Psychoeducation in schizophrenia--results of a survey of all psychiatric institutions in Germany, Austria, and Switzerland

Evaluation of the Psychoeducation Program Given to Behcet's Patients in the Context of the Roy Adaptation Model

The physical, social, and psychological effects of Behcet's disease necessitate the person's adaptation in many areas. This study was conducted to examine the effect of psychoeducation provided to people living with Behcet's disease in the context of the Roy adaptation model on illness adjustment, dyadic adjustment, self-esteem, and psychiatric symptoms. The study was quasi-experimental. The study was with 70 patients with Behcet's disease: 35 patients were in the intervention group and the same number in the control group. The data of the study were collected using the Adaptation to Chronic Illness Scale, Dyadic Adjustment Scale, Rosenberg Self-Esteem Scale, and Brief Symptom Inventory. A seven-session psychoeducation program was provided to the intervention group. After the psychoeducation program, adaptation to illness increased significantly and psychiatric symptoms decreased significantly in the intervention group compared with the control group (P < .05).

Recovery-Oriented Practices in Community-based Mental Health Services: A Systematic Review

Objective: New initiatives are needed to manage patients with mental health problems in the community. Among the core principal ideals of any healthcare system is transition from traditional services to community-based practices. The aim of this study was to assess community-based and recovery-oriented practices and interventions for individuals with mental health problems. Method : MESH keywords, including "mental health recovery", "rehabilitation", "aftercare", "community psychiatry", and "mental health service" were searched in scientific databases such as Medline, EMBASE, PsychInfo, CINAHL, and Cochrane up to July 2022. A snowball search was also conducted on eligible studies. The methodological quality of the studies was determined by Kmet standard criteria. Results: The systematic review included 32 studies, all of which demonstrated a moderate to high promising effect for community-based and recovery-oriented practices or programs on patients with severe mental illness. These practices could help patients to find suitable jobs, avoid isolation and stigma, improve communication skills, increase awareness of problems, and foster independence. The study also highlighted the pivotal role of nurses, artistic and sports activities, electronic (E)-mental health, home visits, psychoeducation, and special recovery programs. Conclusion: Community-based and recovery-oriented practices should be used as an effective means of normalizing the lives of psychiatric patients. In essence, by cultivating hope and empowering these patients, many of the concerns of health systems can be eradicated.

Implementation of Guidelines on Family Involvement for Persons with Psychotic Disorders (IFIP): A Cluster Randomised Controlled Trial

Family involvement is part of the evidence-based treatment for persons with psychotic disorders, yet is under-implemented despite guideline recommendations. This study assessed whether an implementation support programme increased the adherence to guidelines on family involvement, compared to guideline/manual only. In a cluster randomised design, community mental health centre units in South-East Norway went through stratified allocation to the experimental (n = 7) or control (n = 7) arm. Experimental clusters received an implementation support programme including clinical training and supervision, appointing a family coordinator and an implementation team, a toolkit, and fidelity measurements at baseline, 12, 18, and 24 months with on-site feedback and supervision. Control clusters received no such support and had fidelity measurements at baseline and 24 months without feedback. During fidelity measurements, adherence to the guidelines was measured with the basic family involvement and support scale, the general organizational index, and the family psychoeducation fidelity scale, the latter being the primary outcome. The scales consist of 12-14 items rated from 1 to 5. Data was analysed with an independent samples t-test, linear mixed models, and a tobit regression model. At 24 months, the mean scores were 4.00 or higher on all scales in the experimental arm, and the increase in adherence to the guidelines was significantly greater than in the control arm with p-values < 0.001. Large-scale implementation of guidelines on family involvement for persons with psychotic disorders in community mental health centres may be accomplished, with substantial implementation support.Trial Registration: ClinicalTrials.gov Identifier NCT03869177. Registered 11.03.19.

Exploring service user perspectives of behavioural family therapy in early intervention in psychosis

AIMS

Family intervention (FI) is recommended in national guidance to be offered to all service users accessing an early intervention in psychosis (EIP) team, due to the consistent evidence base in reducing relapse and rehospitalisation rates. However, FI implementation is poor nationally. Although barriers have been identified at the level of staff member and the organisation, there is a paucity of research identifying service user perspectives.

METHODS

A qualitative questionnaire design was used to explore service user perspectives of behavioural family therapy (BFT) within a specialist EIP service in northwest England.

RESULTS

Most participants contacted reported they lacked knowledge and understanding of BFT, with 54% reporting that this intervention had not been offered to them. This finding was unexpected and is inconsistent with the offer of BFT documentation in their clinical notes. Reasons for accepting BFT included to increase understanding of family members and for them to also be supported. Reasons for declining BFT included a preference for one-to-one interventions and not wanting family involved in their care.

CONCLUSIONS

National guidance on FI for psychosis is not reliably being translated to clinical practice, with many participants reporting that they were not offered this intervention. A key factor in accepting or declining an offer of BFT appeared to be whether participants wanted family members to be involved in their care. A lack of understanding of the BFT approach was evident, it is recommended that the offer of FI in psychosis is improved for service users to make an informed decision.

Getting the FACS: A Protocol for Developing a Survey Instrument to Measure Carer and Family Engagement with Mental Health Services

Government policies recommend, and all stakeholders benefit, when mental health services meaningfully engage with carers and family. However, health service engagement with carers is inadequate, and often non-existent with children whose parents are service users. There are seven fundamental ways that carers and families want to be integrated with and engaged by health services but current survey instruments do not capture these seven engagement practices. This protocol describes the development of two closely aligned Family and Carer Surveys (FACS) to measure engagement of service users in mental health services. The new measures are based on the seven engagement themes and a conceptual distinction between the carer and family, with particular focus on where the service user is a parent. The instruments will be developed in five stages; (1) item generation (2) Cognitive pretesting of survey (3) preliminary item content quantitative assessment (4) psychometric analysis of a large data collection and (5) selection of items for short form instruments. These steps will operationalise the seven fundamental ways that families and carers want to be engaged with mental health services, thereby providing valid and reliable measures for use in research and benchmarking of carer and family engagement.

Achtsamkeitsbasierte Interventionen für Menschen mit psychotischen Störungen: Ein Überblick über den Forschungsstand zur Wirksamkeit und Implikationen für die klinische Praxis

Achtsamkeitsbasierte Interventionen (AI) stellen mittlerweile eine zentrale Säule der dritten Welle der Kognitiven Verhaltenstherapie dar. In den letzten Jahren wurden AI bei Patient*innen mit psychotischen Störungen implementiert und deren Wirksamkeit im Rahmen von einer kleineren Anzahl von randomisiert-kontrollierten Studien (RCTs) gezeigt. Der vorliegende narrative Übersichtsartikel stellt den aktuellen Stand der Forschung zur Effektivität, sowie zentrale As­pekte der klinischen Anwendungen von AI bei der Behandlung von Patient*innen mit Schizophrenien und primären psychotischen Störungen dar. Aus aktuellen Metaanalysen lässt sich trotz der Heterogenität der Studienergebnisse schlussfolgern, dass AI im Rahmen von RCTs des Vergleichs einer Kontrollgruppe mit einer gewöhnlichen zumeist psychopharmakologischen Behandlung (treatment-as-usual, TAU) und in Prä-Post-Intervention Analysen zu einer Verbesserung der oft schwer zu behandelnden Negativsymptomatik (<i>g</i> = 0,56 und <i>g</i> = 0,75) oder Positivsymptomatik (<i>g</i> = 0,19 und <i>g</i> = 0,32) mit leichten bis großen Effektstärken führen können. Weiterhin wurden auch positive Effekte auf depressive und ängstliche Symptome (<i>g</i> = 0,20 und <i>g</i> = 0,43), sowie eine Reduktion der Rehospitalisierungsraten 12 Monate nach Entlassung und eine Verkürzung der stationä­ren Behandlungsdauer beobachtet. Im Gegensatz zur Therapieforschung aus dem Vereinigten Königreich, Australien oder Hong Kong befinden sich die wissenschaftliche Evaluation und Implementierung von achtsamkeitsbasierten Behandlungsmöglichkeiten im gesamten deutschsprachigen Raum noch in einem frühen Stadium.

