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Jones C, Hacker D, Xia J, Meaden A, Irving CB, Zhao S, Chen J, Shi C. Cognitive behavioural therapy plus standard care versus standard care for people with schizophrenia. Cochrane Database Syst Rev 2018; 12:CD007964. [PMID: 30572373 PMCID: PMC6517137 DOI: 10.1002/14651858.cd007964.pub2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Cognitive behavioural therapy (CBT) is a psychosocial treatment that aims to re-mediate distressing emotional experiences or dysfunctional behaviour by changing the way in which a person interprets and evaluates the experience or cognates on its consequence and meaning. This approach helps to link the person's feelings and patterns of thinking which underpin distress. CBT is now recommended by the National Institute for Health and Care Excellence (NICE) as an add-on treatment for people with a diagnosis of schizophrenia. This review is also part of a family of Cochrane CBT reviews for people with schizophrenia. OBJECTIVES To assess the effects of cognitive behavioural therapy added to standard care compared with standard care alone for people with schizophrenia. SEARCH METHODS We searched the Cochrane Schizophrenia Group's Trials Register (up to March 6, 2017). This register is compiled by systematic searches of major resources (including AMED, BIOSIS CINAHL, Embase, MEDLINE, PsycINFO, PubMed, and registries of clinical trials) and their monthly updates, handsearches, grey literature, and conference proceedings, with no language, date, document type, or publication status limitations for inclusion of records into the register. SELECTION CRITERIA We selected all randomised controlled clinical trials (RCTs) involving people diagnosed with schizophrenia or related disorders, which compared adding CBT to standard care with standard care given alone. Outcomes of interest included relapse, rehospitalisation, mental state, adverse events, social functioning, quality of life, and satisfaction with treatment.We included studies fulfilling the predefined inclusion criteria and reporting useable data. DATA COLLECTION AND ANALYSIS We complied with the Cochrane recommended standard of conduct for data screening and collection. Where possible, we calculated relative risk (RR) and its 95% confidence interval (CI) for binary data and mean difference (MD) and its 95% confidence interval for continuous data. We assessed risk of bias for included studies and created a 'Summary of findings' table using GRADE. MAIN RESULTS This review now includes 60 trials with 5,992 participants, all comparing CBT added to standard care with standard care alone. Results for the main outcomes of interest (all long term) showed no clear difference between CBT and standard care for relapse (RR 0.78, 95% CI 0.61 to 1.00; participants = 1538; studies = 13, low-quality evidence). Two trials reported global state improvement. More participants in the CBT groups showed clinically important improvement in global state (RR 0.57, 95% CI 0.39 to 0.84; participants = 82; studies = 2 , very low-quality evidence). Five trials reported mental state improvement. No differences in mental state improvement were observed (RR 0.81, 95% CI 0.65 to 1.02; participants = 501; studies = 5, very low-quality evidence). In terms of safety, adding CBT to standard care may reduce the risk of having an adverse event (RR 0.44, 95% CI 0.27 to 0.72; participants = 146; studies = 2, very low-quality evidence) but appears to have no effect on long-term social functioning (MD 0.56, 95% CI -2.64 to 3.76; participants = 295; studies = 2, very low-quality evidence, nor on long-term quality of life (MD -3.60, 95% CI -11.32 to 4.12; participants = 71; study = 1, very low-quality evidence). It also has no effect on long-term satisfaction with treatment (measured as 'leaving the study early') (RR 0.93, 95% CI 0.77 to 1.12; participants = 1945; studies = 19, moderate-quality evidence). AUTHORS' CONCLUSIONS Relative to standard care alone, adding CBT to standard care appears to have no effect on long-term risk of relapse. A very small proportion of the available evidence indicated CBT plus standard care may improve long term global state and may reduce the risk of adverse events. Whether adding CBT to standard care leads to clinically important improvement in patients' long-term mental state, quality of life, and social function remains unclear. Satisfaction with care (measured as number of people leaving the study early) was no higher for participants receiving CBT compared to participants receiving standard care. It should be noted that although much research has been carried out in this area, the quality of evidence available is poor - mostly low or very low quality and we still cannot make firm conclusions until more high quality data are available.
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Affiliation(s)
- Christopher Jones
- University of BirminghamSchool of PsychologyEdgbastonBirminghamUKB15 2TT
| | - David Hacker
- Birmingham and Solihull Mental Health Foundation NHS TrustBirminghamUK
| | - Jun Xia
- The University of NottinghamCochrane Schizophrenia GroupTriumph RoadNottinghamUKNG7 2TU
| | - Alan Meaden
- Birmingham and Solihull Mental Health Foundation NHS TrustBirminghamUK
| | - Claire B Irving
- The University of NottinghamCochrane Schizophrenia GroupTriumph RoadNottinghamUKNG7 2TU
| | - Sai Zhao
- The Ingenuity Centre, The University of NottinghamSystematic Review Solutions LtdTriumph RoadNottinghamUKNG7 2TU
| | - Jue Chen
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of MedicineDepartment of Clinical Psychology600 Wan Ping Nan RoadShanghaiChina200030
| | - Chunhu Shi
- University of Manchester, Manchester Academic Health Science CentreDivision of Nursing, Midwifery & Social Work, School of Health Sciences, Faculty of Biology, Medicine & HealthManchesterGreater ManchesterUKM13 9PL
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Jones C, Hacker D, Meaden A, Cormac I, Irving CB, Xia J, Zhao S, Shi C, Chen J. Cognitive behavioural therapy plus standard care versus standard care plus other psychosocial treatments for people with schizophrenia. Cochrane Database Syst Rev 2018; 11:CD008712. [PMID: 30480760 PMCID: PMC6516879 DOI: 10.1002/14651858.cd008712.pub3] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Cognitive behavioural therapy (CBT) is a psychosocial treatment that aims to help individuals re-evaluate their appraisals of their experiences that can affect their level of distress and problematic behaviour. CBT is now recommended by the National Institute for Health and Care Excellence (NICE) as an add-on treatment for people with a diagnosis of schizophrenia. Other psychosocial therapies that are often less expensive are also available as an add-on treatment for people with schizophrenia. This review is also part of a family of Cochrane Reviews on CBT for people with schizophrenia. OBJECTIVES To assess the effects of CBT compared with other psychosocial therapies as add-on treatments for people with schizophrenia. SEARCH METHODS We searched the Cochrane Schizophrenia Group's Study Based Register of Trials (latest 6 March, 2017). This register is compiled by systematic searches of major resources (including AMED, BIOSIS CINAHL, Embase, MEDLINE, PsycINFO, PubMed, and registries of clinical trials) and their monthly updates, handsearches, grey literature, and conference proceedings, with no language, date, document type, or publication status limitations for inclusion of records into the register. SELECTION CRITERIA We selected randomised controlled trials (RCTs) involving people with schizophrenia who were randomly allocated to receive, in addition to their standard care, either CBT or any other psychosocial therapy. Outcomes of interest included relapse, global state, mental state, adverse events, social functioning, quality of life and satisfaction with treatment. We included trials meeting our inclusion criteria and reporting useable data. DATA COLLECTION AND ANALYSIS We reliably screened references and selected trials. Review authors, working independently, assessed trials for methodological quality and extracted data from included studies. We analysed dichotomous data on an intention-to-treat basis and continuous data with 60% completion rate. Where possible, for binary data we calculated risk ratio (RR), for continuous data we calculated mean difference (MD), all with 95% confidence intervals (CIs). We used a fixed-effect model for analyses unless there was unexplained high heterogeneity. We assessed risk of bias for the included studies and used the GRADE approach to produce a 'Summary of findings' table for our main outcomes of interest. MAIN RESULTS The review now includes 36 trials with 3542 participants, comparing CBT with a range of other psychosocial therapies that we classified as either active (A) (n = 14) or non active (NA) (n = 14). Trials were often small and at high or unclear risk of bias. When CBT was compared with other psychosocial therapies, no difference in long-term relapse was observed (RR 1.05, 95% CI 0.85 to 1.29; participants = 375; studies = 5, low-quality evidence). Clinically important change in global state data were not available but data for rehospitalisation were reported. Results showed no clear difference in long term rehospitalisation (RR 0.96, 95% CI 0.82 to 1.14; participants = 943; studies = 8, low-quality evidence) nor in long term mental state (RR 0.82, 95% CI 0.67 to 1.01; participants = 249; studies = 4, low-quality evidence). No long-term differences were observed for death (RR 1.57, 95% CI 0.62 to 3.98; participants = 627; studies = 6, low-quality evidence). Only average endpoint scale scores were available for social functioning and quality of life. Social functioning scores were similar between groups (long term Social Functioning Scale (SFS): MD 8.80, 95% CI -4.07 to 21.67; participants = 65; studies = 1, very low-quality evidence), and quality of life scores were also similar (medium term Modular System for Quality of Life (MSQOL): MD -4.50, 95% CI -15.66 to 6.66; participants = 64; studies = 1, very low-quality evidence). There was a modest but clear difference favouring CBT for satisfaction with treatment - measured as leaving the study early (RR 0.86, 95% CI 0.75 to 0.99; participants = 2392; studies = 26, low quality evidence). AUTHORS' CONCLUSIONS Evidence based on data from randomised controlled trials indicates there is no clear and convincing advantage for cognitive behavioural therapy over other - and sometimes much less sophisticated and expensive - psychosocial therapies for people with schizophrenia. It should be noted that although much research has been carried out in this area, the quality of evidence available is mostly low or of very low quality. Good quality research is needed before firm conclusions can be made.
