Feasibility trial of a technology-based intervention (TI) among men with alcohol dependence from rural settings in India.

This feasibility study utilized two-arm randomized controlled trial (RCT), conducted in a de-addiction unit of tertiary mental care setting, India, between August 2021 and January 2022. Sixty-one participants diagnosed with alcohol dependent syndrome was randomly assigned to receive TI (n = 31) or Treatment as usual (TAU) (n = 30). Participants of both groups were initially assessed for craving, quantity and frequency of alcohol consumption and severity of alcohol use. TI participants received 8 video enabled cue exposure group sessions and periodic mobile phone interventions along with text message reminders after discharge along with routine treatment at de-addiction wards. TAU group participants received only routine treatment. All the participants were followed up over 3 months post-discharge. Results showed that majority (77 %) participants attended all 8-video enabled cue exposure group sessions. Rural men were willing to engage in the program and participated in behavioral rehearsals. Mobile intervention and text messages were accepted. We observed that at 3 months follow-up TI group subjects reported lesser mean craving scores, fewer drinking days, lesser quantity of alcohol consumption and less AUDIT scores compared to TAU group participants. This study provides preliminary support for the hypotheses that it is feasible to implement technology-based alcohol intervention for men with alcohol dependence.

Aggressive behavior and its associated factors among persons with mental illness: An observational study.

BACKGROUND: Aggressive behavior of psychiatric inpatients causes severe complications during treatment; nursing staff needs to understand the factors associated with aggression in inpatient units to prevent aggression. AIM: This study aimed to examine the level of aggression and its associated factors. MATERIALS AND METHODS: A descriptive observational design was conducted among aggressive patients. An aggressive behavior event was observed during the aggression episode. Data were collected from 55 patients with aggressive behavior using the Staff Observation Aggression Scale-Revised (SOAS-R) and Brief Psychiatric Rating Scale (BPRS). Patient-, staff-, and ward-related factors were assessed using a structured questionnaire. RESULTS: About 69% of patients had a severe level of aggressive behavior. There was a significant association between gender, the severity of symptoms, staff-to-patient ratio, ward milieu, and the number of caregivers with levels of aggression. CONCLUSION: The majority of the persons with mental illness exhibited severe aggression in a psychiatric setting. Being male, the presence of psychotic symptoms, ward milieu, staff-to-patient ratio, and availability of caregivers were significantly associated with aggression. This study adds to the existing literature by focusing on managing ward-related factors (avoiding noise and overcrowding) to prevent aggressive behavior among mentally ill patients.

Effectiveness of aggression management training (AMT) on self-esteem, impulsivity, and aggressive behavior among adolescents residing in delinquent homes-A feasibility study from east India.

PURPOSE: This feasibility study examined the aggression management training (AMT) interventions on self-esteem, impulsivity, and aggressive behavior among adolescents residing in delinquent or observation homes. METHODS: A quantitative research approach with the quasi-experimental nonequivalent control group (comparison) pretest and Posttest design was adopted. A total of 32 male adolescents (16 each in experimental and comparison groups) residing in two different observation homes in the state of Bihar, India were selected by convenience sampling technique. The study evaluated the following outcome measures: self-esteem, impulsivity, and aggressive behavior for both groups at baseline and 1 month. AMT was administered to the experimental group bi-weekly for 4 weeks covering four components in 8 sessions. RESULTS: We analysed the data with independent and paired t-tests for between and within the group differences, and Pearson correlation for a relationship. AMT intervention improved self-esteem and reduced aggressive behavior and impulsivity among adolescents residing in delinquent homes. A correlation was found between aggression and impulsivity, and between self-esteem and impulsivity. PSYCHIATRIC NURSING IMPLICATIONS: The study had provided initial evidence for practice that can help psychiatric nurses significantly implement these types of interventions among significant, vulnerable, and ignored groups of adolescents detained in observation homes to prevent the occurrence of repeat offenses.

Self-esteem among heinous and non-heinous male delinquent adolescents- A descriptive comparative study from East India.