Effectiveness of Family-Focused Nurse-led Intervention on Functional Improvement of Patients with Bipolar Disorder at a Tertiary Hospital in South India: A Randomized Controlled Trial

BACKGROUND

Bipolar affective disorder (BPAD) is a chronic, episodic illness that can create problems and disruptions in the social, occupational, and family functioning of a client. Families are frequently most affected by their bipolar member and have a sense of helplessness to fix bipolar symptoms. The current study aimed to assess the effectiveness of Family-focused Nursing Interventions (FFNI) on functional improvement in the sample of symptomatic bipolar affective disorder clients.

METHOD

In this experimental study, 149 patients with BPAD were interviewed along with family members through the consecutive sampling technique from the inpatient ward. Varying block randomization was used to allocate the patients to the control and experimental groups. After obtaining ethical clearance, the study was registered under the Clinical trail registry India (CTRI). Baseline sociodemographic and clinical variables, and the functional levels, were assessed using Longitudinal Interval Follow-up Evaluation-Range of Impaired Functioning Tool and Functional Assessment Short Test. The control group (74) received routine treatment; the experimental group (75) received routine treatment along with FFNI in seven sessions, and posttest was conducted at discharge, one-month, and at two-month follow-up at OPD. The collected data were analyzed using SPSS 20 (IBM Corp. Released 2011. IBM SPSS Statistics for Windows Version 20.0, Armonk, NY: IBM Corp.), independent sample t-test, analysis of variance, and Pearson correlation used. A P-value of less than 0.05 was considered as a statistically significant result.

RESULTS

At the end of the study, 149 clients completed the treatment and follow-up. Both the groups were comparable at baseline in demography as well as clinical variables. There was significant improvement in the functional level after FFNI. The total score of LIFE-RIFT and the Functional Assessment Short Test score were significantly lower in the experimental group than the control group with P = 0.001.

CONCLUSION

The current study concluded that adjuvant to routine treatment FFNI will improve the functional ability of the client along with routine psychiatric treatment for BPAD.

Family involvement practices for persons with psychotic disorders in community mental health centres - a cross-sectional fidelity-based study

BACKGROUND

Family involvement for persons with psychotic disorders is supported by scientific evidence, as well as legal and ethical considerations, and recommended in clinical practice guidelines. This article reports a cross-sectional measurement of the level of implementation of such guidelines in fifteen community mental health centre units in Norway, and presents a novel fidelity scale to measure basic family involvement and support. The aim was to investigate current family involvement practices comprehensively, as a basis for targeted quality improvement.

METHODS

We employed three fidelity scales, with 12-14 items, to measure family involvement practices. Items were scored from 1 to 5, where 1 equals no implementation and 5 equals full implementation. Data was analysed using descriptive statistics, a non-parametric test, and calculation of interrater reliability for the scales.

RESULTS

The mean score was 2.33 on the fidelity scale measuring basic family involvement and support. Among patients with psychotic disorders, only 4% had received family psychoeducation. On the family psychoeducation fidelity assessment scale, measuring practice and content, the mean score was 2.78. Among the eight units who offered family psychoeducation, it was 4.34. On the general organizational index scale, measuring the organisation and implementation of family psychoeducation, the mean score was 1.78. Among the units who offered family psychoeducation, it was 2.46. As a measure of interrater reliability, the intra-class correlation coefficient was 0.99 for the basic family involvement and support scale, 0.93 for the family psychoeducation fidelity assessment scale and 0.96 for the general organizational index scale.

CONCLUSIONS

The implementation level of the national guidelines on family involvement for persons with psychotic disorders was generally poor. The quality of family psychoeducation was high, but few patients had received this evidence-based treatment. Our novel fidelity scale shows promising psychometric properties and may prove a useful tool to improve the quality of health services. There is a need to increase the implementation of family involvement practices in Norway, to reach a larger percentage of patients and relatives.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier NCT03869177 . Registered 11.03.19.

Psychoeducation for Inpatients With First-Episode Psychosis: Results From a Survey of Psychiatry Trainees in New York City

OBJECTIVE

In this study, the authors aimed to characterize psychoeducation provided to inpatients with first-episode psychosis (FEP) and their families.

METHODS

Psychiatrists were surveyed about how they provide psychoeducation to this population.

RESULTS

In total, 60 psychiatry trainees at nine New York City hospitals responded to the survey invitation. Almost all reported that they provide psychoeducation. Most (81% for patients, 84% for families) reported that psychoeducation content and delivery method were not uniform. The most frequently used delivery method was unstructured conversation (98%), followed by handouts (25% for patients, 26% for families). Responses from a national sample (N=167) revealed similar trends.

CONCLUSIONS

Most respondents provided some form of psychoeducation to hospitalized patients with FEP and their families. Few utilized a standardized method, and less than one-third incorporated supplemental materials. Inpatient psychoeducation for this population was largely informal, and patients and their families were not receiving consistent content and quality of information.

[The effectiveness of psychiatric rehabilitation of in-patients with schizophrenia]

OBJECTIVE

To determine clinical and social indicators in in-patients with schizophrenia depending on their participation in psychiatric rehabilitation.

MATERIAL AND METHODS

One hundred in-patients were randomly assigned to receive either rehabilitation along with the standard pharmacological treatment or standard pharmacological treatment alone. Thirty-five patients from the main group and 39 patients from control group completed three-month participation in the study. The Life Skills Profile (LSP-16), HoNOS and PANSS were used at baseline and post-intervention assessment.

RESULTS

There was a statistically significant decrease in scores of almost all LCP-16 subscales and PANSS in the rehabilitation group compared with the control group. No between-group differences in HoNOS scores were observed.

CONCLUSIONS

The findings support implementation of psychiatric rehabilitation programs for in-patients with schizophrenia.

Implementation of guidelines on family involvement for persons with psychotic disorders in community mental health centres (IFIP): protocol for a cluster randomised controlled trial

BACKGROUND

Family involvement for persons with psychotic disorders is under-implemented in mental health care, despite its firm scientific, economic, legal and moral basis. This appears to be the case in Norway, despite the presence of national guidelines providing both general recommendations on family involvement and support in the health- and care services, and specific guidance on family interventions for patients with psychotic disorders. The aim of this project is to improve mental health services and the psychosocial health of persons with psychotic disorders and their relatives, by implementing selected recommendations from the national guidelines in community mental health centres, and to evaluate this process.

METHODS

The trial is cluster randomised, where 14 outpatient clusters from community mental health centres undergo stratified randomisation with an allocation ratio of 1:1. The seven intervention clusters will receive implementation support for 18 months, whereas the control clusters will receive the same support after this implementation period. The intervention consists of: 1. A basic level of family involvement and support. 2. Family psychoeducation in single-family groups. 3. Training and guidance of health care personnel. 4. A family coordinator and 5. Other implementation measures. Fidelity to the intervention will be measured four times in the intervention arm and two times in the control arm, and the differences in fidelity changes between the arms constitute the primary outcomes. In each arm, we aim to include 161 patients with psychotic disorders and their closest relative to fill in questionnaires at inclusion, 6 months and 12 months, measuring psychosocial health and satisfaction with services. Clinicians will contribute clinical data about patients at inclusion and 12 months. Use of health and welfare services and work participation, for both patients and relatives, will be retrieved from national registries. We will also perform qualitative interviews with patients, relatives, health care personnel and leaders. Finally, we will conduct a cost-effectiveness analysis and a political economy analysis.

