidence for combining these interventions and for self-help and self-management was inconclusive. CONCLUSIONS Carer-focused interventions appear to improve the experience of caring and quality of life and reduce psychological distress of those caring for people with severe mental illness, and these benefits may be gained in first-episode psychosis. Interventions for carers should be considered as part of integrated services for people with severe mental health problems.
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Affiliation(s)
- Amina Yesufu-Udechuku
- Amina Yesufu-Udechuku, PhD, Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London; Bronwyn Harrison, BSc, National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK; Evan Mayo-Wilson, DPhil, Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA; Norman Young, MSc, Cardiff and Vale UHB and Cardiff University, Whitchurch Hospital, Cardiff; Peter Woodhams, MCIPD, Carer, Alveston, Stratford upon Avon; David Shiers, MBChB, retired GP, National Audit of Schizophrenia, Royal College of Psychiatrists, London; Elizabeth Kuipers, PhD, Department of Clinical Psychology, King's College London, Institute of Psychiatry, and National Institute for Health Research Mental Health Biomedical Research Centre and Dementia Unit, London; Tim Kendall, FRCPsych, National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK
| | - Bronwyn Harrison
- Amina Yesufu-Udechuku, PhD, Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London; Bronwyn Harrison, BSc, National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK; Evan Mayo-Wilson, DPhil, Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA; Norman Young, MSc, Cardiff and Vale UHB and Cardiff University, Whitchurch Hospital, Cardiff; Peter Woodhams, MCIPD, Carer, Alveston, Stratford upon Avon; David Shiers, MBChB, retired GP, National Audit of Schizophrenia, Royal College of Psychiatrists, London; Elizabeth Kuipers, PhD, Department of Clinical Psychology, King's College London, Institute of Psychiatry, and National Institute for Health Research Mental Health Biomedical Research Centre and Dementia Unit, London; Tim Kendall, FRCPsych, National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK
| | - Evan Mayo-Wilson
- Amina Yesufu-Udechuku, PhD, Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London; Bronwyn Harrison, BSc, National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK; Evan Mayo-Wilson, DPhil, Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA; Norman Young, MSc, Cardiff and Vale UHB and Cardiff University, Whitchurch Hospital, Cardiff; Peter Woodhams, MCIPD, Carer, Alveston, Stratford upon Avon; David Shiers, MBChB, retired GP, National Audit of Schizophrenia, Royal College of Psychiatrists, London; Elizabeth Kuipers, PhD, Department of Clinical Psychology, King's College London, Institute of Psychiatry, and National Institute for Health Research Mental Health Biomedical Research Centre and Dementia Unit, London; Tim Kendall, FRCPsych, National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK
| | - Norman Young
- Amina Yesufu-Udechuku, PhD, Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London; Bronwyn Harrison, BSc, National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK; Evan Mayo-Wilson, DPhil, Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA; Norman Young, MSc, Cardiff and Vale UHB and Cardiff University, Whitchurch Hospital, Cardiff; Peter Woodhams, MCIPD, Carer, Alveston, Stratford upon Avon; David Shiers, MBChB, retired GP, National Audit of Schizophrenia, Royal College of Psychiatrists, London; Elizabeth Kuipers, PhD, Department of Clinical Psychology, King's College London, Institute of Psychiatry, and National Institute for Health Research Mental Health Biomedical Research Centre and Dementia Unit, London; Tim Kendall, FRCPsych, National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK
| | - Peter Woodhams
- Amina Yesufu-Udechuku, PhD, Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London; Bronwyn Harrison, BSc, National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK; Evan Mayo-Wilson, DPhil, Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA; Norman Young, MSc, Cardiff and Vale UHB and Cardiff University, Whitchurch Hospital, Cardiff; Peter Woodhams, MCIPD, Carer, Alveston, Stratford upon Avon; David Shiers, MBChB, retired GP, National Audit of Schizophrenia, Royal College of Psychiatrists, London; Elizabeth Kuipers, PhD, Department of Clinical Psychology, King's College London, Institute of Psychiatry, and National Institute for Health Research Mental Health Biomedical Research Centre and Dementia Unit, London; Tim Kendall, FRCPsych, National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK
| | - David Shiers
