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Chien WT, Chong YY, Bressington D, McMaster CW. A randomized controlled trial of an acceptance-based, insight-inducing medication adherence therapy (AIM-AT) for adults with early-stage psychosis. Psychiatry Res 2024; 339:116046. [PMID: 38908265 DOI: 10.1016/j.psychres.2024.116046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 06/13/2024] [Accepted: 06/15/2024] [Indexed: 06/24/2024]
Abstract
This study aimed to test the effectiveness of an acceptance-based medication adherence intervention for people with early-stage psychosis. An assessor-blind, three-arm randomized controlled trial design was used. One hundred and twenty-six participants who were adults with ≤3 years of psychosis were recruited from four district Integrated Community Centers for Mental Wellness in Hong Kong. They were randomly assigned to receive a 10-session acceptance-based, insight-inducing medication adherence therapy (AIM-AT) intervention, a conventional psychoeducation group program, or usual treatment (n = 42 per group). Primary outcomes were medication adherence and insight into the illness/treatment. All study outcomes were measured at recruitment and immediately, 6 months, and 12 months post-intervention. Participants in the AIM-AT experienced statistically significant improvements in the primary outcomes (levels of medication adherence and insight into illness/treatment), when compared to those in the other two groups over the 12-month follow-ups. The AIM-AT group also had significantly greater improvements in psychotic symptoms, psychosocial functioning, service satisfaction, length of rehospitalization, and total number of patients hospitalized over the follow-up period. These findings support the effectiveness of the AIM-AT to improve medication adherence, psychosocial health, and service satisfaction in people with early-stage psychosis.
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Affiliation(s)
- Wai Tong Chien
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T, Hong Kong SAR.
| | - Yuen Yu Chong
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T, Hong Kong SAR
| | - Daniel Bressington
- College of Nursing and Midwifery, Charles Darwin University, Darwin, Northern Territory, Australia; Faculty of Nursing, Chiang Mai University, 239 Huay Kaew Road, Muang District, Chiang Mai Thailand, 50200.
| | - Cecilia W McMaster
- Psychological Health Center, Concordia University, Montreal, Quebec, Canada.
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2
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O'Brien-Venus B, Ellett L, Burgess-Barr S, Chadwick P. Systematic review of the safety of mindfulness-based interventions for psychosis. Clin Psychol Rev 2024; 112:102445. [PMID: 38851179 DOI: 10.1016/j.cpr.2024.102445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 05/14/2024] [Accepted: 05/16/2024] [Indexed: 06/10/2024]
Abstract
Harmful outcomes of psychological interventions are under-researched, including in mindfulness-based interventions (MBI) for psychosis. This systematic review summarizes reporting and prevalence of 8 harm indices (death, adverse events, hospitalisation, study drop out, noncompletion of therapy, side effects of therapy, symptom deterioration and crisis service use) in Randomised Controlled Trials (RCTs) of MBIs for psychosis. Meta-analyses of risk differences were also calculated for each harm index. The review included 39 studies, with a total n of 2684 participants across studies. The percentage of studies reporting on each index of harm, and the prevalence of harm, varied greatly across each index. 0% of studies reported on side effects of interventions compared to 92% of studies reporting on study dropout. Meta-analyses of risk differences (RD) found a higher risk of hospitalisation (RD (95% CI) = -0.136 (-0.23 to -0.05), p = 0.003) and crisis service use (RD (95% CI) = -0.160 (-0.299, -0.024), p = 0.02) in control arms compared to intervention arms, and no significant difference in adverse events, death, symptom deterioration, noncompletion of therapy, drop out and side effects of therapy. Overall, reporting of harm was inconsistent across studies and the quality of data collection and reporting varied. MBIs for psychosis appear to be safe and may reduce the risk of hospitalisation and use of crisis services. However, the absence of thorough reporting on harm precludes a balanced analysis of benefits versus harms. Future research into the effectiveness of MBIs should consistently operationalise, monitor and report data on harm.
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Affiliation(s)
- Bethany O'Brien-Venus
- Department of Psychology, University of Bath, 10 West, Claverton Down, Bath BA2 7AY, United Kingdom.
| | - Lyn Ellett
- School of Psychology, Building 44, Highfield Campus, University of Southampton, SO17 1BJ, United Kingdom.
| | - Susanna Burgess-Barr
- Department of Psychology, University of Bath, 10 West, Claverton Down, Bath BA2 7AY, United Kingdom.
| | - Paul Chadwick
- Department of Psychology, University of Bath, 10 West, Claverton Down, Bath BA2 7AY, United Kingdom.
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3
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Xue T, Sheng J, Gao H, Gu Y, Dai J, Yang X, Peng H, Gao H, Lu R, Shen Y, Wang L, Wang L, Shi Y, Li Z, Cui D. Eight-month intensive meditation-based intervention improves refractory hallucinations and delusions and quality of life in male inpatients with schizophrenia: a randomized controlled trial. Psychiatry Clin Neurosci 2024; 78:248-258. [PMID: 38318694 DOI: 10.1111/pcn.13641] [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: 08/15/2023] [Revised: 12/10/2023] [Accepted: 12/25/2023] [Indexed: 02/07/2024]
Abstract
AIM This study investigated the impact of an 8-month daily-guided intensive meditation-based intervention (iMI) on persistent hallucinations/delusions and health-related quality of life (QoL) in male inpatients with schizophrenia with treatment-refractory hallucinations and delusions (TRHDs). METHODS A randomized controlled trial assigned 64 male inpatients with schizophrenia and TRHD equally to an 8-month iMI plus general rehabilitation program (GRP) or GRP alone. Assessments were conducted at baseline and the third and eighth months using the Positive and Negative Syndrome Scale (PANSS), 36-Item Short Form-36 (SF-36), and Five Facet Mindfulness Questionnaire (FFMQ). Primary outcomes measured PANSS reduction rates for total score, positive symptoms, and hallucinations/delusions items. Secondary outcomes assessed PANSS, SF-36, and FFMQ scores for psychotic symptoms, health-related QoL, and mindfulness skills, respectively. RESULTS In the primary outcome, iMI significantly improved the reduction rates of PANSS total score, positive symptoms, and hallucination/delusion items compared with GRP at both the third and eighth months. Treatment response rates (≥25% reduction) for these measures significantly increased in the iMI group at the eighth month. Concerning secondary outcomes, iMI significantly reduced PANSS total score and hallucination/delusion items, while increasing scores in physical activity and mindfulness skills at both the third and eighth months compared with GRP. These effects were more pronounced with an 8-month intervention compared with a 3-month intervention. CONCLUSIONS An iMI benefits patients with TRHDs by reducing persistent hallucinations/delusions and enhancing health-related QoL. Longer iMI duration yields superior treatment outcomes.
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Affiliation(s)
- Ting Xue
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
| | - Jialing Sheng
- The First Minzheng Mental Health Center, Shanghai, China
| | - Hui Gao
- The First Minzheng Mental Health Center, Shanghai, China
| | - Yan Gu
- The First Minzheng Mental Health Center, Shanghai, China
| | - Jingjing Dai
- The First Minzheng Mental Health Center, Shanghai, China
| | - Xianghong Yang
- The First Minzheng Mental Health Center, Shanghai, China
| | - Hong Peng
- The First Minzheng Mental Health Center, Shanghai, China
| | - Hongrui Gao
- The First Minzheng Mental Health Center, Shanghai, China
| | - Ruping Lu
- The First Minzheng Mental Health Center, Shanghai, China
| | - Yi Shen
- The First Minzheng Mental Health Center, Shanghai, China
| | - Li Wang
- The First Minzheng Mental Health Center, Shanghai, China
| | - Lijun Wang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
| | - Yuan Shi
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
| | - Zezhi Li
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Donghong Cui
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
- Brain Science and Technology Research Center, Shanghai Jiao Tong University, Shanghai, China
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Qin K, Yu Y, Cai H, Li J, Zeng J, Liang H. Effectiveness of mindfulness-based intervention in schizophrenia: A meta-analysis of randomized controlled trials. Psychiatry Res 2024; 334:115808. [PMID: 38402743 DOI: 10.1016/j.psychres.2024.115808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/30/2024] [Accepted: 02/17/2024] [Indexed: 02/27/2024]
Abstract
Schizophrenia poses significant societal challenges, including interpersonal tension, an increased risk of suicide, and soaring medical costs. Although antipsychotics can prevent relapses, they often give rise to adverse effects and do not provide lasting relief. Mindfulness-based interventions (MBI) emerge as a hopeful avenue for improving outcomes. However, existing research and meta-analyses of the efficacy of MBI in schizophrenia remain limited. This study aimed to evaluate the efficacy of MBI as an adjunctive therapy for schizophrenia. Relevant randomized controlled trials (RCTs) were searched across PubMed, Embase, Web of Science, and Cochrane Library from inception dates up to January 12, 2023. Statistical analyses were conducted using Stata software (version 15.0) and Review Manager 5.4. The quality of the included RCTs was assessed using the revised Cochrane risk of bias tool. A total of 18 RCTs were included, with 675 patients and 704 health controls. Our meta-analysis revealed that MBI significantly improved psychosocial function, insight, and mindfulness in individuals with schizophrenia. The quality of the included RCTs had a low to moderate risk of bias. These findings suggest that MBI holds promise for improving the mental health of individuals with schizophrenia.