Background: Adolescence is the most complex stage of development that causes the greatest difficulties in their life because of frequent physical and emotional issues including deviated character and behavioral disorders. Aim: This descriptive comparative study was intended to compare self-esteem between heinous and non-heinous male delinquent adolescents residing in observation homes. Materials and Methods: A quantitative research approach with a non-experimental descriptive comparative design was adopted. One hundred and seventy-nine male delinquent adolescents (Heinous = 74, Non-Heinous = 105) residing in two observation homes were selected by convenience sampling technique based on the type of crime committed. The standardized Rosenberg's self-esteem scale was used to collect the data. Results: We analyzed the data with Chi-square for homogeneity of sample characteristics, an independent t test for comparison of self-esteem between groups, an independent t test, one-way ANOVA for the association, and stepwise regression for predictors. There was a statistically significant difference in self-esteem between groups, a significant association of self-esteem with age and duration of stay in the heinous group and with the father's education in the non-heinous group, and the father's education, mother's occupation, substance use, and order of birth had predicted the self-esteem in non-heinous group. Conclusion: The study concluded that self-esteem significantly varied between heinous and non-heinous group delinquents. This study is the first of its kind and provided initial evidence by filling the gap in the literature to understand the difference in the level of self-esteem among delinquent adolescents according to the type of crime committed.

Use of Therapeutic Milieu Interventions in a Psychiatric Setting: A Systematic Review.

BACKGROUND: The therapeutic environment is commonly acknowledged as a significant influence on mental inpatient treatment experiences and outcomes. Therapeutic milieu interventions provide a distinct, secure hospital ward/unit atmosphere where patients with mental illness receive therapeutic interactions and collaborative attentiveness. The review aimed to explore the studies related to the role of a nurse using therapeutic milieu/milieu therapy in a psychiatric setting. MATERIALS AND METHODS: A systematic literature search was conducted between 1976 and 2021 using PsycINFO, Medline, Embase, and Scopus. A total of 13 papers were identified for a full review. RESULTS: A total of 70 studies were found, out of which 13 of them were analyzed. These studies looked at several therapeutic milieu concepts, such as therapeutic communication, patient satisfaction, nurse involvement, ward design and structure, and a mixture of therapeutic milieu concepts. Most of the studies explored the concepts of milieu therapy in community settings. CONCLUSION: In the mental health nursing literature, the milieu, as well as milieu therapy, is a well-debated subject. Though the importance of therapeutic milieu in psychiatric settings is recognized, empirical studies on milieu implementation are scarce. Therefore, research is needed to explore the effectiveness of milieu therapy in inpatient psychiatric care, which facilitates patient recovery, safety, and good interpersonal relationships.

Frequency of suicide ideation and attempts and its correlates among inpatients with depressive disorders at a tertiary care center in North India.

Background: Suicidal ideation is higher in psychiatric patients, particularly in those with depressive disorders. It tends to be a precursor to suicide attempts. Aim: To estimate the frequency of suicide ideation and attempts and their sociodemographic and clinical correlations among the inpatients with depressive disorders at a tertiary care center in North India. Methods: A cross-sectional descriptive survey was carried out among 128 participants diagnosed with depressive disorders who were admitted from September 2019 to April 2021 at a tertiary care hospital, India, using a total enumerative sampling technique. The sociodemographic and clinical data (particularly on suicide) were supplemented with the Modified Scale of Suicide Ideation (to evaluate suicidality) and the Hamilton Depression Rating Scale (for the severity of depression). Results: The median suicide ideation score was 11 inter quartile range (IQR: 19), and the overall mean depression score of the sample was 22.74 standard deviation (SD = 6.24). About 87% reported moderate to severe suicidal ideas. Occupation (farmer) (P < 0.01), current medications (tricyclic antidepressant) (P < 0.05), and history of suicide (P < 0.05) were significantly associated with the severity of depression. However, only a history of suicide was significantly associated with the current suicidal ideation (P < 0.05). About 48% had a history of suicide attempts, and among those who were more severely depressed, intoxicated during a suicide attempt (P < 0.01), taken precautions against being interrupted (P < 0.05), and had an intention to die (P < 0.05) had a significant association with their suicide attempts. Conclusion: Among hospitalized patients with depressive disorders, suicidal ideation is common. The study reiterates the importance of screening for suicide, particularly in those with more severe depression in the inpatient setting.

Effectiveness of psychosocial intervention for internalizing behavior problems among children of parents with alcohol dependence: Randomized controlled trial.

