Perceived risk of relapse and role of medication: comparison between patients with psychosis and their caregivers

Rates and correlates of medication non-adherence behaviors and attitudes in adult patients with early psychosis

PURPOSE

Literature on antipsychotic medication adherence in early psychosis primarily assessed adherence behaviors and focused on young patients. There is a paucity of research investigating negative medication attitude and its determinants in the early illness course, particularly in older-aged sample. We aimed to examine prevalence and correlates of medication non-adherence behaviors and negative medication attitudes separately in adult patients with early psychosis.

METHODS

One hundred ninety-nine Chinese early psychosis patients aged 26-55 years who had received three-year treatment for first psychotic episode in Hong Kong were examined. Assessments encompassing socio-demographics, premorbid adjustment, clinical and treatment profiles, self-stigma and therapeutic alliance were conducted. Patients were evaluated with Medication Compliance Questionnaire, which is a modified Chinese-translated version of Medication Adherence Rating Scale and includes items measuring adherence behaviors and attitudes towards medications.

RESULTS

Rates of medication non-adherence and negative attitude towards medications were 38.7% and 50.8%, respectively. Multivariate regression analysis showed that more severe positive symptoms, greater self-stigma and negative medication attitude were independently associated with medication non-adherence. Negative attitude towards medications was significantly associated with younger age, higher educational attainment, diagnosis of other psychotic disorders, poorer insight, greater self-stigma and less satisfaction with communication with healthcare staff, which represented an index reflecting suboptimal therapeutic alliance.

CONCLUSION

Antipsychotic non-adherence and negative medication attitudes are frequently observed in adult early psychosis patients. Our findings indicate that poor insight, elevated self-stigma and suboptimal therapeutic alliance may constitute potential treatment targets for promoting medication adherence and rectifying negative medication attitudes in the early illness stage.

Factors Associated with Non-Adherence to Treatment Among Migrants with MDR-TB in Wuhan, China: A Cross-Sectional Study

Background

Multidrug resistant tuberculosis (MDR-TB) has attracted increasing attention in achieving the global goal of tuberculosis (TB) control. China has the second largest TB burden worldwide and has been experiencing large-scale domestic migration. This study aims to explore the effect of migrants on non-adherence to MDR-TB treatment.

Materials and Methods

A cross-sectional study was carried out in Wuhan, China. The exposure cases were migrants who were not locally registered in the residence registration system. The control cases were local residents. Non-adherence cases were patients who were lost follow-up or refused treatment. Chi-square and t-test were used to compare variables between migrants and local residents. Logistic regression models using enter method were used to determine the relationship between migration and non-adherence to treatment. Moderation and medication effects on the association between migrant status and non-adherence were also explored.

Results

We studied 73 migrants and 219 local residents. The migrants, who did not to adhere to treatment (55, 75.3%), was far higher than that of local residents (89, 40.6%). Migrants with MDR-TB had 10.38-times higher difficulty in adhering to treatment (adjusted OR = 10.38, 95% CI 4.62-25.28) than local residents. This additional likelihood was moderated by age and treatment registration group. Migration had an indirect association with non-adherence to treatment via social medial insurance (adjusted OR = 1.05, 95% CI 1.01-1.13).

Conclusion

There a significant increased likelihood of non-adherence to treatment among migrants with MDR-TB, highlighting the importance of improving treatment adherence in this population. Migration prevented migrants from gaining access to social medical insurance and indirectly reduced their likelihood of adherence to treatment.

Knowledge about schizophrenia test: the Chinese Mandarin version and its sociodemographic and clinical factors

BACKGROUND

Schizophrenia is a chronic, complex, and severe mental disorder and caregivers having knowledge about it can help improve patient adherence to treatment. This study aims to translate the Knowledge About Schizophrenia Test (KAST) into a Chinese Mandarin version and test it among caregivers to validate its reliability and reproducibility, as well as to determine its associated sociodemographic factors and clinical factors.

