Occupational therapy interventions in the treatment of people with severe mental illness

Validity and Reliability of the Turkish Adaptation of the Assessment of Positive Occupation-15 (APO-15) in Serious Mental Illness

The concept of positive occupations that enhance physical, mental, and social well-being is a novel idea that integrates positive psychology and occupational therapy. Valid and reliable scales are required to assess positive occupations for well-being in mental health settings. In this regard, the Assessment of Positive Occupation-15 (APO-15) is unique, as it evaluates positive occupations that promote health and well-being. This study aimed to investigate the validity and reliability of and determine the cutoff value of the Turkish version of the APO-15 in individuals with serious mental illness (SMI). The study was conducted with 106 individuals with SMI. The structural validity of the scale items was determined using confirmatory factor analysis, while the reliability of the scale was analyzed with Cronbach's alpha (α) and McDonald's omega (ω) coefficients. The comparative fit index (0.964) and the Tucker-Lewis index (0.955) demonstrated a good fit. Cronbach's alpha coefficients were .826, .814, .707, and .674, and the total scale score was 0.924. McDonald's ω coefficients for the four scale dimensions were 0.832, 0.818, 0.716, and 0.727. The cutoff point of 49.50 for the APO-15 for point sensitivity (0.727) and specificity (0.766) yielded good results. The Turkish version of the APO-15 is an effective and reliable tool for assessing well-being in mental health settings.

Defining the complexities of an occupational pattern-A concept analysis and theoretical validation

BACKGROUND

The concept of an occupational pattern in occupational therapy and occupational science has evolved with varying definitions, ranging from activity patterns to patterns of daily occupation.

AIMS

This study aimed to explore the concept of occupational pattern, develop an updated definition of the concept, and theoretically validate the concept's definition.

METHOD

Walker and Avant's concept analysis method was used, where both theoretical frameworks and peer-reviewed scientific literature were searched and synthesized to clarify and define the concept. Furthermore, seven occupational therapists theoretically validated the concept.

FINDINGS

The analysis included forty-nine references from various research contexts and theoretical perspectives. The synthesis yielded a conceptualization of the concept of occupational pattern, outlining it into three overarching categories: 'content in an individual's occupational pattern', 'designing an occupational pattern', and 'balancing the occupational pattern'.

IMPLICATIONS

An updated operational definition of the multifaceted concept of an occupational pattern now exists, with practical implications for enhancing the education of occupational therapy students and guiding the utilization of the concept. Moreover, it holds significance for instrument development and outcome measurement in research; especially in lifestyle intervention studies within the field of occupational therapy.

Improvement of personality functioning among people treated within personality disorder mental health services. A longitudinal, observational study

Objective

Evidence-based personality disorder (PD) treatments are dominated by interventions targeting Borderline PD, although clinical populations characteristically include different PD features and severity. Personality functioning is a new concept intended to capture common features across PDs. This study aimed to investigate longitudinal improvement of personality functioning in a clinical sample assigned to PD treatment.

Method

An observational, large, longitudinal study of patients in PD treatments on specialist mental health service levels (N = 1,051). DSM-5 PDs were systematically assessed on referral. Personality functioning was repeatedly assessed (LPFS-BF-2.0), supplemented by symptom distress (anxiety: PHQ-GAD-7, depression: PHQ-9), and social/occupational activity (WSAS, work/study activity). Statistics were linear mixed models.

Results

Thirty per cent had personality difficulties below PD threshold. Among PDs, 31% had Borderline (BPD), 39% Avoidant (AvPD), 15% not otherwise specified, 15% other PDs, and 24% > one PD. More severe initial LPFS-BF was associated with younger age, presence of PD and increasing number of total PD criteria. Across PD conditions, LPFS-BF, PHQ-9 and GAD-7 improved significantly (overall effect size 0.9). Mean duration of PD treatment was 15 (SD 9) months. Drop-out rates were low (12%). LPFS-BF improvement-rates were higher for BPD. Younger age was moderately associated with slower PHQ-9 improvement. Work/study activity was initially poor, poorer levels associated with AvPD and younger age, and improvement was non-significant across PD conditions. AvPD was associated with slower WSAS improvement-rates.

Conclusion

Personality functioning improved across PD conditions. The results highlight BPD improvements. The study points to challenges concerning AvPD treatment, poor occupational activity and age-related differences.

Occupational therapy interventions for adults with severe mental illness: a scoping review

OBJECTIVE

To identify the occupational therapy (OT) interventions in adults with severe mental illness (SMI) most investigated in intervention studies and to describe their characteristics.

DESIGN

Scoping review.

DATA SOURCES

On 17 January 2020, we searched the following electronic databases: MEDLINE, Scopus, Web of Science and EMBASE. We also performed a manual search of TESEO doctoral thesis database and of the journals indexed in the first quartile of OT according to the SCImago Journal Rank. We updated our search on 10 March 2021, performing a complementary search on ProQuest database and repeating the search in all sources. The terms included in the search strategy were: schizophrenia, schizotypal personality, delusional, schizoaffective, psychotic, bipolar, major depression, obsessive-compulsive, severe mental, OT and intervention.

