An assessment of the educational needs of chronic psychiatric patients and their relatives

Assessing the Educational Needs of Family Caregivers of Psychiatric Patients in Jeddah, Saudi Arabia

Background Family caregivers of psychiatric patients in Saudi Arabia and most of the Eastern world are suffering a big burden as a result of their caregiving role. Aim This study aims to assess the need for psychoeducation for family caregivers of psychiatric patients from outpatient clinics in a psychiatric hospital in Jeddah, Saudi Arabia. Materials and methods A cross-sectional descriptive-analytical study was conducted, which included a total of 379 family caregivers providing care to a patient suffering from a psychiatric illness. Results The majority of family caregivers looking after a patient suffering from a psychiatric illness were a brother or sister (20.8%), followed by a son or daughter (20.6%), and lastly, a spouse (10.3%). The top 10 important educational needs of the caregivers included their desire to know about the daily treatment of the patient, followed by how to improve social relationships, and a need for effective stress management. Family caregivers also showed interest in stress and illness. The caregivers' areas of least concern were about the admission of the patients to psychiatric hospitals, recent research on mental illnesses, and how to deal with weight gain. Conclusion The study showed that caregivers demonstrated a need for more experience in how to care for psychiatric patients. Indeed, this has an interrelated impact on the general well-being of both the patient and the caregiver. The study recommends the need for care guidelines to be provided by hospitals from the patient's education department for caregiving to help the family in their daily care.

Information needs and sources of information among people with depression and anxiety: a scoping review

BACKGROUND

Previous studies have identified substantial unmet information needs in people with depression and anxiety. Sufficient information about the disorder, treatment, available services, and strategies for self-management is essential as it may influence quality of care and patients' quality of life. This scoping review aimed to provide a broad overview of information needs of people with depression and anxiety as well as the sources that they use to seek this information.

METHODS

We included all primary research published in English that investigated information needs or information sources in people with depression or anxiety, with no restrictions imposed on the study design, location, setting, or participant characteristics. Six electronic databases (MEDLINE, Embase, PsycINFO, CINAHL, LISTA, Web of Science) and the grey literature (Google and Google Scholar) were searched for relevant studies published up to November 2021. Two reviewers independently screened articles and extracted data. Narrative synthesis was performed to identify key themes of information needs and information sources. Factors associated with information needs/sources such as demographic variables and symptom severity were also identified.

RESULTS

Fifty-six studies (comprising 8320 participants) were included. Information needs were categorised into seven themes, including general facts, treatment, lived experience, healthcare services, coping, financial/legal, and other information. The most frequently reported needs in both people with depression and anxiety were general facts and treatment information. Subclinical samples who self-reported depressive/anxious symptoms appeared less interested in treatment information than patients with clinical diagnoses. Information sources were summarised into five categories: health professionals, written materials, media, interpersonal interactions, and organisational resources. Health professionals and media (including the internet) were the most frequently adopted and preferred sources. Although few studies have examined factors associated with information needs and information sources, there is preliminary evidence that symptom severity and disease subtypes are related to information needs/sources, whereas findings on demographic factors were mixed.

CONCLUSIONS

Information needs appear to be high in people with depression and anxiety. Future research should examine differences between subgroups and associated factors such as the treatment course. Personalised information provision strategies are also needed to customise information according to individual needs and patient profiles.

TRIAL REGISTRATION

The protocol of this scoping review was registered on Open Science Framework (OSF; link: https://doi.org/10.17605/OSF.IO/DF2M6 ).

Family Conundrums with Psychiatric Medication: An Inquiry into Experiences, Beliefs, and Desires

Research with families of people with serious mental illness consistently shows that the concerns and conundrums about their loved one's medication are among those most centrally voiced. The inquiry here relied on an anonymous cross-sectional survey of attitudes, beliefs, and experiences of family members (N = 339) specifically related to psychiatric medication use. A latent profile analysis yielded two categories of respondents: those "skeptical of the medical model," which represented 43% of the survey respondents, and those "supportive of the medical model," which represented 57% of the survey respondents. Data from open-ended questions suggests families crave inclusion and wish providers would more radically embrace both collaboration and balance in their approach to medication maintenance. The hope of this research is to help mental health providers be more responsive and compassionate in their work with families of people with serious mental illness, especially as it relates to psychiatric medication.

Future Care Planning: Concerns of Elderly Parents Caring for a Person With Serious Mental Illness

Although recent advances in early treatment of people with serious mental illness have brought new hope to family members, parents of service users are still often left to worry about their loved one's future care. Without judicious planning, a parent''s death can be a catastrophic event that leaves an adult with serious mental illness without supports. This Open Forum emphasizes the benefits of mental health professionals being proactive and helping families and service users address concerns with future care planning. The active involvement of all stakeholders, including the person with mental illness, relatives, friends, mental health professionals, lawyers, and financial planners, can ensure proper care planning and promote better long-term outcomes.