METHODS

The project surveyed 160 patients with schizophrenia and their caregivers at four community health facilities in Beijing, China, from January 2022 to February 2022. All patients and caregivers completed the sociodemographic questionnaire, and caregivers also completed the Chinese-version KAST, and 143 of these caregivers completed the Chinese-version KAST again 2-4 weeks later.

RESULTS

The mean (SD) of the caregiver score was 11.49 (± 3.13). After item analysis, there was acceptable internal consistency among the 17 items in the Chinese version (KR-20 coefficient 0.702). The intraclass correlation coefficient in the retest (0.686) was statistically significant. Gender, educational attainment, marital status, relationship with the patient, and occupational status were associated with the KAST score.

CONCLUSION

The findings demonstrate that the Chinese-version KAST is a reliable and reproducible instrument that can measure knowledge about schizophrenia and is valid to be applied in schizophrenia research.

Integration of biological and psychological illness attributional belief in association with medication adherence behaviour: A path analysis

AIM

This study aimed to determine the association of biological (BAB) and psychological illness attributional beliefs (PAB) with medication adherence behaviour in patients with psychosis in Hong Kong.

METHODS

A cross-sectional survey of 301 outpatients with psychosis in Hong Kong was conducted from August to October 2016. The survey included a set of questionnaires examining patient medication adherence behaviours (using five behavioural items from the Medication Adherence Rating Scale), illness attributional belief, insight into the illness, and attitudes towards antipsychotics and medical professionals. The associations between these variables were analysed using path analysis and adjusted for covariates of perceived social support, experience of side-effects, and gender.

RESULTS

The data fit a model in which medication adherence behaviour was associated with illness attributional belief, insight, and attitudes (chi-square = 32.33, p = .26; RMSEA = 0.02; SRMR = 0.04; and CFI = 0.97). BAB was positively and directly associated with medication adherence behaviour. PAB was positively and indirectly associated with medication adherence behaviour through insight into the illness and attitude towards medical professionals. PAB can strengthen the relationship between BAB and insight, and only the high PAB group exhibited a positive relationship between BAB and attitude towards medical professionals.

CONCLUSIONS

An integration of biological and psychological attributional beliefs in patients with psychosis is essential for better medication adherence behaviour. Future interventions should aim to modify patients' illness attributional beliefs by integrating both biological and psychological illness attribution to improve medication adherence.

First episode psychosis: A comparison of caregiving appraisals in parents caring for the same child

BACKGROUND

The first onset of psychosis can be a traumatic event for diagnosed individuals but can also impact negatively on their families. Little is known about how parents of the same child make sense of the illness. In mothers and fathers caring for the same child with early psychosis, the current study assessed their similarities and differences in key areas of their caregiving role.

METHODS

Using a cross-sectional design, parental pairs caring for the same child treated within an early intervention in psychosis service, completed self-report measures on their caregiving experiences, illness beliefs, coping styles and affect.

RESULTS

Data from 44 mothers and fathers were analysed. Analyses confirmed that parents reported similar levels of emotional dysfunction and conceptualized the illness in broadly similar ways with regard to what they understood the illness to be, their emotional reactions to the illness, perceived illness consequences and beliefs about treatment. Significant differences were identified in their beliefs about the timeline of the illness and reported approaches to coping.

CONCLUSIONS

With exception of beliefs about illness timeline and an expressed preference for use of emotion-based coping, parent caregivers of the same child in early psychosis services are likely to report similar illness beliefs and caregiving reactions. Efforts to ensure staff awareness of the potential areas of divergence in parental caregiving appraisals and exploring the implications of the divergence for the caregiving relationship and patient outcomes are indicated.

Daily Encounters of Mental Illness Stigma and Individual Strategies to Reduce Stigma - Perspectives of People With Mental Illness

Introduction

A qualitative evaluation of mental illness stigma experienced by people with mental illness (PMI) is currently lacking in Singapore. This study aims to employ qualitative methods to identify the common encounters of mental illness stigma experienced by PMI in Singapore and uncover their individual strategies and efforts to reduce mental illness stigma.