- Amina Yesufu-Udechuku, PhD, Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London; Bronwyn Harrison, BSc, National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK; Evan Mayo-Wilson, DPhil, Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA; Norman Young, MSc, Cardiff and Vale UHB and Cardiff University, Whitchurch Hospital, Cardiff; Peter Woodhams, MCIPD, Carer, Alveston, Stratford upon Avon; David Shiers, MBChB, retired GP, National Audit of Schizophrenia, Royal College of Psychiatrists, London; Elizabeth Kuipers, PhD, Department of Clinical Psychology, King's College London, Institute of Psychiatry, and National Institute for Health Research Mental Health Biomedical Research Centre and Dementia Unit, London; Tim Kendall, FRCPsych, National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK
| | - Elizabeth Kuipers
- Amina Yesufu-Udechuku, PhD, Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London; Bronwyn Harrison, BSc, National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK; Evan Mayo-Wilson, DPhil, Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA; Norman Young, MSc, Cardiff and Vale UHB and Cardiff University, Whitchurch Hospital, Cardiff; Peter Woodhams, MCIPD, Carer, Alveston, Stratford upon Avon; David Shiers, MBChB, retired GP, National Audit of Schizophrenia, Royal College of Psychiatrists, London; Elizabeth Kuipers, PhD, Department of Clinical Psychology, King's College London, Institute of Psychiatry, and National Institute for Health Research Mental Health Biomedical Research Centre and Dementia Unit, London; Tim Kendall, FRCPsych, National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK
| | - Tim Kendall
- Amina Yesufu-Udechuku, PhD, Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London; Bronwyn Harrison, BSc, National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK; Evan Mayo-Wilson, DPhil, Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA; Norman Young, MSc, Cardiff and Vale UHB and Cardiff University, Whitchurch Hospital, Cardiff; Peter Woodhams, MCIPD, Carer, Alveston, Stratford upon Avon; David Shiers, MBChB, retired GP, National Audit of Schizophrenia, Royal College of Psychiatrists, London; Elizabeth Kuipers, PhD, Department of Clinical Psychology, King's College London, Institute of Psychiatry, and National Institute for Health Research Mental Health Biomedical Research Centre and Dementia Unit, London; Tim Kendall, FRCPsych, National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK
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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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14
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Chen M, Wu G, Wang Z, Yan J, Zhou J, Ding Y, Jiang Y, Rao S, Zhou Q, Ni H, Zhao J, Su Y, Hu J, Zhang Y, Yi Z, Yang W, Song L. Two-year prospective case-controlled study of a case management program for community-dwelling individuals with schizophrenia. SHANGHAI ARCHIVES OF PSYCHIATRY 2014; 26:119-28. [PMID: 25114486 PMCID: PMC4118008 DOI: 10.3969/j.issn.1002-0829.2014.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 04/08/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND A community-based rehabilitation program is an essential element of the comprehensive treatment of individuals with schizophrenia. OBJECTIVE Assess the long-term effects of a community-based case management program for providing rehabilitations services to individuals with schizophrenia. METHODS A total of 730 community-residing participants who met ICD-10 diagnostic criteriafor schizophrenia were enrolled, 380 in the case management group and 350 in the control group from two districts in Shanghai. Case management involved monthly training visits with patients and their co-resident family members that focused on encouraging medication adherence. Participants were assessed every three months for 24 months with the Camberwell Assessment of Need (CAN), Positive and Negative Syndrome Scale (PANSS), WHO-Disability Assessment Scale (WHO-DAS), and the Quality of Life Scale (QOLS). Level of discomfort due to side-effects was also assessed every three months. Individuals who discontinued their antipsychotic medication without physician approval for one month or longer at any time during follow-up were classified as 'self-determined medication discontinuation'. RESULTS Compared to the treatment as usual group (i.e., follow-up management every 3 months), by the end of the two-year follow-up those who participated in the case management program had significantly lower rates of medication discontinuation, significantly less severe negative symptoms, lower relapse rates and lower rehospitalization rates. Other factors that had an independent effect on discontinuation of medication included educational level (those with more education had higher discontinuation rates), lack of family supervision of medication, higher dosages of medication, and greater medication-related discomfort. CONCLUSIONS Case management is a feasible and effective long-term method for improving the rehabilitation outcomes of community residents with schizophrenia. Our results highlight the need to involve family members in the management of patients' medication, to use the minimum effective dosage of medication, and to aggressively manage all side-effects.