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Affiliation(s)
- Christopher Jones
- University of BirminghamSchool of PsychologyEdgbastonBirminghamUKB15 2TT
| | - David Hacker
- Birmingham and Solihull Mental Health Foundation NHS TrustBirminghamUK
| | - Alan Meaden
- Birmingham and Solihull Mental Health Foundation NHS TrustBirminghamUK
| | - Irene Cormac
- Rampton HospitalFleming HouseRetfordNottinghamshireUKDN22 0PD
| | - Claire B Irving
- The University of NottinghamCochrane Schizophrenia GroupInstitute of Mental HealthUniversity of Nottingham Innovation Park, Triumph RoadNottinghamUKNG7 2TU
| | - Jun Xia
- The University of Nottingham NingboNottingham China Health Institute199 Taikang E RdYinzhou QuNingboZhejiang ShengChina315000
| | - Sai Zhao
- The Ingenuity Centre, The University of NottinghamSystematic Review Solutions LtdTriumph RoadNottinghamUKNG7 2TU
| | - Chunhu Shi
- University of Manchester, Manchester Academic Health Science CentreDivision of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and HealthManchesterGreater ManchesterUKM13 9PL
| | - Jue Chen
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of MedicineDepartment of Clinical Psychology600 Wan Ping Nan RoadShanghaiChina200030
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Abstract
SummaryThere is a range of psychological interventions for established schizophrenia. These include family interventions, motivational interventions for substance misuse and for non-adherence to medication, cognitive remediation for neurocognitive deficits and cognitive–behavioural therapy for symptoms. Psychological interventions may explicitly target risk factors for poor outcome, such as substance use, or protective factors, such as adherence to medication, or be directed at specific symptoms or deficits. There is emerging evidence for efficacy of psychological treatments during, following and even prior to the first episode. Important areas for further study are how different treatment modalities can interact productively and patient and carer preferences for treatment. Many trials of psychological treatments have design flaws and this tends to overestimate the treatment effect.
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Affiliation(s)
- Shôn W Lewis
- Division of Psychiatry, University of Manchester, Second Floor, Education and Research Centre, Wythenshaw Hospital, Manchester M23 9LT, UK.
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Porcelli S, Bianchini O, De Girolamo G, Aguglia E, Crea L, Serretti A. Clinical factors related to schizophrenia relapse. Int J Psychiatry Clin Pract 2016; 20:54-69. [PMID: 27052109 DOI: 10.3109/13651501.2016.1149195] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Relapses represent one of the main problems of schizophrenia management. This article reviews the clinical factors associated with schizophrenia relapse. METHODS A research of the last 22 years of literature data was performed. Two-hundred nineteen studies have been included. RESULTS Three main groups of factors are related to relapse: factors associated with pharmacological treatment, add-on psychotherapeutic treatments and general risk factors. Overall, the absence of a maintenance therapy and treatment with first generation antipsychotics has been associated with higher risk of relapse. Further, psychotherapy add-on, particularly with cognitive behaviour therapy and psycho-education for both patients and relatives, has shown a good efficacy for reducing the relapse rate. Among general risk factors, some could be modified, such as the duration of untreated psychosis or the substance misuse, while others could not be modified as male gender or low pre-morbid level of functioning. CONCLUSION Several classes of risk factors have been proved to be relevant in the risk of relapse. Thus, a careful assessment of the risk factors here identified should be performed in daily clinical practice in order to individualise the relapse risk for each patient and to provide a targeted treatment in high-risk subjects.
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Affiliation(s)
- Stefano Porcelli
- a Department of Biomedical and NeuroMotor Sciences , University of Bologna , Bologna , Italy
| | - Oriana Bianchini
- a Department of Biomedical and NeuroMotor Sciences , University of Bologna , Bologna , Italy ;,b Institute of Psychiatry, University of Catania , Catania , Italy
| | | | - Eugenio Aguglia
- b Institute of Psychiatry, University of Catania , Catania , Italy
| | - Luciana Crea
- b Institute of Psychiatry, University of Catania , Catania , Italy
| | - Alessandro Serretti
- a Department of Biomedical and NeuroMotor Sciences , University of Bologna , Bologna , Italy
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Family centered approach in primary health care: experience from an urban area of Mangalore, India. ScientificWorldJournal 2015; 2015:419192. [PMID: 25695098 PMCID: PMC4322852 DOI: 10.1155/2015/419192] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 12/22/2014] [Accepted: 12/28/2014] [Indexed: 11/17/2022] Open
Abstract
Introduction. “Health for All” still eludes public health experts despite many approaches to prevent disease and promote health among urban poor. Several key illness factors lie beyond the conventional healthcare boundaries. Objective. To examine the effectiveness of family centered approach (FCA) in addressing health and related issues in an urban area of Mangalore, India. Method. A longitudinal study was conducted in Bengre, an outreach centre of Mangalore from June 2011 to November 2013. Family folders were created with pertinent details. Demand generation and health education activities were conducted through two female community health link workers. An FCA package was implemented by medical and nursing interns, under supervision, to address the priority issues. Effect was assessed by comparing their practices and service utilization before and after the study. Results. About 809 families participated in this study. Social, cultural, and religious factors were responsible for viciousness of malaria and maternal and child health issues. FCA improved their perceptions and practices towards health and related issues. Significant (P < 0.05) and sustained hike in service utilization was evident. Conclusion. FCA exposes key illness factors beyond the conventional care, eases need based healthcare implementation, and provides feasible and enduring solutions. Community involvement makes it more practicable.
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Fleischhacker WW, Arango C, Arteel P, Barnes TRE, Carpenter W, Duckworth K, Galderisi S, Halpern L, Knapp M, Marder SR, Moller M, Sartorius N, Woodruff P. Schizophrenia--time to commit to policy change. Schizophr Bull 2014; 40 Suppl 3:S165-94. [PMID: 24778411 PMCID: PMC4002061 DOI: 10.1093/schbul/sbu006] [Citation(s) in RCA: 130] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Care and outcomes for people with schizophrenia have improved in recent years, but further progress is needed to help more individuals achieve an independent and fulfilled life. This report sets out the current need, informs policy makers and all relevant stakeholders who influence care quality, and supports their commitment to creating a better future. The authors recommend the following policy actions, based on research evidence, stakeholder consultation, and examples of best practice worldwide. (1) Provide an evidence-based, integrated care package for people with schizophrenia that addresses their mental and physical health needs. (2) Provide support for people with schizophrenia to enter and to remain in their community, and develop mechanisms to help guide them through the complex benefit and employment systems. (3) Provide concrete support, information, and educational programs to families and carers on how to enhance care for an individual living with schizophrenia in a manner that entails minimal disruption to their lives. (4) All stakeholders, including organizations that support people living with schizophrenia, should be consulted to regularly revise, update, and improve policy on the management of schizophrenia. (5) Provide support, which is proportionate to the impact of the disease, for research and development of new treatments. (6) Establish adequately funded, ongoing, and regular awareness-raising campaigns that form an integral part of routine plans of action. Implementation of the above recommendations will require engagement by every stakeholder, but with commitment from all, change can be achieved.
