Culturally adapted psychosocial interventions (CaPSI) for early psychosis in a low-resource setting: study protocol for a large multi-center RCT

BACKGROUND

Psychosis treatment guidelines recommend cognitive behaviour therapy (CBT) and family intervention (FI), for all patients with first episode psychosis (FEP), though guidance borrows heavily from literature in adults from high income countries. To our knowledge, there are few randomized controlled trials (RCTs) examining the comparative effect of these commonly endorsed psychosocial interventions in individuals with early psychosis from high-income countries and no such trials from low and middle-income countries (LMICs). The present study aims to confirm the clinical-efficacy and cost-effectiveness of delivering culturally adapted CBT (CaCBT) and culturally adapted FI (CulFI) to individuals with FEP in Pakistan.

METHOD

A multi-centre, three-arm RCT of CaCBT, CulFI, and treatment as usual (TAU) for individuals with FEP (n = 390), recruited from major centres across Pakistan. Reducing overall symptoms of FEP will be the primary outcome. Additional aims will include improving patient and carer outcomes and estimating the economic impact of delivering culturally appropriate psychosocial interventions in low-resource settings. This trial will assess the clinical-efficacy and cost-effectiveness of CaCBT and CulFI compared with TAU in improving patient (positive and negative symptoms of psychosis, general psychopathology, depressive symptoms, quality of life, cognition, general functioning, and insight) and carer related outcomes (carer experience, wellbeing, illness attitudes and symptoms of depression and anxiety).

CONCLUSIONS

A successful trial may inform the rapid scale up of these interventions not only in Pakistan but other low-resource settings, to improve clinical outcomes, social and occupational functioning, and quality of life in South Asian and other minority groups with FEP.

TRIAL REGISTRATION

NCT05814913.

Psychosocial safety climate and self-efficacy: Moderating role of job-related expectations in Pakistani private-sector employees during the COVID-19 pandemic

The labor force in Pakistan comprises 59.8 million individuals. The employees have faced major changes in work dynamics and psychosocial safety climate during the COVID-19 pandemic. The purpose of the current study is to find the relationship between psychosocial safety climate, self-efficacy, and job-related expectations. It explores the moderating role of job-related expectations on the relationship between psychosocial safety climate and self-efficacy. It was hypothesized that there is likely to be a significant relationship between psychosocial safety climate, self-efficacy, and job-related expectations, job-related expectations are likely to moderate the relationship between psychosocial safety climate and self-efficacy, and there are likely to be differences between married and unmarried employees; men and women; satisfied and unsatisfied employees with respect to psychosocial safety, self-efficacy, and job-related expectations. A correlational research design and a convenience sampling strategy were used. A total of 281 employees (M = 30.74 years, SD = 10.99) of the private-sector (including educational, industrial, and IT) organizations during the COVID-19 pandemic were part of the study. Results show that psychosocial safety climate had a positive significant relationship with job-related expectations and self-efficacy. Job expectations also significantly correlated with self-efficacy. There were significant differences in measures of study variables with respect to gender, marital status, and employee satisfaction. This research has implications for administration, managers, policymakers, and organizational psychologists.

Personality assessment in military - Bright and dark sides of the assessment measures: A review

BACKGROUND

Personality assessment has its own bright and dark sides, especially in the military setting. It is at play since the emergence of clinical psychology and its application in the recruitment process during World War I and II. Change in personality assessment trends, the evolution of complex personality traits, and changing geopolitical settings across the world necessitate the development of cost-effective, time-efficient, and reliable assessment measures that overcome issues in current assessment measures and fulfil the needs of present timesOBJECTIVE:The objective of this paper is to explore the evolution of personality assessment measures and their uses in military settings along with the comparison of self-report and non-self-report measures. It would give directions for the development of new measures to overcome the issues and drawbacks associated with current measures of research.

METHODS

The research question was formulated using the most valid SPIDER technique for a comprehensive search. PubMed, Google Scholar, and PsycNet databases were searched. 19 articles were selected based on inclusion and exclusion criteria out of 775 articles.

RESULTS

Thematic analyses show that personality assessment in the military is done to a) detect psychopathology, b) detect aberrant responses, c) recruit new personnel, d) predict training and performance outcomes, and e) predict leadership. The research contributes to the body of knowledge by showing an integrated picture of the most widely used assessment tools and the purpose it serves.

CONCLUSION

There is a need to develop assessment measures that are culture free and can assess more complex personality attributes.

Perceived parenting styles and primary attachment styles of single and children living with both parents

OBJECTIVE

To investigate the association between perceived primary parenting styles and attachment styles between single-parent children and children living with both parents.

Methods

The correlational study was conducted at the Lahore Garrison University, Lahore, Pakistan, from September 2017 to March 2018, and comprised an equal number of children from single-parent families and those living with both the parents. Data was collected using the parental authority questionnaire and the Urdu version of the inventory of parental and peer attachment. Data was analysed using SPSS 21.

