Assessing the efficacy and feasibility of providing metacognitive training for patients with schizophrenia by mental health nurses: A randomized controlled trial

Psychosocial Management of First-Episode Psychosis and Schizophrenia: Synopsis of the US Department of Veterans Affairs and US Department of Defense Clinical Practice Guidelines

BACKGROUND

Despite the large number of people treated for first-episode psychosis and schizophrenia within the Departments of Defense (DOD) and Veterans Affairs (VA), neither the DOD nor VA had established formal recommendations for the treatment of these conditions. This gap led Congress to require the development of clinical practice guidelines (CPG) for the treatment of schizophrenia. This paper reports on the psychosocial and rehabilitative recommendations presented in the VA/DOD Clinical Practice Guidelines for Management of First-Episode Psychosis and Schizophrenia.

STUDY DESIGN

The CPG was developed by an interdisciplinary panel of mental health and primary care providers from DOD and VA following methods specified by the VA/DOD Evidence-Based Practice Guideline Work Group. The panel formulated key questions and identified critical outcomes that guided a comprehensive search of the literature published from November 2011 to December 2021. The evidence considered was limited to systematic reviews, meta-analyses, and randomized clinical trials. Recommendations were based on the evaluation of the evidence using Grading of Recommendations Assessment, Development and Evaluation (GRADE) methods.

STUDY RESULTS

The review process produced 4 psychosocial/rehabilitative treatment recommendations for first-episode psychosis (early intervention services, family interventions, individual placement and support (IPS), and cognitive behavioral therapy for psychosis) and 11 recommendations for schizophrenia (family and caregiver services, assertive community treatment, IPS, smoking cessation, skills training, cognitive training, psychotherapies, aerobic exercise, yoga, weight management, and telephone-based care management).

CONCLUSIONS

The VA/DOD CPG reflects the expansion of treatments for first-episode psychosis and schizophrenia and highlights the challenges in developing clinical practice guidelines.

A Systematic Review and Meta-Analysis on Effect of Metacognitive Training on Cognitive Biases in Patients With Schizophrenia: Implications for Psychiatric Nursing Care

BACKGROUND

Schizophrenia presents significant challenges, with cognitive dysfunction being a hallmark feature affecting daily functioning.

AIMS

The study explores the impact of metacognitive training (MCT) on cognitive function in schizophrenia patients.

METHODS

A systematic review and meta-analysis encompassed 21 studies identified through databases and manual searches. Inclusion criteria focused on MCT interventions, controlled experimental designs and cognitive outcome measures. Data synthesis and meta-analysis followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

RESULTS

The meta-analysis results revealed a significant effect of MCT on Cognitive Biases Questionnaire(CBQ)-catastrophizing (JTC) (No. studies = 3, SMD = -0.61, 95% CI: -0.98, -0.25; I2 = 0.0%, p = 0.92) and CBQ-emotional reasoning(ER) (No. studies = 2, SMD = -0.50, 95% CI: -0.82, -0.18; I2 = 0.0%, p = 0.92), Positive and Negative Syndrome Scale (PANSS)-positive(P) (No. studies = 14, SMD = -0.52, 95% CI: -0.68, -0.35; I2 = 0.0%, p = 0.62), PANSS-negative(N) (No. studies = 8, SMD = -0.21, 95% CI: -0.42, -0.00; I2 = 0.0%, p = 0.94) and PANSS-total(T) (No. studies = 8, SMD = -0.42, 95% CI: -0.68, -0.16; I2 = 22.30%, p = 0.25) among schizophrenia patients. However, we found no significant impact of MCT treatment on CBQ-total(T), CBQ- intentionalizing (I), CBQ-catastrophizing(C), CBQ-dichotomous thinking(DT), Beck Cognitive Insight Scale(BCIS)-self-reflectiveness(SR), BCIS-self-certainty(SC), BCIS-composite index(CI) and PANSS-general(G) scores.