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Affiliation(s)
- W. Wolfgang Fleischhacker
- Department of Psychiatry and Psychotherapy, Medical University Innsbruck, Innsbruck, Austria;,*To whom correspondence should be addressed; Innsbruck Medical University, Anichstrasse 35, A-6020 Innsbruck, Austria; tel: +43-512-504-23669, fax: +43-512-504-25267, e-mail:
| | - Celso Arango
- Hospital General Universitario Gregorio Marañón, CIBERSAM, Madrid, Spain
| | | | - Thomas R. E. Barnes
- Imperial College Centre for Mental Health, Faculty of Medicine, Imperial College London and West London Mental Health NHS Trust, London, UK
| | - William Carpenter
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD
| | | | - Silvana Galderisi
- Department of Psychiatry, Second University of Naples, Naples, Italy
| | | | - Martin Knapp
- London School of Economics and the Institute of Psychiatry, King’s College London, London, UK
| | - Stephen R. Marder
- Semel Institute, UCLA, VA Desert Pacific Mental Illness Research Education and Clinical Center, Los Angeles, CA
| | - Mary Moller
- Past President, American Psychiatric Nurses Association, Yale School of Nursing, New Haven, CT
| | - Norman Sartorius
- Association for the Improvement of Mental Health Programmes, Geneva, Switzerland
| | - Peter Woodruff
- Academic Faculty, Royal College of Psychiatrists, London, UK
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Armijo J, Méndez E, Morales R, Schilling S, Castro A, Alvarado R, Rojas G. Efficacy of community treatments for schizophrenia and other psychotic disorders: a literature review. Front Psychiatry 2013; 4:116. [PMID: 24130534 PMCID: PMC3793168 DOI: 10.3389/fpsyt.2013.00116] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 09/11/2013] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND In Chile, the clinical guidelines "for the treatment of people from first episode of schizophrenia" aim to support individuals with schizophrenia to live independently, establishment occupational goals, and gain an adequate quality of life and social interaction. This requires the implementation of a treatment model that integrates psychosocial and pharmacological dimensions. Community intervention strategies ensure the achievement of these goals. OBJECTIVES This study compiles and synthesizes available scientific evidence from the last 14 years on the effectiveness of community intervention strategies for schizophrenia and related psychotic disorders. METHODOLOGY An electronic search was carried out using PUBMED, LILACS, and Science Direct as databases. Criteria of inclusion: (i) randomized clinical trials, (ii) Community-based interventions, (iii) diagnosis of schizophrenia or related psychotic disorder (section F2 of ICD-10). EXCLUSION CRITERIA (i) treatments exclusively pharmacological, (ii) interventions carried out in inpatient settings, (iii) bipolar affective disorder or substance-induced psychosis (greater than 50% of sample). RESULTS Sixty-six articles were reviewed. Community strategies for integrated treatment from the first outbreak of schizophrenia significantly reduced negative and psychotic symptoms, days of hospitalization, and comorbidity with substance abuse and improved global functioning and adherence to treatment. In other stages, there were improved outcomes in negative and positive symptoms and general psychopathology. Psychoeducation for patients and families reduced the levels of self-stigma and domestic abuse, as well as improved knowledge of the disease and treatment adherence. Training focused on cognitive, social, and labor skills has been shown to improve yields in social functioning and employment status. CONCLUSION Community-based intervention strategies are widely supported in the treatment of patients with schizophrenia.
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Affiliation(s)
- Julio Armijo
- Adult Psychiatry, José Horwitz Barak Psychiatric Hospital, Universidad de Santiago de Chile , Santiago , Chile
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Chien WT, Chan SW. The effectiveness of mutual support group intervention for Chinese families of people with schizophrenia: A randomised controlled trial with 24-month follow-up. Int J Nurs Stud 2013; 50:1326-40. [DOI: 10.1016/j.ijnurstu.2013.01.004] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Revised: 01/15/2013] [Accepted: 01/18/2013] [Indexed: 11/28/2022]
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Mulligan J, Sellwood W, Reid GS, Riddell S, Andy N. Informal caregivers in early psychosis: evaluation of need for psychosocial intervention and unresolved grief. Early Interv Psychiatry 2013; 7:291-9. [PMID: 22741743 DOI: 10.1111/j.1751-7893.2012.00369.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM Relatives of service users involved with Early Intervention in Psychosis services often experience substantial distress and need associated with their role as caregivers. This study adapted versions of the relatives cardinal needs schedule and the Texas inventory of grief and tested their utility for use among relatives of service users experiencing a first episode of psychosis. METHODS staff, service users and relatives were consulted and a pilot took place which facilitated the creation of the relatives' urgent needs schedule-early Intervention version (RUNS-EI) and the Texas inventory of grief-early Intervention version (TIG-EI). Thirty service user-caregiver dyads were recruited for the evaluation of reliability and validity. RESULTS The level of 'urgent need' identified by the RUNS-EI demonstrated good concurrent validity with measures of service user social and global functioning as well as measures assessing relatives' distress, expressed emotion and grief. The measure demonstrated acceptable interrater and test-retest reliability. The profile of need is reported. The TIG-EI demonstrated 'excellent' internal consistency. It also demonstrated good concurrent validity with increased TIG-EI scores correlated with reduced service user social and global functioning as well as increased scores on measures assessing relatives' distress, expressed emotion and caregiving needs. CONCLUSIONS Results appear to support these assessments' utility as measures of need for psychosocial intervention and grief among relatives supporting service users experiencing a first episode of psychosis.
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Affiliation(s)
- John Mulligan
- Greater Manchester West NHS Trust, Manchester Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK.
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A systematic review of randomised controlled trials of interventions reporting outcomes for relatives of people with psychosis. Clin Psychol Rev 2013; 33:372-82. [DOI: 10.1016/j.cpr.2012.12.004] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Revised: 11/01/2012] [Accepted: 12/26/2012] [Indexed: 11/23/2022]
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Chien WT, Leung SF. A controlled trial of a needs-based, nurse-led psychoeducation programme for Chinese patients with first-onset mental disorders: 6 month follow up. Int J Nurs Pract 2013; 19 Suppl 1:3-13. [DOI: 10.1111/ijn.12015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Wai-Tong Chien
- School of Nursing; Faculty of Health & Social Sciences; The Hong Kong Polytechnic University; Kowloon; Hong Kong
| | - Sau-Fong Leung
- School of Nursing; Faculty of Health & Social Sciences; The Hong Kong Polytechnic University; Kowloon; Hong Kong
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Tanrıverdi D, Ekinci M. The effect psychoeducation intervention has on the caregiving burden of caregivers for schizophrenic patients in Turkey. Int J Nurs Pract 2012; 18:281-8. [PMID: 22621299 DOI: 10.1111/j.1440-172x.2012.02033.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study was conducted to determine the effects psychoeducation given to caregivers of schizophrenic patients has on the level of care burdens. The model used was one group pre-test post-test pre-experimental model. It was conducted on 31 caregivers in psychiatry clinics between October 2007 and June 2008. Data were collected using the 'Zarit Caregiver Burden Scale' and the questionnaire form that determined the introductory features of caregivers. The study group participated in eight psychoeducation sessions. The average pre-test score of care burden for caregivers was 57.2 ± 9.9, and the average post-test score was 34.3 ± 9.9. The distinction between the average pre-test and post-test score of care burden for caregivers was significant (P = 0.001). Psychoeducation, given for caregivers of patients with schizophrenia, had a significant effect in decreasing individuals' caregiving burdens. Psychoeducation programmes directed at families should be considered as a therapeutic strategy for patients with schizophrenia.
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Affiliation(s)
- Derya Tanrıverdi
- Department of Psychiatric Nursing, Faculty of Health Sciences, Gaziantep University, Gaziantep, Turkey.
