How Do People With Schizophrenia Manage Their Daily Life? A Qualitative Study

Due to the rising number of long-term mental health conditions, there has been a shift in therapeutic focus from curing these conditions, to living a meaningful life with them. Self-management is described as the ability to live with the emotional, life role and medical consequences of long-term conditions such as schizophrenia. However, the perspective of people with schizophrenia on self-management in current literature is missing. A lack of understanding of strategies used by people with schizophrenia to self-manage, could adversely affect the use of self-management interventions. Therefore, this study aims to identify how people with schizophrenia manage their daily life. Semi-structured interviews (n = 9) were conducted in a qualitative descriptive design. The study is reported by using the COREQ checklist. All participants, recruited through purposive sampling, have been stabilised after a schizophrenic episode and have been reintegrated into their community. The data were analysed through thematic analysis. Self-management for people with schizophrenia is an individualised process that revolves around performing day-to-day activities according to the participant's wishes. In addition, participants tried to prevent relapse by self-managing daily life. Personal-, social- and schizophrenia-related factors were seen as barriers and/or facilitators in their self-management. These barriers and/or facilitators were self-managed using daily activities. Current self-management interventions for this population often aim at improving medication adherence. Self-management interventions facilitated by health care professionals should (i) focus more on supporting patients in finding their daily structure through meaningful activities and (ii) be mindful of the duality contained within self-management of people with stabilised schizophrenia.

Ecological virtual reality-based cognitive remediation among inpatients with schizophrenia: A pilot study

Schizophrenia presents a considerable clinical challenge due to limited progress in promoting daily-life functioning among diagnosed individuals. Although cognitive remediation (CR) has emerged as a promising approach to improving cognitive and functional outcomes in schizophrenia, its effectiveness among inpatients and within hospital environments-where opportunities to practice skills in real-world contexts are limited-remains unclear. Here, we aimed to establish the feasibility and initial efficacy of a short, ecological virtual reality-based CR training (CR-EVR) in acute mental health inpatient settings. Efficacy was assessed at four levels: training engagement, near transfer, far transfer, and ecological transfer. Twenty-three inpatients with schizophrenia (Male: 33.3 ± 8.5; 4 Female) completed 8, 20-min CR-EVR sessions, with exercises training the cognitive abilities of inhibition, planning, working memory, shifting, self-initiation, persistence, and attention. Their cognitive functioning, schizophrenia symptoms, functional capacity, and participation in occupations were evaluated pre- and post-training to address four levels of effectiveness. Of the recruited participants, 25.8 % dropped out. Inpatients who completed the full protocol reported high rates of satisfaction (1-not satisfied; 5-very satisfied)) from the intervention (Median = 4, IQR:3.5-5). Post-training, significant improvements were found in the trained cognitive components (intervention engagement: -6.58 < t/Z < 2.02, p < .05), general cognitive functioning (-2.59 < t/Z < 2.29, p < .05), functional capacity (t = -2.9, p < .05), and diversity of participation in everyday activities (t = -3.36, p < .05). This preliminary study suggests that CR-EVR may be a feasible and practical tool to enhance cognitive and ecological outcomes in short-stay acute inpatient settings. Subject to further research, such intervention may be considered an add-on to current practices that promote recovery and health among inpatient populations.

Occupational intervention in mental health hospitals: Study of contextual impact

BACKGROUND

Recovery-promoting and occupation-oriented interventions for people with schizophrenia who receive in-patient services are scarcely investigated, limiting our understanding of the factors affecting intervention effectiveness and hindering occupational inclusion.

AIMS

To investigate the impact of contextual factors on the effectiveness of 'Occupational Connections' (OC) - occupational intervention for in-patient psychiatric settings.

MATERIALS AND METHODS

Quasi-experimental, single-blind study compared between inpatients with schizophrenia participating in OC (N = 14) and those receiving treatment as usual only (N = 16) on primary outcomes of participation dimensions and recovery-orientation of the service, and on secondary outcomes of cognition, symptom severity, and functional capacity.

RESULTS

Participation in OC in a new context appears to contribute to improvement in cognitive fluency and flexibility, schizophrenia symptoms, and functional capacity (-2.8<t < 4.32, p < 0.05) with no improvement in the participation dimensions (-1.36<t < 1.36, p > 0.05) or reduction (-2.25<t < 3.74, p < 0.05). The pattern of change in primary and secondary outcomes in a new context was distinct from previous reports on OC effectiveness.

CONCLUSIONS AND SIGNIFICANCE

These findings suggest the impact of contextual factors on OC effectiveness. Personal participants' factors, institutional features, clinician characteristics, and intervention qualities should be considered in the process of the OC further development, evidence building, and clinical implementation to ensure optimal intervention results.