DISCUSSION

This project, with its multilevel and mixed methods approach, may contribute valuable knowledge to the fields of family involvement, mental health service research and implementation science.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier NCT03869177 . Registered 11.03.19.

Caregiver involvement in psychiatric inpatient treatment - a representative survey among triads of patients, caregivers and hospital psychiatrists

AIMS

Studies on the frequency of caregiver involvement in representative inpatient samples are scarce. The aim of our study was to conduct a representative survey on caregiver involvement in routine inpatient care involving all three parties (patients, caregivers, psychiatrists). Therefore, we performed face-to-face interviews consisting of open-ended questions to gain a deeper understanding of when and how caregivers are involved in care treatment and to identify which topics are mainly discussed.

METHODS

This cross-sectional survey included inpatients from 55 acute psychiatric wards across ten psychiatric hospitals, their treating psychiatrists and, when possible, their caregivers. In total, we performed semi-structured face-to-face interviews with 247 patients, their treating psychiatrists and 94 informal caregivers. Each psychiatrist named the next two to three patients to be discharged. After a patient had given informed consent, the interview was performed by a researcher. In addition, the psychiatrist and, when possible, the primary caregiver identified by the patient, were also interviewed.

RESULTS

It was perceived by both patients and psychiatrists that contact between caregiver and psychiatrist had taken place in one-third of the patient cases. Predictors for psychiatrist-caregiver-contact were revealed in the patient's diagnosis (schizophrenia), a lower history of inpatient stays, and the respective hospital. According to psychiatrists the most frequent subjects of discussion with caregivers involved therapeutic issues and organisational and social-psychiatric topics (e.g. work, living and social support). Patients and caregivers stated that psychiatric treatment and the diagnostic classification of the mental illness were the most frequent topics of conversation. For all three groups, the most often cited reason for missed caregiver involvement was the subjective perception that a caregiver was not in fact needed.

CONCLUSIONS

Whether or not caregivers were contacted and involved during an inpatient stay strongly depended on the individual hospital. The frequency of involvement of caregivers can certainly be increased by changing processes and structures in hospitals. All three parties (patients, caregivers and psychiatrists) most often stated that the caregiver was not involved in the treatment because they thought it was unnecessary. Evidence demonstrates the positive effect of caregivers' involvement on the therapeutic process but also on the well-being of the caregiver, therefore it is necessary to increase awareness of this evidence among all three interest groups.

Gender differences in patient and caregiver psychoeducation for schizophrenia

Objective:

The aim of this research is to detect gender-related differences in patients and caregivers regarding knowledge about schizophrenia and attitudes towards drugs as well as gender as predictor for changes in these variables during psychoeducation.

Methods:

Data sets of one randomised-controlled (study 1) and one naturalistic psychoeducation study (study 2) were reanalysed. Main outcome measures (knowledge about schizophrenia, drug attitude, confidence in medication) were assessed at baseline, post-intervention and 12 months after index discharge.

Results:

The reanalysed samples consisted in total of 1002 patients and 176 caregivers. In study 2, baseline knowledge was significantly better in male patients and female caregivers. All participants improved significantly their knowledge. The amount of knowledge gain did not differ between genders in either study or either group. Gender was not a major predictor of baseline knowledge or knowledge gain. Only in study 1 did gender significantly impact the knowledge gain from baseline to follow-up. Regarding improvement of drug attitude, females seemed to benefit significantly better from psychoeducation. In both studies, however, changes in drug attitudes respectively confidence in medication were best explained by lower corresponding baseline scores, not gender. Patients’ gender did not influence outcomes of their caregivers.

Conclusion:

Our findings suggest that psychoeducational programs might be better adapted to males in order to improve their drug attitude. Concerning knowledge, gender-related changes do not seem to be necessary.

Psychoeducation and Problem-Solving Therapy as an Integrative Model of Mutual-Help Groups for People with Severe Mental Disorders: A Report from Brazil

This case study describes the "Entrelaços" Peer Support Program, a psychoeducational program of a psychiatric institution in the city of Rio de Janeiro that admitted, between 2011 and 2019, 246 people comprising family members and patients to participate in eight educational seminars followed by multifamily problem-solving groups in cycles that were 18 months in duration. Ninety percent of the participants who completed the program decided to create 7 mutual-help groups in the community independent of technicians and the institution. Community groups have already served spontaneously more than 214 families. They have organized scientific, social and anti-stigma events, expanded their social support network and demonstrated empowerment by switching from service users to peer providers to receive new families. This work is based on a pioneering model in Brazil that integrates psychoeducation with problem-solving therapy, spreading the benefits of education and peer-support with lower cost and greater representativeness.

Drug shortages as a result of parallel export in Poland - Pharmacists' opinions

INTRODUCTION

Drug shortages are recognized as a global problem. However, studies concerning drug shortages in Europe are scarce. Therefore, the main aim of the study was to conduct an analysis concerning drug shortages in Polish pharmacies and to collect pharmacists' opinions about parallel trade and 'reverse traffic' of medicines.

METHODS

The study was conducted between October 2015 and July 2016 using a specially designed anonymous questionnaire consisting of 10 questions. The tool was delivered to pharmacists. From over 1800 distributed sheets, 435 were included.

RESULTS

According to Polish pharmacists' opinions, shortages are most frequently associated with anticoagulants and antidiabetics and are an increasing problem in Poland. In respondents' opinion, fines for 'reverse traffic' should be high and restrictive and manufacturers should be obliged to build stocks for a certain period.

CONCLUSIONS

Drug shortages concern several groups of medicines, often without generics. Solutions incorporated in Poland and aimed to reduce shortages seem to be ineffective. Reduction of drug shortages should be a priority of all stakeholders, because it is not only a Polish problem, but it is a common European issue.

Towards an improved access to psychiatric rehabilitation: availability and effectiveness at 1-year follow-up of psychoeducation, cognitive remediation therapy, cognitive behaviour therapy and social skills training in the FondaMental Advanced Centers of Expertise-Schizophrenia (FACE-SZ) national cohort

Psychosocial Interventions (PIs) have shown positive effects on clinical and functional outcomes of schizophrenia (SZ) in randomized controlled trials. However their effectiveness and accessibility remain unclear to date in "real world" schizophrenia. The objectives of the present study were (i) to assess the proportion of SZ outpatients who benefited from PIs between 2010 and 2015 in France after an Expert Center Intervention in a national multicentric non-selected community-dwelling sample; (ii) to assess PIs' effectiveness at 1-year follow-up. 183 SZ outpatients were recruited from FondaMental Advanced Centers of Expertise for Schizophrenia cohort. Baseline and 1-year evaluations included sociodemographic data, current treatments, illness characteristics and standardized scales for clinical severity, adherence to treatment, quality of life, a large cognitive battery, and daily functioning assessment. Only 7 (3.8%) received a PI before the evaluation, and 64 (35%) have received at least one PI during the 1-year follow-up. Having had at least one PI during the follow-up has been associated in multivariate analyses with significantly higher improvement in positive and negative symptoms (respectively p =0.031; p = 0.011), mental flexibility (TMT B, p = 0.029; C-VF, p = 0.02) and global functioning (p =0.042). CBT and SST were associated with higher cognitive improvements, while CRT was associated with clinical improvement. These results have not been demonstrated before and suggest that the effect of each PI is larger than its initial target. The present study has confirmed the PIs' effectiveness in a large sample of community-dwelling SZ outpatients at 1 year follow-up. Efforts to improve access to PI should be reinforced in public health policies.