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Jones C, Hacker D, Cormac I, Meaden A, Irving CB. Cognitive behaviour therapy versus other psychosocial treatments for schizophrenia. Cochrane Database Syst Rev 2012; 4:CD008712. [PMID: 22513966 PMCID: PMC4163968 DOI: 10.1002/14651858.cd008712.pub2] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Cognitive behavioural therapy (CBT) is now a recommended treatment for people with schizophrenia. This approach helps to link the person's distress and problem behaviours to underlying patterns of thinking. OBJECTIVES To review the effects of CBT for people with schizophrenia when compared with other psychological therapies. SEARCH METHODS We searched the Cochrane Schizophrenia Group Trials Register (March 2010) which is based on regular searches of CINAHL, EMBASE, MEDLINE and PsycINFO. We inspected all references of the selected articles for further relevant trials, and, where appropriate, contacted authors. SELECTION CRITERIA All relevant randomised controlled trials (RCTs) of CBT for people with schizophrenia-like illnesses. DATA COLLECTION AND ANALYSIS Studies were reliably selected and assessed for methodological quality. Two review authors, working independently, extracted data. We analysed dichotomous data on an intention-to-treat basis and continuous data with 65% completion rate are presented. Where possible, for dichotomous outcomes, we estimated a risk ratio (RR) with the 95% confidence interval (CI) along with the number needed to treat/harm. MAIN RESULTS Thirty papers described 20 trials. Trials were often small and of limited quality. When CBT was compared with other psychosocial therapies, no difference was found for outcomes relevant to adverse effect/events (2 RCTs, n = 202, RR death 0.57 CI 0.12 to 2.60). Relapse was not reduced over any time period (5 RCTs, n = 183, RR long-term 0.91 CI 0.63 to 1.32) nor was rehospitalisation (5 RCTs, n = 294, RR in longer term 0.86 CI 0.62 to 1.21). Various global mental state measures failed to show difference (4 RCTs, n = 244, RR no important change in mental state 0.84 CI 0.64 to 1.09). More specific measures of mental state failed to show differential effects on positive or negative symptoms of schizophrenia but there may be some longer term effect for affective symptoms (2 RCTs, n = 105, mean difference (MD) Beck Depression Inventory (BDI) -6.21 CI -10.81 to -1.61). Few trials report on social functioning or quality of life. Findings do not convincingly favour either of the interventions (2 RCTs, n = 103, MD Social Functioning Scale (SFS) 1.32 CI -4.90 to 7.54; n = 37, MD EuroQOL -1.86 CI -19.20 to 15.48). For the outcome of leaving the study early, we found no significant advantage when CBT was compared with either non-active control therapies (4 RCTs, n = 433, RR 0.88 CI 0.63 to 1.23) or active therapies (6 RCTs, n = 339, RR 0.75 CI 0.40 to 1.43) AUTHORS' CONCLUSIONS Trial-based evidence suggests no clear and convincing advantage for cognitive behavioural therapy over other - and sometime much less sophisticated - therapies for people with schizophrenia.
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Absalom-Hornby V, Gooding PA, Tarrier N. Implementing family intervention within forensic services: The perspectives of clinical staff. J Ment Health 2011; 20:355-67. [DOI: 10.3109/09638237.2011.583948] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Psychoeducational family interventions for schizophrenia in the last decade: from explanatory to pragmatic trials. ACTA ACUST UNITED AC 2011. [DOI: 10.1017/s1121189x00004589] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
SUMMARYA number of explanatory RCT studies published since the 1980s have demonstrated the clinical efficacy of Psychoeducational Family Interventions (PFI) for schizophrenia when provided in combination with drug therapy. In recent years, there has been a shift from efficacy to effectiveness studies and great attention by the researchers in developing training programmes in these interventions for ordinary staff. In this paper, we will provide an overview of the studies on PFI for schizophrenia which have been carried out in the last decade in routine clinical settings or with at least a partial involvement of ordinary staff. These studies have been grouped into: a) studies comparing PFI with standard care; b) studies comparing PFI with individual integrated interventions; c) studies comparing different PFI strategies; d) implementation studies. The results of these studies reveal that, when provided in clinical settings, PFI have positive middle-term effects on patients' clinical status and disability, and limited impact on family burden. From a methodological viewpoint, these studies had several similarities, such as homogeneity of PFI models and mid-term follow-up assessments, and several differences, mainly in the intensity and duration of the family exposure to the intervention. Future studies are needed to identify the “best dose” at which PFI can be provided in routine conditions at the most convenient cost-benefit ratio.
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Jones C, Hacker D, Meaden A, Cormac I, Irving CB. WITHDRAWN: Cognitive behaviour therapy versus other psychosocial treatments for schizophrenia. Cochrane Database Syst Rev 2011:CD000524. [PMID: 21491377 DOI: 10.1002/14651858.cd000524.pub3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Cognitive behavioural therapy (CBT) is now a recommended treatment for people with schizophrenia. This approach helps to link the person's feelings and patterns of thinking which underpin distress. OBJECTIVES To review the effects of CBT for people with schizophrenia when compared to other psychological therapies. SEARCH STRATEGY We searched the Cochrane Schizophrenia Group Trials Register (March 2010) which is based on regular searches of CINAHL, EMBASE, MEDLINE and PsycINFO. We inspected all references of the selected articles for further relevant trials, and, where appropriate, contacted authors. SELECTION CRITERIA All relevant clinical randomised trials of cognitive behaviour therapy for people with schizophrenia-like illnesses. DATA COLLECTION AND ANALYSIS Studies were reliably selected and assessed for methodological quality. Two reviewers, working independently, extracted data. We analysed dichotomous data on an intention-to-treat basis and continuous data with 65% completion rate are presented. Where possible, for dichotomous outcomes, we estimated a relative risk (RR) with the 95% confidence interval along with the number needed to treat/harm. MAIN RESULTS Twenty-nine papers described 20 trials. Trials were often small and of limited quality. When CBT was compared with other psychosocial therapies no difference was found for outcomes relevant to adverse effect/events (2 RCTs, n=202, RR death 0.57 CI 0.12 to 2.60). Relapse was not reduced over any time period (5 RCTs, n=183, RR in long term 0.91 CI 0.63 to 1.32) nor was rehospitalisation (5 RCTs, n=294, RR in longer term 0.86 CI 0.62 to 1.21). Various global mental state measures failed to show difference (4 RCTs, n=244, RR no important change in mental state 0.84 CI 0.64 to 1.09). More specific measures of mental state failed to show differential effects on positive or negative symptoms of schizophrenia but there may be some longer term effect for affective symptoms (2 RCTs, n=105, MD BDI -6.21 CI -10.81 to -1.61). Few trials report on social functioning or quality of life. Findings do not convincingly favour either interventions (2 RCT, n=103, MD SFS 1.32 CI -4.90 to 7.54; n=37, MD EuroQOL -1.86 CI -19.20 to 15.48). For the outcome of leaving the study early we found no significant advantage when CBT was compared with either non-active control therapies (4 RCTs, n=433, RR 0.88 CI 0.63 to 1.23) or active therapies (6 RCTs, n=339, RR 0.75 CI 0.40 to 1.43) AUTHORS' CONCLUSIONS Trail-based evidence suggests no clear and convincing advantage for cognitive behavioural therapy over other and sometime much less sophisticated therapies for people with schizophrenia.
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Affiliation(s)
- Christopher Jones
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, UK, B15 2TT
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Macleod SH, Elliott L, Brown R. What support can community mental health nurses deliver to carers of people diagnosed with schizophrenia? Findings from a review of the literature. Int J Nurs Stud 2011; 48:100-20. [DOI: 10.1016/j.ijnurstu.2010.09.005] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2009] [Revised: 07/14/2010] [Accepted: 09/04/2010] [Indexed: 11/29/2022]
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Whitney J, Haigh R, Weinman J, Treasure J. Caring for people with eating disorders: Factors associated with psychological distress and negative caregiving appraisals in carers of people with eating disorders. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2010; 46:413-28. [PMID: 17535529 DOI: 10.1348/014466507x173781] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES Carers of people with eating disorders (ED) have high levels of distress, but little is known about the contributing factors. The aim of this study was to examine predictors of carers' distress and caregiving appraisals using a model of caregiving adapted from the previous literature. DESIGN A cross-sectional design was used. METHODS A sample of 115 individuals currently caring for someone with an ED participated in the study. Carers completed self-report assessments of psychological distress (GHQ-12; Goldberg & Williams, 1988), experience of caregiving (Szmukler et al., 1996), illness representations (IPQ-SCV; Barrowclough, Lobban, Hatton, & Quinn, 2001) and caregiving needs (CaNAM; Haigh & Treasure, 2003). Simple and multiple hierarchical regressions were conducted. RESULTS Approximately 36% (39/109) of carers had scores on the GHQ which indicated mental health difficulties, with 17% (19/109) experiencing high psychological distress. A negative experience of caregiving was associated with carers' distress. The dependency of the individual with the ED and stigma associated with the illness were most highly predictive of carers' distress. Shorter illness duration, higher levels of needs (lower levels of support) and perceptions of high illness consequences contributed to greater negative caregiving appraisals. The belief that the illness was attributable to the sufferers' personality was related to fewer positive appraisals. CONCLUSIONS Adjusting to the impact of a family member experiencing an ED is problematic, as suggested by the relationship between shorter illness duration and greater negative appraisals of caregiving. Interventions to help reduce dependency and alleviate stigma may help to decrease carers' distress.