STUDY SELECTION

The study screening was peer-reviewed. Inclusion criteria were: (1) OT intervention studies in SMI: experimental, randomised, non-randomised and pilot/exploratory studies; (2) adult population with SMI: schizophrenia, schizotypal personality disorder, delusional disorder, obsessive-compulsive disorder, schizoaffective disorder, psychotic disorder, bipolar disorder, major depressive disorder; (3) OT identified as a discipline involved in the intervention; (4) English or Spanish language and (5) studies with full text available.

RESULTS

Thirty-five studies met the inclusion criteria. OT interventions were classified in psychosocial, psychoeducational, cognitive and exercise interventions. The most used OT intervention was psychosocial intervention.

CONCLUSION

Psychosocial intervention was the most investigated OT intervention in SMI, followed by psychoeducational, cognitive and exercise interventions. These interventions are usually group interventions in patients with schizophrenia, performed by a multidisciplinary team (in which an occupational therapist collaborates), with 2-3 weekly 60 min sessions and a duration of 3-6 months.

Impacts of therapeutic horticulture on happiness and loneliness in institutionalized clients with mental health conditions

Introduction

Therapeutic horticulture (TH) can be considered a non-pharmacological approach to support psychiatric treatments for the improvement of physical and mental health, but information is lacking on whether it has advantages as compared to more conventional occupational therapies (OTs).

Method

The study focused on institutionalized 25 clients attending TH among other OTs and 15 clients attending OT other than TH. The measures used were the ‘Subjective Happiness Scale’ (SHS) and the ‘Social and Emotional Loneliness Scale for Adults’ (SELSA-S), along with sociodemographic and clinical data. The study design was descriptive, observational and cross-sectional.

Results

Scores obtained from the SHS and SELSA-S were generally similar for both groups, although 40% of clients in the TH group perceived relaxation. These are in agreement with previous studies performed with chronic schizophrenia clients reporting that TH might effectively decrease depression/anxiety symptoms, but the feeling of hopelessness and quality of life did not change, probably due to long-term institutionalization and required medication that may limit other effects. Within the TH group, clients preferred specific horticultural tasks and more days/week attending activities decreased loneliness and increased happiness.

Conclusion

TH interventions as an integrative treatment option merits further study on both process and outcome evaluation, to maximize its effectiveness.

Ultra-Performance Liquid Chromatography-Tandem Mass Spectrometry for Simultaneous Determination of Antipsychotic Drugs in Human Plasma and Its Application in Therapeutic Drug Monitoring

PURPOSE

We developed and validated an ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) method for simultaneous therapeutic drug monitoring (TDM) and clinical pharmacokinetic antipsychotic drugs: clozapine (CLP), chlorpromazine (CPZ), risperidone (RPD), paliperidone (PLD), quetiapine (QTP;), aripiprazole (APZ), dehydroaripiprazole (DAP), olanzapine (OZP), ziprasidone (ZRD), and amisulpride (ASP).

METHODS

Analytes and internal standards (ISs) were separated using a Phenomenex phenyl-hexyl column (50.0 × 2.1 mm, 1.7 μm) with water containing 0.1% formic acid and 2 mM ammonium acetate, and methanol containing 0.1% formic acid and 2 mM ammonium acetate as the mobile phase. The antipsychotic drugs and ISs were extracted from 50 μL of plasma using acetonitrile.

RESULTS

The calibration ranges were 25.0-1500.0 ng/mL for CLP, CPZ, DAP, and QTP, 10.0-600.0 ng/mL for CPZ and ZRD, 2.5-150.0 ng/mL for RPD, 5.0-300.0 ng/mL for PLD and OZP, and 20.0-1200.0 ng/mL for ASP. Validation was carried out according to the guidelines for bioanalytical validation, including assessment of calibration curves, specificity, accuracy, precision, recovery, stability, dilution integrity, and matrix effect. All the results satisfied the requirements.

CONCLUSION

The results provided significant information to support future clinical TDM and rational drug use research. The proposed method also provided a simple, reliable, specific, and suitable technique for TDM and pharmacokinetic studies.

Implementing an Action Over Inertia Group Program in Community Residential Rehabilitation Services: Group Participant and Facilitator Perspectives

Introduction: A time-use focused intervention, Action Over Inertia (AOI) designed to address restricted activity patterns and support recovery, was adapted for use in Australian community residential mental health services. Method: Qualitative case study research explored the use of AOI groups across three Community Care Units from the perspectives of group participants with enduring mental illness and group facilitators. Fifteen interviews were conducted: five group participants were interviewed twice 4 weeks apart, and five group facilitators on completion of the group intervention. Interview data were analyzed thematically using constant comparative methods. Findings: Two overarching themes, "Making Change" and "Facilitating Change" were identified. Efforts to make change in their lives were supported by participants recognising the value of personally meaningful activities for well-being and of activity experiences that fostered hope and recovery, whereas a sense of "stuckness," time for activities and life events could disrupt "getting me going." For the facilitators, facilitating change involved recognizing inertia as a challenge; getting people going; and looking at how AOI intervention works to impact inertia. Conclusion: AOI in a group format supports participants to identify barriers to more active living; to appreciate how time-use and well-being interrelate; and to reframe and take steps to overcome inertia. Further research should evaluate AOI groups as a means of providing individualized support for activity re-engagement as part of recovery oriented mental health rehabilitation.