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Affiliation(s)
- Meijuan Chen
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guojun Wu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zuowei Wang
- Hongkou Mental Health Center, Shanghai, China
| | - Jun Yan
- Hongkou Mental Health Center, Shanghai, China
| | | | - Yan Ding
- Hongkou Mental Health Center, Shanghai, China
| | - Yaqin Jiang
- Hongkou Mental Health Center, Shanghai, China
| | | | - Qing Zhou
- Xuhui Mental Health Center, Shanghai, China
| | - Hua Ni
- Xuhui Mental Health Center, Shanghai, China
| | - Jun Zhao
- Xuhui Mental Health Center, Shanghai, China
| | - Yanli Su
- Xuhui Mental Health Center, Shanghai, China
| | - Jun Hu
- Xuhui Mental Health Center, Shanghai, China
| | - Yi Zhang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhenghui Yi
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weimin Yang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lisheng Song
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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15
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Gong W, Xu D, Zhou L, Brown HS, Smith KL, Xiao S. Village doctor-assisted case management of rural patients with schizophrenia: protocol for a cluster randomized control trial. Implement Sci 2014; 9:13. [PMID: 24433461 PMCID: PMC3929227 DOI: 10.1186/1748-5908-9-13] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 12/27/2013] [Indexed: 01/07/2023] Open
Abstract
Background Strict compliance with prescribed medication is the key to reducing relapses in schizophrenia. As villagers in China lack regular access to psychiatrists to supervise compliance, we propose to train village ‘doctors’ (i.e., villagers with basic medical training and currently operating in villages across China delivering basic clinical and preventive care) to manage rural patients with schizophrenia with respect to compliance and monitoring symptoms. We hypothesize that with the necessary training and proper oversight, village doctors can significantly improve drug compliance of villagers with schizophrenia. Methods/design We will conduct a cluster randomized controlled trial in 40 villages in Liuyang, Hunan Province, China, home to approximately 400 patients with schizophrenia. Half of the villages will be randomized into the treatment group (village doctor, or VD model) wherein village doctors who have received training in a schizophrenia case management protocol will manage case records, supervise drug taking, educate patients and families on schizophrenia and its treatment, and monitor patients for signs of relapse in order to arrange prompt referral. The other 20 villages will be assigned to the control group (case as usual, or CAU model) wherein patients will be visited by psychiatrists every two months and receive free antipsychotic medications under an on-going government program, Project 686. These control patients will receive no other management or follow up from health workers. A baseline survey will be conducted before the intervention to gather data on patient’s socio-economic status, drug compliance history, and clinical and health outcome measures. Data will be re-collected 6 and 12 months into the intervention. A difference-in-difference regression model will be used to detect the program effect on drug compliance and other outcome measures. A cost-effectiveness analysis will also be conducted to compare the value of the VD model to that of the CAU group. Discussion/implications Lack of specialists is a common problem in resource-scarce areas in China and other developing countries. The results of this experiment will provide high level evidence on the role of health workers with relatively limited medical training in managing severe psychiatric disease and other chronic conditions in developing countries. Trial registration ChiCTR-TRC-13003263.
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Affiliation(s)
| | | | | | | | | | - Shuiyuan Xiao
- School of Public Health, Central South University, 110 Xiangya Road, Changsha 410078, Hunan, China.
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Dabaghzadeh F, Ghaeli P, Khalili H, Alimadadi A, Jafari S, Akhondzadeh S, Khazaeipour Z. Cyproheptadine for prevention of neuropsychiatric adverse effects of efavirenz: a randomized clinical trial. AIDS Patient Care STDS 2013; 27:146-54. [PMID: 23442031 DOI: 10.1089/apc.2012.0410] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Cyproheptadine prevention of the neuropsychiatric adverse effects of an antiretroviral regimen including efavirenz has been evaluated in a randomized clinical trial. Twenty-five patients (16 males and 9 females with mean±SD ages of 36±9 years) in a cyproheptadine group, and 26 patients (17 males and 9 females with mean±SD ages of 34±7 years) in a control group completed the trial. Sexual contact and injection drug use were the main routs of HIV infection in both groups. The patients' neuropsychiatric adverse effects were evaluated based on the Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, Positive and Negative Syndrome Scale, Beck Depression Scale, Pittsburgh Sleep Quality Inventory, Positive and Negative Suicide Ideation, and Somatization Subscale of Symptom Checklist 90 at baseline and 4 weeks after treatment. Cyproheptadine significantly decreased the scores of Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, Positive and Negative Syndrome Scale, Beck Depression Scale, Pittsburgh Sleep Quality Inventory, Positive and Negative Suicide Ideation of the patients after 4 weeks in comparison with control group. All of the scores increased in control group following antiretroviral therapy. Although short duration of the patients' follow-up was a major limitation of the study, the results of the study showed that cyprohepradine is effective in prevention of depression, anxiety, hallucination, aggressive behaviors, emotional withdrawal, poor rapport, poor impulse control, active social avoidance, suicidal ideation, and improved sleep quality of HIV-positive patients after initiation of antiretroviral therapy including efavirenz.