Psychoeducation as Precision Health in Military-Related Mild Traumatic Brain Injury

A significant proportion of Service Members and Veterans (SMVs) experience at least 1 mild traumatic brain injury during military activities (mil-mTBI), which can result in enduring cognitive symptoms. Although multiple cognitive rehabilitation (CR) interventions have been developed for this population, patient psychoeducation focusing on biopsychosocial relationships and health behaviors is often cited as the first line of defense for mil-mTBI sequelae. However, theoretical and conceptual foundations of these psychoeducational techniques are not well articulated. This raises questions about the potency of attempts to boost health literacy in affected SMVs, who represent a highly heterogeneous patient population within a special cultural milieu. To elucidate the significance of this problem and identify opportunities for improvement, we view the psychoeducation of SMVs through the lens of educational principles described in serious mental illness, where "psychoeducation" was first formally defined, as well as contextual and phenomenological aspects of mil-mTBI that may complicate treatment efforts. To advance psychoeducation research and practice in mil-mTBI, we discuss how treatment theory, which seeks to link active treatment ingredients with specific therapeutic targets, and an associated conceptual framework for medical rehabilitation-the Rehabilitation Treatment Specification System-can be leveraged to personalize educational content, integrate it into multicomponent CR interventions, and evaluate its effectiveness.

One-year outcome of low-intensity booster sessions versus care as usual in psychosis patients after a short-term psychoeducational intervention

Objective

In this study we aimed to evaluate long-term effects of a community-based, quality of life oriented psychoeducational intervention for schizophrenia with and without booster sessions.

Method

One hundred and three outpatients with a diagnosis of schizophrenia or schizoaffective disorder completed a 9-week psychoeducational programme. At the end of the programme groups were block-randomised to either an extension programme comprising monthly booster sessions for a further nine months (booster condition) or routine clinical care with no further group meetings (non-booster condition). Outcome measures were applied before and after the seminar and at 6 and 12 months.

Results

Positive effects were observed after the short-term 9-week programme with regard to symptoms, knowledge about the illness, illness concept, control convictions and quality of life. These effects were retained over the 12-month period in both conditions. The only relevant difference between the booster and the non-booster conditions concerned external control convictions.

Conclusion

Overall this 9-week programme has shown encouraging effects still present at 12 months after baseline independent of booster or non-booster conditions. Further studies are needed to explore whether a subgroup of patients, those with impaired neurocognitive and social functioning, can benefit significantly from booster sessions.

Functional Recovery in Schizophrenia

Recovery in schizophrenia is a topic that generates not only major clinical attention but also a significant economic and social impact. Until seventy years ago, these patients remained held in psychiatric institutions or asylums, usually with no hope of reintegrating into the community. A narrative review of relevant literature was conducted in order to answer key questions regarding recovery in schizophrenia. Treatment objectives in schizophrenia have changed substantially: from expecting a modest control of psychotic symptoms to considering functional recovery as a possibility. Available evidence indicates that one in seven patients with schizophrenia will achieve functional recovery, which implies that remission of positive symptoms is not the ultimate goal of treatment but only a basis for better social and cognitive functioning that translates into better quality of life. This view until recently was not believed to be possible for this major mental disorder.

Information and decision-making needs of psychiatric patients: the perspective of relatives

Background

Mental illness may strongly affect relatives’ lives. Therefore, it is important to empower relatives by providing health information according to their preferences.

Methods

An online cross-sectional survey was conducted using a purpose-designed questionnaire on online health information and decision-support needs.

Results

Prevalent reasons for online health information search of the 185 participating relatives were the need for general information and the insufficiency of the information given by the health care provider. The most difficult treatment decisions concerned the treatment setting (inpatient or outpatient) as well as the psychopharmacological treatment.

Discussion

Since psychiatric patients’ relatives report extensive information and decision-support needs, it is essential to address their needs in health information material. Assessment of relatives’ needs when developing health information materials is recommended.

Perspectives on Sleep, Sleep Problems, and Their Treatment, in People with Serious Mental Illnesses: A Systematic Review

Sleep problems are common in people with serious mental illness, and impact negatively on functioning and wellbeing. To understand the development of sleep problems, their maintenance, and their treatment, an in depth understanding of patient perspectives is crucial. A systematic literature review was conducted using Medline, AMED, PsychInfo, Embase and CINAHL. Qualitative and quantitative studies were included if they explored or measured patient perspectives on sleep, sleep problems or sleep treatments in people with serious mental illness. Of the 2,067 hits, only 22 met review inclusion criteria, and high quality evidence was sparse. The limited findings suggested sleep was seen as highly interlinked with mental health. Evaluations of treatments varied, however perceived efficacy and personalisation of treatments were valued. Some evidence suggested patient priorities and conceptualisations regarding sleep may diverge from those of validated screening tools developed in general population and sleep medicine samples. More rigorous research is needed to support adaptation and development of interventions and outcome measures for use in specialist mental health settings. Qualitative studies exploring the experience of sleep disturbance in particular diagnostic groups and contexts are urgently required, as are patient perspectives on sleep interventions.

Pathway to mental health recovery: a qualitative and quantitative study on the needs of Chinese psychiatric inpatients

BACKGROUND

Exploration of the information and participation needs of psychiatric inpatients is an important step for the implementation of recovery-oriented mental health service. The objective of this study was to explore the information and participation needs of Chinese psychiatric inpatients in the largest psychiatric hospital in Hong Kong.

METHODS

The study was divided into two parts. In the first part, eight focus groups with patients, patients' relatives and healthcare professionals were held to identify 22 items of information needs and 16 items of participation needs of Chinese psychiatric inpatients. Basing on the items identified in the first part of the study, a questionnaire was developed to survey on the importance of the different information and participation needs in the second part of the study. Participants were asked to rate in rank order their perceived importance of the items in the questionnaire survey.

RESULTS

A hundred and eighty three Chinese psychiatric inpatients completed the questionnaire and the majority of them suffered from schizophrenia (68.3 %). For information needs, the top three needs rated by patients as the most important in descending order were: "Information on the classifications of mental illnesses, signs and symptoms and factors contributing to relapse", "Information on the criteria and arrangements for discharge", and "Information on the importance of psychiatric drug taking and its side effects". For participation needs, the top three needs rated by patients as the most important in descending order were: "Enquiring about personal needs and arrangements", "Keeping in touch with the outside world", and "Learning and practising self-management".