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Affiliation(s)
- Jenna Whitney
- Eating Disorders Research Unit, Institute of Psychiatry, King's College, London, UK.
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Dixon LB, Dickerson F, Bellack AS, Bennett M, Dickinson D, Goldberg RW, Lehman A, Tenhula WN, Calmes C, Pasillas RM, Peer J, Kreyenbuhl J. The 2009 schizophrenia PORT psychosocial treatment recommendations and summary statements. Schizophr Bull 2010; 36:48-70. [PMID: 19955389 PMCID: PMC2800143 DOI: 10.1093/schbul/sbp115] [Citation(s) in RCA: 518] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The Schizophrenia Patient Outcomes Research Team (PORT) psychosocial treatment recommendations provide a comprehensive summary of current evidence-based psychosocial treatment interventions for persons with schizophrenia. There have been 2 previous sets of psychosocial treatment recommendations (Lehman AF, Steinwachs DM. Translating research into practice: the Schizophrenia Patient Outcomes Research Team (PORT) treatment recommendations. Schizophr Bull. 1998;24:1-10 and Lehman AF, Kreyenbuhl J, Buchanan RW, et al. The Schizophrenia Patient Outcomes Research Team (PORT): updated treatment recommendations 2003. Schizophr Bull. 2004;30:193-217). This article reports the third set of PORT recommendations that includes updated reviews in 7 areas as well as adding 5 new areas of review. Members of the psychosocial Evidence Review Group conducted reviews of the literature in each intervention area and drafted the recommendation or summary statement with supporting discussion. A Psychosocial Advisory Committee was consulted in all aspects of the review, and an expert panel commented on draft recommendations and summary statements. Our review process produced 8 treatment recommendations in the following areas: assertive community treatment, supported employment, cognitive behavioral therapy, family-based services, token economy, skills training, psychosocial interventions for alcohol and substance use disorders, and psychosocial interventions for weight management. Reviews of treatments focused on medication adherence, cognitive remediation, psychosocial treatments for recent onset schizophrenia, and peer support and peer-delivered services indicated that none of these treatment areas yet have enough evidence to merit a treatment recommendation, though each is an emerging area of interest. This update of PORT psychosocial treatment recommendations underscores both the expansion of knowledge regarding psychosocial treatments for persons with schizophrenia at the same time as the limitations in their implementation in clinical practice settings.
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Affiliation(s)
- Lisa B Dixon
- VA Capitol Health Care Network Mental Illness Research Education and Clinical Center, Baltimore, MD, USA.
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Loughland CM, Lawrence G, Allen J, Hunter M, Lewin TJ, Oud NE, Carr VJ. Aggression and trauma experiences among carer-relatives of people with psychosis. Soc Psychiatry Psychiatr Epidemiol 2009; 44:1031-40. [PMID: 19333531 DOI: 10.1007/s00127-009-0025-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2008] [Accepted: 02/24/2009] [Indexed: 10/21/2022]
Abstract
BACKGROUND Exposure to aggression and associated psychological outcomes are poorly characterised among carer-relatives of people with psychosis. METHOD Carer-relatives (N = 106) completed questionnaires assessing socio-demographics and perceived prevalence of aggression in their caring role in the last 12 months. Carers exposed to moderate-severe levels of aggression were re-approached to assess PTSD and coping strategies. RESULTS Most respondents (77.4%) reported experiencing moderate-severe levels of aggression. Increased contact with (M = 15.12 vs. M = 6.71 days per month), and significantly higher ratings of affective, antisocial, negative and psychotic symptomology in affected relatives were associated with experiences of moderate-severe aggression. Approximately half of the moderate-severe respondents reported potentially significant levels of PTSD (52%, N = 34), which was associated with greater exposure to verbal aggression and increased usage of coping strategies. CONCLUSIONS Comparable ratios of physical to non-physical aggression to those reported by professional carers working in acute psychiatric treatment settings were reported. Carer-relatives require greater levels of information and support to assist them in their community caring roles.
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Affiliation(s)
- Carmel M Loughland
- Centre for Brain and Mental Health Research, Hunter New England Mental Health, The University of Newcastle, PO Box 833, Newcastle, NSW 2300, Australia.
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Rodrigues MGA, Krauss-Silva L, Martins ACM. [Meta-analysis of clinical trials on family intervention in schizophrenia]. CAD SAUDE PUBLICA 2009; 24:2203-18. [PMID: 18949223 DOI: 10.1590/s0102-311x2008001000002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2008] [Accepted: 06/16/2008] [Indexed: 11/22/2022] Open
Abstract
The present study aimed to assess the efficacy of cognitive-behavioral family interventions by relatives of schizophrenic patients under community care, specifically targeting relapse and family burden as outcomes. Independent researchers conducted the analyses of the pertinence and quality of trials identified through a search strategy, following a previously developed protocol. Eleven randomized or quasi-randomized trials were selected. The summary relative risk of relapse using the fixed effects model was favorable to family intervention, with estimated efficacy reaching nearly 60% (50%-70%). Summary relative risk in the cognitive-behavioral therapy trials subgroup [RR = 0.43 (0.28-0.67)] was equivalent to that of the behavioral therapy subgroup [RR = 0.37 (0.23-0.60)] and the "pragmatic" subgroup [RR = 0.37 (0.21-0.66)], although the "pragmatic" trials were generally analyzed for effective treatment. The difference in summary overall risk of relapse was nearly 30% using the random effects model. Only four trials analyzed family burden as outcome, including different dimensions of burden. Results of individual trials were generally favorable to family intervention, for both the objective and subjective dimensions.
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Gray B, Robinson CA, Seddon D, Roberts A. An emotive subject: insights from social, voluntary and healthcare professionals into the feelings of family carers for people with mental health problems. HEALTH & SOCIAL CARE IN THE COMMUNITY 2009; 17:125-132. [PMID: 18700869 DOI: 10.1111/j.1365-2524.2008.00803.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Caring for people with mental health problems can generate a whole range of positive and negative emotions, including fear, disbelief, guilt and chaos as well as a sense of purpose, pride and achievement. This paper explores the emotions of family carers from the perspectives of social, voluntary and healthcare professionals. Sixty-five participants were interviewed, the sample included directors, managers and senior staff from social, voluntary and healthcare organisations. Participants were encouraged to talk in detail about their understanding of the emotions of family carers. Findings highlight a rich understanding of the broad spectrum of carer emotions and the huge emotional adjustments that are often involved. Diagnosis was seen to be imbued with negative emotions, such as fear, anger and denial. However, feelings of hopelessness and desolation were often counterbalanced by feelings of hope, satisfaction and the emotional rewards of caring for a loved one. Participants noted a clear lack of emotional support for family carers, with accompanying feelings of marginalisation, particularly during transitions and especially involving young carers as well as ethnic minorities. By way of contrast, carer support groups were suggested by professionals to be a holistic, effective and economical way of meeting carers' emotional needs. This paper explores the challenge of family carer emotions from the perspective of managers and practitioners and draws out implications for research, policy and practice.
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Affiliation(s)
- Ben Gray
- Canterbury Christ Church University, Canterbury, UK.