BACKGROUND: Parental drinking has a direct bearing on children. Behavioral problems such as anxiety and depression are common problems among children whose parents drink heavily. Psychosocial interventions have shown promising results for anxiety and depression among children; however, few studies have been conducted in the context of children of parents with alcohol dependence in India. AIM: To evaluate the efficacy of psychosocial intervention for internalizing behavioral problems among children of parents with alcohol dependence. METHODS: A randomized controlled trial with a 2 × 4 factorial design was adopted with longitudinal measurement of outcomes for 6 mo. Two-hundred and eleven children who met the eligibility criteria (at least one parent with alcohol dependence) at government high schools in Bangalore, India, were randomized to the experimental (n = 97) or control group (n = 98). The psychosocial intervention was administered to the experimental group in eight sessions (biweekly) over 4 wk after baseline assessment. The intervention focused on identifying and modifying negative thoughts, replacing thinking errors with realistic alternatives, modification of maladaptive behavior, developing adaptive coping skills and building self-esteem. The data was collected pre-intervention and at 1, 3 and 6 mo after the intervention. Data were analyzed using SPSS 28.0 version. RESULTS: Mean age of the children was 14.68 ± 0.58 years, 60.5% were male, 56% were studying in 9th standard, 70.75% were from nuclear families, and mean family monthly income was 9588.1 ± 3135.2 INR. Mean duration of parental alcohol dependence was 7.52 ± 2.94 years and the father was the alcohol-consuming parent. The findings showed that there were significant psychosocial intervention effects in terms of decreasing anxiety and depression scores, and increasing self-esteem level among experimental group subjects over the 6-mo interval, when compared with the control group (P < 0.001). CONCLUSION: The present study demonstrated that the psychosocial intervention was effective in reducing anxiety and depression, and increasing self-esteem among children of parents with alcohol dependence. The study recommends the need for ongoing psychosocial intervention for these children.

Impact of nurse-led medication adherence therapy on bipolar affective disorder: A randomized controlled trial.

PURPOSE: This study evaluated the impact of nurse-led medication adherence therapy (MAT) on medication adherence behavior and symptom severity of inpatients with bipolar disorder. METHOD: Two arms, single-blind, randomized controlled trial on individuals with bipolar disorder was conducted at inpatient department of mental healthcare setting, India. Eighty-five participants were randomly allocated to MAT group and Treatment as usual group. Standard measures were used to assess medication adherence and symptom severity of both groups at baseline and follow-up time points. CONCLUSION: MAT improved medication adherence behavior resulting in marked decrease in symptom severity of participants with bipolar disorders. IMPLICATIONS FOR NURSING PRACTICE: Psychiatric nurses can effectively implement MAT for bipolar inpatients, which improves better clinical outcomes, prevent relapse, and readmissions.

Effect of holistic relapse prevention intervention among individuals with alcohol dependence: a prospective study at a mental health care setting in India.

Present study examined effectiveness of Integrative Body Mind Spirit (I-BMS) intervention among individuals with alcohol dependence. A 2-group single blind RCT design was used, comparing I-BMS to treatment as usual (TAU) on drinking and psychological outcomes. One hundred participants diagnosed with alcohol dependent syndrome were randomly assigned to receive 7 sessions of I-BMS or TAU. Measurements done by a registered nurse who was blinded to the experimental design used standardized questionnaire on wellbeing, readiness to change, craving, quantity and frequency of drinking before and up to 6 months after the intervention. With respect to the within group effects, the I-BMS group demonstrated significant improvement in all outcome measures with large effect size. Compared to TAU, I-BMS participants showed lesser relapse rates and quantity of drinking at 3-month follow-up, reduction in craving and drinking days at 2-month follow-up. At 6 months follow-up, participants in I-BMS group reported significant improvement in wellbeing and motivation compared to TAU. Results of binary logistic regression showed that number of previous attempts and living in urban area positively predicted participant's relapse possibility at 6-month follow-up. Results suggest that I-BMS is worthy of further efficacy testing. In conclusion, it is feasible to implement I-BMS intervention for individuals with alcohol dependence.

Psychiatric nurse delivered group-cognitive-behavioral therapy for internalizing behavior problems among children of parents with alcohol use disorders.

PURPOSE: The present study aimed at assessing the effectiveness of group-cognitive-behavioral therapy for anxiety, depression, and self-esteem among children of parents with alcohol use disorder. DESIGN AND METHODS: A randomized, controlled trial study was conducted with 70 children of parents with alcohol use disorder. The children were initially screened for the presence of behavioral problems and living with parents with alcohol use disorder, then assigned randomly to experimental and control groups. The experimental group received eight biweekly group CBT sessions. RESULTS: Over 3-month study period, the results showed a statistically significant reduction in depression and anxiety scores and a significant improvement in self-esteem scores among CBT group children compared with the control group children. CONCLUSION: Our study demonstrates the effectiveness of CBT group treatment for children of parents with an alcohol use disorder and that school mental health nurses/psychiatric nurses can effectively deliver psychotherapy for behavioral and emotional problems of high-risk children.