A Mismatch of Paradigms Disrupts the Introduction of Psycho-Educative Interventions for Families of Persons with SMI: An Interview Study with Staff from Community Services

Treatment and support of people diagnosed with severe mental illness in Sweden takes place in out-patient psychiatric services or municipality services. Most of the responsibility for support in daily life are provided by the close family. One crucial matter is how to support these families. This research project aimed to investigate the Swedish construction with shared responsibility between county psychiatric care and municipality social care for consumers with severe mental illness affects actions in municipalities in relation to family support. Ten representatives from five municipality settings were interviewed. Five semi-structured interviews were analysed using a thematic analysis. The following themes emerged; One overarching theme, "a mismatch of paradigms", and sub-themes: (a) "accentuating differences", (b) "doubts about including the entire family in the same session" and (c) "lack of a uniform family support policy". We conclude that a shared mandate needs a dialogue between psychiatric and municipality services concerning this mismatch.

An Internet-Based Intervention for the Relatives of People with Mental Illnesses

Abstract. Relatives of individuals with mental illness are exposed to an elevated level of burden. Consequently, it is important to provide them with coping strategies. We explored the benefits of an online skills-training intervention. This open, uncontrolled interventional pilot study included 104 relatives of individuals with a mental illness. They participated either in a face-to-face group ( n = 60) or online intervention ( n = 44); participants were free to choose the type of intervention. Depressive symptoms and emotion regulation were assessed before and after the interventions. The analysis was based on an intention-to-treat model. About one-third of both samples did not complete the posttest assessments. The results of a multivariate analysis of variance revealed a significant effect of the interaction between time and intervention type, F(2,101) = 11.77, p < .01. Reductions in depressive symptoms, F(1,102) = 9.41, p < .01, ε2p = .08, and emotion-regulation difficulty, F(1,102) = 8.01, p < .01, ε2p = .07, following the online intervention were greater relative to the group intervention. Despite the limitations of this study because of group differences, the results demonstrated the benefits of an online intervention for the relatives. These encouraging initial results require further confirmation using a randomized controlled trial.

Family and Patient Psychoeducation for Severe Mental Disorder in Iran: A Review

Objective: There are evidence-based practices in the field of family and patient psychoeducation for patients suffering from severe mental disorders. However, given the variation in resources and cultural contexts, implementation of these services, especially in low and middle-income countries is faced with challenges. This study aimed to review articles on family and patient psychoeducation of severe mental disorders in Iran and to find the characteristics of the main components necessary for the implementation of such practices in clinical settings. Method : All published studies on family and patient psychoeducation for severe mental disorders (schizophrenia, schizoaffective, and bipolar disorder) conducted in Iran were searched up to May 2018; and key features and findings of each study were extracted and presented. Results: Forty-eight studies were included in this review, of which 27 were randomized controlled trials, and 20 were quasi-experimental. One study was an implementation and service development report. The main findings of these studies were a significant decrease in relapse rate and/or rehospitalization rate and a significant decrease of burden and distress of families. Conclusion: Despite a wide diversity in approaches, this review showed that different psychosocial interventions in which psychoeducation is one of their core and main components have promising results, demonstrating the significance of this intervention in Iranian mental health research. In our opinion, based on evidence, even with limited resources, it is no longer acceptable to deprioritize some forms of psychoeducation for patients and their families in clinical settings.

[Education care in patients with psychiatric disorders in France: Psychoeducation or therapeutic patient education?]

CONTEXT

Psychoeducation and therapeutic patient education can be effectively included in treatments for patients with psychiatric disorders. These two effective educational therapies have the common purpose of improving disorder-related morbidity, compliance with treatment and patients' quality of life. While they have different methods of application, both teach patients to play an active role in their own care. However, it is still critical to combine them for care of patients with psychiatric and addiction disorders in a manner that allows for specificity. To do this, the differences between psychoeducation and therapeutic patient education must be considered, and their potential for the management of patients with psychiatric and addiction disorders must be determined.

METHODS

In our article, we review the literature concerning therapeutic education programs for patients and discuss the literature based on the experiences of psychiatrists trained in these therapies.

RESULTS

Despite rather nonrestrictive guidelines, and after reviewing numerous studies, we found that psychoeducation seems to be rarely used in psychiatry. The use of therapeutic patient education programs for psychiatric patients has doubled in four years but still accounts for less than 4% of validated programs in France. Only 154 programs were developed in 1175 public psychiatric facilities in 2016. Therapeutic patient education has a legal framework and recommendations, which make it suitable for inclusion in care and in the training of care providers. The rigor in the development of therapeutic patient education programs and the requirement for training and financial support reinforce the need for their establishment in healthcare institutions. As such, they could help to modify professional practices and the culture of care in mental health fields.

CONCLUSION

There is a place for therapeutic patient education in psychiatry as it provides a real benefit for patients. It could modify care practices and costs, and is suitable for patients with psychiatric or addiction disorders by helping them play an active role in their care, thereby improving treatment outcomes and quality of life.

Association of lifestyle-related factors and psychological factors on quality of life in people with schizophrenia

In people with schizophrenia several factors are associated with poor quality of life (QoL), namely, lifestyle-related factors and psychological factors. However, there has been little research on the impact of these factors on QoL. Therefore, the relation between lifestyle-related factors, psychological factors, and QoL in people with schizophrenia was assessed. A cross-sectional study was conducted among 115 patients (25% women, 50% inpatients). QoL was measured by World Health Organisation Quality of Life- Brief Version. Lifestyle-related factors were assessed, namely physical activity (International Physical Activity Questionnaire- Short Form), sleep quality (Pittsburgh Sleep Quality Index) and dietary intake (Mediterranean Diet score). Psychological factors such as self-esteem (Rosenberg Self-Esteem Scale) and autonomous motivation (Behavioural Regulation Questionnaire- version 3) were also measured. Regression analyses were performed to identify significant predictors of QoL. Results showed that self-esteem predicted better global, physical, psychological and environmental QoL. Physical activity predicted better global and physical QoL, while sedentary time predicted poor social and environmental QoL. Identifying predictors of QoL has implication for the effective design and delivery of lifestyles interventions, including physical activity, dietary education and smoking cessation in people with schizophrenia. Adopting healthy lifestyles may lead to improved physical health, psychological well-being and QoL in this population.

Patient and family psychoeducation: Service development and implementation in a center in Iran

BACKGROUND

Family and patient psychoeducation have demonstrated significant improvement in clinical and social outcomes for patients suffering from severe mental disorders and their families. However, these evidence-based practices are not widely implemented at service delivery level and into routine clinical practice, especially in less developed countries.

AIM

The aim of this article is to report the processes of development and implementation of a psychoeducational service for patients with severe mental illnesses and their families in Iran.

METHOD

The program was developed at Roozbeh Hospital in Tehran, Iran. A group of clinicians worked on the development phase of the program and drafting the manuals. Then, a series of workshops and supervision sessions were held to train group leaders for implementation of the group psychoeducation for patients and families. In the pilot phase, the services were delivered to two groups of patients and families, and then the manual was revised based on the feedback from group leaders and participants.

RESULTS

The program consisted of eight 90-minute weekly patient group sessions and 6 weekly multiple family group sessions. Two manuals for patient education (schizophrenia and bipolar disorder) were developed. Several information sheets were developed and distributed during different sessions of family and patient psychoeducation related to the content of each session. Despite providing the hospital clinicians with the information regarding these new services, less than 10% of the admitted patients were referred by their clinicians.

CONCLUSION

Feasibility and sustainability of the program are affected by a number of factors. Low referral rate of clinicians, limited resources of the hospital, issues related to stigma and logistic issues are barriers in implementation of these services. Administrators' and clinicians' understanding of the importance of patient and family psychoeducation seems to be crucial in sustainability of such programs in routine service delivery.