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Affiliation(s)
- Keke Qin
- School of Politics and Public Administration, Guangxi Normal University, No. 15 Yucai Road, Qixing District, Guilin City, Guangxi Province 541004, China
| | - Yong Yu
- School of Politics and Public Administration, Guangxi Normal University, No. 15 Yucai Road, Qixing District, Guilin City, Guangxi Province 541004, China.
| | - Huiling Cai
- School of Politics and Public Administration, Guangxi Normal University, No. 15 Yucai Road, Qixing District, Guilin City, Guangxi Province 541004, China
| | - Jiahong Li
- School of Politics and Public Administration, Guangxi Normal University, No. 15 Yucai Road, Qixing District, Guilin City, Guangxi Province 541004, China
| | - Jingyuan Zeng
- School of Politics and Public Administration, Guangxi Normal University, No. 15 Yucai Road, Qixing District, Guilin City, Guangxi Province 541004, China
| | - Huolan Liang
- School of Politics and Public Administration, Guangxi Normal University, No. 15 Yucai Road, Qixing District, Guilin City, Guangxi Province 541004, China
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Su Y, Pan X, Li H, Zhang G. Effects of mind-body therapies on schizophrenia: A systematic review and network meta-analysis. Schizophr Res 2024; 264:236-247. [PMID: 38185028 DOI: 10.1016/j.schres.2023.12.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 12/09/2023] [Accepted: 12/25/2023] [Indexed: 01/09/2024]
Abstract
OBJECTIVE The objective of this meta-analysis is to evaluate and compare the effectiveness of different mind-body therapies in reducing the symptoms of schizophrenia. METHODS A systematic search was performed using databases such as PubMed, Embase, Cochrane Library, Web of Science, and Scopus. Randomized controlled trials that assessed the effects of mind-body therapies on patients with schizophrenia were included. The search covered the period between the inception of each database and November 17th, 2022. The methodological quality of the trials was assessed using the Cochrane risk of bias tool. A network meta-analysis was conducted to compare the effects of various mind-body therapies, including Yoga, Mindfulness, Tai Chi, Baduanjin, and Yijinjing. RESULTS The analysis included 22 randomized controlled trials involving a total of 2064 subjects. The network meta-analysis revealed that Yoga and Mindfulness interventions were more effective than other mind-body therapies in reducing the symptoms of schizophrenia. Specifically, Yoga improved PANSS-positive symptom scores (SUCRA: 74.8 %) and PANSS-negative symptom scores (SUCRA: 80.4 %), whereas Mindfulness improved PANSS-positive symptom scores (SUCRA: 85.6 %). CONCLUSION The findings of this study indicate that Yoga may be a promising intervention for the treatment of schizophrenia. However, the small sample size and the low quality of the included studies have limited the generalizability of our findings Therefore, this study must be understood with caution, and further investigation is warranted when more relevant studies emerge.
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Affiliation(s)
- Yuqin Su
- Institute of Sport Science, College of Physical Education, Southwest University, Chongqing, China; College of Physical Education, Chongqing University of Posts and Telecommunications, Chongqing, China.
| | - Xiaoli Pan
- Institute of Sport Science, College of Physical Education, Southwest University, Chongqing, China
| | - Hansen Li
- Institute of Sport Science, College of Physical Education, Southwest University, Chongqing, China
| | - Guodong Zhang
- Institute of Sport Science, College of Physical Education, Southwest University, Chongqing, China.
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Sabé M, Kohler R, Perez N, Sauvain-Sabé M, Sentissi O, Jermann F, Prada P, Perroud N, Böge K. Mindfulness-based interventions for patients with schizophrenia spectrum disorders: A systematic review of the literature. Schizophr Res 2024; 264:191-203. [PMID: 38157679 DOI: 10.1016/j.schres.2023.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/29/2023] [Accepted: 12/10/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Mindfulness-based interventions (MBIs) have emerged as secular practices, including elements of mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT). While MBIs have been widely adopted for physical and mental illness, only a few available programs are explicitly adapted for psychosis. However, previous reviews have reported the vital heterogeneity regarding treatment program structure. Therefore, this review aims to compare the structure of different mindfulness protocols applied to patients with schizophrenia spectrum disorder (SSD). METHODS A systematic search was conducted up to March 2023 in PubMed, Embase and PsycInfo. Following our protocol (CRD 42023253356), we followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) checklist. RESULTS We included 22 randomized controlled trials (RCTs) involving 1500 patients SSD. All programs varied in structure, session components, duration, and instructor experience. While MBSR-like programs focused on stress reactivity, MBCT-like programs addressed primary symptoms of psychosis and relapse prevention. Despite the heterogeneity of programs, some common mechanisms emerged, including attention training, emotion and stress regulation, decentering, self-compassion, and cognitive restructuring. CONCLUSIONS The critical heterogeneity found limits the interpretation of results. However, most recent trials present fewer risks of bias and more homogenous programs. Findings suggested potential benefits, such as reduced negative symptoms, increased well-being, and decreased hospitalization rates. For future studies, authors should align on more congruent MBIs programs for patients with SSD. Further research is needed to identify optimal mindfulness teaching approaches for patients with psychosis and investigate specific mechanisms of action, relevant processes, and optimal doses in varying settings.
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Affiliation(s)
- Michel Sabé
- Division of Adult Psychiatry, Department of Psychiatry, University Hospitals of Geneva, 2, Chemin du Petit-Bel-Air, CH-1226 Thonex, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland.
| | - Raoul Kohler
- Division of Adult Psychiatry, Department of Psychiatry, University Hospitals of Geneva, 2, Chemin du Petit-Bel-Air, CH-1226 Thonex, Switzerland
| | - Natacha Perez
- Division of Adult Psychiatry, Department of Psychiatry, University Hospitals of Geneva, 2, Chemin du Petit-Bel-Air, CH-1226 Thonex, Switzerland
| | - Mathilde Sauvain-Sabé
- Division of Adult Psychiatry, Department of Psychiatry, University Hospitals of Geneva, 2, Chemin du Petit-Bel-Air, CH-1226 Thonex, Switzerland
| | - Othman Sentissi
- Division of Adult Psychiatry, Department of Psychiatry, University Hospitals of Geneva, 2, Chemin du Petit-Bel-Air, CH-1226 Thonex, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Francoise Jermann
- Division of Psychiatric Specialties, Department of Psychiatry, University Hospitals of Geneva, Switzerland
| | - Paco Prada
- Consultation Liaison and Crisis Intervention, University Hospitals of Geneva, Switzerland
| | - Nader Perroud
- Division of Psychiatric Specialties, Department of Psychiatry, University Hospitals of Geneva, Switzerland
| | - Kerem Böge
- Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin; and Freie Universität Berlin; and Humboldt-Universität zu Berlin; and Berlin Institute of Health, Germany; German Center of Mental Health (DZPG), Germany
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7
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Chien WT, Bressington D, Yip A, Karatzias T. An international multi-site, randomized controlled trial of a mindfulness-based psycho-education group program for people with schizophrenia - CORRIGENDUM. Psychol Med 2023; 53:2720. [PMID: 36660915 PMCID: PMC10123818 DOI: 10.1017/s0033291723000041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- W T Chien
- Mental Health Care Research Group, School of Nursing, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, People's Republic of China
| | - D Bressington
- Mental Health Care Research Group, School of Nursing, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, People's Republic of China
| | - A Yip
- Mental Health Care Research Group, School of Nursing, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, People's Republic of China
| | - T Karatzias
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, UK
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Shen H, Zhang L, Li Y, Zheng D, Du L, Xu F, Xu C, Liu Y, Shen J, Li Z, Cui D. Mindfulness-based intervention improves residual negative symptoms and cognitive impairment in schizophrenia: a randomized controlled follow-up study. Psychol Med 2023; 53:1390-1399. [PMID: 36468948 PMCID: PMC10009398 DOI: 10.1017/s0033291721002944] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/22/2021] [Accepted: 07/03/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND Residual negative symptoms and cognitive impairment are common for chronic schizophrenia patients. The aim of this study was to investigate the efficacy of a mindfulness-based intervention (MBI) on negative and cognitive symptoms of schizophrenia patients with residual negative symptoms. METHODS In this 6-week, randomized, single-blind, controlled study, a total of 100 schizophrenia patients with residual negative symptoms were randomly assigned to the MBI or control group. The 6-week MBI group and the control group with general rehabilitation programs maintained their original antipsychotic treatments. The scores for the Positive and Negative Syndrome Scale (PANSS), the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), and the Symptom Checklist 90 (SCL-90) were recorded at baseline and week 6 to assess psychotic symptoms, cognitive performance, and emotional state, respectively. RESULTS Compared with general rehabilitation programs, MBI alleviated the PANSS-negative subscore, general psychopathology subscore, and PANSS total score in schizophrenia patients with residual negative symptoms (F = 33.77, pBonferroni < 0.001; F = 42.01, pBonferroni < 0.001; F = 52.41, pBonferroni < 0.001, respectively). Furthermore, MBI improved RBANS total score and immediate memory subscore (F = 8.80, pBonferroni = 0.024; F = 11.37, pBonferroni = 0.006), as well as SCL-90 total score in schizophrenia patients with residual negative symptoms (F = 18.39, pBonferroni < 0.001). CONCLUSIONS Our results demonstrate that MBI helps schizophrenia patients with residual negative symptoms improve clinical symptoms including negative symptom, general psychopathology symptom, and cognitive impairment. TRIAL REGISTRATION ChiCTR2100043803.