CONCLUSIONS

This study reveals that Chinese psychiatric inpatients are concerned about information on their mental illness and its treatments as well as the criteria for discharge. On the other hand, patients are concerned about their personal needs, their self-management, as well as their keeping in touch with the outside world during their hospitalisation. Moreover, patients with different socio-demographic and clinical characteristics have different information and participation needs. The results of the present study serve as a reference for designing guidelines, strategies, and programmes to meet the information needs and participation needs of psychiatric inpatients in Hong Kong.

Information needs, care difficulties, and coping strategies in families of people with mental illness

Objective:

To determine information needs, care difficulties, and coping mechanisms of family members of people with mental illness.

Methods:

In this descriptive cross-sectional study, the study sample consisted of the families of 134 patients who were treated in the Psychiatric Unit of Cumhuriyet University Training and Research Hospital in Sivas, Turkey between January and May 2011. Data was collected by a questionnaire and analysed descriptively, and by chi-square testing.

Results:

It was determined that 79.1% of family members were knowledgeable of the patients’ illness. It was found that they experienced difficulties in communicating with the patient, and in ensuring drug compliance and anger management and that they used psychological and social coping strategies.

Conclusion:

Our results indicate that access to medical information on its own is not sufficient for carers of people with mental illness, and the necessity of developing positive attitudes when dealing with the illness and its symptoms. We recommend that nurses and other health professionals offer long term support and consultation programs to family members.

Information and decision-making needs among people with affective disorders - results of an online survey

BACKGROUND

Patient decision aids are one possibility for enabling and encouraging patients to participate in medical decisions.

OBJECTIVE

This paper aims to describe patients' information and decision-making needs as a prerequisite for the development of high-quality, web-based patient decision aids for affective disorders.

DESIGN

We conducted an online cross-sectional survey by using a self-administered questionnaire including items on Internet use, online health information needs, role in decision making, and important treatment decisions, performing descriptive and comparative statistical analyses.

PARTICIPANTS

A total of 210 people with bipolar disorder/mania as well as 112 people with unipolar depression participated in the survey.

RESULTS

Both groups specified general information search as their most relevant information need and decisions on treatment setting (inpatient or outpatient) as well as decisions on pharmacological treatment as the most difficult treatment decisions. For participants with unipolar depression, decisions concerning psychotherapeutic treatment were also especially difficult. Most participants of both groups preferred shared decisions but experienced less shared decisions than desired.

DISCUSSION AND CONCLUSION

Our results show the importance of information for patients with affective disorders, with a focus on pharmacological treatment and on the different treatment settings, and highlight patients' requirements to be involved in the decision-making process. Since our sample reported a chronic course of disease, we do not know if our results are applicable for newly diagnosed patients. Further studies should consider how the reported needs could be addressed in health care practice.

Desire for information of people with severe mental illness

PURPOSE

To assess (1) the desire of people with severe mental illness for information on their treatment and (2) whether the desire for information is associated with socio-demographic variables, diagnosis, illness duration, therapeutic relationship, needs and symptom severity.

METHODS

588 outpatients with severe mental illness were recruited in six European countries (Germany, Denmark, Hungary, Italy, Switzerland, United Kingdom) during the "Clinical decision making and outcome in routine care of people with severe mental illness (CEDAR)" study (ISRCTN75841675). Desire for information was assessed by the Information subscale of the Clinical Decision Making Style Scale. Study participants with high desire for information were compared with those with moderate or low desire for information.

RESULTS

80 % of study participants (n = 462) wanted to receive information on all aspects of their treatment (management, prognosis, alternative options for care). Participants with a high desire for information had less severe symptoms (OR = 0.988, CI = 0.977-1.000) and a better self-rated therapeutic alliance (OR = 1.304, CI = 1.130-1.508) with their clinician.

CONCLUSIONS

Most, but not all, people with severe mental illness have a high desire for information. Desire for information is associated with variables, such as therapeutic relationship and symptom severity, which are amenable to change during treatment.

Early Intervention in Psychotic Relapse: Cognitive Approaches to Detection and Management

Clinical observation and retrospective and prospective studies of relapsing psychosis have demonstrated that early symptoms of decompensation are observable in one half to two thirds of patients over a period of 1 to 4 weeks. Whilst the sensitivity of prodromal symptoms is established, their specificity is less certain, particularly at the first episode. The appearance of an “at risk” mental state, if not leading to decompensation, may nevertheless be part of a “transitional” stage to psychosis that is affected by psychological factors concerning the attributions that are made about a change in mental life. The research on prodromal signs is reviewed, with three areas of focus: prodromes as continuous versus discrete phenomena, sensitivity and specificity, and early intervention studies. A psychological model of the transitional process is described with case examples, together with an exploration of its implications for early intervention, again illustrated by case material.

Information and decision-making needs among people with mental disorders: a systematic review of the literature

BACKGROUND

Assessment of users' information and decision-making needs is one key step in the development of decision-support interventions.

OBJECTIVE

To identify patients' information and decision-making needs as a pre-requisite for the development of high-quality web-based patient decision aids (PtDAs) for common mental disorders.

SEARCH STRATEGY

A systematic MEDLINE search for papers published until December 2012 was conducted, and reference lists of included articles and relevant reviews were searched.