Methods

This study is part of a larger research project that explores the concept of mental illness stigma among different stakeholders in Singapore. Focus group discussions (FGDs) were conducted with 42 PMI to collect qualitative data on their experience with mental illness stigma, including encounters of stigma and individual strategies to reduce stigma. The inductive thematic analysis method was employed to analyze the data.

Results

The eight emergent themes associated with encountering stigma in PMI's everyday life were categorized into two over-arching themes, public stigma (i.e., negative beliefs and attitudes, subjected to contemptuous treatment, social exclusion, over-scrutinizing, and receiving excessive care and concern) and structural stigma (i.e., the requirement to declare psychiatric conditions during job interviews, excluded from consideration after the declaration, and requirement of medical endorsements for employment). Four themes regarding PMI's individual strategies to reduce stigma were also identified (i.e., non-disclosure of condition, standing up for themselves, individual efforts in raising awareness, improving themselves, and living life as per normal).

Limitations

Participants may be influenced by social desirability bias due to the presence of other participants in an FGD setting. Also, those who agreed to participate in the study may possess strong views or beliefs about mental illness stigma and may therefore be inherently different from those who refused to participate.

Conclusion

Our findings on instances of public and structural stigma encountered by PMI in Singapore can guide policymakers with the development of future policies and strategies to reduce mental illness stigma in the Singapore society. Furthermore, our study also identified individual strategies that PMI employed to reduce mental illness stigma. However, the effectiveness of these strategies was unclear and little is known of their effect on PMI themselves. Hence, there is a need for future studies to examine these strategies.

Systematic review (meta-aggregation) of qualitative studies on the experiences of family members caring for individuals with early psychosis

Despite the importance of the role of caregivers of people with psychosis being widely recognized, comprehensive understanding of their experience is limited. A thorough understanding of the experience of caregivers over the journey of the illness, particularly during its early stages, is crucial. Qualitative studies published between 1 January 1949 and 31 January 2018 were obtained from seven databases based on PICo search strategy. Meta-aggregation methodology of the Joanna Briggs Institute (JBI) was adopted to aggregate existing qualitative findings about caregivers' experiences. Twenty-eight qualitative studies on 635 caregivers and family members were included in the review. Six inter-related categories-'stigma', 'help-seeking', 'service encounter', 'emotional challenges', 'on becoming a caregiver' and 'making sense of experience'-were aggregated from 129 themes from the sub-acute stage, the acute stage and the recovery or residual stage. Three statements about caregivers' experiences of their relative's first episode of psychosis were synthesized from the findings. Results highlighted the need of incorporating caregiver intervention into the existing services to support the emotional challenges, uncertainty, and stigma-related burden along the caregiving journey.

Brief interactive psychoeducation for caregivers of patients with early phase psychosis in Yogyakarta, Indonesia

AIM

Brief psychoeducation for families of psychotic patients has been shown to significantly increase family members' knowledge of the disorder. This increase is associated with reductions in relapse and rehospitalization. The aim of this study was to assess the effectiveness of brief psychoeducation about schizophrenia to caregivers of patients in early phases of psychotic disorders in Yogyakarta, Indonesia.

METHODS

This study was a prospective, randomized trial with 2 parallel groups. Subjects were patients in the early phase of psychotic disorders and their respective caregivers. Inclusion criteria included a diagnosis of acute and transient psychotic disorders, schizophrenia, schizoaffective disorder or delusional disorder. Participants were randomly assigned to either control or intervention groups by means of paired simple randomization. A brief psychoeducation was conducted for both the patients and caregivers. The interventions were conducted in 4 interactive sessions, once per week. Effectiveness was measured using standardized instruments before the intervention, and at 1 and 6 months post-intervention. Assessment instruments included the Knowledge of Psychosis (KOP), the Compliance and Relapse Assessment, the Brief Psychiatric Rating Scale and the Positive and Negative Symptoms of Schizophrenia scale.