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Affiliation(s)
- Hui Shen
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Li Zhang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuhuan Li
- Qingdao Mental Health Center, Qingdao University, Qingdao, China
| | - Denise Zheng
- McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Lizhao Du
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Med-X Engineering Research Center, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Feikang Xu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chuchen Xu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yan Liu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jie Shen
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zezhi Li
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
- Department of Neurology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Donghong Cui
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
- Brain Science and Technology Research Center, Shanghai Jiao Tong University, Shanghai, China
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Bighelli I, Wallis S, Reitmeir C, Schwermann F, Salahuddin NH, Leucht S. Effects of psychological treatments on functioning in people with Schizophrenia: a systematic review and meta-analysis of randomized controlled trials. Eur Arch Psychiatry Clin Neurosci 2022:10.1007/s00406-022-01526-1. [PMID: 36477405 DOI: 10.1007/s00406-022-01526-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 11/15/2022] [Indexed: 12/12/2022]
Abstract
Functioning is recognized as a key treatment goal in alleviating the burden of schizophrenia. Psychological interventions can play an important role in improving functioning in this population, but the evidence on their efficacy is limited. We therefore aimed to evaluate the effect of psychological interventions in functioning for patients with schizophrenia. To conduct this systematic review and meta-analysis, we searched for published and unpublished randomized controlled trials (RCTs) in EMBASE, MEDLINE, PsycINFO, BIOSIS, Cochrane Library, WHO International Clinical Trials Registry Platform (ICTRP), ClinicalTrials.gov and the Study register of the Cochrane Schizophrenia Group. The outcome functioning was measured with validated scales. We performed random-effects pairwise meta-analysis to calculate standardized mean differences (SMDs) with 95% confidence intervals (CIs). We included 58 RCTs (5048 participants). Psychological interventions analyzed together (SMD = - 0.37, 95% CI - 0.49 to - 0.25), cognitive behavioral therapy (30 RCTs, SMD = - 0.26, 95% CI - 0.39 to - 0.12), and third wave cognitive-behavioral therapies (15 RCTs, SMD = - 0.60, 95% CI - 0.83 to - 0.37) were superior to control in improving functioning, while creative therapies (8 RCTs, SMD = 0.01, 95% CI - 0.38 to 0.39), integrated therapies (4 RCTs, SMD = - 0.21, 95% CI - 1.20 to 0.78) and other therapies (4 RCTs, SMD = - 0.74, 95% CI - 1.52 to 0.04) did not show a benefit. Psychological interventions, in particular cognitive behavioral therapy and third wave cognitive behavioral therapies, have shown a therapeutic effect on functioning. The confidence in the estimate was evaluated as very low due to risk of bias, heterogeneity and possible publication bias.
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Affiliation(s)
- Irene Bighelli
- Department of Psychiatry and Psychotherapy, School of Medicine, Klinikum Rechts Der Isar, Technical University of Munich, Ismaningerstraße 22, 81675, Munich, Germany.
| | - Sofia Wallis
- Department of Psychiatry and Psychotherapy, School of Medicine, Klinikum Rechts Der Isar, Technical University of Munich, Ismaningerstraße 22, 81675, Munich, Germany
| | - Cornelia Reitmeir
- Department of Psychiatry and Psychotherapy, School of Medicine, Klinikum Rechts Der Isar, Technical University of Munich, Ismaningerstraße 22, 81675, Munich, Germany
| | - Felicitas Schwermann
- Department of Psychiatry and Psychotherapy, School of Medicine, Klinikum Rechts Der Isar, Technical University of Munich, Ismaningerstraße 22, 81675, Munich, Germany
| | - Nurul Husna Salahuddin
- Department of Psychiatry and Psychotherapy, School of Medicine, Klinikum Rechts Der Isar, Technical University of Munich, Ismaningerstraße 22, 81675, Munich, Germany
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, School of Medicine, Klinikum Rechts Der Isar, Technical University of Munich, Ismaningerstraße 22, 81675, Munich, Germany
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10
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Yip ALK, Karatzias T, Chien WT. Mindfulness-based interventions for non-affective psychosis: a comprehensive systematic review and meta-analysis. Ann Med 2022; 54:2340-2353. [PMID: 36004784 PMCID: PMC9423825 DOI: 10.1080/07853890.2022.2108551] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
AIM Although mindfulness-based interventions (MBIs) are routinely used in clinical practice, a comprehensive synthesis of the effectiveness of MBIs for non-affective psychosis has yet to be conducted. The aim of the present review and meta-analysis was to investigate the effectiveness of MBIs including those with mindfulness as an active treatment component for alleviating symptoms of psychosis to inform future clinical practice. METHODS A systematic review of studies published in journals or in dissertations in CINAHL, PubMed, EMBASE, PsycINFO, CENTRAL, ISRCTN, or CNKI from January 1990 until December 2020. A total of 31 eligible studies (n = 2146) were included. RESULTS Effect-size estimates suggested that 22 independent samples (n = 1632) produced a statistically significant small effect for psychotic symptoms (g = -0.48), and with a clinically significant reduction of 50% from baseline (pooled OR: 1.84). Separate meta-analyses demonstrated small effects for affective symptoms (g = -0.44) and small-to-large positive effects for quality of life (g = 0.38), mindfulness skills (g = 0.45), and insight into illness/treatment (g = 1.35). The heterogeneity was high across the studies. CONCLUSION Results suggest that short-term MBIs can be beneficial for non-affective psychosis. Future research is needed to test the efficacy and safety of dedicated MBIs for this population group over a longer term. KEY MESSAGESSchizophrenia spectrum and other psychotic disorders, also known as non-affective psychosis, is the most chronic and debilitating type of psychosis, seriously affecting every aspect of a person's life, including social, occupational, or general functioning.The aim of the current systematic review and meta-analysis was to investigate formerly unexamined questions regarding the clinical significance of MBIs including yoga as an increasingly utilized, conceptualized psychological intervention on overall psychotic symptoms for people with non-affective psychosis.No serious adverse events were reported in the studies, suggesting that MBIs may be safe interventions, while there is robust evidence to support the view that MBIs are beneficial to young people in particular.
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Affiliation(s)
- Annie Lai King Yip
- School of Health and Social Care, Edinburgh Napier University, Sighthill Campus, Edinburgh, UK
| | - Thanos Karatzias
- School of Health and Social Care, Edinburgh Napier University, Sighthill Campus, Edinburgh, UK
| | - Wai Tong Chien
- School of Health and Social Care, Edinburgh Napier University, Sighthill Campus, Edinburgh, UK
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A randomized controlled trial of a peer-facilitated self-management program for people with recent-onset psychosis. Schizophr Res 2022; 250:22-30. [PMID: 36242787 DOI: 10.1016/j.schres.2022.09.028] [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: 03/16/2022] [Revised: 06/07/2022] [Accepted: 09/29/2022] [Indexed: 11/06/2022]
Abstract
Early patient-centered interventions can improve mental health and prevent psychotic relapse in people with recent-onset psychosis (ROP). However, limited effective peer-facilitated early interventions are found worldwide. We aimed to test the effects of a four-month peer-facilitated self-management intervention (PFSMI) for Chinese patients with ROP compared with a psychoeducation group (PEG) and treatment-as-usual (TAU) group. A randomized controlled trial was conducted at six Integrated Community Centers for Mental Wellness in Hong Kong. The primary outcome was level of recovery. Secondary outcomes were improvement of problem-solving ability, insight into illness/treatment, and functioning, and reducing psychotic symptoms and re-hospitalization rates. Overall, 180 ROP patients were randomly selected, and after collecting baseline data, randomly assigned to the PFSMI, PEG or TAU (60 per group). Their outcomes were measured at 1-week and 6-month post-intervention. One hundred and sixty-one patients (89.4 %) completed their interventions, with an overall attrition rate of 7.8 % (n = 14). Based on intention-to-treat principle, results of generalized estimating equation test indicated that the PFSMI group reported significantly greater improvements in levels of recovery, functioning and insight into illness/treatment and reductions in psychotic symptoms and duration of re-hospitalizations (p = 0.0007-0.02, with moderate to large effect sizes) than the TAU group at 1-week post-intervention, and both the TAU and PEG at 6-month post-intervention. Significantly fewer PFSMI participants were hospitalized than the TAU and PEG over 6-month follow-up (p = 0.003). The findings support that PFSMI can produce medium-term positive effects on the mental health and functioning of patients with ROP.
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Yıldırım Üşenmez T, Gültekin A, Erkan FM, Bayar BD, Can SY, Şanlı ME. The effect of mindfulness on medication adherence in individuals diagnosed with Schizophrenia: A cross-sectional study. Perspect Psychiatr Care 2022; 58:2585-2591. [PMID: 35474214 DOI: 10.1111/ppc.13098] [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: 02/10/2022] [Revised: 04/07/2022] [Accepted: 04/10/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE The aim of this study is to determine the effect of mindfulness on medication adherence in individuals diagnosed with schizophrenia. MATERIALS AND METHODS This cross-sectional study was conducted with 147 individuals diagnosed with schizophrenia. The data were collected using the Descriptive Characteristics Form, Morisky Medication Adherence Scale, and Mindful Attention Awareness Scale. RESULTS A strong positive correlation was determined between the mindfulness level and medication adherence of the individuals diagnosed with schizophrenia. Furthermore, mindfulness of the individuals diagnosed with schizophrenia was statistically significant in explaining medication adherence (p < 0.05) and mindfulness predicted medication adherence by 64%. CONCLUSION It was observed that the individuals' mindfulness level was low and half of the participants had low medication adherence. Moreover, as their mindfulness level increased, so did their medication adherence.
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Affiliation(s)
- Tülay Yıldırım Üşenmez
- Department of Nursing, Atatürk Health Sciences Faculty, Dicle University, Diyarbakir, Turkey
| | - Abdurrezzak Gültekin
- Department of Psychiatric Nursing, Faculty of Nursing, Inonu University, Malatya, Turkey
| | - Fatma Melike Erkan
- Department of Psychiatric Nursing, Faculty of Nursing, Inonu University, Malatya, Turkey
| | - Behiye Dilmen Bayar
- Department of Medical Services and Techniques, Vocational Higher School of Health Services, Mardin Artuklu University, Mardin, Turkey
| | - Sevinç Yaşar Can
- Department of Medical Services and Techniques, Vocational Higher School of Health Services, Mardin Artuklu University, Mardin, Turkey
| | - Mehmet Emin Şanlı
- Department of Medical Services and Techniques, Vocational Higher School of Health Services, Batman University, Batman, Turkey
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13
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Jacobsen P, Choksi T, Sawyer K, Maximen C, Harding E, Richardson M. Home practice in mindfulness-based interventions for psychosis groups: a systematic review and qualitative study. BMC Psychol 2022; 10:9. [PMID: 35022085 PMCID: PMC8756717 DOI: 10.1186/s40359-021-00694-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 11/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Regular home practice is considered a core component of mindfulness groups and may be associated with better treatment outcomes. This study aimed to (1) review the existing evidence on how much home practice people do in mindfulness-based interventions for psychosis groups, and (2) explore participants' experiences of the barriers and facilitators to completing home practice in a mindfulness for psychosis group using a qualitative study. METHODS In study 1, we conducted a systematic review of mindfulness-based interventions for psychosis studies and extracted data on home practice rates. In study 2, we conducted semi-structured interviews with people who had completed a mindfulness for psychosis group (N = 5) as part of their routine community care, specifically focusing on experiences of home practice. RESULTS Out of 43 studies included in the systematic review, only 5 reported any data on amount of home practice, and none examined the relationship between completion of home practice and treatment outcomes. In the qualitative study, participants described home practice as being difficult but important. Arising themes were similar to findings from previous (non-psychosis) studies suggesting that generic challenges are common, rather than being specific to psychosis. CONCLUSIONS We recommend that future mindfulness-based interventions for psychosis studies record data on home practice rates, in order to investigate any association between home practice and treatment outcome. Our qualitative findings suggest home practice can be a valued part of mindfulness for psychosis group, and a normalising approach could be taken when and if participants encounter common challenges.
