Social cognition intervention in schizophrenia: Description of the training of affect recognition program - Indian version

A systematic review of the effectiveness and implementation readiness of psychosocial interventions for psychosis in South Asia

BACKGROUND

Little is known about the effectiveness and implementation of psychosocial interventions for psychosis in low- and middle-income countries (LMICs). In South Asia, specialist psychiatric resources are scarce. Support for psychosis often falls on the family or caregiver which can increase feelings of burden, impact caregivers' wellbeing, and increase mental health stigma. Psychosocial interventions are increasingly used for psychosis in South Asia and could reduce relapse and symptoms, reduce caregiver burden, conserve cost and resources. The aim of this review was to appraise the effectiveness and implementation readiness of psychosocial interventions for people with psychosis in South Asia.

METHOD

A systematic search was conducted on MEDLINE, PsycINFO, Global Health, and Web of Science. The review was prospectively registered on PROSPERO (CRD42022329254). Studies were rated on two scales assessing quality and implementation readiness.

RESULTS

Twenty-six papers were included, nine intervention-types including community-based interventions/assertive outreach; CaCBTp; FAP; psychoeducation; cognitive retraining/rehabilitation; social cognition/skills; family/ caregiver intervention; telehealth intervention; yoga-based intervention in six South Asian countries. Findings suggest a multicomponent community-based intervention (MCBI) was the most implementation ready due to its standardisation, good clinical outcomes for patients and caregivers, and training and cost evaluations.

CONCLUSION

Of the included studies, MCBI and community-based outreach interventions utilising lay health workers appear to be the most implementation ready and are suggested to best address the treatment gap in South Asia.

Living beyond the limitation: Rehabilitation, life and productivity of individuals with schizophrenia in South-West Nigeria

INTRODUCTION

Schizophrenia, the most chronic and stigmatized form of mental illness, can be described as a brain disorder that affects an individual's cognition. Individuals with schizophrenia exhibit socially unacceptable symptoms that affect their psychosocial lives. They suffer from reduced productivity due to the debilitating effect of the illness, and the negative symptoms impede their employability; such symptoms and effects aggravate the stigma around mental illness. However, when rehabilitation is successfully achieved, so is productivity, and this decreases the associated stigma. Thus, this study describes the rehabilitation experiences and productivity of individuals with schizophrenia in South-West Nigeria.

METHODS AND ANALYSIS

A descriptive qualitative approach with semi-structured interviews was used to gather information from mental health service users. The discharged users in this study received in-hospital or outpatient rehabilitation care at four outpatient units within two specialist mental health-care facilities in South-West Nigeria. These facilities offer vocational training and rehabilitation services for individuals with schizophrenia. Twenty-nine mental health service users were interviewed. The data from the interviews were independently analysed by two researchers through a content analysis approach using NVIVO version 11. The researchers compared the results of the analysis and reached an agreement on the conclusion.

FINDINGS AND RECOMMENDATIONS

The rehabilitation services availed by patients in the research setting are of three types. Some attend occupational rehabilitation to learn a trade; they depend on professionals for the choice of skill but at a cost that is not affordable to many. Some stay in rehabilitation units linked to the hospital, rendering their services at a cost, and their living expenses and skill acquisition processes are based on the remuneration they get from the services rendered to the institution. Others depend on their family members' efforts to afford rehabilitation services but set up on job by family or employed in family business. The mental health service users in this study who offered their services to the institutions were able to make informed decisions and showed better performance with their chosen occupation than those who depended on their family or health professionals for the choice of rehabilitation service or vocational career. Therefore, this study concludes that prioritizing mental health facility users' preferences in terms of productive activities (sales, services, vocation) or rehabilitation goals should be encouraged.

Well-informed but not aware: The P.A.C.T.® psychoeducation program for schizophrenia improves knowledge about, but not insight into, the illness

BACKGROUND

Most individuals with schizophrenia (SZ) have little to no insight regarding the presence of their illness. Psychoeducational programs are state-of-the-art interventions that consist in delivering stabilized patients with accurate knowledge about their illness and its treatment. Evidence suggests a significant relationship between levels of illness-related knowledge and insight in SZ patients. However, the effect of psychoeducation on these related outcomes needs to be explored further.

METHODS

In this open label study involving 30 French-speaking patients with SZ, we propose to compare levels of knowledge and insight before and after the French P.A.C.T.® psychoeducation program to investigate how this approach affects both outcomes. Knowledge levels were measured with the self-questionnaire "What do I know?". Insight levels were measured using the Scale to Assess Unawareness of Mental Disorder (SUMD). Symptoms were assessed with the Positive And Negative Syndrome Scale (PANSS).

RESULTS

A large significant improvement of knowledge was observed (p < 0.001; d = 0.77). By contrast, the analysis reported no significant effect of psychoeducation on insight (p = 0.86; d = 0.07). PANSS total scores were significantly decreased after treatment (p = 0.001; d = 0.66).

CONCLUSIONS

Although the P.A.C.T.® program is a promising tool for improving illness-related knowledge in SZ patients, its use is not sufficient to significantly improve insight levels.

Improving the quality of life of people with schizophrenia through community based rehabilitation in Yogyakarta Province, Indonesia: A quasi experimental study

OBJECTIVE

The persistent disability and low Quality of Life (QoL) are the impacts of schizophrenia. Community-Based Rehabilitation (CBR) is recommended for people with schizophrenia. The objective of this study is to analyze the effectiveness of CBR to improve the quality of life of people with schizophrenia.

METHODS

It was a quasi-experimental study, conducted in February-December 2017, in Yogyakarta, Indonesia. Subjectwere people with schizophrenia, 18-56 years old, with their caregiver. CBRintervention using psychoeducation module and social skill module during 12 weeks. It was conducted by local health workers, sub district social welfare workers, community health workers (called Kader in Indonesia) and supervised by a psychiatrist. The QoL was assessed using a validated measuring instrument at the baseline and at the week 16. Hypothesis test using Wilcoxon test RESULTS: There were 100 people with schizophrenia involved in the study. They were divided into intervention group and control group. Every group consists of 50 subjects. Both groups had similar characteristics at the baseline. The intervention group received CBR, whereas the control group didn't. Thirty-four people (68%) of intervention group increased their QoL, whereas in the control group there were twenty-three people (46%) increased their QoL. The QoL decrease occurred in one subject (4%) from the control group. Other subjects had constant QoL. Improvement of QoL in the intervention group is higher than the control group (p < 0.05).

CONCLUSIONS

CBR is effective for improving the QoL of people with schizophrenia in the community. CBR is conducted by the health worker and sub-district social welfare worker.