RESULTS

Of the 200 children, 100(50%) were in each of the two groups, and both the groups had 50(50%) girls and boys each. The overall mean age of the sample was 14.56±3.03 years (range: 11-18 years). There was a significant negative correlation between permissive parenting styles with mother's communication (p<0.05); authoritarian parenting style had negative correlation with parental communication and trust(p<0.001). Authoritative parenting had significant positive relationship with trust (p<0.001), and communication with parents (p<0.001), and there was negative relationship between authoritative parenting with feeling alienated from parents (p<0.01). Single-parent children perceived their parents as authoritarian (p<0.001) and had more alienated attachment with parents (p<0.001), whereas children living with both the parents had more trust (p<0.001) and had better communication with their parents (p<0.001).

CONCLUSIONS

It is important to understand the role of parents and different parenting styles in building up strong parentchild attachment.

TechCare: Mobile-assessment and therapy for psychosis: An intervention for clients within the early intervention service

Introduction

In the UK, mental illness is a major source of disease burden costing in the region of £105 billion pounds. mHealth is a novel and emerging field in psychiatric and psychological care for the treatment of mental health difficulties such as psychosis.

Objective

To develop an intelligent real-time therapy (iRTT) mobile intervention (TechCare) which assesses participant's symptoms in real-time and responds with a personalised self-help based psychological intervention, with the aim of reducing participant's symptoms. The system will utilise intelligence at two levels:

– intelligently increasing the frequency of assessment notifications if low mood/paranoia is detected;

– an intelligent machine learning algorithm which provides interventions in real-time and also provides recommendations on the most popular selected interventions.

Aim

The aim of the current project is to develop a mobile phone intervention for people with psychosis, and to conduct a feasibility study of the TechCare App.

Methods

The study consists of both qualitative and quantitative components. The study will be run across three strands:

– qualitative work;

– test run and intervention refinement;

– feasibility trial.

Results

Preliminary analysis of qualitative data from Strand 2 (test run and intervention refinement) in-depth interviews with service users (n = 2) and focus group with health professionals (n = 1), highlighted main themes around security of the device, multimedia and the acceptability of psychological interventions being delivered via the TechCare App.

Conclusions

Research in this area can be potentially helpful in addressing the demand on mental health services globally, particularly improving access to psychological interventions.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Feasibility study of culturally adapted cognitive behaviour therapy for psychosis in Pakistan

Background

It is becoming well established that CBT is both effective and cost efficient in the treatment of positive and negative symptoms of schizophrenia. However, there is a need to adapt CBT to the cultural, linguistic, and socioeconomic context of diverse cultural groups. We aimed to establish the feasibility of culturally adaptive cognitive behavior therapy for treatment of psychosis in a low-income country.

Methods

This is a rater-blind, randomized, controlled trial of the use of CBT in patients with psychosis from a low-income country. Patients with a DSM-IV diagnosis of schizophreniform disorder were assessed using Positive and Negative Syndrome Scale for Schizophrenia (PANSS), PSYRATS (Psychotic Symptom Rating Scales), and the Insight Scale. Participants were randomized into the intervention group (n = 18) and TAU group (n = 18). The intervention group received 12 weekly sessions of culturally adapted CBT for psychosis (CaCBTp).

Results

There were no significant differences between the two groups at baseline. At three months follow-up, there was a statistically significant improvement in the CaCBTp group on PANSS general Psychopathology subscale, PANSS overall score and Insight scale, as compared to the TAU group. The CaCBTp group had lower scores on PANSS positive, PANSS negative sub-scales, and the two subscales of Psychotic Symptom Rating Scale, but differences were not statistically significant.

Conclusion

Culturally adapted CBT added to pharmacological treatment as usual was acceptable to patients and was helpful in reduction of severity of psychotic symptoms. Adjunctive culturally adapted CBT should be further investigated in this population.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Evidence of patient beliefs, values, and preferences is not provided in osteoporosis clinical practice guidelines

We examined how patient beliefs, values, and preferences (BVPs) were included and conceptualized in international osteoporosis guidelines. The majority of guidelines did not mention BVPs. When mentioned, BVPs were conceptualized as preference for one medication over another. A broader conceptualization and inclusion of BVPs should be incorporated in osteoporosis guidelines.

INTRODUCTION

Our objectives were to determine (1) the extent to which osteoporosis guidelines reflected patients' beliefs, values, and preferences (BVPs); (2) how BVPs were conceptualized; and (3) the methods used to elicit BVPs in the references cited by the guidelines.

METHODS

We conducted a document analysis of English-language international osteoporosis guidelines based on the International Osteoporosis Foundation website. We examined each guideline and extracted all instances of statements pertaining to BVPs. The statements were reviewed by two independent researchers. Discrepancies in data extraction were resolved by the first author. We developed categories based on five common elements that represented the BVP statements.

RESULTS

Twenty-seven of 70 (39%) guidelines included 95 statements about patient BVPs. Of the 95 statements, 32 statements (14 guidelines) were classified under BVP related to the choice of pharmacotherapy or general treatment, 10 (7 guidelines) under BVP related to adherence to pharmacotherapy or treatment in general, 5 (5 guidelines) under BVP related to financial costs and benefits, 43 (19 guidelines) under other BVP mentioned but not supported by a reference to a primary study or systematic review, and 5 (3 guidelines) under other BVP mentioned and supported by at least one reference to a primary study or systematic review. Twenty-nine references were cited to reflect the BVPs mentioned, including an editorial and quantitative studies.