CONCLUSION

MCT demonstrates a positive impact on cognitive biases and symptom severity in schizophrenia patients. These results advocate for innovative, personalised interventions to complement traditional approaches in schizophrenia management.

Data harmonization for the analysis of personalized treatment of psychosis with metacognitive training

Personalized medicine is a data-driven approach that aims to adapt patients' diagnostics and therapies to their characteristics and needs. The availability of patients' data is therefore paramount for the personalization of treatments on the basis of predictive models, and even more so in machine learning-based analyses. Data harmonization is an essential part of the process of data curation. This study presents research on data harmonization for the development of a harmonized retrospective database of patients in Metacognitive Training (MCT) treatment for psychotic disorders. This work is part of the European ERAPERMED 2022-292 research project entitled 'Towards a Personalized Medicine Approach to Psychological Treatment of Psychosis' (PERMEPSY), which focuses on the development of a personalized medicine platform for the treatment of psychosis. The study integrates information from 22 studies into a common format to enable a data analytical approach for personalized treatment. The harmonized database comprises information about 698 patients who underwent MCT and includes a wide range of sociodemographic variables and psychological indicators used to assess a patient's mental health state. The characteristics of patients participating in the study are analyzed using descriptive statistics and exploratory data analysis.

Schizophrenia and cancer: Insights into psychiatric nursing care

INTRODUCTION

Few studies have applied Benner's nursing theory in evaluating psychiatric nursing care for patients with schizophrenia and the complication of cancer. Further study and training are needed in the management of these diseases.

OBJECTIVES

(1) To elucidate and categorize psychiatric nursing expertise in schizophrenia and cancer according to the five stages of Benner's nursing theory. (2) To identify stage-specific learning needs for the psychiatric nursing care of schizophrenia and cancer, and to propose tailored educational programs. (3) To clarify the differences in the roles and training of psychiatric nurses in Malaysia and Japan.

METHODS

A qualitative descriptive design was adopted. Semi-structured interviews were conducted with a total of 20 psychiatric nurses in Malaysia and Japan. The data were thematically analyzed and categorized with Benner's theory.

RESULTS

Benner's five stages of proficiency were: Novices followed pre-established routines; advanced beginners focused on psychiatric symptoms and behavior; competent nurses determined and prioritized methods of care; proficient nurses flexibly adjusted care to the patient's condition; and experts lent extensive experience to the team and patients. The following learning needs were identified: Novices struggled with identifying physical and psychiatric symptoms; advanced beginners had difficulties understanding ambiguous patient statements; competent nurses needed to improve emergency response skills; proficient nurses faced ethical challenges; and experts sought to pass on their knowledge. Stage-appropriate educational programs, such as a Visual Pain and Psychiatric Symptoms Evaluation Sheet, were proposed accordingly.

DISCUSSION

Further investigations should assess the effectiveness of these educational programs, Japanese-Malaysian cultural differences, and psychiatric liaison nursing.

Assessing Patient Satisfaction With Metacognitive Training (MCT) for Psychosis: A Systematic Review of Randomized Clinical Trials

OBJECTIVES

Metacognitive training (MCT) for psychosis is a group intervention that combines cognitive-behavioural therapy and psychoeducation. It has proven efficacy in reducing psychotic symptoms and correcting cognitive biases implicated in the development and maintenance of psychotic symptoms. However, other outcomes, such as patient satisfaction with the intervention, have not been well studied despite their importance for adherence and overall success. A systematic review of randomized clinical trials was conducted to assess satisfaction with MCT among adults with psychotic spectrum disorders.

METHODS

The search was conducted in Ovid Embase, Ovid MEDLINE, PsycINFO and Cochrane Central Register of Controlled Trials (CENTRAL). PRISMA guidelines and the Cochrane Risk of Bias Tool were followed, and certainty of evidence was ascertained using the Grading of Recommendations Assessment, Development and Evaluation framework. The study is registered with PROSPERO (CRD42023418097).