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Affiliation(s)
- Pamela Jacobsen
- Department of Psychology, University of Bath, Bath, BA2 7AY, UK.
| | - Twinkle Choksi
- Department of Psychology, University of Bath, Bath, BA2 7AY, UK
| | | | - Cassia Maximen
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Emma Harding
- South London and Maudsley NHS Foundation Trust, London, UK
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Lam AHY, Cheung YTD, Wong KH, Leung SF, Chien WT. Dispositional Mindfulness and Psychotic Symptoms in Schizophrenia Spectrum Disorders: The Mediating Roles of Rumination and Negative Emotion. Neuropsychiatr Dis Treat 2022; 18:75-85. [PMID: 35046658 PMCID: PMC8760986 DOI: 10.2147/ndt.s338133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 12/26/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Studies have shown that rumination plays a significant mediating role between dispositional mindfulness (DM) and psychopathological symptoms in both clinical and non-clinical populations. However, no studies have examined this pathway in people with schizophrenia spectrum disorders (SSDs). METHODS A cross-sectional, clinician-administered survey was conducted among people with SSDs (n = 52) in a community setting. Participants completed the Chinese versions of the Depression Anxiety Stress Scale, Five Facet Mindfulness Questionnaire-Short Form, Psychotic Symptom Rating Scale and Scale for the Assessment of Negative Symptoms. Structural equation modelling was performed to examine the pathways of mindfulness facets, rumination, negative emotions and psychotic symptoms. RESULTS Two facets of mindfulness (nonjudging and acting with awareness) reduced rumination and negative emotional status. Rumination fully mediated the relationship between nonjudging and negative emotions and partially mediated the relationship between acting with awareness and negative emotions. Furthermore, rumination and negative emotions sequentially mediated the relationship between acting with awareness and hallucination (B = -0.44, 95% confidence interval [CI] = -0.338 to -0.045, p = 0.01) and between nonjudging and hallucination (B = -0.356, 95% CI = -0.255 to -0.008, p = 0.034). The model fit the data well (χ2(2) = 1.318, p = 0.517, Tucker-Lewis index = 1.075, comparative fit index = 1, standardised root mean residual = 0.0251, root mean square error of approximation = 0.0001). CONCLUSION Rumination and negative emotions serially mediated the relationship between DM and hallucination. The findings support the contribution of changes across transdiagnostic mediators underlying the therapeutic effects of mindfulness training. Further research examining the transdiagnostic processes of DM in influencing clinical outcomes in SSDs is warranted.
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Affiliation(s)
- Angie Ho Yan Lam
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Yee Tak Derek Cheung
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Kwan Ho Wong
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Sau Fong Leung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region
| | - Wai Tong Chien
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
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15
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Wang M, Wang J, Wang Y, Huang X, Huang Y, Huang J, Feng Y, Li X. Reliability and validity of the Mental Health Self-management Questionnaire among Chinese patients with mood and anxiety disorders. Front Psychiatry 2022; 13:952951. [PMID: 35966465 PMCID: PMC9372341 DOI: 10.3389/fpsyt.2022.952951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 07/01/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Self-management plays an important role in promoting and restoring mental health for individuals with mental health issues. However, there is no valid and reliable Chinese tool assessing the self-management behaviors of people with mood and anxiety disorders. This study aimed to develop a Chinese version of the Mental Health Self-management Questionnaire (MHSQ-C) and to verify its psychometric properties. METHODS A total of 440 potential participants were recruited by convenience sampling from June to August 2020. Item analysis and analyses of internal consistency, test-retest reliability, content validity, construct validity and criterion validity were performed. RESULTS Data from 326 participants were used. Three factors obtained via principal component analysis and varimax rotation explained 53.68% of the total variance. The average content validity index was 0.99. The Cronbach's α coefficient (total: 0.874, clinical: 0.706, empowerment: 0.818, vitality: 0.830) and test-retest reliability (ICC: total: 0.783, 95% confidence interval (CI) [0.616, 0.882], clinical: 0.525, 95% CI [0.240, 0.725], empowerment: 0.786, 95% CI [0.622, 0.884], vitality: 0.748, 95% CI [0.564, 0.862]) were good. The MHSQ-C was well correlated with the Partners in Health scale and showed no floor or ceiling effect. DISCUSSION The MHSQ-C is a reliable and valid tool to evaluate the self-management strategies of patients with mood and anxiety disorders.
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Affiliation(s)
- Mengmeng Wang
- West China School of Nursing and West China Hospital, Sichuan University, Chengdu, China
| | - Jingjun Wang
- West China School of Nursing and West China Hospital, Sichuan University, Chengdu, China
| | - Ya Wang
- Department of Nursing, West China Hospital and West China School of Nursing, Sichuan University, Chengdu, China
| | - Xia Huang
- Mental Health Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Yalin Huang
- Mental Health Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Junqiang Huang
- Chengdu Dekang Hospital/Chengdu Psychiatric Hospital, Chengdu, China
| | - Yan Feng
- Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiaolin Li
- West China School of Nursing and West China Hospital, Sichuan University, Chengdu, China
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16
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Tao TJ, Hui CLM, Lam BST, Ho ECN, Hui PWM, Suen YN, Lin JJ, Tong ACY, Lee EHM, Chan SKW, Chang WC, Chen EYH. Mindfulness meditation for Chinese patients with psychosis: A systematic review and meta-analysis. Schizophr Res 2021; 237:103-114. [PMID: 34509897 DOI: 10.1016/j.schres.2021.08.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/27/2021] [Accepted: 08/27/2021] [Indexed: 11/29/2022]
Abstract
Mindfulness meditation (MM) and its alignment with the mind-body perspective of health in Chinese cultures indicate its potential to benefit Chinese patients with psychosis. This is the first systematic review and meta-analysis to address the following questions: (1) Does MM improve clinical, well-being, and third-wave outcomes (i.e., mindfulness, acceptance, and compassion levels) among Chinese patients with psychosis? (2) What are the patient- and/or intervention-specific factors that moderate the efficacy of MM? (3) Are improvements on third-wave outcomes associated with improvements on clinical and well-being outcomes? (4) What are the mechanisms underlying the effects of MM? Evidence synthesized from 23 relevant articles (20 studies) involving 1749 patients showed that (1) MM improved a wide range of patients' outcomes, most consistently and sustainably for insight, rehospitalization duration, recovery rate, and social functioning; (2) age and duration of illness, but not the cumulated intervention hours, moderated the overall efficacy of MM; (3) post-MM improvements on mindfulness and on clinical and well-being outcomes were related, and (4) the effects of MM on patients' outcomes may be driven by its ability to promote positive changes in personal growth and enhance one's coping with the illness and its symptoms. Our data showed preliminary support for the benefits of MM in Chinese patients with psychosis. However, results should be considered in light of the varying quality of included studies and their heterogeneity in multiple aspects. Further research is needed to deduce the sustainability of MM's effects, its active ingredients, underlying mechanisms, and additional moderators of its efficacy.
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Affiliation(s)
| | | | | | | | | | - Yi Nam Suen
- Department of Psychiatry, The University of Hong Kong, Hong Kong, China
| | - Jessie Jingxia Lin
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Alan Chun Yat Tong
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong, China
| | - Edwin Ho Ming Lee
- Department of Psychiatry, The University of Hong Kong, Hong Kong, China
| | - Sherry Kit Wa Chan
- Department of Psychiatry, The University of Hong Kong, Hong Kong, China; State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, China
| | - Wing Chung Chang
- Department of Psychiatry, The University of Hong Kong, Hong Kong, China; State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, China
| | - Eric Yu Hai Chen
- Department of Psychiatry, The University of Hong Kong, Hong Kong, China; State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, China
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17
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Lam AHY, Leung SF, Chien WT. Mindfulness-based psychoeducation for schizophrenia spectrum disorders: a qualitative analysis of participants' experiences. Contemp Nurse 2021; 57:387-406. [PMID: 34661495 DOI: 10.1080/10376178.2021.1994864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Mindfulness-based psychoeducation program (MBPP) has been proposed as a new approach to improve the overall outcomes for individuals with schizophrenia spectrum disorders. However, to date, limited studies have examined the participants' experiences of MBPP for schizophrenia. The aim of this study was to explore the experiences of individuals with schizophrenia spectrum disorders (SSDs) who underwent an 8-week MBPP with respect to their perception of the benefits and unusual challenges of mindfulness training and self-practices. Twenty-four (n = 24) individuals with SSDs were invited to participate in an 8-week MBPP. A total of eight participants were invited for semi-structured interview one week after the final class of MBPP. The semi-structured interview was conducted in Cantonese and data were transcribed by the first author. Of the eight participants, five participants had unusual experiences and three participants had a positive experience with MBPP. They were included to provide more candid understanding on the constituents of diverse experience towards MBPP. An interview guide was developed to understand the patients' perceptions of MBPP, the challenege in self-practising mindfulness, and the changes in how they coped with their illness during and after taking part in MBPP. Qualitative data from the semi-structured interview were recorded by a research assistant and the transcripts were proof-read by the participants to ensure accuracy. The Software NVivo 12 Pro was used to manage the qualitative data from the semi-structured interview. Thematic analysis was adopted to identify the major themes from the qualitative data. Five themes emerged: developing a state of mindfulness, empowering illness management, learning a new way to regulate emotion, encountering barriers in self-practising mindfulness and preference for bodily mindfulness. The findings provide comprehensive knowledge and deeper insights into treatment processes of mindfulness psychoeducation as an intervention for schizophrenia spectrum disorders. IMPACT STATEMENT This study establishes a body of knowledge regarding people with schizophrenia spectrum disorders who received mindfulness psychoeducation intervention. The results suggest that patients can develop a new way to regulate emotion and manage their illness through mindfulness psychoeducation. The perceived negative experience of some patients also warrants closer attention in mindfulness practice, especially for individuals with schizophrenia spectrum disorders. Further research could focus on factors leading to the negative consequences of mindfulness practice and the ways to minimize the negative consequeces.
