Effects of Relaxation Exercises and Music Therapy on the Psychological Symptoms and Depression Levels of Patients with Schizophrenia

Efficacy of music therapy and predictors of sleep disturbance among patients with chronic schizophrenia: A prospective study

STUDY OBJECTIVES

Patients with schizophrenia often suffer from sleep disturbance. Music therapy, as a non-invasive intervention, may have benefit on sleep problem in such population. Our study aimed to investigate the efficacy of music therapy on sleep disturbance among patients with schizophrenia.

METHOD

This prospective study recruited participants with schizophrenia along with sleep disturbances in the chronic wards. Patients in the control group received standard care, and those in the intervention group received additional music therapy before sleeping at night for four weeks. The Pittsburgh Sleep Quality Index (PSQI) was used to measure the severity of sleep disturbance. The generalized estimating equation (GEE) was used to analyze measure the difference of change in PSQI scores between both groups at the baseline and four weeks later. It was also applied to find the predictors of treatment efficacy within intervention group.

FINDINGS

A total of 66 (31 in control group and 35 in intervention group) participants were recruited. After adjusting with the demographic variables, the change of PSQI among intervention group was significantly more than the change among control group (Group × time; Estimate = -7.05, p < 0.001), indicating the efficacy of music therapy. In addition, irreligious patients and those with chronic medical disease predicted better efficacy. Whereas, elderly patients had compromising efficacy of music therapy.

CONCLUSION

Music therapy demonstrated its merit on sleep disturbance among patients with schizophrenia. Whereas, healthcare workers should consider the variability of severity in schizophrenia during clinical practice.

The efficacy of complementary and traditional practice on psychiatric patients with depression symptoms: A meta- analysis study

PURPOSE

This study examined the effect sizes of the complementary and traditional practices on the depressive symptom levels in psychiatric patients DESIGN AND METHODS: The "Health Evidence™ Quality Assessment Tool" and "Comprehensive Meta-Analysis 3" program was used.

FINDINGS

A total of 81 studies with 5934 patients were included. The effect size of the complementary and traditional methods applied to psychiatric patient on depressive symptoms was calculated as d = 0.718 (p = 0.000). According to Cohen, studies have moderate effect size.

PRACTICE IMPLICATIONS

Complementary and traditional practices were found to be significant and effective on depressive symptoms in psychiatric patients.

Music Therapy vs. Music Listening for Negative Symptoms in Schizophrenia: Randomized, Controlled, Assessor- and Patient-Blinded Trial

Objective: To investigate the efficacy of music therapy for negative symptoms in patients with schizophrenia. Methods: Randomized, participant- and assessor-blinded, multicenter, controlled trial including patients diagnosed with schizophrenia according to ICD-10 with predominantly negative symptoms, between 18 and 65 years. Participants were randomized to 25 successive weekly individual sessions (excluding holidays, including cancellation by the participant) of either music therapy conducted by trained music therapists, or music listening together with a social care worker. The primary outcome was reduction in negative symptoms as measured by The Positive and negative Syndrome Scale (PANSS) negative subscale total score, assessed by a blinded rater, utilizing mixed-effects model analysis. Results: In total, 57 participants were randomized; 39 completed the study's initial 15 weeks, and 30 completed follow-up at 25 weeks. On the primary outcome of PANSS negative subscale, no significant difference was observed between groups with a coefficient of -0.24 (95% CI -1.76 to 1.27, P = 0.754) in the intention to treat analysis, and -0.98 (95% CI -5.06 to 3.09, P = 0.625) when only analyzing completers. Both interventions showed significant reduction from baseline to 25 weeks on PANSS negative subscale. On secondary outcomes, no between group differences were observed in The Brief Negative Symptom Scale, WHOQOL-Bref (Quality of Life), The Helping Alliance Questionnaire and The Global Assessment of Functioning in the intention to treat or completers populations utilizing Mixed Effects Models. Conclusion: No difference between groups randomized to music therapy vs. musical listening was observed resulting in no clear recommendation for which intervention to use as the first choice for treatment of patients diagnosed with schizophrenia and predominantly having negative symptoms. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT02942459.

Effectiveness of autogenic relaxation training in addition to usual physiotherapy on emotional state and functional independence of stroke survivors

INTRODUCTION

The occurrence of post-stroke emotional problems is significant during the early post-stroke stage and affects the recovery of functionality among the survivors. Because stroke survivors require active engagement in rehabilitation to optimize the process of neuroplasticity in the initial stage of stroke, there is a need to integrate an intervention, preferably therapists-mediated during rehabilitation, which reduce emotional problems thus improve motivation level among the survivors. One such technique is autogenic relaxation training (ART). ART has been found to reduce anxiety and depression among patients with several medical conditions. However, its usage in stroke survivors during rehabilitation has been limited to date. Therefore, this study is intended to evaluate the effectiveness of ART in addition to usual physiotherapy in improving emotional state and functional level of stroke survivors during rehabilitation.