INCLUSION CRITERIA

Original studies containing data on information or decision-making needs of adults with depression, anxiety disorders, somatoform disorders, alcohol-related disorders and schizophrenia were included.

DATA EXTRACTION AND SYNTHESIS

Data extraction was performed using a standardized form, and data synthesis was conducted using a theory-based deductive approach by two independent reviewers. Studies were quality assessed using the Mixed Methods Appraisal Tool.

MAIN RESULTS

Twelve studies were included focusing on information needs or the identification of decisions patients with depression and schizophrenia were facing. No studies were found for the other mental disorders. Overall, seven information needs categories were identified with the topics 'basic facts', 'treatment' and 'coping' being of major relevance. Six decision categories were identified of which decisions on 'medication' and 'treatment setting' were most often classified.

CONCLUSIONS

This review reveals that patients with schizophrenia and depression show extensive information and decision-making needs. The identified needs can initially inform the design of PtDAs for schizophrenia and depression. However, there is an urgent need to investigate information and decision-making needs among patients with other mental disorders.

An assessment of the psychoeducational needs of long-term psychiatric patients

Objectives: We aimed to identify which illness related topics were of most interest to chronic psychiatric patients in our catchment area service, and to obtain a baseline measure of the amount of knowledge which patients with schizophrenia had about their illness.

Method: Patients attending for a minimum of one year were recruited from the outpatient clinic and day centre. Participants completed three instruments: a brief questionnaire which asked about the details of their diagnosis and drug treatment regimen, the ‘Educational Needs Questionnaire’ (ENQ), and a modified form of the ‘Understanding Schizophrenia Scale’ (USS).

Results: Forty-seven patients with a chronic psychotic illness participated in the study. Despite having attended the service for an average of 14 years, the majority of patients were unable to correctly identify their diagnosis. Most patients were able to name the drugs which they had been prescribed; but were not able to describe the dosage of these drugs. According to the ENQ results, patients expressed most interest in learning about general aspects of their illness, such as ‘how to cope with stress’, and less in how to manage specific illness related symptoms. Similarly, schizophrenia patients were found to know more about general aspects of their illness, such as rehabilitation and non-medical aspects of treatment, than about medication.

Conclusion: Chronic psychiatric patients, especially those with schizophrenia, have very limited knowledge of their illness and its treatment. The focus of psychoeducation should be extended from insight and compliance to include broader ‘quality of life’ issues which appear to be of more concern to patients themselves. Patient participation in psychoeducation can thus be improved by including topics identified by such instruments as the ENQ. It is encouraging that cognitive deficits and negative symptomatology do not seem to prevent long-term psychiatric patients from benefiting from such inputs.

How psychiatrists should introduce themselves in the first consultation: an experimental study

BACKGROUND

How psychiatrists introduce themselves in the first consultation may influence the therapeutic relationship. There is no evidence about what type of introduction patients prefer.

AIMS

To assess experimentally patients' preferences for how psychiatrists introduce themselves.

METHOD

Twelve psychiatrists were filmed, each with three different introductions: stating name, profession and reason for consultation; the same, plus information on what will happen during the consultation; and the same, plus disclosure of a personal difficulty. Six randomly selected videos, of different psychiatrists, two of each type of introduction, were rated by each of 120 psychiatric in- and out-patients on Likert-type scales.

RESULTS

Patients gave the most positive ratings to psychiatrists who introduced themselves with information about what will happen in the consultation rather than ones with briefer introductions or with additional personal disclosure (P = 0.002). Preferences were similar in different subgroups.

CONCLUSIONS

Psychiatrists should introduce themselves with information about what they intend to do in the consultation, but without personal disclosure.

Psychosocial treatments for schizophrenia

The current state of the literature regarding psychosocial treatments for schizophrenia is reviewed within the frameworks of the recovery model of mental health and the expanded stress-vulnerability model. Interventions targeting specific domains of functioning, age groups, stages of illness, and human service system gaps are classified as evidence-based practices or promising practices according to the extent to which their efficacy is currently supported by meta-analyses and individual randomized controlled trials (RCTs). Evidence-based practices include assertive community treatment (ACT), cognitive behavior therapy (CBT) for psychosis, cognitive remediation, family psychoeducation, illness self-management training, social skills training, and supported employment. Promising practices include cognitive adaptive therapy, CBT for posttraumatic stress disorder, first-episode psychosis intervention, healthy lifestyle interventions, integrated treatment for co-occurring disorders, interventions targeting older individuals, peer support services, physical disease management, prodromal stage intervention, social cognition training, supported education, and supported housing. Implications and future directions are discussed.

Implementing a structured psychosocial interventions group programme for people with bipolar disorder

It has been reported that, at any time, over half of the people with bipolar disorder are receiving no active treatment. Despite the availability of effective medications and psychotherapies, research concludes that the care of bipolar disorder in everyday practice is often deficient. Evidence base reports the effectiveness of psychosocial interventions using many of the same ideas as the recovery approach; both attempt to place clients at the heart of service delivery. This paper reports on the development and implementation of three pilot group programmes for service users with bipolar disorder, in a community clinical setting in South East England. The group programme design and development was based upon the evidence-based psychosocial interventions advocated in national clinical guidelines and research literature. The programme incorporated the key effective psychosocial interventions and self-management mechanisms within its 12 sessions spanning over 3 months, followed by three booster sessions in 6 months' time. Twenty-three service users have to date completed the programme. Participant feedback will be discussed and reported to inform further development and research implications of such innovative evidence-based interventions for service users with bipolar disorder.