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Affiliation(s)
- Fatemeh Dabaghzadeh
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
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17
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Effectiveness of a low-intensity home-based aftercare for patients with severe mental disorders: a 12-month randomized controlled study. Community Ment Health J 2012; 48:766-70. [PMID: 22772746 DOI: 10.1007/s10597-012-9516-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2011] [Accepted: 06/27/2012] [Indexed: 10/28/2022]
Abstract
To examine the effectiveness of a low-intensity home-based aftercare service, 130 patients with schizophrenia, schizoaffective disorder or bipolar disorder were randomized to receive either home aftercare or treatment-as-usual. In home aftercare, a general practitioner and a social worker made home visits once in a month after discharge from the hospital wherein they provided education and treatment. In a 1-year follow-up, home aftercare led to greater reduction in rehospitalization rate, more improvement in psychotic symptoms and global illness severity, as well as greater service satisfaction. The implementation of this low-intensity aftercare is recommended, especially in less resourceful settings.
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Sharif F, Shaygan M, Mani A. Effect of a psycho-educational intervention for family members on caregiver burdens and psychiatric symptoms in patients with schizophrenia in Shiraz, Iran. BMC Psychiatry 2012; 12:48. [PMID: 22632135 PMCID: PMC3441201 DOI: 10.1186/1471-244x-12-48] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Accepted: 05/09/2012] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND This study explored the effectiveness of family psycho-education in reducing patients' symptoms and on family caregiver burden. METHODS Seventy Iranian outpatients with a diagnosis of schizophrenia disorder and their caregivers were randomly allocated to the experimental (n = 35) or control groups (n = 35). Patients in the experimental group received antipsychotic drug treatment and a psycho-educational program was arranged for their caregivers. The psycho-educational program consisted of ten 90-min sessions held during five weeks (two session in each week). Each caregiver attended 10 sessions (in five weeks) At baseline, immediately after intervention, and one month later. Validated tools were used to assess patients' clinical status and caregiver burden. RESULTS Compared with the control group, the case group showed significantly reduced symptom severity and caregiver burden both immediately after intervention and one month later. CONCLUSIONS These results suggest that even need based short-term psycho-educational intervention for family members of Iranian patients with schizophrenic disorder may improve the outcomes of patients and their families. TRIAL REGISTRATION IRCT Number:138809122812 N1`.
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Affiliation(s)
- Farkhondeh Sharif
- Department of Mental Health & Psychiatric Nursing, Community Based Nursing & Midwifery Research Center, Faculty of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran.
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Psychopathology, rehospitalization and quality of life among patients with schizophrenia under home care case management in Taiwan. J Formos Med Assoc 2012; 112:208-15. [PMID: 23537867 DOI: 10.1016/j.jfma.2012.01.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Revised: 01/12/2012] [Accepted: 01/31/2012] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND/PURPOSE To study the outcome of a group of patients with schizophrenia receiving community home care case management programs by delineating the relationship among their psychopathology, rehospitalization rates and health-related quality of life (HRQoL). METHODS This is a cross-sectional study on HRQoL, functioning and associating factors and a retrospectivehistorical control study by comparing the frequency and duration of rehospitalization in a sample of 60 patients with schizophrenia under nonintensive case management (non-ICM) in Taiwan. All participants were assessed on the Positive and Negative Syndrome Scale for Schizophrenia (PANSS) for psychopathology, on EuroQoL-5D (EQ-5D) and EQ visual analogue (EQ-VAS) for HRQoL, andGlobal Assessment of Functioning (GAF) for socio-occupational dysfunction. Other clinical characteristics are also gathered. RESULTS Patients with schizophrenia treated with non-ICM had a significant reduction in admission frequency (-0.10 ± 0.36 times per year, p = 0.042) and length of inpatient stay (-27.8 ± 78.0 days per year, p = 0.008). Better EQ-5D and EQ-VAS are significantly associated with lower general psychopathology score, while better EQ-VAS is significantly associated with older age and higher negative symptoms subscale score. GAF is negatively associated with higher positive symptoms and negative symptoms subscale scores, while positively correlated with a greater reduction in number and frequency of admission. CONCLUSION Non-ICM can help to decrease rehospitalization of home care patients. HRQoL and functioning can be assessed by the three perspectives we used, and each measure was correlated to different dimensions of patient psychopathology. It will be better if we include baseline and post-intervention PANSS scores, HRQoL and functioning as outcome indicators.