RESULTS

Interventions improved KOP scores significantly in the intervention group. The intervention group had increased regularity of follow-up with health providers and improved compliance. No statistically significant difference in relapses/rehospitalization was observed.

CONCLUSIONS

This study demonstrated that brief psychoeducation with caregivers of patients with early phase psychosis was feasible in our setting, significantly improved caregivers' knowledge, and resulted in improved regularity of contact with health providers and compliance with pharmacotherapy.

Rates and predictors of disengagement of patients with first-episode psychosis from the early intervention service for sychosis service (EASY) covering 15 to 64 years of age in Hong Kong

AIM

This study aims at assessing the rate and predictors of disengagement of patients with first-episode psychosis (FEP) from the early intervention (EI) service in Hong Kong (EASY) that covers age 15 to 64.

METHODS

All FEP patients aged 15 to 64 years who were newly registered with the EASY programme of Kowloon West Psychiatric Unit from January to December 2012 were included. Data on socio-demographic, clinical characteristics and disengagement over 3 years of the EI service were obtained retrospectively through systematic clinical record review. Predictors of 3 different types of disengagement and their rate of occurrence were identified: complete disengagement (type I), disengaged and re-engaged through hospitalization (type II) and re-engaged as outpatient (type III).

RESULTS

Among the 277 patients included for analysis, 36 patients (13%) had type I disengagement, 17.2% (N = 21) were of age 15 to 25 and 9.7% (N = 15) were of age 25 to 64. Type II and type III disengagements were 4.3% and 13.4%, respectively. Early-stage poor drug compliance significantly predicted type I and type II disengagements. History of substance use, suicidal attempts and poor drug compliance predicted type III disengagement. Younger patients had significant earlier disengagement (χ²  = 5.01, df = 1, P = .025).

CONCLUSION

Results of the current study highlighted the different patterns of disengagement for different age groups and the importance of identifying the high-risk group at early stage of the illness. With the expansion of EI service for wider age group, studies of the differential needs of patient with different ages would be important to guide the future service development.

Perception towards relapse and its predictors in psychosis patients: A qualitative study

AIMS

To explore in psychosis patients their subjective perceptions on the definition of relapse, the costs involved, the potential risk and protective factors for relapse, the effect of medication and the consequences of relapse.

METHOD

Sixteen patients who had previously enrolled into a randomized controlled trial of medication discontinuation during first-episode psychosis were interviewed after 10 years.

RESULTS

Patients had a broader definition of the criteria of relapse, extending from medication discontinuation to family support. Although most agreed that taking antipsychotics is effective in preventing relapse, most have negative views on them. All patients predicted their risk of relapse to be less than 50% and they were generally optimistic about the future.

CONCLUSION

These findings have implications for development of effective medication compliance and relapse prevention programmes in psychosis.

Managing information gaps on caregivers of psychotic patients in primary health settings of Yogyakarta, Indonesia

Background: Information gaps hinder the management of psychotic patients. Incorporating mental health services into primary care might solve the problem. Health workers can be trained to provide psycho-education for caregivers of psychotic patients.

Methods: This study was a two stage experimental study. In the first stage, 43 health workers were trained to provide a psycho-education for caregivers of psychotic patients. Next, 10 health workers were selected to provide the psycho-education. Participants were family caregivers of psychotic patients (n = 113) randomly assigned to control and intervention groups. Pre- and post-tests were conducted to assess the results. Statistical analyses were conducted using paired t tests and analysis of covariance (ANCOVA).

Results: The intervention group scored higher for Knowledge of Psychosis at post-test. Both groups showed significant increase of knowledge (paired t tests: P<0.001; P<0.001; respectively) and the increases were not significantly different between the groups (ANCOVA: P=0.057).

Conclusion: Psycho-education was applicable in primary care settings. Training primary care health workers is a feasible method to address information gaps in the management of mental health problems.