Mental health professionals' family-focused practice with families with dependent children: a survey study

Background

Many people with a mental illness are parents caring for dependent children. These children are at greater risk of developing their own mental health concerns compared to other children. Mental health services are opportune places for healthcare professionals to identify clients’ parenting status and address the needs of their children. There is a knowledge gap regarding Thai mental health professionals’ family-focused knowledge and practices when working with parents with mental illness and their children and families.

Methods

This cross –sectional survey study examined the attitudes, knowledge and practices of a sample (n = 349) of the Thai mental health professional workforce (nurses, social workers, psychologists, psychiatrists) using a translated version of the Family-Focused Mental Health Practice Questionnaire (FFMHPQ).

Results

The majority of clinicians reported no training in family (76.8%) or child-focused practice (79.7%). Compared to other professional groups, psychiatric nurses reported lower scores on almost all aspects of family-focused practice except supporting clients in their parenting role within the context of their mental illness. Social workers scored highest overall including having more workplace support for family-focused practice as well as a higher awareness of family-focused policy and procedures than psychiatrists; social workers also scored higher than psychologists on providing support to families and parents. All mental health care professional groups reported a need for training and inter-professional practice when working with families.

Conclusions

The findings indicate an important opportunity for the prevention of intergenerational mental illness in whose parents have mental illness by strengthening the professional development of nurses and other health professionals in child and family-focused knowledge and practice.

The mediating effect of family cohesion in reducing patient symptoms and family distress in a culturally informed family therapy for schizophrenia: A parallel-process latent-growth model

OBJECTIVE

Although both patients with schizophrenia and their caregivers report elevated levels of depression, anxiety, and stress (DASS), affective symptoms in patients and family members seldom constitute a primary treatment focus. The present study tested whether a culturally informed family therapy for schizophrenia (CIT-S) outperformed standard family psychoeducation (PSY-ED) not only in decreasing patient schizophrenia symptoms, but also in decreasing individual DASS. Because CIT-S fostered family cohesion throughout treatment, we predicted that increases in family cohesion would mediate treatment effects.

METHOD

Participants included 266 patients and family members nested within 115 families, randomized to the CIT-S or PSY-ED conditions. We specified a series of multilevel latent growth and latent change models to examine direct effects of CIT-S on patient schizophrenia symptoms, individual DASS, and family cohesion over time. Next, we used parallel-process growth models to test the indirect effect of CIT-S on decreasing patient and caregiver psychopathology over time via changes in family cohesion.

RESULTS

The CIT-S treatment significantly reduced patient schizophrenia symptoms from baseline to follow-up (γ = -1.72, 95% confidence interval [CI] [-2.83, -0.60]), as well as individual DASS (γ = -4.39, 95% CI [-6.44, -2.34]) from baseline to termination. In line with treatment goals, CIT-S increased family cohesion from baseline to midpoint (γ = 0.93, 95% CI [0.06, 1.80]). The CIT-S-related change in cohesion mediated changes in DASS (γ = -0.87, 95% CI [-1.47, -0.27]), but not patient symptoms.

CONCLUSION

By integrating the family's cultural context into treatment, clinicians may foster family dynamics that enhance treatment outcomes and promote broad improvements in mental health. (PsycINFO Database Record

Roles of Psychiatry Nurses Within a Therapeutic Environment of Psychiatry Clinics in Turkey

OBJECT

The object of this study is to determine the roles of psychiatry nurses within the therapeutic environment of psychiatry clinics in Turkey.

METHODS

This study was performed in a cross-sectional and descriptive design in 195 institutes comprising psychiatry clinics in Turkey.

RESULTS

When the responsibilities of nurses for clinical activities were asked, the following answers were obtained: playing with patients or painting at a rate of 54,4%. It was determined that in the majority of psychiatry clinics, there were educational activities which were conducted by nurses.

CONCLUSION

The researchers propose that the increase in the roles and responsibilities of nurses in such activities be supported.

The customer is always right? Subjective target symptoms and treatment preferences in patients with psychosis

Clinicians and patients differ concerning the goals of treatment. Eighty individuals with schizophrenia were assessed online about which symptoms they consider the most important for treatment, as well as their experience with different interventions. Treatment of affective and neuropsychological problems was judged as more important than treatment of positive symptoms (p < 0.005). While most individuals had experience with Occupational and Sports Therapy, only a minority had received Cognitive-Behavioral Therapy, Family Therapy, and Psychoeducation with family members before. Patients appraised Talk, Psychoanalytic, and Art Therapy as well as Metacognitive Training as the most helpful treatments. Clinicians should carefully take into consideration patients' preferences, as neglect of consumers' views may compromise outcome and adherence to treatment.

Professional views of supporting relatives of mental health clients with severe mental illness

BACKGROUND

Supporting families where one person suffers from long-term severe mental illness (SMI) is essential, but seems hard to reach. The aim of this study was to examine professionals' views of supporting relatives of persons with SMI.

MATERIAL

Individual interviews mirroring personal narratives and group interviews reflecting group-processed answers were conducted among 23 professionals and analyzed thematically.

RESULTS

Three themes emerged: (a) information and group interaction reduces stigma and increases well-being, (b) professionals need to feel secure and confident about how the support structure works and (c) collaboration is difficult but required on several levels.

CONCLUSION

Trusting relationships with families were considered important, although seldom achieved; professionals wished to feel secure in their role toward relatives of a person with SMI; and professionals wanted to feel confident when working together with other services to support families.

The Cost of Inpatient Care of Schizophrenia and Treatment Schedules Used in German Academic Center: Kiel

The authors aimed at analyzing the costs of inpatient care of schizophrenia in Kiel (Germany). The study was also to present treatment regimens used at the German Academic Center. Moreover, the study is a continuation and complement of the previous study conducted in Polish and Ukrainian Academic Center. Therefore, it helps increase the awareness and knowledge of residents concerning the cost of inpatient care of schizophrenia. The analysis was based on 105 hospital records of patients treated between January 2012 and June 2013. According to inclusion criteria, 50 adult patients (27 women and 23 men) were included in the study. The study was approved by the Ethics Committee of the Medicine Faculty of CAU in Kiel. The cost of schizophrenia treatment of 50 patients in Kiel was EUR 604,280.90 ([Formula: see text] = EUR 12,085.62). The duration of hospital stay was on average [Formula: see text] = 51.02 days. The patients were treated with neuroleptics of all generations. The most popular atypical neuroleptic was amisulpride and the most popular typical neuroleptic was haloperidol. Patients from Kiel were provided a comprehensive non-pharmacological treatment. Treatment regiments and evaluations of costs of schizophrenia vary between countries. The costs of inpatient care of schizophrenia are high in Kiel. Treatment of schizophrenia seems to be comprehensive in Kiel and wide range of treatment opportunities contribute to a more effective treatment confirmed by less frequent relapses of schizophrenia than in Lviv (Ukraine), for example. Comprehensive treatment should be available everywhere, because it is a right of every patient.

[Therapeutic benefit of a registered psychoeducation program on treatment adherence, objective and subjective quality of life: French pilot study for schizophrenia]

INTRODUCTION

In schizophrenic disorders, supportive psychosocial therapies have been used as adjuncts to pharmacotherapy to help alleviate residual symptoms and to improve social functioning and quality of life. Among these therapies, psychoeducational therapies showed a significant efficacy on improving drug adherence and on reducing relapses. However, according to the French Health Agency, fewer than 10% of psychiatric structures in France offer registered psychoeducation programs. Caregiver apprehension of patients' depressive reactions to the awareness of the disease could underlie the underuse of psychoeducation therapies. Indeed, the psychoeducation programs' impact on objective and subjective quality of life is discussed among the literature. In this context, we conducted a retrospective, monocentric, open-labelled and non-controlled pilot study to measure the impact of a registered psychoeducation program on objective and subjective quality of life of patients suffering from schizophrenia. Secondary objectives included measures of the effects on drug observance and awareness of the disease.

