Primary caregivers experience of anti-psychotic medication: A qualitative study

Experiences of Informal Caregivers Caring for Individuals With Chronic Schizophrenia in Asia: A Systematic Review and Meta-Synthesis

INTRODUCTION

In Asia, many caregivers are culturally obliged to assume the role of taking care of individuals experiencing chronic schizophrenia, even as they grapple with stigma and compassion fatigue. Despite the significance of this phenomenon, the collective experiences of Asian caregivers remain poorly understood.

AIM

To synthesise qualitative evidence on the experiences of informal caregivers when caring for individuals with chronic schizophrenia in Asia.

METHODS

A search was conducted on seven databases for studies published between 2013 and 2023. The included studies were appraised using the Critical Appraisal Skills Program tool. Data extraction was based on the Joanna Briggs Institute (JBI) Qualitative Extraction Form. The data synthesis was based on the framework by Sandelowski and Barroso.

RESULTS

Our review included the experiences of 1345 informal caregivers from 57 included studies. The analysis yielded the overarching theme of 'Navigating Challenges, Forging Resilience'. Three themes were identified: (i) challenges in caregiving, (ii) lack of support and (iii) coping and resilience.

DISCUSSION

Our findings highlighted the Asian caregivers' stressors, particularly cultural and traditional factors, a facet often overlooked in the literature.

IMPLICATIONS FOR PRACTICE

Mental healthcare practitioners must provide caregivers with comprehensive information. Anticipatory guidance is essential during the initial stages of the diagnosis. To negate geographical limitations, caregiver-training sessions can be pre-recorded and posted to online platforms. Finally, cultural and spiritual beliefs can be integrated into the treatment plans for individuals with schizophrenia in the community.

RELEVANCE STATEMENT

Within the institutional setting, mental healthcare practitioners are encouraged to provide caregivers with comprehensible information or training in person and through written or online platforms, which can transcend geographical limitations. Anticipatory guidance is essential, especially during the initial stages of the diagnosis, when confusion and uncertainties are prevalent. Periodic home visits by mental healthcare practitioners can help ease caregivers' concerns and enhance their caregiving confidence. Finally, cultural and spiritual beliefs should be integrated into the treatment plans for individuals with schizophrenia in the community as it promotes cultural acceptability, encourages referrals to appropriate institutions and reduces the stigma of mental healthcare.

Medication adherence and needs among patients with schizophrenia in China: a qualitative study

OBJECTIVES

To explore the factors influencing medication adherence and the medication needs of patients with schizophrenia when living in a community in China.

DESIGN

A qualitative study.

SETTING

Community and psychiatric ward in Zhuhai city, Guangdong province.

PARTICIPANTS

Patients with schizophrenia and (or) their primary caregivers.

PRIMARY AND SECONDARY OUTCOME MEASURES

Facilitators and barriers of medication adherence and the medication needs.

RESULTS

A total of 20 patients with schizophrenia and 12 primary caregivers participated in the study. Based on the Health Ecology Model, the analysis identified four levels of factors influencing medication adherence, categorised as individual (facilitators: effective treatment, positive expectation, establishing a routine and assistive tools; barriers: side effects, inadequate knowledge, forgetfulness and irregular daily schedule), interpersonal (facilitators: caregiver assistance and psychiatrist's recommendation; barriers: lack of social support), community (facilitators: community mental health services and reducing medication use frequency; barriers: limited medication accessibility and affordability) and policy and culture related (facilitators: collectivist culture and social security policy; barriers: stigma). Additionally, five medication needs (managing side effects, applying for social security, improving medication accessibility, transitioning to long-acting injections and getting health education) were recognised.

CONCLUSIONS

These findings offer valuable insights for healthcare providers and policymakers, underscoring the need for targeted interventions to enhance medication adherence among patients with schizophrenia in China.

Nurses' Roles in Educating and Treating Families of Children and Adolescents Requiring Antipsychotic Treatment: Overcoming Obstacles

Irritability, anger, or aggression and other emergency situations related to dysregulated behaviors or emotions, when present, may require antipsychotic treatment. The purpose of this article is to review current evidence and treatment guidelines regarding symptom and diagnostic indications, patient-family collaboration, and monitoring of children and adolescents treated with antipsychotics. Multiple resources are available to nurse practitioners, nurses, other team members, and parent/guardians to prevent adverse outcomes. [Journal of Psychosocial Nursing and Mental Health Services, 63(1), 8-11.].

The impact of caring for family members with mental illnesses on the caregiver: a scoping review

A large number of multidisciplinary, qualitative and quantitative research suggests that providing care for family members with mental health illnesses can have both positive and negative effects on the carers' wellbeing. However, to date a comprehensive overview and synthesis of literature that compares and contrasts positive and negative effects of family-caregiving on the carer is missing. To address this gap, this scoping review examines the effects of family-caregiving on carers' wellbeing. A Boolean search generated a total of 92 relevant articles that were included in the analysis. The results suggest that, to understand the effects of family-caregiving on the carer's mental and physical wellbeing, it is necessary to take a combination of situational and sociodemographic characteristics into consideration. Elderly, female, spousal-carers and primary-carers may be a group that is at risk of suffering from a lack of positive mental and physical wellbeing as a result of caring. However, the negative effects of caregiving can be balanced by extraversion, social support and religious or spiritual beliefs. Therefore, future interventions that aim to promote family caregivers' wellbeing may need to take personality, particular circumstances as well as cultural and personal beliefs into consideration.