METHODS

This is an assessor blinded randomized controlled trial comparing 2 intervention approaches namely ART-added physiotherapy (experimental group) and usual physiotherapy (control group). A total of 70 post-stroke patients will be recruited and allocated into either the ART-added physiotherapy or the usual physiotherapy group. The ART-added physiotherapy group will undergo a 20-minute ART session followed by 40 minutes of usual physiotherapy. While the usual physiotherapy group will receive usual physiotherapy alone for 60 minutes. All participants will be treated once a week and are required to carry out a set of home exercises for 2 times per week during the 12-week intervention. Assessment of emotional status and functional independence will be carried out at pre-intervention and week 13 of the intervention with the use of Hospital anxiety and depression scale, Barthel index, and EuroQol-5 dimensions-5 levels. All data will be analyzed using descriptive and inferential statistics.

DISCUSSION

The expected main study outcome is an enhanced evidence-based physiotherapy program that may be used by physiotherapists in the rehabilitation of stroke patients with emotional disturbances.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry, ACTRN12619001664134 (last updated on 28/11/2019).

Strategies for Psychiatric Rehabilitation and their Cognitive Outcomes in Schizophrenia: Review of Last Five-year Studies

BACKGROUND

Cognitive deficits are core features of Schizophrenia, showing poor response to antipsychotic treatment, therefore non-pharmacological rehabilitative approaches to such a symptom domain need to be identified. However, since not all patients with Schizophrenia exhibit the same cognitive impairment profile, individualized rehabilitative approaches should be set up.

OBJECTIVES

We explored the last five-year literature addressing the issue of cognitive dysfunction response to rehabilitative methodologies in Schizophrenia to identify possible predictors of response and individualized strategies to treat such a dysfunction.

CONCLUSION

A total of 76 studies were reviewed. Possible predictors of cognitive rehabilitation outcome were identified among patient-specific and approach-specific variables and a general overview of rehabilitative strategies used in the last five years has been depicted. Studies suggest the existence of multifaced and multi-domain variables that could significantly predict pro-cognitive effects of cognitive rehabilitation, which could also be useful for identifying individual-specific rehabilitation trajectories over time.An individualized rehabilitative approach to cognitive impairment in Schizophrenia is possible if taking into account both patient and approach specific predictors of outcomes.

Effects of progressive muscle relaxation training with music therapy on sleep and anger of patients at Community Mental Health Center

OBJECTIVE

The objective is to examine the effects of progressive muscle relaxation training and music therapy applied to chronic psychiatric patients attending the Community Mental Health Center (CMHC) on their anger level and sleep quality.

METHODS

The sample of the study consisted of 66 chronic psychiatric patients (n = 32 in the control group; n = 34 in the intervention group). Progressive muscle relaxation training with music therapy were implemented in the intervention group as 2 sessions per week for 3 months.

RESULTS

A statistically significant difference was found between the pre-test and post-test mean scores of the intervention group (p ≤ .001). After the intervention, a statistically significant difference was found between the PSQI, anger-in, anger-out, anger-control, and trait anger scale scores of the two groups (p ≤ .001).

CONCLUSION

Relaxation training and music therapy are effective in controlling anger and increasing sleep quality in chronic psychiatric patients.

CLINICAL TRIAL NUMBER

NCT04620122.

Eficacia de los programas de musicoterapia: un metanálisis cualitativo

Resumen El aumento de enfermedades transmisibles justifica la necesidad de verificar la eficacia no farmacológica de los tratamientos alternativos. La música promueve las interacciones sociales y el trabajo en grupo, ayuda en varios aspectos del aprendizaje humano, la emoción y la memoria, y puede convertirse en una herramienta terapéutica complementaria. El objetivo de este estudio fue analizar la evidencia de la eficacia de la musicoterapia como tratamiento no farmacológico mediante un diseño descriptivo retrospectivo utilizando como parámetros de búsqueda: “musicoterapia” o “programas musicales” y “salud” en las bases de datos Scopus y Web of Science. Entre los principales resultados, destacamos que los programas de intervención que utilizan la música como tratamiento coadyuvante no farmacológico en enfermedades no transmisibles ofrecen resultados positivos y significativos sobre la mejora de las patologías en las que interviene. A partir de estos resultados, sería importante ampliar la formación de los profesionales de la salud en la aplicación de técnicas basadas en el arte y específicamente en la musicoterapia.