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Affiliation(s)
- Angie Ho Yan Lam
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, 4/F, William M.W. Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong
| | - Sau Fong Leung
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Wai Tong Chien
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, Hong Kong
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van Ginneken N, Chin WY, Lim YC, Ussif A, Singh R, Shahmalak U, Purgato M, Rojas-García A, Uphoff E, McMullen S, Foss HS, Thapa Pachya A, Rashidian L, Borghesani A, Henschke N, Chong LY, Lewin S. Primary-level worker interventions for the care of people living with mental disorders and distress in low- and middle-income countries. Cochrane Database Syst Rev 2021; 8:CD009149. [PMID: 34352116 PMCID: PMC8406740 DOI: 10.1002/14651858.cd009149.pub3] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Community-based primary-level workers (PWs) are an important strategy for addressing gaps in mental health service delivery in low- and middle-income countries. OBJECTIVES: To evaluate the effectiveness of PW-led treatments for persons with mental health symptoms in LMICs, compared to usual care. SEARCH METHODS: MEDLINE, Embase, CENTRAL, ClinicalTrials.gov, ICTRP, reference lists (to 20 June 2019). SELECTION CRITERIA: Randomised trials of PW-led or collaborative-care interventions treating people with mental health symptoms or their carers in LMICs. PWs included: primary health professionals (PHPs), lay health workers (LHWs), community non-health professionals (CPs). DATA COLLECTION AND ANALYSIS: Seven conditions were identified apriori and analysed by disorder and PW examining recovery, prevalence, symptom change, quality-of-life (QOL), functioning, service use (SU), and adverse events (AEs). Risk ratios (RRs) were used for dichotomous outcomes; mean difference (MDs), standardised mean differences (SMDs), or mean change differences (MCDs) for continuous outcomes. For SMDs, 0.20 to 0.49 represented small, 0.50 to 0.79 moderate, and ≥0.80 large clinical effects. Analysis timepoints: T1 (<1 month), T2 (1-6 months), T3 ( >6 months) post-intervention. MAIN RESULTS: Description of studies 95 trials (72 new since 2013) from 30 LMICs (25 trials from 13 LICs). Risk of bias Most common: detection bias, attrition bias (efficacy), insufficient protection against contamination. Intervention effects *Unless indicated, comparisons were usual care at T2. "Probably", "may", or "uncertain" indicates "moderate", "low," or "very low" certainty evidence. Adults with common mental disorders (CMDs) LHW-led interventions a. may increase recovery (2 trials, 308 participants; RR 1.29, 95%CI 1.06 to 1.56); b. may reduce prevalence (2 trials, 479 participants; RR 0.42, 95%CI 0.18 to 0.96); c. may reduce symptoms (4 trials, 798 participants; SMD -0.59, 95%CI -1.01 to -0.16); d. may improve QOL (1 trial, 521 participants; SMD 0.51, 95%CI 0.34 to 0.69); e. may slightly reduce functional impairment (3 trials, 1399 participants; SMD -0.47, 95%CI -0.8 to -0.15); f. may reduce AEs (risk of suicide ideation/attempts); g. may have uncertain effects on SU. Collaborative-care a. may increase recovery (5 trials, 804 participants; RR 2.26, 95%CI 1.50 to 3.43); b. may reduce prevalence although the actual effect range indicates it may have little-or-no effect (2 trials, 2820 participants; RR 0.57, 95%CI 0.32 to 1.01); c. may slightly reduce symptoms (6 trials, 4419 participants; SMD -0.35, 95%CI -0.63 to -0.08); d. may slightly improve QOL (6 trials, 2199 participants; SMD 0.34, 95%CI 0.16 to 0.53); e. probably has little-to-no effect on functional impairment (5 trials, 4216 participants; SMD -0.13, 95%CI -0.28 to 0.03); f. may reduce SU (referral to MH specialists); g. may have uncertain effects on AEs (death). Women with perinatal depression (PND) LHW-led interventions a. may increase recovery (4 trials, 1243 participants; RR 1.29, 95%CI 1.08 to 1.54); b. probably slightly reduce symptoms (5 trials, 1989 participants; SMD -0.26, 95%CI -0.37 to -0.14); c. may slightly reduce functional impairment (4 trials, 1856 participants; SMD -0.23, 95%CI -0.41 to -0.04); d. may have little-to-no effect on AEs (death); e. may have uncertain effects on SU. Collaborative-care a. has uncertain effects on symptoms/QOL/SU/AEs. Adults with post-traumatic stress (PTS) or CMDs in humanitarian settings LHW-led interventions a. may slightly reduce depression symptoms (5 trials, 1986 participants; SMD -0.36, 95%CI -0.56 to -0.15); b. probably slightly improve QOL (4 trials, 1918 participants; SMD -0.27, 95%CI -0.39 to -0.15); c. may have uncertain effects on symptoms (PTS)/functioning/SU/AEs. PHP-led interventions a. may reduce PTS symptom prevalence (1 trial, 313 participants; RR 5.50, 95%CI 2.50 to 12.10) and depression prevalence (1 trial, 313 participants; RR 4.60, 95%CI 2.10 to 10.08); b. may have uncertain effects on symptoms/functioning/SU/AEs. Adults with harmful/hazardous alcohol or substance use LHW-led interventions a. may increase recovery from harmful/hazardous alcohol use although the actual effect range indicates it may have little-or-no effect (4 trials, 872 participants; RR 1.28, 95%CI 0.94 to 1.74); b. may have little-to-no effect on the prevalence of methamphetamine use (1 trial, 882 participants; RR 1.01, 95%CI 0.91 to 1.13) and functional impairment (2 trials, 498 participants; SMD -0.14, 95%CI -0.32 to 0.03); c. probably slightly reduce risk of harmful/hazardous alcohol use (3 trials, 667 participants; SMD -0.22, 95%CI -0.32 to -0.11); d. may have uncertain effects on SU/AEs. PHP/CP-led interventions a. probably have little-to-no effect on recovery from harmful/hazardous alcohol use (3 trials, 1075 participants; RR 0.93, 95%CI 0.77 to 1.12) or QOL (1 trial, 560 participants; MD 0.00, 95%CI -0.10 to 0.10); b. probably slightly reduce risk of harmful/hazardous alcohol and substance use (2 trials, 705 participants; SMD -0.20, 95%CI -0.35 to -0.05; moderate-certainty evidence); c. may have uncertain effects on prevalence (cannabis use)/SU/AEs. PW-led interventions for alcohol/substance dependence a. may have uncertain effects. Adults with severe mental disorders *Comparisons were specialist-led care at T1. LHW-led interventions a. may have little-to-no effect on caregiver burden (1 trial, 253 participants; MD -0.04, 95%CI -0.18 to 0.11); b. may have uncertain effects on symptoms/functioning/SU/AEs. PHP-led or collaborative-care a. may reduce functional impairment (7 trials, 874 participants; SMD -1.13, 95%CI -1.78 to -0.47); b. may have uncertain effects on recovery/relapse/symptoms/QOL/SU. Adults with dementia and carers PHP/LHW-led carer interventions a. may have little-to-no effect on the severity of behavioural symptoms in dementia patients (2 trials, 134 participants; SMD -0.26, 95%CI -0.60 to 0.08); b. may reduce carers' mental distress (2 trials, 134 participants; SMD -0.47, 95%CI -0.82 to -0.13); c. may have uncertain effects on QOL/functioning/SU/AEs. Children with PTS or CMDs LHW-led interventions a. may have little-to-no effect on PTS symptoms (3 trials, 1090 participants; MCD -1.34, 95%CI -2.83 to 0.14); b. probably have little-to-no effect on depression symptoms (3 trials, 1092 participants; MCD -0.61, 95%CI -1.23 to 0.02) or on functional impairment (3 trials, 1092 participants; MCD -0.81, 95%CI -1.48 to -0.13); c. may have little-or-no effect on AEs. CP-led interventions a. may have little-to-no effect on depression symptoms (2 trials, 602 participants; SMD -0.19, 95%CI -0.57 to 0.19) or on AEs; b. may have uncertain effects on recovery/symptoms(PTS)/functioning. AUTHORS' CONCLUSIONS PW-led interventions show promising benefits in improving outcomes for CMDs, PND, PTS, harmful alcohol/substance use, and dementia carers in LMICs.