CONCLUSIONS

Twenty-seven (39%) of the guidelines included mention of patients' BVPs. In 19 guidelines, the importance of BVPs was mentioned but these statements were not supported by references to a primary study or systematic review. BVPs were most often (14 guidelines) conceptualized as preference for one medication over another. We suggest that qualitative data be included as evidence of BVPs in guidelines.

Development and assessment of a mobile phone-based intervention to reduce maternal depression and improve child health

Introduction

Postnatal depression is known to cause disability and suffering in women and negative consequences both for their infants and their families, with huge costs globally. Several studies from low and middle income countries (LAMIC) have demonstrated that effectively delivered psychological interventions are cost effective for improving maternal and child health, but access to these interventions is limited in both the low and high income countries.

Objective

The objective of the study is to develop and test a mobile phone-based intervention (TechMotherCare), which will include components of cognitive behavioural therapy (CBT) and child development related psychoeducation.

Aim

The aim of the study is to examine the feasibility and acceptability of the TechMotherCare intervention.

Methods

A total of 36 participants will be recruited from health centers in Karachi, Pakistan for this 2-arm randomized pilot study. The TechMotherCare App intervention will be based on principles of CBT and learning-through-play (LTP) a parenting intervention and will assess the real-time depressive symptoms of participants and respond, using intelligent real time therapy (iRTT) dependent on symptoms reported by participants.

Results

Outcome assessments will be completed after 3 months (end of intervention). In-depth qualitative interviews will also be conducted with participants pre- and post-intervention. The trial is ongoing and we will present both the qualitative and quantitative results.

Conclusions

The results of this pilot trial will inform the design of a larger randomised controlled trial using a mobile based technology platform to address the huge treatment gap in LAMICs.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Ascorbate prevents placental oxidative stress and enhances birth weight in hypoxic pregnancy in rats

This study isolated the effects of maternal hypoxia independent of changes in maternal nutrition on maternal circulatory and placental molecular indices of oxidative stress and determined whether maternal antioxidant treatment conferred protection. Pregnant rats were subjected to normoxic pregnancy or 13% O2 chronic hypoxia for most of gestation with and without maternal treatment with vitamin C in the drinking water. Maternal hypoxia with and without vitamin C did not affect maternal food or water intake and led to a significant increase in maternal and fetal haematocrit. At gestational day 20, maternal plasma urate and L-cysteine concentrations, and placental levels of 4-hydroxynonenal and heat shock protein 70 were increased while placental heat shock protein 90 levels were decreased in hypoxic pregnancy. The induction of maternal circulatory and placental molecular indices of oxidative stress in hypoxic pregnancies was prevented by maternal treatment with vitamin C. Maternal hypoxia during pregnancy with or without vitamin C increased placental weight, but not total or compartmental volumes. Maternal treatment with vitamin C increased birth weight in both hypoxic and normoxic pregnancies. The data show that maternal hypoxia independent of maternal undernutrition promotes maternal and placental indices of oxidative stress, effects that can be prevented by maternal treatment with vitamin C in hypoxic pregnancy. While vitamin C may not be the ideal candidate of choice for therapy in pregnant women, and taking into consideration differences in ascorbic acid metabolism between rats and humans, the data do underlie that antioxidant treatment may provide a useful intervention to improve placental function and protect fetal growth in pregnancy complicated by fetal hypoxia.

FC16-02 - Workshop: culutrally adapting CBT

There is sufficient evidence to suggest that CBT is an effective treatment for mental health problems. Current evidence suggests that ethnic minorty clients are less likely to engage in psychological interventions. We have adapted CBT for ethnic minorities in the UK. The aim of this workshop is to help the participants to realize the barriers posed by ethnic minority clients in therapy and how to overcome these.

Our work has highlighted that culture, capacity of the system and cognitions and beliefs are the areas which need addressing in this regard. We found that although therapists do not need to make major changes in therapy techniques they need to be aware of issues related to culture and patients beliefs about therapy. This workshop will especially focus on difficult areas such as assessment of ethnic minority clients and their engagement with therapy.

Psychiatric Training in Pakistan

High rates of mental illness, particularly depression have been reported in Pakistan. The health system is both under developed and poorly resourced. It is therefore not surprising that psychiatric training is at its very early stages, at both undergraduate and the postgraduate level. In order to look after the mentally ill patients radical changes need to be implemented in training of doctors. Medical curriculum needs to place more focus on psychiatry. This should not only help junior doctors in understanding the need for psychiatry, but will also prepare them for the challenges they will face as a General Practitioner or a Family Physician. Similarly, postgraduate training can be made more useful by placing more emphasis on community based and primary care psychiatry and psychotherapy; especially family interventions. The training needs to aim towards preparing psychiatrists who are not only clinicians, but can be agents of change in the society, through health education.