Effect of executive music therapy on state and trait anxiety levels of patients in a psychiatric ward: A quasi-experimental study

AIM

This quasi-experimental study aimed to assess the effect of executive music therapy (EMT) on the state and trait anxiety levels of patients with psychiatric disorders.

DESIGN AND METHODS

The study sample consisted of 64 patients who were hospitalized in a psychiatric ward in Giresun, Turkey between January and April 2019.

FINDINGS

This study showed that EMT decreased the state anxiety levels of inpatients with psychiatric disorders (P < .05). However, the treatment caused no effect on trait anxiety levels (P > .05).

PRACTICE IMPLICATIONS

In line with these results, we recommend that EMT should be included in therapeutic nursing interventions in psychiatric ward.

Effects of Mindfulness on Stimulating Hope and Recovery among People with Schizophrenia

Background: Hope has an essential role in the recovery journey for people with schizophrenia. Current studies showed that people with schizophrenia reported having low hope. There is growing evidence that mindfulness has favorable effects on mental health in populations with chronic illness, including people with schizophrenia. However, the studies evaluating effects of mindfulness on hope and recovery for people with schizophrenia are limited.Purpose: This study aimed to examine the effects of mindfulness on hope and recovery among people with schizophrenia.Methods: This quasi-experimental study was carried out on 54 patients with schizophrenia based on purposive sampling in a psychiatric hospital in Indonesia. The respondents were divided into two groups with 27 patients each in the intervention and the control group. The intervention group received 2-session mindfulness, while the control group received standard care. The data were collected using the demographic questionnaire, the Schizophrenia Hope Scale (SHS-9), and Recovery Assessment Scale (RAS), and analyzed using the Chi-Square and Mann-Whitney tests. Results: After mindfulness therapy, the intervention group showed a higher mean score of hope than the control group (14.30±2.50 and 9.04±2.15, respectively) as well as in the mean of recovery (86.78±4.00 and 73.56±6.04, respectively). There were significant differences in hope and recovery levels between the two groups with p-value <0.001.Conclusion: This study showed that mindfulness is an effective strategy to stimulate hope and recovery among people with schizophrenia. Nurses can apply mindfulness as one of the nursing interventions for helping the recovery process among this population. 

The Life Course Paradigm as a Lens for Holistic Nursing Research in Older Adults Diagnosed With Schizophrenia

Older adults diagnosed with schizophrenia (OADWS) have unique needs for care and live longer today than their forebears who were diagnosed with schizophrenia. As a result, nurses need to be prepared for the specific care of individuals who live with schizophrenia as they age. Together, Life Course Theory and holistic nursing suggest a good fit in the quest for successful solutions and/or outcomes for the unique problems that OADWS face. Holistic nursing views the patient as a whole person, considering all aspects of the patient’s experiences within life’s broader environment. The life course paradigm offers an effective way for nurses to understand issues that patients face throughout their lives, thus enhancing holistic nursing with a historical perspective. This is especially important for the care of OADWS, who face unique disparities as well as physical and psychological comorbidities over their life course. This article is intended to initiate a discussion of OADWS, focused with Life Course Theory as a holistic lens. Literature pertinent to the life course of OADWS is reviewed, followed by an analysis of the life course paradigm in relation to OADWS’ unique experiences. Conclusions support the holistic use of Life Course Theory in research and interventions for OADWS.

Creative art therapy for mental illness

Creative art therapy (CAT) for severe mental illness (SMI) represents an extremely heterogenous body of literature that encompasses the use of a large variety of creative mediums (i.e. visual art, music, dance, drama, writing) in the treatment of mental disorders. The present review provides a narrative summary of the findings on the use of CAT for the selected SMI, being: schizophrenia, trauma-related disorders, major depression, and bipolar disorder. A database search of PubMed and the Cochrane Library was conducted related to the use of CAT in the treatment of mental disorders published between January 2008 and March 2019. A total of 9697 citations were identified to match the search criteria and 86 full-texts were reviewed. Although literature suggests CAT to be a potentially low-risk and high benefit intervention to minimize symptoms and maximize functioning in individuals living with SMI, the lack of methodological rigor, and inconsistency in study methods and outcome measures have prevented the advancement of CAT for use in SMI. Although creation of a single CAT regimen for all psychiatric disorders stands neither practical nor advisable, greater standardization of methods would improve evaluation of CAT interventions. Future research should elucidate biological mechanisms underlying CAT methods.