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Affiliation(s)
- Nadja van Ginneken
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Weng Yee Chin
- Department of Family Medicine and Primary Care, The University of Hong Kong, Pokfulam, Hong Kong
| | | | - Amin Ussif
- Norwegian Institute of Public Health, Oslo, Norway
| | - Rakesh Singh
- Department of Community Health Sciences, School of Medicine and School of Public Health, Patan Academy of Health Sciences, Lalitpur, Nepal
| | - Ujala Shahmalak
- Division of Population Health, Health Services Research & Primary Care, The University of Manchester, Manchester, UK
| | - Marianna Purgato
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Antonio Rojas-García
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | - Eleonora Uphoff
- Cochrane Common Mental Disorders, Centre for Reviews and Dissemination, University of York, York, UK
| | - Sarah McMullen
- Division of Population Health, Health Services Research & Primary Care, The University of Manchester, Manchester, UK
| | | | - Ambika Thapa Pachya
- Department of Community Health Sciences, School of Medicine and School of Public Health, Patan Academy of Health Sciences, Lalitpur, Nepal
| | | | - Anna Borghesani
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | | | - Lee-Yee Chong
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Simon Lewin
- Norwegian Institute of Public Health, Oslo, Norway
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
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19
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Liu YC, Li IL, Hsiao FH. Effectiveness of mindfulness-based intervention on psychotic symptoms for patients with schizophrenia: A meta-analysis of randomized controlled trials. J Adv Nurs 2021; 77:2565-2580. [PMID: 33450107 DOI: 10.1111/jan.14750] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 11/16/2020] [Accepted: 12/10/2020] [Indexed: 12/23/2022]
Abstract
AIMS To evaluate the effects of mindfulness-based intervention on psychotic symptoms, positive symptoms, negative symptoms, depressive symptoms, anxiety, and rehospitalization. DESIGN A meta-analysis of randomized controlled trials. DATA SOURCES Medline, Embase, Cochrane Central Register of Controlled Trials, PsycINFO, CINAHL, National Digital Library of Theses and Dissertations in Taiwan, and Airiti Library were searched from their earliest available date up to April 2019. REVIEW METHODS The guidelines of the Cochrane Collaboration were followed to report this systematic review. Two authors conducted this meta-analysis independently. RESULTS Nine randomized controlled trials were included. Meta-analysis showed that mindfulness-based intervention significantly decreased psychotic symptoms, positive symptoms, negative symptoms, depressive symptoms, and duration of rehospitalization among patients with schizophrenia, and that the reduction in negative symptoms lasted through short-term follow-up. The moderation analysis showed that significantly decreased positive symptoms occurred in the nurse-led intervention group, while no significant impact was found in the psychologist-led intervention group. CONCLUSION The psychotic symptoms of the patients with schizophrenia are improved after mindfulness-based intervention and the effects on the negative symptoms can be maintained for at least 3 to 6 months. Mindfulness-based intervention provided by nurses produces more improvements in positive symptoms than intervention provided by psychologists. IMPACT A growing number of mindfulness-based interventions have been implemented for patients with schizophrenia, although the effectiveness had not previously been established by meta-analysis. Mindfulness-based interventions appear to reduce the symptom severity of schizophrenia patients. Further suggestions for healthcare providers and researchers are provided and discussed.
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Affiliation(s)
- Yu-Chen Liu
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - I-Ling Li
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Fei-Hsiu Hsiao
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan.,National Taiwan University Hospital, Taipei, Taiwan
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20
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Ting KT, Tam W, Jacobsen P. Mindfulness for psychosis groups; description and preliminary evaluation of a novel routine care pathway in Hong Kong. Int J Ment Health Syst 2020; 14:81. [PMID: 33292380 PMCID: PMC7653858 DOI: 10.1186/s13033-020-00415-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 10/29/2020] [Indexed: 11/18/2022] Open
Abstract
Background There is no current guidance on where Mindfulness for Psychosis groups should best be situated within care pathways. The objectives of this paper are to (1) describe a novel care pathway tested out in a psychiatric outpatient service in Hong Kong, and (2) to present feasibility outcomes on attendance and drop-out, and routine clinical outcomes. Methods A new mindfulness pathway was set up, for service users with psychosis who had first completed a course of Cognitive Behavioural Therapy for psychosis (CBTp). After attending an orientation ‘taster’ session, service users could then attended a 4-session weekly Mindfulness for Psychosis group, followed by optional monthly follow-up sessions. Results A high proportion of service users referred into the pathway (19/22; 86%) went on to attend a Mindfulness for Psychosis group after attending an orientation ‘taster’ session. Attendance at group sessions was high, with all participants attending at least 2/4 group sessions, and no drop-outs. Attendance at monthly follow-up groups was also high, with 84% (16/19) attending at least one monthly follow-up. Routine clinical outcome data showed a reduction in negative symptoms of psychosis, and an increase in mindfulness and mindful responding in daily life, from pre- to post group. Conclusions Offering service users with psychosis the opportunity to attend a mindfulness for psychosis group after completing a course of CBTp was highly acceptable, as evidenced by high attendance, and low drop-out. Possible benefits in terms of improving negative symptoms may be particularly important in promoting recovery through improved everyday functioning.
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Affiliation(s)
- K T Ting
- Department of Clinical Psychology, Kowloon Hospital, Kowloon, Hong Kong
| | - Wendy Tam
- Department of Clinical Psychology, Kowloon Hospital, Kowloon, Hong Kong
| | - Pamela Jacobsen
- Department of Psychology, University of Bath, Bath, BA2 7AY, UK.
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Shen H, Chen M, Cui D. Biological mechanism study of meditation and its application in mental disorders. Gen Psychiatr 2020; 33:e100214. [PMID: 32695961 PMCID: PMC7359050 DOI: 10.1136/gpsych-2020-100214] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 05/08/2020] [Accepted: 06/09/2020] [Indexed: 02/07/2023] Open
Abstract
In recent years, research on meditation as an important alternative therapy has developed rapidly and been widely applied in clinical medicine. Mechanism studies of meditation have also developed progressively, showing that meditation has great impact on brain structure and function, and epigenetic and telomere regulation. In line with this, the application of meditation has gradually been expanded to mental illness, most often applied for major depressive disorders and substance-related and addictive disorders. The focus of this paper is to illustrate the biological mechanisms of meditation and its application in mental disorders.
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Affiliation(s)
- Hui Shen
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Meijuan Chen
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Donghong Cui
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
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22
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Mindfulness-Based Interventions for People with Schizophrenia: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17134690. [PMID: 32629764 PMCID: PMC7369977 DOI: 10.3390/ijerph17134690] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/19/2020] [Accepted: 06/26/2020] [Indexed: 12/19/2022]
Abstract
(1) Background: There is increasing interest in the practice of mindfulness-based interventions (MBIs) to treat people with schizophrenia, as evidenced by the publication of different randomized controlled trials (RCTs). However, no meta-analysis of RCTs has been carried out to date with the exclusive inclusion of this type of interventions. (2) Objective: To analyze empirical evidence regarding the effectiveness of MBIs for the improvement of clinical parameters associated with schizophrenia. Method: A systematic review and meta-analysis was conducted of RCTs published in the databases PsycINFO, PubMed, WOS, and Cochrane Library. (3) Results: A total of 10 articles (n = 1094) fulfilled the criteria for inclusion in the review. The analysis of these studies suggests that MBIs combined with standard interventions are able to generate significant improvements in a variety of clinical schizophrenia-related parameters, such as the intensity of overall symptomatology (g = 0.72), positive symptoms (g = 0.32), negative symptoms (g = 0.40), functioning level (g = 1.28), and awareness of illness (g = 0.65). (4) Conclusions: There is evidence that supports the effectiveness and safety of MBIs for the treatment of people with schizophrenia. The results obtained by MBIs are comparable to those obtained by cognitive-behavioral therapy for psychosis. However, given the heterogeneity of the applied interventions and the methodological limitations found in the reviewed trials, the results should be interpreted with caution.
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23
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Jansen JE, Gleeson J, Bendall S, Rice S, Alvarez-Jimenez M. Acceptance- and mindfulness-based interventions for persons with psychosis: A systematic review and meta-analysis. Schizophr Res 2020; 215:25-37. [PMID: 31780349 DOI: 10.1016/j.schres.2019.11.016] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 10/03/2019] [Accepted: 11/11/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Acceptance- and mindfulness-based approaches have gained popularity in recent years. OBJECTIVE A systematic review and meta-analysis of the efficacy and safety of acceptance- and mindfulness-based therapies for persons with a psychotic or schizophrenia spectrum disorder. METHODS Following PRISMA guidelines, relevant databases were searched for published randomized controlled trials (RCTs) up to October 2018. Outcomes were severity of overall symptomatology, hospitalization, positive and negative symptoms, depression, anxiety, social functioning, quality of life, acceptance, mindfulness skills and safety of the interventions. RESULTS Sixteen studies comprising 1268 people with a schizophrenia spectrum disorder were included in the meta-analyses. Moderate to large effect sizes were found for overall symptomatology and hospitalization at endpoint (SMD .80, 95% CI -1.31, -0.29 and MD 4.38, -5.58, -3.17 respectively) and follow-up (SMD 1.10, -2.09, -0.10 and MD 7.18, -8.67, - 5.68 respectively). There were significant small effects on negative symptoms (SMD .24; -0.44, -0.03), small to moderate effects for depression (SMD .47; -0.80, -0.14), social functioning (SMD .43; -0.75, - 0.12) and mindfulness (SMD .51; -0.97, -0.05), moderate to large effects for acceptance (SMD .78; -1.44, -0.12), while no significant effects for positive symptoms (SMD .27; -0.65, 0.00), anxiety (SMD 2.11; -4.64, 0.42) or quality of life (SMD .43; -0.88, 0.02). Majority of studies (75%) had low risk of bias and sensitivity analyses supported the findings. CONCLUSION Acceptance- and mindfulness-based approaches appear to be effective and safe interventions for individuals with schizophrenia spectrum disorders and could be a useful extension of standard casemanagement and psychofarmacology.