METHODS

We included stabilized patients over the age of eighteen suffering from schizophrenia. Referent psychiatrics were asked to inform the patient of the diagnosis and to prescribe psychoeducation therapy. From 2011 to 2014, we offered three ambulatory programs, each program including fifteen two-hour group sessions. The groups were opened for three to six patients and managed by two caregivers. Themes discussed during the sessions included: schizophrenic disease, treatments, relationships to family, diet, social issues, toxics, relaxation. Objective and subjective quality of life were evaluated one month before and one month after the program using respectively the global assessment functioning (GAF) and the subjective quality of life (SQoL) scales. The Medical Adherence Rating Scale (MARS) and the French IQ8 scale evaluated respectively drug adherence and awareness of the disease. All patients gave their written consent for the study. Based on medical records and scales, we compared data before and after the program using the Wilcoxon test, adapted for small samples.

RESULTS

Fourteen patients, with a mean age of 37.6 years, were included. All patients had a chronic antipsychotic treatment and four benefitted from a bitherapy with a mood stabilizer. The mean length of disease was 15.3 years, with a mean number of 3.4 hospitalizations before inclusion. The participation rate was nearly twelve sessions out of fifteen. Mean GAF score before the program was 48/100. After the program, mean GAF score was significantly increased to 54/100 (P=0.008). As to SQoL score, we found a significant difference of the sub item psychological well-being from 3.2/5 before the program to 3.8/5 after the program (P=0.03). Global SQoL score and other sub items (self-esteem, resilience, and physical well-being) showed a slight but not significant improvement. The sub items family relationships and sentimental life were diminished, non-significantly. Concerning the drug adherence, the mean MARS score was significantly increased from 6.1 to 6.4/8 (P=0.03). Comparison of the insight IQ8 scale showed a slight but non-significant increase. When asked to note the program, patients were globally very satisfied, with a mean rate of 8.6/10. Of fourteen patients, one needed to be hospitalized three years after program.

DISCUSSION

This retrospective study on a small sample of patients suffering from schizophrenic disorder pointed out a significant improvement on drug adherence, objective quality of life and psychological well-being, after an eight-month registered program of psychoeducational therapy. These results are in line with a recent report from the Cochrane group who reported a significant raise of GAF associated with psychoeducational therapies. The literature data for subjective quality of life are more contradictory. Despite the small sample and evaluation means that need to be corrected in further studies, we reproduced the results described in the literature regarding the improvement on drug adherence. However, the stability of these effects should be checked in the medium and long term.

CONCLUSION

Adjunctive psychoeducation therapy has a positive impact on reducing relapses in schizophrenia. In this study, we showed a significant benefit on drug adherence, objective quality of life and psychological well-being on a small sample of patients and provide arguments for the development of psychoeducation programs which are currently underrepresented in France. Our results encourage conducting a further prospective multicenter controlled study on a larger sample to clarify the benefit of psychoeducational therapy on objective and subjective quality of life in schizophrenia.

How Professionals View Multifamily Psychoeducation: A Qualitative Study

Severe mental illness causes suffering for the patient as well as the patient's immediate family. The Swedish National Board of Health and Welfare has recommended the implementation of multifamily psychoeducation in order to assist patient and family in the recovery process. The aim of this study was to determine how introducing multifamily psychoeducation in Sweden has been viewed by professionals. Semi-structured interviews were conducted with 11 service providers, who were involved in evaluating multifamily psychoeducation. Our main findings fell under the headings of defensive culture and unsuitable model. Resistance to introducing the new intervention was found on multiple levels. The model proposed was considered too rigid for both the target group and the organizations because it could not be adjusted to the needs of patients, families, or facilitators. Despite good evidence for the effectiveness of the intervention, there were difficulties introducing the multifamily psychoeducation model in clinical practice. The feasibility of an intervention needs to be evaluated before adopting it as a national guideline.

Schizophrenia and Employment: Evaluation From Professionals Point of View

Schizophrenia is a severe and chronic disorder requiring long-lasting and comprehensive treatment. Because of this disorder patients are socially isolated. Consequently, schizophrenia has a significant economic burden both in a group of direct and indirect costs. The aim was to analyse experts' opinions in the field of psychiatry concerning work possibilities among people with schizophrenia and to present the importance of employment for more effective treatment. A worldwide study was conducted between June 2011 and June 2013 using a questionnaire consisting of six open-closed questions and a short metrics. The questionnaire was delivered to experts and spread all over the world by post and via the internet. Over 3000 questionnaires were sent and the addressed specialists were requested to return them. From received 403 questionnaires 320 were included into the study, based on adopted inclusion and exclusion criteria. Although patients are afraid of looking for a job, respondents indicated that they crave for employment. The number of people that are able to work during remission of schizophrenia is considerably higher (50.35 %) than the number of actually employed (15.85 %). Non-pharmacological therapies were indicated as important to improve patients' chances of finding a job during remission of schizophrenia. The number of people that can work during remission of schizophrenia is considerably higher than the number of affected people employed. Patients crave for a job and supported employment should be treated as priority by health-care decision makers.

The family-focused practice of primary care clinicians: a case of missed opportunities

BACKGROUND

Many patients who present to primary care settings with mental health concerns are parents with dependent children. However, little is known about the family-focused practices of these clinicians.

AIM

To identify the family-focused practices of a group of primary care clinicians.

METHODS

A sequential mixed methodology was employed; 21 primary care clinicians completed the Family Focused Mental Health Practice Questionnaire and then participated in one of three focus groups.

RESULTS

Primary care clinicians do not commonly engage with patients about family issues though many acknowledged that family-focused practice was important. Some questioned whether being family focused was part of their role with other barriers related to funding. Most expressed a need for training, though some indicated that they would not engage in a family-focused manner nor be trained in this approach, unless it was compulsory. The study highlights the missed opportunity for family-focused practices in primary care settings.

CONCLUSIONS

This study demonstrates the need for an "authorising" environment in which family-focused practices are not only supported but expected.

The effectiveness of psychoeducational family intervention for patients with schizophrenia in a 14-year follow-up study in a Chinese rural area

BACKGROUND

It is unclear if the impact of psychoeducational family intervention for patients with schizophrenia can be sustained over 10 years. In this study, we explored the 14-year effect of psychoeducational family intervention for patients with schizophrenia in a Chinese rural area.

METHOD

The data from a cluster randomized control trial (CRCT) study of psychoeducational family intervention in a 14-year follow-up was analyzed. All patients with schizophrenia (n = 326) who participated in the CRCT drawn from six townships in Xinjin County of Chengdu in 1994, of whom 238 (73.0%) who were still alive, and their informants were followed up in 2008. The Patients Follow-up Scale, the Positive and Negative Syndrome Scale (PANSS) and the Global Assessment of Functioning were used in the follow-up study.

RESULTS

There were no significant differences of marital status, mean scores of PANSS positive symptoms, negative symptoms, general mental health, and total scores among the psychoeducational family intervention, medication, and control groups in 2008. The psychoeducational family intervention group had a significantly higher rate of antipsychotic medication and a higher level of work ability than other two groups. The control group had a significantly higher rate of never-treated (26.0%) than psychoeducational family intervention group (6.5%).

CONCLUSION

Psychoeducational family intervention might be still effective in the 14-year follow-up, especially in patients' treatment adherence/compliance and social functioning. Psychoeducational family intervention might be more effective in places where family members frequently participated in patients' care and had a lower level of knowledge on mental illness. Family intervention should be considered when making mental health policy and planning mental health services.