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Farsi version of the Neuropsychiatric Inventory: validity and reliability study among Iranian elderly with dementia. Int Psychogeriatr 2012; 24:223-30. [PMID: 21995955 DOI: 10.1017/s1041610211001797] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND This study aimed to validate the Farsi version of Neuropsychiatric Inventory (F-NPI), with the aim of promoting clinical assessment and local research on evaluation of neuropsychiatric symptom profiles of individuals with dementia in Iran. METHODS In this cross-sectional, psychometric study, 100 patients with dementia in the age range of 60–90 years participated. Two trained psychiatrists interviewed the study subjects. Positive and Negative Symptoms Scale (PANSS) and Geriatric Depression Scale (GDS) were used to determine the concurrent validity. Testretest,inter-rater reliability and internal consistency were calculated. Discrimination validity was determined,using a matched control group consisting of 49 participants without dementia. Cronbach’s α and Pearson’ scorrelation coefficients were used to analyze the data. RESULTS The internal consistency (Cronbach’s α = 0.9) was excellent. The inter-rater reliability varied between 0.6 and 0.98 for frequency, severity and total scale of the F-NPI, and test-retest reliability was between 0.4 and 0.96. Concurrent validity varied between 0.3 and 0.9 (P < 0.05). The most prevalent symptom was “apathy” and the least prevalent was “euphoria”. CONCLUSION The Farsi version of NPI has satisfactory psychometric indexes and is applicable for clinical and study works in Iranian community.
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Zahid MA, Ohaeri JU. Relationship of family caregiver burden with quality of care and psychopathology in a sample of Arab subjects with schizophrenia. BMC Psychiatry 2010; 10:71. [PMID: 20831806 PMCID: PMC2945972 DOI: 10.1186/1471-244x-10-71] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2010] [Accepted: 09/10/2010] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Although the burden experienced by families of people with schizophrenia has long been recognized as one of the most important consequences of the disorder, there are no reports from the Arab world. Following the example of the five-nation European (EPSILON) study, we explored the following research question: How does the relationship between domains of caregiving (as in the Involvement Evaluation Questionnaire--IEQ-EU) and caregiver psychic distress on the one hand, and caregiver's/patient's socio-demographics, clinical features and indices of quality of care, on the other hand, compare with the pattern in the literature? METHOD Consecutive family caregivers of outpatients with schizophrenia were interviewed with the IEQ-EU. Patients were interviewed with measures of needs for care, service satisfaction, quality of life (QOL) and psychopathology. RESULTS There were 121 caregivers (66.1% men, aged 39.8). The IEQ domain scores (total: 46.9; tension: 13.4; supervision: 7.9; worrying: 12.9; and urging: 16.4) were in the middle of the range for the EU data. In regression analyses, higher burden subscale scores were variously associated with caregiver lower level of education, patient's female gender and younger age, as well as patient's lower subjective QOL and needs for hospital care, and not involving the patient in outdoor activities. Disruptive behavior was the greatest determinant of global rating of burden. CONCLUSION Our results indicate that, despite differences in service set-up and culture, the IEQ-EU can be used in Kuwait as it has been used in the western world, to describe the pattern of scores on the dimensions of caregiving. Differences with the international data reflect peculiarities of culture and type of service. Despite generous national social welfare provisions, experience of burden was the norm and was significantly associated with patient's disruptive behavior. The results underscore the need for provision of community-based programs and continued intervention with the families in order to improve the quality of care.
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Affiliation(s)
- Muhammad A Zahid
- Department of Psychiatry, Faculty of Medicine, Kuwait University; P,O, Box 24923, Safat 13110, Kuwait.
| | - Jude U Ohaeri
- Department of Psychiatry, Psychological Medicine Hospital, Kuwait
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