Relapse Prevention: A Model for Psychosis?

Evidence suggests that there are substantial costs (in a variety of spheres: personal, social, financial, etc.) associated with psychotic relapse. Furthermore, relapse increases the likelihood of future relapses and increased costs. This paper explores the application of a model of relapse prevention (RP) outlined by Marlatt and Gordon (1985) to the field of psychosis. The original model was designed to help individuals who abuse substances to maintain control over their habit. The advantages and limitations of applying the original model to the prevention of psychotic relapse are explored in detail in the context of an amended model. One major advantage of the RP model is that it provides a framework for the coordination of treatment interventions. The complex intervention packages, which may be useful in the management of psychotic illnesses, are described. The RP framework may be used to coordinate treatments in a manner that maximises their potential and emphasises patient control.

Integrated treatment to achieve functional recovery for first-episode psychosis

This study describes an integrated treatment approach that was implemented to enhance functional recovery in first-episode psychotic patients. Patients were randomized to two treatment conditions: either to an integrated treatment approach: pharmacotherapy, psychosocial treatment, and psychoeducation (experimental group: N = 39) or to medication alone (control group: N = 34). Patients were evaluated at baseline and after one year of treatment. Functional recovery was assessed according to symptomatic and functional remission. At the end of treatment, experimental patients showed a 94.9% of symptomatic remission compared to 58.8% of the control group. Functional remission was 56.4% for the experimental group and 3.6% for the control group, while 56.4% of the experimental group met both symptomatic and functional remission criteria and were considered recovered compared to 2.9% of the control group.

Being informed and involved in treatment: what do psychiatric patients think? A review

Aims – A narrative review of studies on the information needs of psychiatric patients, the knowledge of their diagnosis and treatment expectations. Methods – A literature review, limited to studies between 1980 to 2003, was carried out using Medline and Psychlnfo databases. Results – Sixty five studies of interest were identified. Less than half of the psychiatric patients know their diagnosis and patients affected by schizophrenia are the least informed. Notions about aetiology and treatment are patchy, and the concept of ‘multifactorial cause’ seems unknown. Little knowledge emerged about drugs and side effects, expecially in the long term. Patients want to be informed, involved in decisions and their treatment programme. They feel that their psychiatrists are more interested in pharmacological aspects than in their personal problems. Conclusions – A better quality of communication, the involvement of patients in decision processes and meeting patients' information needs is necessary to improve therapeutic relationships, to encourage greater compliance with treatment programs and to reduce the stigma of psychiatric illness.

Declaration of Interest: none of the three authors has had any interest or received any form of support, including that from drug companies and honoraria for lectures and consultancies, potentially in conflict with this scientific work.

Development, item analysis, and initial reliability and validity of a multiple-choice knowledge of mental illnesses test for lay samples

The public's level of mental health literacy remains low, despite growing access to information regarding mental illnesses. Because few measures exist to assess the level of knowledge of mental illnesses in lay samples, the Multiple-Choice Knowledge of Mental Illnesses Test (MC-KOMIT) was developed, initially for use in a study involving police officers, some of whom received 40 h of training focused on recognizing mental illnesses, using verbal de-escalation techniques, and making mental health referrals when appropriate. This report details the initial development of the 100 questions in the item bank and the eventual selection of the final 33 items that were retained. For these 33 items, internal consistency was demonstrated, and test-retest reliability was examined among officers not in the mental health-related training who completed the test on Monday morning and again on Friday afternoon. Construct validity was examined by three hypothesis tests: the MC-KOMIT was sensitive to change related to the educational intervention, scores were significantly correlated with years of educational attainment, and officers reporting past or current treatment for a mental health problem scored higher than those without such a history. This initial report suggests that the MC-KOMIT may be useful in quantifying knowledge of mental illnesses in police officers and other diverse lay samples.

Knowledge and informative needs of patients with the diagnosis of schizophrenia, explored with focus group methods

Aims – Psychiatric patients often are not informed about their diagnosis and their involvement in the decision making process is rare. Aim of the study was to explore the informative needs of patients with schizophrenia and the knowledge about their illness. Method – Three focus groups were conducted with 25 long-stay patients with the diagnosis of schizophrenia, attending the Mental Health Centre of the South-Verona Community-based Mental Health Service. The group discussions were audiotaped and transcribed. Results – The authors identified 18 different thematic categories which were used by two raters to classify all patient contributions. The interrater reliability was satisfactory. The qualitative analysis evidenced that patients have little knowledge about their illness. Patients had confuse and vague ideas on schizophrenia but their knowledge on drug names, dosages and side effects appeared precise and detailed. Several patients have looked for information in encyclopedias and medical dictionaries. Conclusion – The findings suggest a need of patients affected by schizophrenia for an information exchange with their psychiatrists that takes into account their informative needs, corrects wrong beliefs and actively involves them in therapeutic decisions.

Health education needs of family caregivers supporting an adolescent relative with schizophrenia or a mood disorder in taiwan

This study, which is part of a larger research program, examined the health education needs of family caregivers providing care and support for an adolescent relative with schizophrenia or mood disorder in Taiwan. Family caregivers reported significant unmet information needs, and those with higher incomes or educational levels were more likely to report unmet educational needs. Caregivers using information resources consistently had high unmet educational needs. Results revealed the importance of assessing specific educational needs of families, as educational needs of caregivers differed according to diagnostic group, especially with regard to etiology, symptoms, and coping strategies.