Do symptoms moderate the association between participation and executive functions outcomes among people with schizophrenia?

BACKGROUND

Literature explains participation limitations among people with schizophrenia through the context of metacognitive limitations, specifically in symptoms and in executive functions (EF). Research has shown mixed results regarding associations between symptoms and participation, reporting association with negative symptoms, positive symptoms, or only metacognitive limitations. The aim of this study was to deepen understanding of the symptoms' impact on the association between participation and executive function among people with schizophrenia.

METHODS

Forty-three participants with schizophrenia received 8 group sessions of focused metacognitive intervention (MCG) aimed at promoting participation by focusing on EF components (e.g., analyzing individual cognitive strategy use). Three measures were administered: the Positive and Negative Syndrome Scale (PANSS) to evaluate symptoms, the Weekly Calendar Planning Assessment (WCPA) to assess EF, and the Activity Card Sort (ACS) to measure participation at the baseline and 12 weeks following completion of the intervention. Scores were compared to a matched control group of 41 people with schizophrenia who instead received treatment as usual. The role of PANSS as moderator was examined using multiple hierarchical regressions, entering interactions between the PANSS scores and WCPA change scores in the final regression step.

RESULTS

Relationships were not significant for participants with high PANSS scores. A positive relationship existed between change in WCPA and change in ACS for participants with low PANSS scores.

CONCLUSIONS

These results demonstrate that low PANSS scores moderate the association between EF and participation and highlight the importance of symptoms as a predictor of participation following the MCG intervention.

TRIAL REGISTRATION

The trial was retrospectively registered at clinical.

TRIAL

gov.

CLINICALTRIALS

gov Identifier: NCT05556941. Clinicaltrial.gov registration date: 27/09/2022.

Preliminary study of time estimation of daily activities in patients with chronic schizophrenia by questionnaire survey

Introduction

Few studies have investigated time estimation of daily activities in patients with mental illness. Therefore, we conducted a preliminary study to extract the characteristics of time estimation in patients with schizophrenia.

Method

We conducted an investigation using the Questionnaire of Time Experience in Daily Activities in patients with schizophrenia and healthy controls. We compared the results between schizophrenia patients and healthy controls using t-tests.

Results

Thirty-four people participated in each group. T-tests showed significantly shorter length of time answers in the schizophrenia group for question 4, (“How long does it take you to go out after waking up in the morning?”). For question 5 (“When you have to take a bus, how long before departure time do you arrive at the bus stop?”) and question 6 (“You have an appointment with your friend. How long beforehand do you arrive at the appointed place?”), the answers of the schizophrenia group were significantly longer than the healthy controls.

Conclusion

Time estimations of some daily activities of patients with schizophrenia were significantly different from those of healthy controls. This study will support the next phase of psychometric testing of the Questionnaire of Time Experience in Daily Activities, after which the results will applicable to practice.

Activity participation patterns of community mental health consumers

Introduction

Previous international research indicates that people with severe mental illness often experience lower levels of activity participation and may therefore be marginalized from occupational opportunities that support recovery. This study aimed to describe activity and participation patterns of consumers of mental health services living in the community and identify significant relationships with demographic characteristics.

Method

A cross-sectional observational study design was utilized, via data mining of the Activity and Participation Questionnaires completed while receiving services from an area mental health service. Data for 282 consumers, who submitted 333 questionnaires, were included.

Results

Consumers were mostly engaged in home-based and unpaid work, and their participation in these tasks significantly increased over time. Significant relationships were found between activity participation and age, gender and primary language. Consumers who were older were less likely to participate in employment, education and physical activity, while female and culturally and linguistically diverse consumers were less likely to engage in activities in the community.

Conclusion

Demographic factors may have a significant impact on the ability of consumers to participate in activities. This may require targeted approaches to activity and participation interventions for specific groups of consumers.

Test–Retest Reliability and Minimal Detectable Change of the Comprehensive Occupational Therapy Evaluation Scale (COTES) in People With Schizophrenia

Importance: A reliable observational measure is necessary to measure clients’ behaviors as they participate in activities. The Comprehensive Occupational Therapy Evaluation Scale (COTES) is designed to measure strengths and difficulties in various behaviors that support occupational performance.

Objective: To examine the test–retest reliability of the COTES (overall score and scores on the General Behavior, Social Behavior, and Work Behavior subscales) and calculate the minimal detectable change (MDC) for people with schizophrenia.

Design: Prospective, observational study.

Setting: A psychiatric center.