Cross-Cultural Adaptation, Validation and Reliability of the Spanish Satisfaction with Daily Occupations-Occupational Balance (SDO-OB): An Evaluation Tool for People with Mental Disorders

Occupation can be defined as all activities that occupy a person's time. The Satisfaction with Daily Occupations and Occupational Balance instrument evaluates the perceived satisfaction with performance and the balance in time dedicated to different occupations. The main aim was to translate the original instrument to Spanish and examine and establish the psychometric properties. This is a quantitative, cross-sectional study conducted in two stages: translation and cultural adaptation (forward translation, expert panel, back-translation, second expert panel and pre-testing and cognitive interviewing) and collecting data to evaluate psychometric properties (homogeneity, construct validity, known-groups validity, and floor/ceiling effects). One hundred participants took part in the study, adults with a diagnosis of a mental health disorder and adults without any known health problems. The Spanish version showed known-groups validity, acceptable internal consistency, and construct validity, although the relationships with some of the indicators of discriminant validity were somewhat higher than expected. The instrument shows promise as a useful screening tool for assessing activity level and satisfaction with daily occupations among a Spanish speaking population.

Navigating in a Misty Landscape - Perceptions of Supporting a Relative Residing in Supported Housing for People with a Psychiatric Disability

The aim was to explore informal carers' perceptions of supporting the everyday life of a relative who has a psychiatric disability and resides in supported housing (SH). A qualitative study based on interviews with 12 informal carers was performed, and the data was analyzed with qualitative content analysis. The theme "Navigating in a misty landscape when striving to support a relative with a psychiatric disability" was identified, encompassing four categories pertaining to residents' needs, collaboration, environmental issues and the carer's situation. SH services can be enhanced by addressing informal carers' experiences and developing greater collaboration involving informal carers, residents and staff.

Validation and Cross-Cultural Adaptation of the Volitional Questionnaire in an Italian Population with Psychiatric Disorders: A Cross-Sectional Study

The aims of this study were to translate and culturally adapt the Volitional Questionnaire (VQ) into Italian and to evaluate its psychometric properties in an Italian population of patients with psychiatric disorders. The translation process from English into Italian was carried out in agreement with the authors of the original scale. The study was carried out in three psychiatric facilities, with 33 patients with psychiatric diagnoses, who were older than 18 years, and two raters (6 total) for each facility in Rome, Italy. The psychometric properties were assessed via its internal consistency, test-retest and inter-rater reliability and construct validity through comparisons with the Barthel Index, Short Form-12, Beck Depression Inventory-II and Camberwell Assessment of Need (CAN). Results showed internal consistency, using Cronbach's alpha, was significant at 0.92. In the test-retest reliability evaluation, the intraclass correlation coefficient was 0.97 and the interclass correlation coefficient was 0.99. The Spearman correlation showed significant results in the comparison with the CAN (r = -0.45, p < 0.05). These results suggest that the IT-VQ may be a valid, standardized and reliable evaluation tool that can be used to detect volitional performance improvements in a population of Italian psychiatric patients.

'Being normal' and self-identity: the experience of volunteering in individuals with severe mental disorders-a qualitative study

OBJECTIVE

This study sought to explore the views and experiences of a group of people with severe mental disorders (SMDs) who performed volunteer services.

DESIGN

A qualitative phenomenological study.

SETTING

Community public mental health services of the Community of Madrid and the province of Barcelona (Spain).

PARTICIPANTS

Purposive sampling techniques were used between September 2016 and April 2017. The inclusion criteria were: individuals aged 18-65 years who participated in volunteer activities during the performance of this study, based on the regulations of volunteer services in Spain and the community of Madrid; a diagnosis of non-organic psychotic disorder (F20.x, F21, F22, F24, F25, F28, F29, F31.x, F32.3 and F33) according to the International Classification of Diseases, 10th Revision; an evolution of ≥2 years; and a moderate to severe dysfunction of global functioning with scores ≤70 in the Global Assessment of Functioning Scale. Ultimately, 23 people with SMD participated in the study with a mean age of 47 years (SD 8.23).

METHODS

Data were collected through in-depth interviews and researcher field notes. A thematic analysis was performed following appropriate guidelines for qualitative research.

RESULTS

Two main themes emerged to describe the experience of participating in volunteer activities: (1) rebuilding self-identity, based on the participant's experience of volunteering, of acquiring a new role and a new perceived identity that made them feel valued and respected; and (2) being a so-called normal person with a 'normal' life, based on recovering a sense of normality, unmarked by the illness, thanks to daily responsibilities and occupations.

CONCLUSIONS

Qualitative research offers insight into the way people with SMD experience volunteering and may help to improve understanding of the underlying motivations that drive these individuals. These findings may be applied to improve guidance during their process of recovery and subsequent inclusion into society.