Health education needs of patients with schizophrenia and their relatives

The purpose of this study was to determine the health education needs of patients with schizophrenia and their relatives. A total of 80 patients and 80 relatives were included in the study. The data were collected using Descriptive Characteristics Questionnaire and Evaluation of Health Educational Needs Form. The subjects that patients and their relatives felt they had the greatest need to learn more about were general information about schizophrenia, coping with symptoms of schizophrenia, and communication and social relationships. It was determined that the patients' health education needs were affected by their employment status, income level, and longest place of residence, and their relatives' health education needs, by their marital status, degree of family relationship, educational level, income level, whether or not they were a member of an association or group, and whether or not they had received education about schizophrenia. On the basis of the health education needs identified by the patients with schizophrenia and their relatives, a health education program should be prepared.

The perceived burden among Chinese family caregivers of people with schizophrenia

AIMS

The aim of this study was to examine the level of perceived burden of the Chinese families caring for a relative with schizophrenia and to test its associations with their demographic characteristics, social and family factors and health condition.

BACKGROUND

Despite the increased demands on family members to provide care for patients with schizophrenia in community care, little is known about the level of family burden among these family caregivers and its relationship with their demographic, social and cultural backgrounds.

METHODS

This was a cross-sectional descriptive study. A total of 203 family caregivers were recruited from three regional psychiatric outpatient clinics in Hong Kong. They were asked to complete a set of well-validated questionnaires, consisting of the Chinese version of four instruments - Family Burden Interview Schedule, Family Assessment Device, Six-item Social Support Questionnaire and MOS 36-Item Short Form Health Survey and a socio-demographic data sheet. Statistical analyses were conducted to test the differences in mean burden scores between subgroups, the inter-relationships among the mean scores of the scales and socio-demographic variables and the predictors of family burden.

RESULTS

The families who perceived a higher level of caregiver burden were those who lived in a family with poorer functioning, worse health status and less satisfaction of social support. The caregivers' burden score was positively correlated with their age; conversely, it was negatively correlated with their monthly household income and number of family members living with patient. Social support was the best predictor of caregiver burden.

CONCLUSION

These findings increase our understanding about the socio-demographic and cultural variables influencing the well being of family caregivers of a relative with schizophrenia. Helping families to maintain and enhance a supportive social network may represent a useful means to reduce family burden in schizophrenia.

RELEVANCE TO CLINICAL PRACTICE

This understanding helps health professionals and researchers to identify different sources and domains of burden from a Chinese cultural perspective and take into account of these factors when planning interventions for family caregivers.

Educational Needs of Inpatients with Severe and Persistent Mental Illnesses: A Partial Replication

Although a great deal has been written about the importance of patient education, few replications of past research have been conducted to increase clinicians' confidence in the conclusions of previous studies. This is especially true of studies conducted in clinical settings where findings may or may not be generalizable to other institutions. This partial replication study tested whether previous findings about patient education in an outpatient setting were applicable to an inpatient setting using a modified version of the instrument. A 1998 study published in this journal suggested that differences may exist between the perceived health education needs of outpatients and their health care providers. In this partial replication, we examined the differences between the educational needs of inpatients and those perceived by their attending nurses. As in the original study, we found discrepancies between patients' actual needs and nurses' perceptions of those needs, supporting the importance of assessing patients' health educational needs in the treatment planning process.

Implementing a self-management model of relapse prevention for psychosis into routine clinical practice

This paper describes an implementation project to incorporate an evidence-based, structured model of relapse prevention into routine clinical practice at the Community Mental Health Team in Reading, Berkshire. This project has currently reached the end of the pilot stage, which this paper reports in details. It is proposed that clinicians will adopt Smith's Self-Management Training Manual for individuals with psychosis as a clinical tool for working with patients who have schizophrenic-form disorders or bipolar affective disorders with psychosis. Effects of the proposed change are considered from the viewpoint of the clients and families/carers, the clinicians and the service. The process of transition and its impact on members of the multidisciplinary team is examined. It includes an audit of Care Programme Approach (CPA) forms and a staff survey, which give background information on the needs for improvement and staff development initiatives. A pilot study incorporating the structured relapse prevention work into the local community mental health team is also underway. The method of evaluation and dissemination to the wider team and service settings across the organizational boundaries is reviewed with implications for practice drawn. This paper aims to describe the background and development of this ongoing development project whilst focusing on the current pilot stage. Ongoing work will be carried out in addressing and reporting the outcomes of the full project in future papers.

Predischarge psychoeducational needs in Taiwan: comparisons of psychiatric patients, relatives, and professionals

A survey was conducted to assess the predischarge psychoeducational needs of psychiatric inpatients and their relatives compared to the perception of their needs by mental health professionals in Taiwan. A questionnaire survey adapted from Mueser et al. was used with a sample of 300 participants for this descriptive study. Patients and relatives reported a strong interest in learning more about psychiatric medications and strategies for managing common problems, respectively. Mental health professionals were more concerned with patients coping with depression and suicidal thoughts, which reflect current issues in Taiwan. Mental health professionals in Taiwan need to better understand their clients' needs in order to provide more effective predischarge psychoeducation.

Educational needs of families caring for Chinese patients with schizophrenia

BACKGROUND

Schizophrenia is a disruptive and distressing illness for patients and family members who care for them. As in Western countries more than 20% of people with schizophrenia in Hong Kong are discharged to their homes, but their families are unprepared to care for them. Studies of caregivers' opinions about the information required to supervise patients are limited, particularly for the purposes of optimizing family-centred care.