Web-Based Psychoeducation Program for Caregivers of First-Episode of Psychosis: An Experience of Chinese Population in Hong Kong

Caregivers of patients with first-episode psychosis are often with little knowledge about the illness and experience more burden of care. Psychoeducation to caregivers has shown to be effective in improving outcomes of patients and possibly reduce stress of the caregivers. This has been recommended as one of the key psychosocial interventions for specific early intervention for psychosis service. However, the accessibility of the service, high case load of the health care professionals and self-stigma of caregivers are often the barriers of implementation of these programs in the real world. Incorporating the convenience of information access via internet and the concept of self-management approach, an interactive internet-based self-help psychoeducation program (iPEP) (www.ipep.hk) for the caregivers of patients with psychosis was established targeting the caregivers of patients with psychosis at early stage in Hong Kong. It provides a comprehensive online resource center in both written and video format on knowledge about psychosis, skills of care, and information of local resources. It also has a forum facilitate information exchange between healthcare professionals and the caregivers, allowing for self-management. Over 800 caregivers have joined the program as members. The evaluation of the subset of the members/users of the iPEP suggested that the iPEP program has been well received and appreciated by the caregivers of patients with first episode psychosis locally. It can potentially serve as a platform for future development of specific manual-based psychoeducation program for caregivers targeting at the needs of different groups.

A population study of public stigma about psychosis and its contributing factors among Chinese population in Hong Kong

PURPOSE

Public stigma is an important barrier to the recovery of patients with psychosis. This study aimed to explore public stigma associated with a newly adopted Chinese name for psychosis 'si-jue-shi-tiao' in a representative Chinese population in Hong Kong, focusing on factors contributing to public stigma. Exposure to mass media and its relationship with the stigma were explored in detail.

METHODS

Random telephone survey of general population in Hong Kong was conducted. Information including basic demographics, psychosis literacy, recent news recall about psychosis and stigma, measured with the revised Link's Perceived Discrimination-Devaluation Scale (LPDDS) were obtained. Univariate analysis of LPDDS score and demographic variables, news exposure, previous contacts with people with psychosis and knowledge about psychosis were conducted. Further hierarchical regression analysis was performed.

RESULTS

A total of 1,016 subjects were interviewed. The sample was comparable with the whole Hong Kong population aged 18 years and above. Those of female gender, with higher educational level and better knowledge about symptoms and treatment of psychosis had higher score of LPDDS. The model significantly explained 8.3% of variance of LPDDS score (F(7, 895) = 12.606, p < .0001, p < .0001). The negative news recall had trend significance in the model.

CONCLUSION

The finding suggested that discrimination among the general public against people with psychosis was still common. Specific strategies will need to be established in targeting media news reporting about psychosis, knowledge disseminating and needs of specific population. Further researches should be conducted to understand the mechanisms of the stigma development in relation to these factors so that more focused and effective strategies could be developed.

Knowledge in schizophrenia: The Portuguese version of KAST (Knowledge About Schizophrenia Test) and analysis of social-demographic and clinical factors' influence

Schizophrenia is a complex disorder, and the knowledge about it can have a positive impact. The purpose of this study was to make the translation and cultural adaptation of the Knowledge About Schizophrenia Test (KAST) into Portuguese and determine the influence of clinical and socio-demographic factors on knowledge. The test was applied to 189 caregivers of patients enrolled in Schizophrenia Program of the Federal University of São Paulo, 30 caregivers of clinical patients of the General Outpatient Clinic of the same University, and 30 health professionals. The face and content validity of the test was established. The mean value (SD) obtained with the application of the final version to caregivers of schizophrenic patients was 12.96 (2.45) - maximum 17. Level of knowledge increased considering the following order: caregivers of clinical patients, caregivers of patients with schizophrenia and mental health professionals. The intraclass correlation coefficient (0.592) obtained in the test-retest was statistically significant. An influence of social class, race, gender and education of the caregiver on the test was observed, and the last two factors were more relevant. The KAST translated and adapted into Portuguese is a valid instrument and can be used as an evaluation tool on psychoeducational interventions.