Participants: COTES data for 118 people with schizophrenia were collected from occupational therapy records. Data from the initial and second COTES measurements were chosen for analysis.

Outcomes and Measures: Test–retest reliability of the overall scale and three subscales was evaluated using the intraclass correlation coefficient (ICC). The MDC was calculated on the basis of the standard error of measurement.

Results: ICCs for the overall scale and three subscales ranged from .91 to .97. The MDC values (MDC%) were 6.5 (10.5%) for the overall scale, 3.4 (13.5%) for the General Behavior subscale, 2.3 (15.2%) for the Social Behavior subscale, and 2.4 (11.0%) for the Work Behavior subscale.

Conclusion and Relevance: The COTES has good test–retest reliability. Clinicians and researchers can use the MDC values provided in this study to explain the implications of change scores for behaviors that affect occupational performance for people with schizophrenia.

What This Article Adds: The COTES has sound reliability and support for its use in determining whether people with schizophrenia make real improvements in behavior that affects occupational performance over time.

"I just don't look forward to anything". How anticipatory pleasure and negative beliefs contribute to goal-directed activity in patients with negative symptoms of psychosis

Anticipatory pleasure refers to a state of positive affect in anticipation of future events that has been found to motivate goal-directed behavior. Previous research has indicated that patients with negative symptoms of psychosis show reduced goal-directed behavior because 'demotivating beliefs' impede anticipatory pleasure. This study aims to link demotivating beliefs and anticipatory pleasure to patients' motivation in everyday life. Using the Experience Sampling Method, we examined the motivational process of goal-directed activity in the daily lives of 35 patients with negative symptoms and 36 healthy controls. We tested whether the mechanism underlying goal-directed behavior differs between patients and healthy controls and whether demotivating beliefs interfere with goal-directed behavior by impeding anticipatory pleasure. Multilevel analyses revealed that anticipatory pleasure mediated the association between goal-intentions and goal-directed activity in both groups (indirect effects: 24-30%). In the patient group, however, the association between social goal-intentions and anticipatory pleasure was weaker (b = -0.09, SE = 0.05, p ≤ .01, [-0.17;-0.04]) than in the controls, but this was not found for goal-intentions related self-care or recreational activites. Also, demotivating beliefs were more pronounced in the patient sample. (F(1,70) = 72.11, p ≤ .001) and moderated the effect of goal-intentions on anticipatory pleasure for social activities in the whole sample (b = -0.12, SE = 0.05, p ≤ .01, [-0.20;-0.08]). Our results support the assumption that a set of demotivating beliefs prevents patients with negative symptoms from looking forward to social activities and thus provide a possible psychological explanation for the social withdrawal of patients with negative symptoms.

Occupation-focused intervention for in-patient mental health settings: Pilot study of effectiveness

PURPOSE

Participation in meaningful occupation is associated with recovery in serious mental illnesses, however, few evidence-based, occupation-focused interventions for hospital settings exist. This study investigated the effectiveness of "Occupational Connections" (OC), a manualized, short-term, group intervention, addressing issues in daily-life occupations' participation and functioning of people with serious mental illness as early as during hospitalization.

METHODS

Thirty-three inpatients with schizophrenia completed single-blind, pre-post study procedures (up to 10 weeks) in two groups: OC group intervention and open leisure activity group (control condition), in addition to treatment as usual. They were assessed for occupation and participation dimensions, perceptions of services as recovery-oriented, comprehensive cognitive functioning and schizophrenia symptoms. The sampling was convenience with sequential group allocation.

RESULTS

Improvements were found in the study group in the following measurements: intention to participate in daily activities (t(15) = -2.62, p < .05), participation diversity (t(15) = -2.11, p < .05), experience the recovery orientation of the service (t(15) = -3.15, p < .01), functional capacity (t(15) = -3.44, p < .01), cognitive abilities of language understanding, memory and shifting (-4.5<t(15)<3.3, p < .05), and schizophrenia symptoms (positive, negative and general: 8.47<t(15)<9.12, p < .01). The control group has improved on attention (t(16) = -2.89, p < .05), visual-motor organization (t(16) = 2.14, p < .05) and schizophrenia symptoms (4.4<t(16)<6.6, p < .01) only.

CONCLUSIONS

The study provides initial evidence for the effectiveness of OC. The results suggest that interventions with a focus on personal, meaningful daily life occupations such as the OC, may be a useful tool contributing to a positive experience of the in-patient staying and successful community reintegration after acute psychiatric hospitalization.