Using films as a psychoeducation tool for patients with schizophrenia: a pilot study using a quasi-experimental pre-post design

BACKGROUND

Relapses and, subsequently, readmissions are common in patients with schizophrenia. Psychoeducation has been shown to reduce the number and duration of readmissions. Yet, only little more than 20% of psychiatric patients in German speaking countries receive psychoeducation. Among other reasons, costs may be considered too high by hospitals. The objective of the present study was to test the feasibility of a new cost-efficient approach in the psychoeducation of patients with schizophrenia. In this study, films were used to impart knowledge about the illness to inpatients.

METHODS

A total of 113 participants were initially included in the study, eleven of which were not included in the final analyses. Six films about the symptoms, diagnosis, causes, warning signs, treatment of schizophrenia and about the influence of family members and friends were shown in a group setting in the presence of nursing staff. All films combined facts, expert opinions, and personal experiences of peers. As the main outcome criterion of this feasibility pilot study, we measured the effects on knowledge. Secondary outcome measures included compliance, insight into illness, side effects, and quality of life. Data were collected directly after the intervention and about half a year afterwards. The number and the duration of readmissions to the hospital were recorded and compared to the number and duration of prior admissions. Patients were also asked to state their subjective opinion about the films. Main data analyses were done using paired t-tests and Wilcoxon signed-rank tests. Secondary analyses also involved ANOVAs and ANCOVAs.

RESULTS

One hundred and two inpatients were included in the data analyses. Showing the films in the tested setting was shown to be feasible. Knowledge about schizophrenia (p < .001), compliance (ps < .01), insight into illness (p < .01), and quality of life (p < .001) all increased significantly after patients had watched the films and remained stable for at least half a year. A vast majority (84.9%) of the patients found the films to be interesting and informative.

CONCLUSIONS

Using films to educate inpatients about schizophrenia is a feasible method that is cost- and time-efficient and well received by the patients.

The cost of inpatient care of schizophrenia in the Polish and Ukrainian academic centers--Poznan and Lviv

OBJECTIVE

The authors aimed to analyze and compare treatments of schizophrenia in Poznan and Lviv to present the potential differences between Poland and Ukraine in pharmacotherapy and economic availability of medicines, to emphasize the role of academic centers in the effective treatment of schizophrenia, and to raise the awareness of residents about economics and the cost of inpatient care.

METHODS

The analysis was based on 307 hospital records of patients treated in 2010 and 2011 and data from the hospital accounting department. Per the inclusion criteria, 108 adult patients (50 in Poznan and 58 in Lviv) were enrolled in the study. Monetary values were converted into euros (EUR) at the rate published by the National Bank of Poland (NBP) on October 9, 2012.

RESULTS

The total cost of schizophrenia treatment in Poznan was EUR 160,489.26, x = EUR 3,209.78 per patient, and in Lviv it was EUR 30,943.38, x = EUR 533.5 per patient. Treatment schedules differed between Poznan and Lviv, and pharmacotherapy was limited economically, especially in Lviv.

CONCLUSION

Although the results differ between Poznan and Lviv, the study shows that schizophrenia treatment is expensive in both centers. Differences in the health care systems make use of innovative neuroleptics unavailable especially in Lviv, which may contribute to non-compliance or higher level of relapses. Distinctive efforts to improve therapies should be made and efforts to equalize access to innovative pharmacotherapy should be supported to improve the therapy's efficacy and the economic values of schizophrenia treatment.

Selective review of age-related needs of women with schizophrenia

OBJECTIVE

Recognizing that needs differ between men and women with schizophrenia and that they vary over time, this review attempts to categorize the needs that are relevant to younger and to older women.

METHOD

This is a selective literature review focusing on topic areas the two authors determined to be most germane to women with schizophrenia. Articles were selected on the basis of currency, comprehensiveness, and study design. Particular attention was paid to the voices of the women themselves.

RESULTS

There is considerable overlap between the needs of younger and older women with schizophrenia, but as a general rule, younger women require preventive strategies to stop the escalation of illness while older women require recovery interventions to regain lost hopes and abilities.

CONCLUSIONS

There is clinical utility in cataloguing the needs of younger and older women with schizophrenia and conceptualizing interventions according to gender and age rather than viewing needed services along purely diagnostic lines.

Psychoeducation for schizophrenia in the Czech Republic: curriculum modification based on opinions of service users and providers

OBJECTIVE

The authors examined current knowledge about psychoeducation for schizophrenia in Czech Republic.

METHODS

The authors sent a screening survey to 550 mental health-care facilities and administered a detailed questionnaire to 113 providers of mental health and social services and to 200 service users. The authors also carried out 14 focus groups and 16 individual interviews.

RESULTS

Forty-six departments provided some type of psychoeducation for schizophrenia; of these, 16 provided family psychoeducation for patients and relatives and 1 provided psychoeducation only for relatives. Service users who received psychoeducation performed significantly better in the test of knowledge than did service users who did not receive psychoeducation.

CONCLUSION

The authors propose a service user-driven curriculum based on information delivery followed by skills training. Psychiatrists should learn to explain schizophrenia relapse neurobiology to laypeople and to address relatives' frustrations.

An Integrated Care Initiative to Improve Patient Outcome in Schizophrenia

The optimal treatment of schizophrenia patients requires integration of medical and psychosocial inputs. In Germany, various health-care service providers and institutions are involved in the treatment process. Early and continuous treatment is important but often not possible because of the fragmented medical care system in Germany. The Integrated Care Initiative Schizophrenia has implemented a networked care concept in the German federal state of Lower Saxony that integrates various stakeholders of the health care system. In this initiative, office-based psychiatrists, specialized nursing staff, psychologists, social workers, hospitals, psychiatric institutional outpatient's departments, and other community-based mental health services work together in an interdisciplinary approach. Much emphasis is placed on psychoeducation. Additional efforts cover socio-therapy, visiting care, and family support. During the period from October 2010 (start of the initiative) to December 2012, first experiences and results of quality indicators were collected of 713 registered patients and summarized in a quality monitoring report. In addition, standardized patient interviews were conducted, and duration of hospital days was recorded in 2013. By the end of 2012, patients had been enrolled for an average of 18.7 months. The overall patient satisfaction measured in a patient survey in June 2013 was high and the duration of hospital days measured in a pre-post analysis in July 2013 was reduced by 44%. Two years earlier than planned, the insurance fund will continue the successfully implemented Integrated Care Initiative and adopt it in the regular care setting. This initiative can serve as a learning case for how to set up and measure integrated care systems that may improve outcomes for patients suffering from schizophrenia.

Profession differences in family focused practice in the adult mental health system

There is a large gulf between what psychiatric services should (or could) provide and what they do in practice. This article sought to determine practice differences between the differing professions working in adult mental health services in terms of their family focused work. Three hundred and seven adult mental health professionals completed a cross-sectional survey of family focused practices in adult mental health services. Findings highlight that social workers engaged in more family focused practice compared to psychiatric nurses, who performed consistently the lowest on direct family care, compared to both social workers and psychologists. Clear skill, knowledge, and confidence differences are indicated between the professions. The article concludes by offering direction for future profession education and training in family focused practices.

Effects of an integrated care program for outpatients with affective or psychotic disorders

For many psychiatric conditions outcomes of standard care still fall short of outcomes that are possible according to research literature. One of the major reasons is patient׳s non-adherence to long-term medication. We performed a mirror image interventional study involving patients suffering from affective (N=219) or psychotic disorders (N=210) who participated in an integrated care program focusing on treatment adherence. The main outcome variable was the number of inpatients days during the integrated care program compared to the time before the program. The integrated care project studied showed a drop of inpatient days of approx. 75% within the 18-months observation period for both groups. In the affective (psychotic) sample inpatients days dropped from M=47.1 days (M=62.2 days) in the 18 months before the program to M=10.8 days (M=15.3 days) during the adherence program. Patients with affective disorders additionally profited with regard to symptom reduction, quality of life and self-reported adherence. Thus, a complex intervention addressing frequent weaknesses of routine psychiatric outpatient care and focussing on adherence and linking up outpatient services is effective with regard to the reduction of inpatient days for patients with affective and patients with schizophrenic disorders.