The Level of Burden among Caregivers of Patients with Alzheimer's Disease in Saudi Arabia

BACKGROUND

Caregiver burden is a serious global issue associated with the growing number of older adult patients with Alzheimer's disease (AD). AD patients become more dependent on their caregivers and require assistance with basic daily life activities. This study aims to measure the caregiver burden of informal caregivers of AD patients and to determine their characteristics. In addition, it intends to understand caregiver coping techniques and assess their medication knowledge.

METHODS

This was a cross-sectional study including 148 informal caregivers mainly recruited by the Saudi Alzheimer's Disease Association (SADA). A four-part study questionnaire was used for data collection in the Arabic Language and included the following: socio-demographic characteristics of AD patients and their caregivers, the 12-item version of the Zarit Burden Interview (ZBI), and adapted questions on coping techniques and medication knowledge.

RESULTS

A total of 148 caregivers (62% were female) participated in this study, and 79.06% were between 30 and 60 years old. The ZBI average score was 27, indicating a moderate to high burden. Caregivers reported their need for services to improve their quality of life. The medication knowledge was insufficient in most aspects except that more than half were aware of medications' side effects.

CONCLUSION

Our study revealed that the average burden among informal caregivers of AD patients was moderate-high.

Combating with Compassion Fatigue: The Perspective of Family Caregivers of People with Schizophrenia

PURPOSE

The purpose of this study was to explore the coping processes used by family caregivers of individuals with schizophrenia to deal with compassion fatigue (CF).

METHODS

Grounded theory was used in this study. For recruitment, purposive and theoretical samplings were used to recruit participants. Data were collected from 29 family caregivers through in-depth interviews and field notes. Data were analyzed using constant and comparative methods.

RESULTS

The study revealed a core process for dealing with CF as "Combating with compassion fatigue" that comprised three dynamic phases: strengthening attachment with the care recipient to increase willpower, learning how to deal with the illness, and self-empowerment to fight to the physical and mental fatigue.

CONCLUSIONS

Family caregivers of people with a diagnosis of schizophrenia use various strategies to fight to CF. These combine the past experiences of strategies that work and new approaches. Our research will allow mental health professionals to provide basic strategies to family caregivers of people with a diagnosis of schizophrenia to help them to cope with CF.

Perceptions of Family Caregivers of Patients with Schizophrenia Towards Antipsychotics Associated Side-Effects in China:A Qualitative Study

PURPOSE

To explore perceptions of antipsychotics associated side-effects among family caregivers of patients with schizophrenia.

PATIENTS AND METHODS

A descriptive qualitative study was applied in a tertiary referral hospital in China. Purposeful sampling of 18 family caregivers of patients with schizophrenia were interviewed about their perceptions towards antipsychotics related side effects.

RESULTS

According to content analysis, three themes emerged from the data: (a) nightmare in the treatment with the categories of sleep disturbances; physical impairment; appearance impairment; (b) opposite attitudes toward side-effect with the categories of being vigilant; do not care; (c) diverse ways of coping side-effects with the categories of asking for help from professionals; self-determined; try any quack's prescription.

CONCLUSION

The side effects of antipsychotics not only damage the health of patients, but also increase the burden and stress of caregivers. However, caregivers have different attitudes and coping styles about the side effects of antipsychotics. Health professionals should be aware of the influence of individual background and cultural factors on caregivers' attitudes towards drug side effects. Furthermore, health professionals should also provide caregivers with knowledge about drug side effects, coping skills, and appropriate management strategies to promote health outcomes for people with schizophrenia.

The experiences of family caregivers of people with severe mental illness in the Middle East: A systematic review and meta-synthesis of qualitative data

BACKGROUND

There is a wealth of literature exploring the experiences of family caregivers of people with severe mental illness (SMI) in western countries, however, this topic has been neglected in the Middle East, despite families being the main source of caregiving in this context. The purpose of this review was to conduct a systematic review and qualitative meta-synthesis to explore the experiences of family caregivers living in countries in the Middle East caring for a relative with severe mental illness.

METHODS

A systematic review and meta-synthesis were conducted, to comprehensively gain a thorough and detailed overview of what is known about family caregivers' experiences from published qualitative research in the Middle East geographical area from inception to May 2021. The review protocol was pre-registered with PROSPERO (Ref: CRD42020165519).

RESULTS

The review identified twelve qualitative studies that explored caregivers' experiences of caring for relatives with SMI in Middle East countries. Family caregivers' experiences were captured under seven overarching themes. The participants across all studies reported negative consequences of providing care, increased burden and emotional distress. Many experienced issues with family/marital relationships and stigmatizing attitudes and behaviours from their communities. Caregivers expressed the need for increased support which was perceived to have a critical role in improving family caregivers' experiences.

CONCLUSIONS

The meta-synthesis revealed many challenges and issues that affect caregivers of people with SMI in the Middle East. Family caregivers experienced distress and burden, and reported significant impact on their psychological well-being. Their experiences highlight the urgent need to provide more support for family caregivers in Middle East countries.