AIM

The aim of this study was to identify the educational needs of Chinese families caring for a relative with schizophrenia.

METHODS

A cross-sectional survey was conducted in Hong Kong with a random sample of 204 family members caring for a relative with schizophrenia. A Chinese version of the Modified Educational Needs Questionnaire, validated in a previous study, was used to identify educational needs that family caregivers considered important in caring for mentally ill relatives.

FINDINGS

Educational needs perceived as important by caregivers included gaining information about early warning signs of illness and relapse, effects of medication and ways of coping with patients' bizarre and assaulting behaviour. Gender, education level and closeness of the relationship with the patient correlated positively and significantly with need importance. Conversely, the relationship between duration of caring for patient and need importance correlated significantly but negatively, indicating the adverse effect of enduring mental illness on family caregivers' interest in mental health education.

CONCLUSION

This study emphasizes the importance of assessing specific family needs in caring for a relative with mental illness. It also raises concern about the negative effects of the length of time of caring for such patients and the role of socio-economic factors on the perceived educational needs of these families.

Perceptions of problems and needs for service among middle-aged and elderly outpatients with schizophrenia and related psychotic disorders

We examined the perceived problems and needs for services among 72 middle-aged and elderly outpatients with schizophrenia and related psychotic disorders. The survey questionnaire included 50 Likert scaled items involving everyday functioning skills, health, clinical symptoms, and social skills. Subjects assigned the highest priority to physical health and memory. Other areas of high priority were: social functioning, education about their own mental illness, and improvements in sleep and mood. Reducing frequency of psychiatric hospitalization, and drug or alcohol rehabilitation received low priority. Focused interventions targeting health-related and social issues are needed in older patients with schizophrenia.

A family intervention program for dual disorders

OBJECTIVE

To provide a rationale for working with families of clients with psychiatric and substance use disorder, and to describe a new program, family intervention for dual disorders (FIDD).

METHOD

We developed and manualized the FIDD program, which includes both single-family and multiple-family group formats. We trained several clinicians at a local mental health center in the model and conducted a small pilot study.

RESULTS

Clinicians were able to implement the program, and to successfully engage families in treatment. Most clients demonstrated significant improvements in substance abuse over one to two years of treatment.

CONCLUSIONS

The FIDD program is feasible and appears to promote collaboration between families and professionals, thereby improving the course of dual disorders. Controlled research is underway to evaluate the effects of the FIDD program on client and family outcomes.

Caregiving types and psychosocial well-being of caregivers of people with mental illness in Finland

The burden on caregivers of the mentally ill and their need for information and support have been well documented. The present study aimed to describe how different types of caregivers cope with the demands imposed by a family member's mental illness. Five distinct types of caregivers were identified according to the caregiving dimensions: supervising, anxious, coping, resigned, and activating. The results of this study show that mental health professionals should be aware of the caregiving consequences, personal meaning in caregiving, and coping strategies used in order to be able to offer appropriate interventions that optimally meet caregivers' needs.

Early intervention in psychotic relapse

In spite of advances in neuroleptic treatment, relapse of positive symptoms continues to punctuate the course of schizophrenia. In this paper the conceptual and empirical basis for early intervention in the process of psychotic relapse as a preventative manoeuvre is evaluated. The predictive efficacy of early, 'prodromal' signs, their nature, and the utility of early detection and intervention strategies are reviewed. There is strong evidence that relapse is preceded by early signs, but the classical (medical) concept of prodrome is inadequate to explain the findings. The early detection and treatment of early signs appears to confer protection from relapse, but the active ingredients of the pharmacological and psychological based treatment studies are as yet unclear and suggest important avenues for future research.

An assessment of the patients' needs in mental health education

AIM OF THE STUDY

The aim of this study was to identify the specific educational needs of Chinese patients with schizophrenia using a Chinese version of the Educational Needs Questionnaire.

BACKGROUND

Patient education provides adequate clinical information to patients, increases understanding of their illness condition and encourages their health-promoting behaviour. A full understanding and satisfaction of patient needs in relation to specific illness has played an important part in the development of an education programme for psychiatric patients. However, psychiatric patients' perceptions of their specific educational needs and whether or not these needs are being met have seldom been explored for the purposes of optimizing the effects of patient education programmes. This study served the purpose of assessing the learning needs of Chinese patients with schizophrenia in Hong Kong.

DESIGN

A cross-sectional survey was conducted in Hong Kong with 192 Chinese outpatients with schizophrenia. The principles for determining the equivalence of translated tools were applied to the development of the Chinese version of the questionnaire.

RESULTS

Patients gave high importance to gaining information about mental illness, strategies for improving social relationships and solving daily problems. Socioeconomic factors including education level and membership in a mutual support group correlated significantly with need importance and the unmet-need score. Length of illness negatively correlated with need importance, indicating the adverse effect of illness on patients' interests in fulfilling needs.

CONCLUSIONS

Assessment of mental health consumers' perceptions of their specific educational needs and tailoring patient educational curricula to the expressed needs appear essential. The importance of validity testing of a translated tool is also highlighted in this study.

Journey of Hope program outcomes

Families of persons with mental illness often benefit from participating in interventions which provide education and support. The present study describes outcomes reported by 424 families who participated in one such intervention, the Journey of Hope (JOH) program. Hierarchical regression analyses found that program outcomes-increased knowledge of the causes and treatment of mental illness, increased understanding of the mental health service system, and improved morale-were predictive of one another. JOH therefore may provide families with the knowledge and support they need to strengthen their ability to cope with their relative's mental illness.