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Hempel S, Norman G, Golder S, Aguiar-Ibáñez R, Eastwood A. Psychosocial interventions for non-professional carers of people with Parkinson’s disease: a systematic scoping review. J Adv Nurs 2008; 64:214-28. [DOI: 10.1111/j.1365-2648.2008.04806.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Chien WT, Thompson DR, Norman I. Evaluation of a peer-led mutual support group for Chinese families of people with schizophrenia. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2008; 42:122-134. [PMID: 18584319 DOI: 10.1007/s10464-008-9178-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Family interventions in schizophrenia have shown positive effects on patients but little attention has been paid to their effects on family members, particularly those in non-Western countries. This randomized controlled trial evaluated the effectiveness of a bi-weekly, 12-session, family-led mutual support group for Chinese caregivers of schizophrenia sufferers over 6 months compared with standard psychiatric care. It was conducted with 76 families of outpatients with schizophrenia in Hong Kong of whom 38 were assigned randomly to either a mutual support group or standard care. Families' psychosocial health status and patients' symptom severity and length of re-hospitalizations at recruitment, one-week and 12-month post-intervention were compared between groups. Results of repeated-measures mixed model indicated that the mutual support group experienced significantly greater improvements in families' burden, functioning and number of support persons and length of patients' re-hospitalizations at two post-tests. The findings provide evidence that mutual support groups can be an effective family-initiated, community-based intervention for Chinese schizophrenia sufferers.
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Affiliation(s)
- Wai-Tong Chien
- The Nethersole School of Nursing, Chung Chi College, Chinese University of Hong Kong, 7/F., Esther Lee Building, Shatin, NT, Hong Kong.
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Chien WT. Effectiveness of psychoeducation and mutual support group program for family caregivers of chinese people with schizophrenia. Open Nurs J 2008; 2:28-39. [PMID: 19319218 PMCID: PMC2582821 DOI: 10.2174/1874434600802010028] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2008] [Revised: 04/02/2008] [Accepted: 04/03/2008] [Indexed: 12/18/2022] Open
Abstract
Schizophrenia is a disruptive and distressing illness, not only for the person affected but also for family members. Family intervention, particularly in a group format using a diverse range of modalities, is thought to effectively satisfy the informational needs of families and enhance their coping abilities when caring for a relative with schizophrenia, and thus reduce a patient's relapse from illness. This study tested the hypothesis that participants in a family psychoeducation and mutual support group would demonstrate significant improvements in levels of patient and family functioning and shorter duration of re-hospitalization than families in routine care. A randomized controlled trial was conducted with a sample of 68 Chinese families of schizophrenia sufferers in Hong Kong, who were randomly assigned to either a family psychoeducation and support group (n = 34), or a routine care group (n = 34). The interventions were delivered at two psychiatric outpatient clinics over a nine-month period. Results of multivariate analyses of variance test indicated that the psychoeducation and support group reported greater improvements on family and patient functioning and shorter lengths of patient hospitalizations at the two post-tests (one month and one year after completion of the intervention), compared with the routine care group. The findings substantiate that within a Chinese context, psychoeducation and mutual support group intervention can effectively help families care for a mentally ill relative.
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Affiliation(s)
- Wai Tong Chien
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, P.R. China
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Abstract
BACKGROUND People who are prescribed self-administered medications typically take less than half the prescribed doses. Efforts to assist patients with adherence to medications might improve the benefits of prescribed medications, but also might increase their adverse effects. OBJECTIVES To update a review summarizing the results of randomized controlled trials (RCTs) of interventions to help patients follow prescriptions for medications for medical problems, including mental disorders but not addictions. SEARCH STRATEGY We updated searches of The Cochrane Library, MEDLINE, CINAHL, EMBASE, International Pharmaceutical Abstracts (IPA), PsycINFO (all via OVID) and Sociological Abstracts (via CSA) in January 2007 with no language restriction. We also reviewed bibliographies in articles on patient adherence and articles in our personal collections, and contacted authors of relevant original and review articles. SELECTION CRITERIA Articles were selected if they reported an unconfounded RCT of an intervention to improve adherence with prescribed medications, measuring both medication adherence and treatment outcome, with at least 80% follow-up of each group studied and, for long-term treatments, at least six months follow-up for studies with positive initial findings. DATA COLLECTION AND ANALYSIS Study design features, interventions and controls, and results were extracted by one review author and confirmed by at least one other review author. We extracted adherence rates and their measures of variance for all methods of measuring adherence in each study, and all outcome rates and their measures of variance for each study group, as well as levels of statistical significance for differences between study groups, consulting authors and verifying or correcting analyses as needed. The studies differed widely according to medical condition, patient population, intervention, measures of adherence, and clinical outcomes. Therefore, we did not feel that quantitative analysis was scientifically justified; rather, we conducted a qualitative analysis. MAIN RESULTS For short-term treatments, four of ten interventions reported in nine RCTs showed an effect on both adherence and at least one clinical outcome, while one intervention reported in one RCT significantly improved patient adherence, but did not enhance the clinical outcome. For long-term treatments, 36 of 81 interventions reported in 69 RCTs were associated with improvements in adherence, but only 25 interventions led to improvement in at least one treatment outcome. Almost all of the interventions that were effective for long-term care were complex, including combinations of more convenient care, information, reminders, self-monitoring, reinforcement, counseling, family therapy, psychological therapy, crisis intervention, manual telephone follow-up, and supportive care. Even the most effective interventions did not lead to large improvements in adherence and treatment outcomes. AUTHORS' CONCLUSIONS For short-term treatments several quite simple interventions increased adherence and improved patient outcomes, but the effects were inconsistent from study to study with less than half of studies showing benefits. Current methods of improving adherence for chronic health problems are mostly complex and not very effective, so that the full benefits of treatment cannot be realized. High priority should be given to fundamental and applied research concerning innovations to assist patients to follow medication prescriptions for long-term medical disorders.
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Affiliation(s)
- R B Haynes
- McMaster University, Clinical Epidemiology & Biostatistics and Medicine, Faculty of Health Sciences, 1200 Main Street West, Rm. 2C10B, Hamilton, Ontario, Canada L8N 3Z5.
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Sellwood W, Wittkowski A, Tarrier N, Barrowclough C. Needs-based cognitive-behavioural family intervention for patients suffering from schizophrenia: 5-year follow-up of a randomized controlled effectiveness trial. Acta Psychiatr Scand 2007; 116:447-52. [PMID: 17961200 DOI: 10.1111/j.1600-0447.2007.01097.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine whether a 24-week, needs-based cognitive-behaviourally oriented family intervention for patients suffering from schizophrenia led to improved relapse profiles over a 5-year follow-up period. METHOD The case notes of 60 patients who had participated in a randomized, controlled effectiveness trial were examined to determine relapse rates over a 5-year period. RESULTS Patients were less likely to relapse over the 5-year follow-up when they received the needs-based family intervention, especially in relation to exacerbations of symptoms not requiring inpatient admissions: 86.7% of control participants relapsed compared with 53.3% (P = 0.01). Survival analysis indicated that the relapse risk was 2.5 times higher for patients receiving routine care, compared with those receiving family intervention. A similar trend was observed for the final 4 years of follow-up. CONCLUSION The present study provides some tentative support for the long-term effectiveness of family-based interventions for the management of schizophrenia in general mental health services.
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Affiliation(s)
- W Sellwood
- Division of Clinical Psychology, University of Liverpool, Liverpool, UK
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Rodrigues MGA, Silva LK. Intervenção familiar na esquizofrenia: recorte de modelos de ensaios clínicos. ACTA ACUST UNITED AC 2006. [DOI: 10.1590/s0104-80232006000200008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
O entendimento do formato da Intervenção Familiar citada pelos ensaios clínicos controlados na condição esquizofrenia foi o foco de nossa investigação aqui relatada. Procedemos a uma busca sistemática na base de dados MedLine e elaboramos a compreensão da fundamentação teórica das práticas descritas para avaliar a heterogeneidade clínica das intervenções que são objeto de estudo dos ensaios que resgatamos. Descrevemos um modelo denominado "pragmático", que apresenta fragmentos de técnicas, sem princípios de base ou técnicas derivadas de teorias; outro modelo cuja ênfase do trabalho é na mudança comportamental; e por fim um modelo cognitivo comportamental, que privilegia a abordagem cognitiva. Fazemos considerações sobre os conceitos de Emoção Expressa (EE) e Sobrecarga Familiar, subjacentes aos modelos comportamental e cognitivo comportamental na Intervenção Familiar para Portadores de Esquizofrenia. Consideramos que esse modelo, que privilegia um maior entendimento do familiar acerca da esquizofrenia, com a devida adequação devido às especificidades culturais nacionais, deve ser investigado para a utilização nos CAPS do Brasil.