RESULTS

Patient satisfaction was considered the primary outcome in 3 of the 10 studies reviewed. Four studies compared MCT with other psychosocial interventions (a newspaper discussion group, cognitive remediation and supportive therapy), two of which found significantly higher satisfaction with MCT. A high percentage of all patients found MCT comprehensible and considered it an important part of their treatment; they would recommend the training to others and found the group setting advantageous. Most participants expressed high subjective satisfaction or acceptance of MCT.

CONCLUSIONS

The authors found evidence that MCT may be associated with high levels of satisfaction in clinical trials whose main objective is to assess patient satisfaction, but more research is needed to consolidate the findings, especially for the extended version of MCT.

Real-World Effectiveness and Predictors of Nurse-Led Individual Cognitive Behavioral Therapy for Mental Disorders: An Updated Pragmatic Retrospective Cohort Study

The importance of nurses integrating effective psychological techniques into their clinical practice is widely recognized. Nevertheless, further evidence from real-world settings is needed to establish nurse-led cognitive behavioural therapy (CBT) as an effective approach in clinical practice. This study aimed to examine the clinical effectiveness and predictors of individual CBT for mental disorders delivered by nurses in various routine clinical settings. This pragmatic retrospective cohort study collected data from participants who received nurse-led individual CBT at four institutions from different prefectures in Japan between April 2015 and March 2023. During the study period, 280 clients were referred to nurses for CBT, 240 of whom received nurse-led individual CBT of at least one session. The common primary diagnoses among participants were major depressive disorder (33.8%), social phobia (12.9%), and obsessive-compulsive disorder (10.0%). Of these, 23 participants were ongoing cases at the end of the observation period, and 217 who had completed the course of therapy or discontinued/dropped out from the therapy were included in the analysis (173 completed and 44 discontinued/dropped out (i.e., dropout rate = 20.3%)). Based on the clinical significance definition (primary outcome), 62.4% of the participants who completed the therapy were judged to demonstrate positive clinical significance (recovered or improved), with only a few participants (6.9%) demonstrating deterioration. Significant improvements were observed before and after nurse-led individual CBT across all secondary outcomes, including depression and anxiety symptoms, health-related quality of life, and functional disability (all ps ≤ 0.001). Univariate logistic regression revealed that clients with higher baseline severity of depression and anxiety symptoms were less likely to achieve positive clinical significance following nurse-led individual CBT. The real-world evidence gained through this study will encourage frontline nurses and motivate institutional/organizational leaders and policymakers to employ nurse-led individual CBT, especially for depression and anxiety-related disorders.

COVID-19 infection: Positive mental health, psychological vulnerability and sex: Cross-sectional study

Since mid-March 2020, a state of emergency was decreed in Portugal due to the COVID-19 pandemic and, consequently, measures were implemented to protect public health, such as social isolation, which will certainly have a notable impact on the mental health of the population, especially in the most vulnerable groups. Positive Mental Health (PMH) is essential to deal with adversity, in this case with the pandemic, and to live better and with greater satisfaction. We consider it relevant to investigate how PMH was used as a resource to deal with the pandemic, depending on the level of vulnerability and sex. A, cross-sectional study was carried out whose the aim was to evaluate the levels of PMH and psychological vulnerability in people with COVOD-19 infection and analyze the association between PMH and psychological vulnerability among men and women.

METHODS

The instruments used were a sociodemographic characterization questionnaire, the Positive Mental Health Questionnaire, and the Psychological Vulnerability Scale (PVS), that were sent and filled out online. A quantitative, cross-sectional, descriptive, and correlational study was carried out.

RESULTS

After analyzing the results, it was found that approximately 50.4% of the respondents (n = 387) had global PMH values that place them in quartile 50. There was also a statistically significant difference between female and male PMH, with women showing greater psychological vulnerability and lower overall PMH.

CONCLUSIONS

We conclude that the women present a greater psychological vulnerability and a lower level of PMH when compared to men.

RELEVANCE TO CLINICAL PRACTICE

Considering the study's statistically significant results, when we talk about mental health, we should always consider the sex variable as a vulnerability factor, in a pandemic or non-pandemic phase.