[Therapeutic needs in psychiatric patients: a systematic review of the literature. I. General concepts and assessment measures. Needs for services]

OBJECTIVE

In Italy, mental health care is in phase of reorganisation. In this frame the measurement of users' needs may be a useful tool in planning individualised mental health service interventions and in their evaluation. Aims of the present study are (I) to highlight the basic concepts of 'needs for care' and give a brief description of the main needs assessment tools specifically developed for psychiatric patients; (II) to review studies assessing needs for mental health services in the general population; (III) to discuss the role played by the assessment of needs in planning mental health care.

METHODS

Studies published in the international literature from January 1980 to June 1999 were reviewed. The studies were located through a computerised search of the databases MEDLINE and PsycLit; in addition, the reference lists of the studies located through the computerised search and the content of main international psychiatric journals were manually scanned in order to avoid possible omissions. Studies assessing needs for services and studies assessing needs on individual level were separately reviewed. Both groups of studies, in turn, were divided in studies assessing needs for mental health care in the general population and in psychiatric patients.

RESULTS

Although most studies on needs for services used indirect methodologies and employed quite heterogeneous experimental design, they provide at large overlapping results. In the general population, about 60%-70% of patients with anxiety, depression and other neurotic disorders and 30%-40% of psychotic patients do not receive any specialist mental health care, suggesting that the majority of subjects suffering from a psychiatric disorder do not receive the mental health care they need.

CONCLUSIONS

Unmet needs for services show a higher frequency in patients with neurotic and depressive disorders, indicating a shortage in services delivery that should be taken into account both by psychiatrists and mental health planners. Moreover, the finding that a large number of patients suffering from psychotic disorders do not receive any kind of mental health care is of particular relevance for planning mental health services, since these subjects are usually the most problematic and difficult to treat.

Instruments measuring behavioral disturbance in relatives with schizophrenia

This article presents a review of 16 instruments measuring behavioral disturbance of persons with schizophrenia as perceived by their family members. Information about the domain, the types of rating scales, and the psychometric properties of these instruments are provided. Future directions in the study of behavioral disturbance are proposed.

Patients versus rehabilitation practitioners: a comparison of assessments of needs for care

OBJECTIVE

A group of 47 young adults suffering from schizophrenia was interviewed to garner their views on their needs for care.

METHOD

Three members of a specialized multidisciplinary rehabilitation team, who had been caring for these patients, on average, for the past 4 years, completed a questionnaire to assess the needs for care of these individuals. Patient and staff assessments were then compared.

RESULTS

Patients and staff do not share similar views on the presence of clinical and social problems. Further analyses of the perceived importance of living-skills deficits, the perceived difficulties in dealing with these, and the recent developments in rehabilitation practices challenge whether patient-staff consensus is indeed essential for rehabilitation.

CONCLUSION

We propose that staff should listen to patients' points of view more carefully, especially in the areas of work, studies, and independent living.

Health Teaching Needs of Clients With Serious and Persistent Mental Illness: Client and Provider Perspectives

1. Clients are interested in health education regardless of age, sex, or primary Axis I diagnosis. 2. Contrasts between staff and client ratings suggest that results support the practice of assessing clients' own perceptions of their needs in treatment planning and developing educational programs. 3. Items ranked as having most interest to clients included: psychiatric medication and side effects; getting what you need from the mental health system; and ways to solve problems.

Educational interests of individuals with spinal cord injury living in the community: medical, sexuality, and wellness topics

As a component of Baylor College of Medicine study of the life status of people with spinal cord injury (SCI), this study determined the educational topics of interest to a cohort of 590 adults with SCI living in the community. Thirty-five items in nine topic areas were included in the inventory. Three topic areas--medical, sexuality, and wellness--are discussed in this article. Across the three topic areas, the five topics of greatest interest were exercise programs, testing of nerve and muscle function, bladder or kidney problems, pain, and sexuality issues. Information about smoking cessation and alcohol or drug abuse was of interest to very few participants. Ten grouping variables were analyzed and individual differences, such as educational level and whether an individual had paraplegia or quadriplegia, were found to account for differences in the topics of interest. The results of this study can be used in setting priorities for the development of educational activities and learning experiences for individuals with SCI living in the community.

Rehabilitation learning needs: patient and family perceptions

Understanding consumer needs for information provides the foundation for empowering patients and families to assume more responsibility for their own care both in hospital and after discharge. Self administered questionnaires identified adult rehabilitation learning needs from the perspectives of patients and their families both during and following hospitalization. The greatest needs for both groups in both time periods were for information about medical, psychosocial and community integration topics. During the in-patient phase, families identified high needs for information which suggests that they should be targeted for educational activities along with patients. Surveys repeated 6 weeks following discharge indicated that information needs were lower but continued to exist.

How much should patients be told about their medication?

Much has been written on the education of patients about their medication, and yet what patients need to know has not been identified and agreed upon by professionals. This study sought to design a tool for this purpose using a series of interviews with experts to identify categories of information. Many core categories were identified and ambiguous sections such as 'side-effects' were clarified. A test-re-test strategy was used to identify the reliability of the resulting questionnaire. A high level of inconsistencies and a low response rate were, in part, attributable to poor design and distribution of the questionnaire. Other contributory factors and the reluctance/inability of respondents to identify what they felt patients should know about their medication are discussed. Some deficits are identified, in addition to an agreement that current systems for educating patients are inadequate. Areas for future research are also identified.

Family support for persons with dual disorders

Families are critically important sources of housing, financial support, and direct care for persons with dual disorders.