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Velligan DI, Lam YWF, Glahn DC, Barrett JA, Maples NJ, Ereshefsky L, Miller AL. Defining and assessing adherence to oral antipsychotics: a review of the literature. Schizophr Bull 2006; 32:724-42. [PMID: 16707778 PMCID: PMC2632258 DOI: 10.1093/schbul/sbj075] [Citation(s) in RCA: 195] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The definition and assessment of adherence vary considerably across studies. Increasing consensus regarding these issues is necessary to improve our understanding of adherence and the development of more effective treatments. We review the adherence literature over the past 3 decades to explore the definitions and assessment of adherence to oral antipsychotics in schizophrenia patients. A total of 161 articles were identified through MEDLINE and PsycINFO searches. The most common method used to assess adherence was the report of the patient. Subjective and indirect methods including self-report, provider report, significant other report, and chart review were the only methods used to assess adherence in over 77% (124/161) of studies reviewed. Direct or objective measures including pill count, blood or urine analysis, electronic monitoring, and electronic refill records were used in less than 23% (37/161) of studies. Even in studies utilizing the same methodology to assess adherence, definitions of an adherent subject varied broadly from agreeing to take any medication to taking at least 90% of medication as prescribed. We make suggestions for consensus development, including the use of recommended terminology for different subject samples, the increased use of objective or direct measures, and the inclusion in all studies of an estimate of the percentage of medication taken as prescribed in an effort to increase comparability among studies. The suggestions are designed to advance the field with respect to both understanding predictors of adherence and developing interventions to improve adherence to oral antipsychotic medications.
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Affiliation(s)
- Dawn I Velligan
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229-3900, USA.
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Mclnnis E, Sellwood W, Jones C. A cognitive behavioural groupbased educational programme for psychotic symptoms in a low secure setting: a pilot evaluation. ACTA ACUST UNITED AC 2006. [DOI: 10.1108/14636646200600018] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Chien WT, Norman I, Thompson DR. Perceived benefits and difficulties experienced in a mutual support group for family carers of people with schizophrenia. QUALITATIVE HEALTH RESEARCH 2006; 16:962-81. [PMID: 16894226 DOI: 10.1177/1049732306290140] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
In this qualitative study, the authors explore from the participants' perspective the benefits and difficulties experienced by participants in a mutual support group for Chinese family carers of patients with schizophrenia in Hong Kong. Thirty family carers and 10 patients who had participated in a 12-session mutual support group were interviewed, and the 12 group sessions were audiotaped for content analysis. Three main themes emerged from the data: (a) positive personal changes attributed to group participation, which included enhanced self-identity and acceptance of the caregiving role, increased knowledge of the illness, and adoption of new coping skills; (b) positive characteristics of the mutual support group, including the explicit group ideology and consensus, perceived social climate of the group, and informational support and empowerment; and (c) major inhibitors of group development, specifically low or irregular group attendance, negative pressure from dominant members, and overexpression of intense and negative feelings. These findings contribute to our understanding of the therapeutic components and limitations of mutual support groups for family carers.
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Affiliation(s)
- Wai-Tong Chien
- Nethersole School of Nursing, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, Shatin, China.
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Chien WT, Chan SWC, Thompson DR. Effects of a mutual support group for families of Chinese people with schizophrenia: 18-month follow-up. Br J Psychiatry 2006; 189:41-9. [PMID: 16816305 DOI: 10.1192/bjp.bp.105.008375] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Family intervention in schizophrenia can reduce patient relapse and improve medication adherence, but few studies on this have involved a Chinese population. AIMS To examine the effects of a mutual support group for Chinese families of people with schizophrenia, compared with psychoeducation and standard care. METHOD Randomised controlled trial in Hong Kong with 96 families of out-patients with schizophrenia, of whom 32 received mutual support, 33 psychoeducation and 31 standard care. The psychoeducation group included patients in all the sessions, the mutual support group did not. Intervention was provided over 6 months, and patient- and family-related psychosocial outcomes were compared over an 18-month follow-up. RESULTS Mutual support consistently produced greater improvement in patient and family functioning and caregiver burden over the intervention and follow-up periods, compared with the other two conditions. The number of readmissions did not decrease significantly, but their duration did. CONCLUSIONS Mutual support for families of Chinese people with schizophrenia can substantially benefit family and patient functioning and caregiver burden.
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Affiliation(s)
- Wai-Tong Chien
- Nethersole School of Nursing, Chinese University of Hong Kong, 7/F, Esther Lee Building, Chung Chi College, Shatin, N.T., Hong Kong SAR, China.
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Pearce K, McGovern J, Barrowclough C. Assessment of need for psychosocial interventions in an Asian population of carers of patients with schizophrenia. J Adv Nurs 2006; 54:284-92. [PMID: 16629913 DOI: 10.1111/j.1365-2648.2006.03811.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM This paper reports on a study to establish the profile of need for psychosocial family interventions and to examine the concurrent validity of the Relatives' Cardinal Needs Schedule with an Asian population of carers in England, UK. BACKGROUND Although psychosocial interventions for schizophrenia have a strong evidence base, little is known of the needs of Asian families. A cardinal need is indicative of the existence of a problem causing the carer a strain for which the carer is willing to co-operate if help is offered and for which systematic help has not been provided in the last 12 months. METHODS The Relatives' Cardinal Needs Schedule was used to assess needs in a small randomly selected sample of Asian carers in one English locality and to compare the results with independent measures of patient symptoms and carer distress. RESULTS Feedback from carers indicated that the Relatives' Cardinal Needs Schedule was culturally acceptable and appropriate to their needs. There was evidence for the validity of the assessment in that there were large and statistically significant associations between the number of needs detected by the Relatives' Cardinal Needs Schedule and independent measures of both carer distress (as measured by the 28 item General Health Questionnaire) and patient symptom severity (as reliably assessed from case notes). CONCLUSION The Relatives' Cardinal Needs Schedule may prove useful for nurses and service managers in establishing the need for psychosocial family interventions amongst Asian families in the United Kingdom.
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Haynes RB, Yao X, Degani A, Kripalani S, Garg A, McDonald HP. Interventions to enhance medication adherence. Cochrane Database Syst Rev 2005:CD000011. [PMID: 16235271 DOI: 10.1002/14651858.cd000011.pub2] [Citation(s) in RCA: 226] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND People who are prescribed self-administered medications typically take less than half the prescribed doses. Efforts to assist patients with adherence to medications might improve the benefits of prescribed medications, but also might increase their adverse effects. OBJECTIVES To update a review summarizing the results of randomized controlled trials (RCTs) of interventions to help patients follow prescriptions for medications for medical problems, including mental disorders but not addictions. SEARCH STRATEGY Computerized searches were updated to September 2004 without language restriction in MEDLINE, EMBASE, CINAHL, The Cochrane Library, International Pharmaceutical Abstracts (IPA), PsycINFO and SOCIOFILE. We also reviewed bibliographies in articles on patient adherence and articles in our personal collections, and contacted authors of original and review articles on the topic. SELECTION CRITERIA Articles were selected if they reported an unconfounded RCT of an intervention to improve adherence with prescribed medications, measuring both medication adherence and treatment outcome, with at least 80% follow-up of each group studied and, for long-term treatments, at least six months follow-up for studies with positive initial findings. DATA COLLECTION AND ANALYSIS Study design features, interventions and controls, and results were extracted by one reviewer and confirmed by at least one other reviewer. We extracted adherence rates and their measures of variance for all methods of measuring adherence in each study, and all outcome rates and their measures of variance for each study group, as well as levels of statistical significance for differences between study groups, consulting authors and verifying or correcting analyses as needed. MAIN RESULTS For short-term treatments, four of nine interventions reported in eight RCTs showed an effect on both adherence and at least one clinical outcome, while one intervention reported in one RCT significantly improved patient compliance, but did not enhance the clinical outcome. For long-term treatments, 26 of 58 interventions reported in 49 RCTs were associated with improvements in adherence, but only 18 interventions led to improvement in at least one treatment outcome. Almost all of the interventions that were effective for long-term care were complex, including combinations of more convenient care, information, reminders, self-monitoring, reinforcement, counseling, family therapy, psychological therapy, crisis intervention, manual telephone follow-up, and supportive care. Even the most effective interventions did not lead to large improvements in adherence and treatment outcomes. Six studies showed that telling patients about adverse effects of treatment did not affect their adherence. AUTHORS' CONCLUSIONS Improving short-term adherence is relatively successful with a variety of simple interventions. Current methods of improving adherence for chronic health problems are mostly complex and not very effective, so that the full benefits of treatment cannot be realized. High priority should be given to fundamental and applied research concerning innovations to assist patients to follow medication prescriptions for long-term medical disorders.