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Affiliation(s)
| | - John Gleeson
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Australia
| | - Sarah Bendall
- Centre for Youth Mental Health, The University of Melbourne, Australia; Orygen: The National Centre of Excellence in Youth Mental Health, Melbourne, Australia
| | - Simon Rice
- Centre for Youth Mental Health, The University of Melbourne, Australia; Orygen: The National Centre of Excellence in Youth Mental Health, Melbourne, Australia
| | - Mario Alvarez-Jimenez
- Centre for Youth Mental Health, The University of Melbourne, Australia; Orygen: The National Centre of Excellence in Youth Mental Health, Melbourne, Australia
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24
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Lam AHY, Leung SF, Lin JJ, Chien WT. The Effectiveness of a Mindfulness-Based Psychoeducation Programme for Emotional Regulation in Individuals with Schizophrenia Spectrum Disorders: A Pilot Randomised Controlled Trial. Neuropsychiatr Dis Treat 2020; 16:729-747. [PMID: 32210567 PMCID: PMC7075335 DOI: 10.2147/ndt.s231877] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 01/29/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Emotion dysregulation has emerged as a transdiagnostic factor that potentially exacerbates the risk of early-onset, maintenance, and relapse of psychosis. Mindfulness is described as the awareness that emerges from paying attention to the present moment without judgment. It gently pulls the mind out of the negative emotions induced by the disparity between expectation and reality by focusing on the present moment, instead of worrying about the future or regretting the past. However, only a few research has ever focused on the efficacy of using a mindfulness-based intervention to improve emotion regulation in schizophrenia spectrum disorders. PURPOSE The purpose of this study was to examine the effectiveness of a Mindfulness-Based Psychoeducation Programme (MBPP) on the emotion regulation of individuals with schizophrenia, in particular, to access emotion regulation strategies. The objective of this study was to find out whether MBPP is feasible for improving emotion regulation strategies, in terms of rumination, cognitive reappraisal, and expressive suppression, with a sustainable effect at a three-month follow-up. PATIENTS AND METHODS A single-blinded pilot randomised controlled trial with repeated-measures designs was adopted. Forty-six participants diagnosed with schizophrenia and its subtypes were randomised in either the 8-week mindfulness-based psychoeducation programme or treatment-as-usual (control) group. RESULTS The results of the Generalised Estimating Equations test indicated that the MBPP group showed a significant improvement in reappraisal at a three-month follow-up (β = -6.59, Wald's χ 2=4.55, p=0.033), and a significant reduction in rumination across time. However, the Generalised Estimating Equations indicated no significant difference in rumination and expressive suppression in the MBPP group. Two participants reported having unwanted experiences, including feelings of terror and distress during the mindfulness practice. CONCLUSION The MBPP appeared to be effective for improving emotion regulation, which will contribute to future large-scale RCT to confirm the treatment effects in more diverse groups of schizophrenic patients.
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Affiliation(s)
| | - Sau Fong Leung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong
| | | | - Wai Tong Chien
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong
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25
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Böge K, Karadza A, Fuchs LM, Ehlen F, Ta TMT, Thomas N, Bajbouj M, Hahn E. Mindfulness-Based Interventions for In-Patients With Schizophrenia Spectrum Disorders-A Qualitative Approach. Front Psychiatry 2020; 11:600. [PMID: 32676042 PMCID: PMC7333646 DOI: 10.3389/fpsyt.2020.00600] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 06/10/2020] [Indexed: 12/25/2022] Open
Abstract
In recent years, mindfulness-based interventions (MBI) have gained clinical relevance in the treatment of patients with schizophrenia spectrum disorders (SSDs). High symptom burden, long durations of hospitalization and high rehospitalization rates demonstrate the severity and cost-intensity of these disorders. MBIs have shown promising treatment outcomes in a small number of trials, primarily taking place in English-speaking countries. The current study aims to explore mechanisms and processes as well as adverse effects of MBIs on in-patients with SSDs in a German university hospital setting. A qualitative design based on inductive thematic analysis accompanied by quantitative assessments was chosen. A semi-structured interview guide was developed by psychiatrists and psychologists to assess patient experiences, perceptions, thoughts, and feelings during and after taking part in a MBI. Twenty-seven interviews were conducted between September 2017 and October 2018 with in-patients who are diagnosed with schizophrenia or schizoaffective disorder. Rater-based questionnaires, such as the Positive and Negative Syndrome Scale (PANSS), Montgomery Asberg Depression Rating Scale (MADRS), and Psychotic Symptom Rating Scales-Auditory Hallucination (PSYRATS-AH) were administered at baseline to collect clinical outcomes. Qualitative analysis revealed two domains: content and function. In the first domain related to content with the core elements "detachment and rumination", "presence and getting lost", "non-judgment and judgment", and effects with "emotions", "cognition", and "symptom changes". A second domain related to function was extracted, including the relevance of perception of context and transfer to everyday life. Overall, improvements concerning cognition, distress, and psychopathology were detected, while no adverse effects, such as increased psychotic symptoms, were revealed. As the first study of its kind, mechanisms, processes, and the safety of MBIs were explored and confirmed in a sample of German in-patients with SSDs. The results of this qualitative study are in line with recent findings on MBIs amongst patients with psychotic disorders from other countries. Results lay the ground for future research to focus on the systematic study of MBIs in large samples, its treatment processes, outcomes, and effectiveness for in-patients with SSDs.
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Affiliation(s)
- Kerem Böge
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Almira Karadza
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Clinical Psychology and Psychotherapy, Psychologische Hochschule Berlin, Berlin, Germany
| | - Lukas M Fuchs
- Institute of Sociology, Freie Universität Berlin, Berlin, Germany
| | - Felicitas Ehlen
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Department of Psychiatry, Jüdisches Krankenhaus, Berlin, Germany
| | - Thi Minh Tam Ta
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Neil Thomas
- Centre for Mental Health, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Malek Bajbouj
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Eric Hahn
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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26
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Chien WT, Chow KM, Chong YY, Bressington D, Choi KC, Chan CWH. The Role of Five Facets of Mindfulness in a Mindfulness-Based Psychoeducation Intervention for People With Recent-Onset Psychosis on Mental and Psychosocial Health Outcomes. Front Psychiatry 2020; 11:177. [PMID: 32218747 PMCID: PMC7078358 DOI: 10.3389/fpsyt.2020.00177] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 02/25/2020] [Indexed: 01/09/2023] Open
Abstract
Objective: This study aimed to examine how five facets of mindfulness may be associated with the changes in psychotic patients' health outcomes after participating in a mindfulness-based psychoeducation group (MBPEG) program. Methods: Longitudinal follow-up data from two pragmatic randomized controlled trials of MBPEG for psychotic patients were used for this study. A total of 124 patients who completed the MBPEG program were included in this analysis. Patient outcomes (psychotic symptoms, functioning, insight into illness/treatment, subjective recovery) and five facets of mindfulness were assessed at baseline and six, 12 and 24 months post-intervention. Areas under the curve of individual outcomes in repeated-measures were computed using trapezoidal method, rescaled to the original possible range of the underlying variable and used for correlation and regression analyses. Results: All mean scores of the five facets increased across time and were significantly correlated with the improvements in all patient outcomes (p-values ranged from <0.001 to <0.05), except "non-judging" facet and symptom severity. Regression analyses revealed that only "observing" and "acting with awareness" were significantly associated with positive changes across all outcomes (increase in adjusted R 2 ranged from 5.9% to 24.2%, p < 0.001). Conclusions: Two facets of mindfulness, "observing" and "acting with awareness," were related to positive outcomes of psychotic patients after participating in the MBPEG. More efforts in addressing these two facets of mindfulness can be considered to increase the efficacy of mindfulness-based interventions in psychosis.
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Affiliation(s)
- Wai Tong Chien
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Ka Ming Chow
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Yuen Yu Chong
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Daniel Bressington
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Kai Chow Choi
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Carmen Wing Han Chan
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, Hong Kong
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27
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Chien WT, Cheng HY, McMaster TW, Yip ALK, Wong JCL. Effectiveness of a mindfulness-based psychoeducation group programme for early-stage schizophrenia: An 18-month randomised controlled trial. Schizophr Res 2019; 212:140-149. [PMID: 31416744 DOI: 10.1016/j.schres.2019.07.053] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 04/17/2019] [Accepted: 07/28/2019] [Indexed: 10/26/2022]
Abstract
Current psychosocial interventions in schizophrenia are evidenced to improve patients' illness-related knowledge, mental status and relapse rate, but substantive benefits to patients, such as their functioning and insight into the illness, remain uncertain. This multi-centre randomised clinical trial aimed to examine the effects of mindfulness-based psycho-education group intervention for adult patients with early-stage schizophrenia over an 18-month follow-up. The controlled trial was conducted with a repeated-measure, three-arm design at two psychiatric outpatient clinics in Jilin (China) and Hong Kong. A stratified random sample of 180 outpatients with schizophrenia spectrum disorders (60/group) was randomly assigned to a mindfulness-based psycho-education group programme, psycho-education group and treatment-as-usual group. The primary outcomes on patients' psychosocial functioning and other patient outcomes, such as psychotic symptoms, in the three groups were compared over the 18-month follow-up (baseline and 1-week, 9-month and 18-month post-intervention). One hundred and sixty (89%) patients completed at least two post-tests. Their mean age and duration of illness were 25-28 years (SD = 6.1-7.8) and 2.1-2.5 years (SD = 1.3-2.0; range 4-54 months), respectively. Compared with the two other groups, the mindfulness-based group exhibited a significantly greater improvement with moderate to large effect sizes (Cohen's d = 0.49-0.98) in functioning (p = 0.005), duration of psychiatric re-hospitalisations (p = 0.007), psychotic symptoms (p = 0.008) and illness insight (p = 0.001) over the 18-month follow-up. Supplementary MRI findings indicated that the mindfulness-based intervention resulted in significant changes in gray matter volume and density in brain regions concerning attention and emotional regulation. Mindfulness-oriented psycho-education group intervention can be an effective intervention for adults with early-stage schizophrenia and exert long-term effects on patients' functioning and mental conditions.