Effects of psychological treatments on functioning in people with Schizophrenia: a systematic review and meta-analysis of randomized controlled trials

Functioning is recognized as a key treatment goal in alleviating the burden of schizophrenia. Psychological interventions can play an important role in improving functioning in this population, but the evidence on their efficacy is limited. We therefore aimed to evaluate the effect of psychological interventions in functioning for patients with schizophrenia. To conduct this systematic review and meta-analysis, we searched for published and unpublished randomized controlled trials (RCTs) in EMBASE, MEDLINE, PsycINFO, BIOSIS, Cochrane Library, WHO International Clinical Trials Registry Platform (ICTRP), ClinicalTrials.gov and the Study register of the Cochrane Schizophrenia Group. The outcome functioning was measured with validated scales. We performed random-effects pairwise meta-analysis to calculate standardized mean differences (SMDs) with 95% confidence intervals (CIs). We included 58 RCTs (5048 participants). Psychological interventions analyzed together (SMD =  - 0.37, 95% CI  - 0.49 to  - 0.25), cognitive behavioral therapy (30 RCTs, SMD =  - 0.26, 95% CI  - 0.39 to  - 0.12), and third wave cognitive-behavioral therapies (15 RCTs, SMD =  - 0.60, 95% CI  - 0.83 to  - 0.37) were superior to control in improving functioning, while creative therapies (8 RCTs, SMD = 0.01, 95% CI  - 0.38 to 0.39), integrated therapies (4 RCTs, SMD =  - 0.21, 95% CI  - 1.20 to 0.78) and other therapies (4 RCTs, SMD =  - 0.74, 95% CI  - 1.52 to 0.04) did not show a benefit. Psychological interventions, in particular cognitive behavioral therapy and third wave cognitive behavioral therapies, have shown a therapeutic effect on functioning. The confidence in the estimate was evaluated as very low due to risk of bias, heterogeneity and possible publication bias.

Naturalistic outcome of nurse-led psychological therapy for mental disorders in routine outpatient care: A retrospective chart review

This study aimed to investigate the clinical effectiveness of nurse-led cognitive/behavioral therapy (CBT) in Japanese routine outpatient care. We retrospectively collected data from 100 cases with mental disorders who had received nurse-led CBT. Results demonstrated that CBT provided by nurses led to significant improvements in quality of life and other clinical outcomes during the intervention period (all p < 0.001). Among participants who received optional follow-up, these improvements were well-maintained. This real-world evidence of nurse-led CBT bridges the research-practice gap, and will encourage frontline nurses and motivate institutional/organizational leaders, academic/professional societies, and policymakers to employ empirically-supported psychotherapeutic techniques in routine nursing care.

The Efficacy of Extended Metacognitive Training on Neurocognitive Function in Schizophrenia: A Randomized Controlled Trial

The aim of this study was to evaluate the effect of metacognitive training (MCT) on improving the neurocognitive function of Chinese patients with schizophrenia. One hundred inpatients with schizophrenia were selected by regional group randomization and divided into the control (treated as usual, TAU) group (n = 50) and the TAU + MCT group (n = 50). In this study, a 10-module MCT was used and the intervention process lasted 30 days. Cognitive function was assessed blindly using the Repeatable Battery of Neuropsychological Status (RBANS) scale at baseline, 24 h post-treatment, and 12 weeks’ post-treatment. The differences between the total RBANS score and baseline (pre-test) for the post-test and 12-week-follow-up tests were used as the primary outcome, and the difference between the RBANS dimension scores and baseline (pre-test) were used as a secondary outcome in this study. The completion rate at follow-up was high in the TAU + MCT group (94%). Intention-to-treat analysis and per-protocol analysis showed a significant increase in total neurocognitive function scores and three-dimensional scores (delayed memory, visual breadth, and attention) in the TAU + MCT group immediately after the intervention and at the 12-week follow-up compared with baseline. This study provides support for the efficacy of 10 module MCT concerning neurocognition.