Social exclusion of people with severe mental illness in Switzerland: results from the Swiss Health Survey

AIMS

People with severe mental illness (SMI) have a high risk of living socially excluded from the mainstream society. Policy initiatives and health systems aim to improve the social situation of people who suffer from mental health disabilities. The aim of this study was to explore the extent of social exclusion (employment and income, social network and social activities, health problems) of people with SMI in Switzerland.

METHODS

Data from the Swiss Health Survey 2012 were used to compare the social exclusion magnitude of people with SMI with those suffering from severe physical illness, common mental illness and the general population.

RESULTS

With the exception of Instrumental Activities of Daily Living, we found a gradient of social exclusion that showed people with SMI to be more excluded than the comparison groups. Loneliness and poverty were widespread among people with SMI. Logistic regression analyses on each individual exclusion indicator revealed that people with SMI and people with severe physical illness were similarly excluded on many indicators, whereas people with common mental illness and the general population were much more socially included.

CONCLUSIONS

In contrast to political and health system goals, many people with SMI suffer from social exclusion. Social policy and clinical support should increase the efforts to counter exclusionary trends, especially in terms of loneliness and poverty.

Food skills group value, meaning, and use with inpatients in a mental health setting

Introduction

Occupational therapists use food skills groups to support mental health recovery and engagement in meaningful occupation. Research examining participants’ experiences in these mental health groups is sparse.

Method

Researchers used a convergent parallel mixed methods design. Following participation in an inpatient food skills group, 60 participants completed a questionnaire, and 20 also participated in a semi-structured interview. The questionnaire data was analysed using descriptive and correlational statistics. The interview data was analysed using thematic analysis. Triangulation was used to combine and interpret findings from the different methods to gain a more complete understanding of the participants’ experiences.

Findings

Participants strongly agreed/agreed that they enjoyed participating, felt having the opportunity to participate was important to their recovery, and after discharge would use the skills they had learnt. Age, sex, and level of education were associated with some of the questionnaire responses. Three main themes emerged from the interview data: importance of engaging/doing, connections with food, and being involved in a group process.

Conclusion

Individuals who participated in the food skills group valued having the opportunity to build skills and engage in meaningful activities with others while in hospital. They identified the food skills group as important to their recovery.

Social anhedonia and asociality in psychosis revisited. An experience sampling study

The DSM-5 appended the conceptualization of asociality in psychotic disorders as the manifestation of diminished interest in social interactions, but it also admitted that it might merely be the result of limited opportunities for social interactions. In an effort to investigate this apparent dichotomy, we used experience sampling data from 149 patients with psychotic disorder and 143 controls, and divided their social interactions into those occurring in the context of work and other structured activities that patients have limited access to, and those occurring in the context of unstructured activities such as visits and conversations that both groups can choose relatively more freely. Patients spent significantly smaller proportion of their time in structured social context, but matched the controls in the time spent in unstructured social contexts, and endorsed intact hedonic experience of both social contexts. Moreover, employment and living situation, in addition to the severity of symptoms of avolition, predicted the proportion of time patients spent in structured and unstructured social contexts, supporting the notion that both lifestyle as well as disease-specific factors contribute to real-life social behavior in psychosis.

Prediction of the intensity and diversity of day-to-day activities among people with schizophrenia using parameters obtained during acute hospitalization

PURPOSE

Participation in day-to-day activities of people with schizophrenia is restricted, causing concern to them, their families, service providers and the communities at large. Participation is a significant component of health and recovery; however, factors predicting participation are still not well established. This study examines whether the parameters obtained during acute hospitalization can predict the intensity and diversity of participation in day-to-day activities six months after discharge.

METHOD

In-patients with chronic schizophrenia (N = 104) were enrolled into the study and assessed for cognitive functioning, functional capacity in instrumental activities of daily living (IADL), and symptoms. Six months after discharge, the intensity and diversity of participation in day-to-day activities were evaluated (N = 70).

RESULTS

Multiple correlations were found between parameters obtained during hospitalization and participation diversity, but not participation intensity. The model that is better suited to the prediction of participation diversity contains cognitive ability of construction, negative symptoms and number of previous hospitalizations. The total explained variance is 37.8% (F_3,66=14.99, p < 0.001).

CONCLUSIONS

This study provides evidence for ecological validity of the in-patient evaluation process for the prediction of participation diversity in day-to-day activities six months after discharge. Participation diversity is best predicted through a set of factors reflecting personal and environmental indicators. Implications for rehabilitation Results of in-patient evaluations can predict the diversity of participation in day-to-day activities six months after discharge. Higher prediction of participation diversity is obtained using a holistic evaluation model that includes assessments for cognitive abilities, negative symptoms severity and number of hospitalizations.