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Affiliation(s)
- R B Haynes
- McMaster University Medical Centre, Clinical Epidemiology and Biostatistics, HSC Room 2C10b, 1200 Main St. West, Hamilton, Ontario, Canada L8N 3Z5.
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Chien WT, Chan S, Morrissey J, Thompson D. Effectiveness of a mutual support group for families of patients with schizophrenia. J Adv Nurs 2005; 51:595-608. [PMID: 16129010 DOI: 10.1111/j.1365-2648.2005.03545.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIM This paper reports a study to examine the effectiveness of a 12-session mutual support group for Chinese families caring for a relative with schizophrenia compared with a psycho-educational group and routine family support services in Hong Kong. BACKGROUND Schizophrenia is a disruptive and distressing illness for patients and their families. With the current trend of community care for mental illness, there is evidence that family intervention reduces patient relapse and re-hospitalization, satisfies the health needs of families and enhances their coping capabilities. METHODS A randomized controlled trial was conducted from May 2002 to June 2003 with 96 Chinese families of a relative with schizophrenia selected from two psychiatric outpatient clinics in Hong Kong. Families were randomly assigned to receive mutual support (n = 32), psycho-education (n = 33) or standard care only (n = 31). The interventions were delivered at outpatient clinics over a 6-month period. Pre- and post- (1 week and 6 months) testing took place and families' functioning, mental health service utilization, patients' level of functioning and duration of re-hospitalization were measured. RESULTS At both post-test periods, family caregivers and patients in the mutual support group reported statistically significant improvements on family and patients' level of functioning, when compared with their counterparts in the psycho-education and standard care groups. CONCLUSIONS The findings support the use of mutual support groups as an effective modality of family intervention in a Chinese population caring for a family member with schizophrenia to improve both family and patient functioning.
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Affiliation(s)
- Wai Tong Chien
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong SAR, China.
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Abstract
Estimates of adherence to long-term medication regimens range from 17% to 80%, and nonadherence (or nonpersistence) can lead to increased morbidity, mortality, and healthcare costs. Multifaceted interventions that target specific barriers to adherence are most effective, because they address the problems and reinforce positive behaviors. Providers must assess their patients' understanding of the illness and its treatment, communicate the benefits of the treatment, assess their patients' readiness to carry out the treatment plan, and discuss any barriers or obstacles to adherence that patients may have. A positive, supporting, and trusting relationship between patient and provider improves adherence. Individual patient factors also affect adherence. For example, conditions that impair cognition have a negative impact on adherence. Other factors--such as the lack of a support network, limited English proficiency, inability to obtain and pay for medications, or severe adverse effects or the fear of such effects--are all barriers to adherence. There are multiple reasons for nonadherence or nonpersistence; the solution needs to be tailored to the individual patient's needs. To have an impact on adherence, healthcare providers must understand the barriers to adherence and the methods or tools needed to overcome them. This report describes the barriers to medication adherence and persistence and interventions that have been used to address them; it also identifies interventions and compliance aids that practitioners and organizations can implement.
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Hübner-Liebermann B, Spiessl H, Iwai K, Cording C. Treatment of schizophrenia: implications derived from an intercultural hospital comparison between Germany and Japan. Int J Soc Psychiatry 2005; 51:83-96. [PMID: 15864978 DOI: 10.1177/0020764005050337] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The study was aimed at evaluating facets of psychiatric inpatient care of patients with schizophrenia in a German and a Japanese hospital. METHODS Based upon a sample of 865 inpatients of the Psychiatric State Hospital Regensburg (BKR) and 50 inpatients of the Tokyo Women's Medical University (TWMU) admitted in 1997, data of a psychiatric basic documentation system (BADO) were analysed with regard to essential process and outcome indicators. RESULTS Despite dissimilarities between both patient groups with respect to schizophrenic subtype, duration of illness as well as severity of illness and psychosocial functioning, the differences regarding therapeutic treatment and outcome were marked. In 1997, the rate of atypical neuroleptics was 18% at the BKR and 12% at the TWMU. Inpatients of the TWMU were given benzodiazepines and anticholinergic drugs significantly more frequently. Male patients of the TWMU showed more severe side-effects. Psychotherapy and sociotherapy were less frequently applied at the TWMU. Although the patient groups did not differ with regard to suicidal behaviour and overt aggressions during hospitalisation, we found a higher rate of mechanical restraints at the TWMU. In 1997, the average length of stay was significantly higher at the TWMU (153 days) than at the BKR (52 days), but inpatients of the TWMU improved only slightly better with regard to global psychosocial functioning (GAF) and severity of illness (CGI). CONCLUSIONS The revealed differences in treatment are likely due to differences in service provision and national practices in Germany and Japan and provide clues for quality improvements. The BADO is a useful tool for continuous quality management and an ongoing international exchange concerning psychiatric inpatient care.
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Affiliation(s)
- B Hübner-Liebermann
- Department of Psychiatry and Psychotherapy, University of Regensburg, Germany.
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Jones SH, Sellwood W, McGovern J. Psychological therapies for bipolar disorder: the role of model-driven approaches to therapy integration. Bipolar Disord 2005; 7:22-32. [PMID: 15654929 DOI: 10.1111/j.1399-5618.2004.00157.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The psychological and social aspects of bipolar disorder are receiving increasing recognition. Recently, there have been promising developments in psychological interventions, but there is scope for further improvement of therapeutic outcomes. This paper argues for the use of more detailed psychological models of bipolar disorder to inform the further development of therapeutic approaches. METHOD Evidence for psychological, family and social factors in bipolar disorder is reviewed. The efficacy of current individual and family interventions are discussed. A model, which has potential to synthesize group and individual approaches, is outlined. RESULTS Psychological, social and family factors have important influences on the onset, course and outcome of bipolar disorder. Interventions based on vulnerability stress models have proved effective. However, to enhance efficacy future developments need to be based on models that integrate current understandings of the multiple levels at which mood fluctuations occur. A particular recent model is discussed which leads to specific proposals for future intervention research. CONCLUSIONS Psychological and family approaches to BD have much potential. They clearly have a role in conjunction with appropriate pharmacological treatment. If this potential is to be fully realized future developments need to be based on psychological models that can accommodate the complexity of this illness.
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Affiliation(s)
- Steven H Jones
- Academic Division of Clinical Psychology, University of Manchester and Pennine Care Trust, Greater Manchester, UK.
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Tarrier N, Lewis S, Haddock G, Bentall R, Drake R, Kinderman P, Kingdon D, Siddle R, Everitt J, Leadley K, Benn A, Grazebrook K, Haley C, Akhtar S, Davies L, Palmer S, Dunn G. Cognitive-behavioural therapy in first-episode and early schizophrenia. 18-month follow-up of a randomised controlled trial. Br J Psychiatry 2004; 184:231-9. [PMID: 14990521 DOI: 10.1192/bjp.184.3.231] [Citation(s) in RCA: 195] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The initial phase of a trial of cognitive-behavioural therapy (CBT) for acutely ill patients with schizophrenia of recent onset showed that it speeded recovery. AIMS To test the hypothesis that CBT in addition to treatment as usual (TAU) during the first or second acute episode of schizophrenia will confer clinical benefit over a follow-up period. METHOD This was an 18-month follow-up of a multicentre prospective trial of CBT or supportive counselling administered as an adjunct to TAU, compared with TAU alone, for patients hospitalised for an acute episode of schizophrenia of recent onset. Primary outcomes were total and positive symptom scales, time to relapse and re-hospitalisation. RESULTS There were significant advantages for CBT and supportive counselling over TAU alone on symptom measures at 18 months but no group difference was seen for relapse or re-hospitalisation. There was a significant centre-treatment interaction, reflecting centre differences in the effect of introducing either treatment, but not in the comparison of CBT and supportive counselling. Medication dosage and compliance did not explain group differences. CONCLUSIONS Adjunctive psychological treatments can have a beneficial long-term effect on symptom reduction.
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Affiliation(s)
- Nicholas Tarrier
- School of Psychiatry and Behavioural Sciences, University of Manchester, UK.
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