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Affiliation(s)
- Wai Tong Chien
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China.
| | - Ho Yu Cheng
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
| | - Terry W McMaster
- Department of Psychology, Concordia University, Montreal H4B 1R6, Quebec, Canada
| | - Annie L K Yip
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China
| | - JoJo C L Wong
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
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28
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Sabe M, Sentissi O, Kaiser S. Meditation-based mind-body therapies for negative symptoms of schizophrenia: Systematic review of randomized controlled trials and meta-analysis. Schizophr Res 2019; 212:15-25. [PMID: 31378557 DOI: 10.1016/j.schres.2019.07.030] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 07/16/2019] [Accepted: 07/21/2019] [Indexed: 02/01/2023]
Abstract
Meditation-based mind-body therapies (yoga, tai-chi, qi-gong, mindfulness) have been suggested to have a potential therapeutic effect on negative symptoms. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) examining effectiveness of yoga, tai-chi, qi-gong and mindfulness on negative symptoms of schizophrenia, using different databases and trial registries. The primary outcome was effect of mind-body therapies on negative symptoms and the secondary outcome was effect on positive symptoms. Fifteen RCTs were included in the meta-analysis (N = 1081 patients). Overall, we found a beneficial effect of mind-body interventions on negative symptoms at endpoint compared to treatment-as-usual or non-specific control interventions, but the effect was small and moderate to high heterogeneity was present. A subgroup analysis for different types of therapy revealed a significant effect of mindfulness-based and yoga interventions on negative symptoms, but heterogeneity within the yoga subgroup was high. Our results did not show an increase of positive symptoms (N = 1051). Our results suggest a potential for meditation-based mind-body therapies in the treatment of negative symptoms, in particular for mindfulness based approaches and to a lesser extent yoga. Limitations in the available comparisons do not allow concluding on a specific effect of these interventions. Overall, the currently available evidence remains limited and does not yet allow one to recommend mind-body therapies for the reduction of negative symptoms. However, the present findings justify further research on mind-body therapies for the treatment of negative symptoms.
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Affiliation(s)
- Michel Sabe
- Division of Adult Psychiatry, Department of Psychiatry, University Hospitals of Geneva, 2, Chemin du Petit-Bel-Air, CH-1226 Thonex, Switzerland.
| | - Othman Sentissi
- Division of Adult Psychiatry, Department of Psychiatry, University Hospitals of Geneva, 2, Chemin du Petit-Bel-Air, CH-1226 Thonex, Switzerland.
| | - Stefan Kaiser
- Division of Adult Psychiatry, Department of Psychiatry, University Hospitals of Geneva, 2, Chemin du Petit-Bel-Air, CH-1226 Thonex, Switzerland.
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Hill H, Killaspy H, Ramachandran P, Ng RMK, Bulman N, Harvey C. A structured review of psychiatric rehabilitation for individuals living with severe mental illness within three regions of the Asia-Pacific: Implications for practice and policy. Asia Pac Psychiatry 2019; 11:e12349. [PMID: 30734499 DOI: 10.1111/appy.12349] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Accepted: 12/27/2018] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Psychiatric rehabilitation can provide and support recovery-oriented care by assisting individuals living with severe mental illness to lead full lives. Despite a well-established evidence-base, implementation and access to these interventions in clinical practice for people with severe mental illness in the Asia-Pacific region is low. We therefore aimed to evaluate prominent themes impacting on clinical practice, policy, and the implementation of psychiatric rehabilitation across the Asia-Pacific region. METHODS A comprehensive review of relevant literature on psychiatric rehabilitation of three regions within the Asia-Pacific was conducted using a structured search of PubMed and other databases. Eligible articles were selected which focussed on how psychiatric rehabilitation is defined and implemented across the Asia-Pacific region, as well as the associated successes and challenges. Common themes were generated. RESULTS Six themes emerged: the impact of policy, legislation, and human rights; access difficulties; the important role of family; the significance of culture, religion, and spiritual beliefs; the widespread impact of stigma; and the indigenous models of excellence being developed. DISCUSSION Consideration of the six themes and their implications should help raise awareness of the issues involved in the provision of psychiatric rehabilitation in the Asia-Pacific region and may improve outcomes for people living with severe mental illness. Suggested strategies include: developing a shared understanding of psychiatric rehabilitation; establishing quality legislation that's well implemented; adapting evidence-based models to develop culturally appropriate services; implementing stigma reduction and empowerment-based interventions; and, ensuring coordinated action among all stakeholders, combined with effective leadership.
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Affiliation(s)
- Harry Hill
- Mental Health, Drugs & Alcohol Service, Barwon Health, Geelong, Australia.,Department of Psychiatry, The University of Melbourne, Parkville, Australia.,School of Medicine, Deakin University, Geelong, Australia
| | - Helen Killaspy
- Division of Psychiatry, University College London, London, UK
| | | | | | - Nicole Bulman
- Mental Health, Drugs & Alcohol Service, Barwon Health, Geelong, Australia
| | - Carol Harvey
- Department of Psychiatry, The University of Melbourne, Parkville, Australia.,North West Area Mental Health Service, NorthWestern Mental Health, Melbourne, Australia
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30
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Lean M, Fornells-Ambrojo M, Milton A, Lloyd-Evans B, Harrison-Stewart B, Yesufu-Udechuku A, Kendall T, Johnson S. Self-management interventions for people with severe mental illness: systematic review and meta-analysis. Br J Psychiatry 2019; 214:260-268. [PMID: 30898177 PMCID: PMC6499726 DOI: 10.1192/bjp.2019.54] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Self-management is intended to empower individuals in their recovery by providing the skills and confidence they need to take active steps in recognising and managing their own health problems. Evidence supports such interventions in a range of long-term physical health conditions, but a recent systematic synthesis is not available for people with severe mental health problems.AimsTo evaluate the effectiveness of self-management interventions for adults with severe mental illness (SMI). METHOD A systematic review of randomised controlled trials was conducted. A meta-analysis of symptomatic, relapse, recovery, functioning and quality of life outcomes was conducted, using RevMan. RESULTS A total of 37 trials were included with 5790 participants. From the meta-analysis, self-management interventions conferred benefits in terms of reducing symptoms and length of admission, and improving functioning and quality of life both at the end of treatment and at follow-up. Overall the effect size was small to medium. The evidence for self-management interventions on readmissions was mixed. However, self-management did have a significant effect compared with control on subjective measures of recovery such as hope and empowerment at follow-up, and self-rated recovery and self-efficacy at both time points. CONCLUSION There is evidence that the provision of self-management interventions alongside standard care improves outcomes for people with SMI. Self-management interventions should form part of the standard package of care provided to people with SMI and should be prioritised in guidelines: research on best methods of implementing such interventions in routine practice is needed.Declaration of interestsNone.
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Affiliation(s)
- Melanie Lean
- Trainee Clinical Psychologist, Division of Psychology and Language Sciences, University College London, UK,Correspondence: Dr Melanie Lean, Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Road, Stanford, CA 94305, USA.
| | - Miriam Fornells-Ambrojo
- Lecturer in Clinical Psychology, Division of Psychology and Language Sciences, University College London, UK
| | - Alyssa Milton
- Postdoctoral Research Fellow, Brain and Mind Centre, University of Sydney, Australia
| | - Brynmor Lloyd-Evans
- Senior Lecturer in Mental Health and Social Care, Division of Psychiatry, University College London, UK
| | - Bronwyn Harrison-Stewart
- Research Assistant, Centre for Outcomes Research and Effectiveness, University College London, UK
| | - Amina Yesufu-Udechuku
- Research Associate, Centre for Outcomes Research and Effectiveness, University College London, UK
| | - Tim Kendall
- National Clinical Director, Mental Health NHS England, UK
| | - Sonia Johnson
- Professor of Social and Community Psychiatry, Division of Psychiatry, University College London, UK
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Chin G, Anyanso V, Greeson J. ADDRESSING DIVERSITY IN MINDFULNESS RESEARCH ON HEALTH: A NARRATIVE REVIEW USING THE ADDRESSING FRAMEWORK. COOPER ROWAN MEDICAL JOURNAL 2019; 1:2. [PMID: 31528848 PMCID: PMC6746558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Gabrielle Chin
- COLLEGE OF SCIENCE AND MATHEMATICS, DEPARTMENT OF PSYCHOLOGY, ROWAN UNIVERSITY, GLASSBORO, NJ
| | | | - Jeffrey Greeson
- COLLEGE OF SCIENCE AND MATHEMATICS, DEPARTMENT OF PSYCHOLOGY, ROWAN UNIVERSITY, GLASSBORO, NJ
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Chien WT, Bressington D, Chan SWC. A Randomized Controlled Trial on Mutual Support Group Intervention for Families of People With Recent-Onset Psychosis: A Four-Year Follow-Up. Front Psychiatry 2018; 9:710. [PMID: 30618880 PMCID: PMC6305581 DOI: 10.3389/fpsyt.2018.00710] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 12/03/2018] [Indexed: 12/04/2022] Open
Abstract
Introduction: Recent research in Western countries has indicated that family interventions in schizophrenia and other psychotic disorders can reduce patient relapse and improve medication compliance. Few studies have addressed Chinese and Asian populations. This study tested the long-term effects of a 9-month family-led mutual support group for Chinese people with schizophrenia in Hong Kong, compared with psycho-education and standard psychiatric care. Methods: A randomized controlled trial of Chinese families of patients with recent-onset psychosis (≤5 years of illness) was conducted between August 2012 and January 2017, with a 4-year follow-up. Two hundred and one Chinese families of adult outpatients with recent-onset psychosis were randomly selected from the computerized patient lists and randomly assigned to either mutual support, psycho-education, or standard care group (n = 70 per group). Family caregivers were mainly the parent, spouse, or child of the patients. Mutual support and psycho-education group consisted of 16 two-hour group sessions and patients participated in three sessions. The standard care group and the two treatment groups received the routine psychiatric outpatient care. Results: Patients and families in the mutual support group reported consistently greater improvements in overall functioning [family functioning, F (2, 203) = 8.13, p = 0.003; patient functioning, F (2, 203) = 6.01, p = 0.008] and reductions in duration of hospitalizations [F (2, 203) = 6.51, p = 0.005] over the 4-year follow-up. There were not any significant increases of medication dosages or service use by both the family support and psycho-education groups over time. Conclusions: The peer-led family support group can be an effective psychosocial intervention in early psychosis indicating long-term benefits on both patient and family functioning and re-hospitalizations. Clinical Trial Registration: NCT00940394: https://register.clinicaltrials.gov.
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Affiliation(s)
- Wai Tong Chien
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Daniel Bressington
- School of Nursing, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Sally W. C. Chan
- School of Nursing and Midwifery, University of Newcastle, Callaghan, NSW, Australia
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