Provision of group psychoeducation for relatives of persons in inpatient depression treatment--a cross-sectional survey of acute care hospitals in Germany

BACKGROUND

Depressive disorders are often recurrent and place a high burden on patients and their relatives. Psychoeducational groups for relatives may reduce relatives' burden, help prevent relapses in patients, and are recommended by the German "National Disease Management Guideline Unipolar Depression". Since there is limited knowledge on the provision of psychoeducational groups for relatives of persons in inpatient depression treatment, we conducted a survey among acute care hospitals in Germany.

METHODS

We conducted a two-step cross-sectional survey. Step I consisted of a questionnaire asking the heads of all psychiatric/psychosomatic acute care hospitals in Germany (N = 512) whether psychoeducational groups for relatives were provided within depression treatment, and if not, the reasons for not implementing them. In group offering hospitals the person responsible for conducting psychoeducational groups received a detailed questionnaire on intervention characteristics (step II). We performed descriptive data analysis.

RESULTS

The response rate was 50.2% (N = 257) in step I and 58.4% in step II (N = 45). 35.4% of the responding hospitals offered psychoeducational groups for relatives of patients with depressive disorders. According to the estimates of the respondents, relatives of about one in five patients took part in psychoeducational groups in 2011. Groups were mostly provided by two moderators (62.2%) as continuous groups (77.8%), without patients' participation (77.8%), with up to ten participants (65.9%), consisting of four or fewer sessions (51.5%) which lasted between one and one and a half hours each (77.8%). The moderators in charge were mostly psychologists (43.9%) or physicians (26.8%). Approximately one third used published manuals. Reasons for not conducting such psychoeducational groups were lack of manpower (60.1%), time (44.9%) and financial constraints (24.1%). 25.3% mentioned adequate concepts of intervention as a required condition for initiating such groups.

CONCLUSIONS

Only a small proportion of relatives of patients with depressive disorders participated in psychoeducational groups in 2011 in Germany. Mostly short interventions were favoured and main implementation barriers were scarce resources. Brief interventions that fit with healthcare routine should be developed and tested within randomised controlled trials. This could promote the provision of psychoeducational groups for relatives as evidence-based practice in inpatient depression treatment in Germany.

Providing information about the neurobiology of alcohol use disorders to close the 'referral to treatment gap'

Only a small proportion of the 18 million Americans who could benefit from alcohol treatment actually receive it. Disseminating information on the neurobiological base of alcohol disorders may be useful in removing the prevailing barriers to accepting a referral to alcohol treatment. Nurses, guided by a set of clinical strategies known as screening, brief intervention, and referral to treatment, can be instrumental in closing this treatment gap.

Frequency and relevance of psychoeducation in psychiatric diagnoses: results of two surveys five years apart in German-speaking European countries

BACKGROUND

Psychoeducation has been shown to reduce relapse rates in several psychiatric disorders. Studies investigating for which psychiatric diagnoses psychoeducation is offered and assessing its perceived relevance compared to other interventions are lacking.

METHODS

A two-part questionnaire addressing these questions was sent to the heads of all psychiatric hospitals in Germany, Austria and Switzerland. Results were compared with those from a similar survey 5 years earlier.

RESULTS

289 of 500 (58%) institutions responded. Significantly (p = 0,02) more institutions (93%) offer any type of psychoeducation as compared to 5 years before (86%). Psychoeducation is mainly offered for schizophrenia (86%) and depression (67%) and less frequently for anxiety disorders (18%) and substance abuse (17%). For the following specific diagnoses it is offered by less than 10% of the institutions: Personality disorder, bipolar disorder, posttraumatic stress disorder, dementia, obsessive compulsive disorder, sleeping disorders, eating disorders, schizophrenia plus substance abuse, pain, attention deficit hyperactivity disorder and early psychosis. 25% offer diagnosis-unspecific psychoeducation. 'Pharmacotherapy' (99%), 'basic occupational therapy' (95%) and 'psychoeducation for patients' (93%) were the therapies being most often, 'light therapy' (24%) and 'sleep deprivation' (16%) the therapies being least often perceived as relevant by the respondents when asked about the value of different interventions offered in their hospitals. Art therapy (61%) and psychoanalytically oriented psychotherapy (59%), two therapies with a smaller evidence base than light therapy or sleep deprivation, were perceived as relevant by more than the half of the respondents.

CONCLUSION

Psychoeducation for patients is considered relevant and offered frequently in German-speaking countries, however, mostly only for schizophrenia and depression. The ranking of the perceived relevance of different treatment options suggests that the evidence base is not considered crucial for determining their relevance.

The influence of Antonovsky's sense of coherence (SOC) and psychoeducational family intervention (PEFI) on schizophrenic outpatients' perceived quality of life: a longitudinal field study

BACKGROUND

Antonovsky's sense of coherence (SOC) as well as psychoeducational interventions has a convincing impact on the quality of life (QOL) of patients suffering from schizophrenia. This study explores the influence of SOC on QOL among participants of a PEFI group (PG) compared to a control group (CG).

METHODS

In a quasi-experimental field study 46 schizophrenic outpatients had an option to participate together with their family members the PG (n = 25) or the CG (n = 21). They were assessed amongst others with the Quality of Life Questionnaire (WHOQOL-BREF), the Global Assessment of Functioning Scale (GAF), the Positive and Negative Syndrome Scale (PANSS) and the Sense of Coherence Scale (SOC-29). The efficacy of the PG on QOL was compared to the CG within two different SOC levels.

RESULTS

Before intervention patients with high SOC scores had significant higher levels in GAF and QOL and a trend of lower PANSS scores. The strongest relationship was found between SOC and QOL. Regarding the SOC level after intervention PG participants had higher QOL values than the CG within the last three measurements. The highest benefit due to QOL was observed within PG participants with high SOC scores.

CONCLUSIONS

The results of the study suggest that SOC is a good predictive variable for clinical outcomes including QOL. Generally, the influence of the SOC level on QOL was stronger than the effect of PEFI. Hence schizophrenic patients with high SOC scores did benefit most from participating in a PG regarding their QOL. To optimize the effect of PEFI more efforts are needed to enhance the SOC of the participants. Altogether PEFI seems to be an important completion to the standard treatment for schizophrenic outpatients.

Efficacy of bifocal diagnosis-independent group psychoeducation in severe psychiatric disorders: results from a randomized controlled trial

Despite evidence for its efficacy, diagnosis-specific psychoeducation is not routinely applied. This exploratory randomized controlled trial analyses the efficacy of an easily implementable bifocal diagnosis-mixed group psychoeducation in the treatment of severe psychiatric disorders regarding readmission, compliance and clinical variables, for example global functioning. Inpatients of the Psychiatric Hospital of the University of Basel (N = 82) were randomly assigned to a diagnosis-mixed psychoeducational (PE) or a non-specific intervention control group. Relatives were invited to join corresponding family groups. Results at baseline, 3- and 12-month follow-ups are presented. Better compliance after 3 months and a lower suicide rate were significant in favour of PE. For most other outcome variables, no significant differences, however advantages, in PE were found. In summary, it can be concluded that diagnosis-mixed group psychoeducation is effective in the treatment of severe psychiatric disorders. The effects can be classified as induced by distinctive psychoeducational elements. Findings similar to those on psychosis-specific programmes justify clinical application and further investigation.