Application of Mobile Call-Based Integrative Body-Mind-Spirit (IBMS) Intervention to Deal With Psychological Issues of COVID-19 Patients: A Case Study in India.

Aim: The aim of this case study was to assess whether 8 sessions of mobile call based integrated Body-Mind-Spirit (IBMS) intervention could help COVID-19 patient to deal with psychological issues. Methods: This article is based on a practical example of working with COVID-19 patient using the IBMS model. It is a single subject study involving a 50 year old south Indian male living in a Covid Care Center (CCC). Mobile call interviews and brief symptom inventory were used for evaluation. Subject underwent 8 sessions of integrated body-mind-spirit Intervention through video/mobile calls of 45 minutes each time for 8 sessions offered on alternative days over a period of 15 days with pre-post assessments. Results: The results indicate that there was a reduction in somatic symptoms, anxiety and depression on 15th day. Conclusion: Illustrations of real life cases may help psychiatric nurses to gain insight into the application of psycho-social-spiritual interventions through mobile phone during isolation and lockdown.

Nurses' knowledge, attitude and practices on use of restraints at State Mental health care setting: An impact of in-service education programme.

OBJECTIVES: To evaluate the effectiveness of short-term in-service education program in improving nurse's knowledge, attitude and self-reported practices related to physical restraint use. METHODS: A quasi-experimental one group pre-post study was conducted involving nurses working at a tertiary mental health care setting, Dharwad, India. We provided 3 consecutive days of intensive restraint management education (total 6 hours-two hours per day) with a follow-up assessment after one month. The standard questionnaires on knowledge, attitude and practice regarding physical restraints were used as tools for measuring the impact of in-service education program. The program was conducted for a group of five to six nurses at a time. Teaching was done using lecture method, group discussion and demonstrations. RESULTS: Of the 52 nurses who participated in the study, 52% were male, 58.5% had a baccalaureate degree. The mean age of respondents was 33.3 years, the mean work experience was 6.7 years. The findings of the study revealed that the mean scores on the knowledge regarding physical restraints increased after the in-service education from 6.4 to 8.2 (p<0.001). The mean attitude scores improved from 18.5 to 23.1 (p<0.001). There was a significant difference in mean practice scores between pre and post-intervention phases (23.7 versus 25.4; p<0.001). There was a significant correlation between post-test knowledge, attitude and practice scores. CONCLUSIONS: The in-service education program improved nurse's knowledge, attitude and self-reported practice scores. This may lead to more effective restraints management by psychiatric nurses.

Nurses' knowledge, attitude and practices on use of restraints at State Mental health care setting: An impact of in-service education programme

Objective. To evaluate the effectiveness of short-term in-service education program in improving nurse's knowledge, attitude and self-reported practices related to physical restraint use. Methods. A quasi-experimental one group pre-post study was conducted involving nurses working at a tertiary mental health care setting, Dharwad, India. We provided 3 consecutive days of intensive restraint management education (total 6 hours-two hours per day) with a follow-up assessment after one month. The standard questionnaires on knowledge, attitude and practice regarding physical restraints were used as tools for measuring the impact of in-service education program. The program was conducted for a group of five to six nurses at a time. Teaching was done using lecture method, group discussion and demonstrations. Results. Of the 52 nurses who participated in the study, 52% were male, 58.5% had a baccalaureate degree. The mean age of respondents was 33.3 years, the mean work experience was 6.7 years. The findings of the study revealed that the mean scores on the knowledge regarding physical restraints increased after the in-service education from 6.4 to 8.2 (p<0.001). The mean attitude scores improved from 18.5 to 23.1 (p<0.001). There was a significant difference in mean practice scores between pre and post-intervention phases (23.7 versus 25.4; p<0.001). There was a significant correlation between post-test knowledge, attitude and practice scores. Conclusion. The in-service education program improved nurse's knowledge, attitude and self-reported practice scores. This may lead to more effective restraints management by psychiatric nurses.

Objetivo. Evaluar la efectividad a corto plazo de un programa de educación en servicio para enfermeros, el cual tenía como fin mejorar los conocimientos, las actitudes y las prácticas auto-informadas en relación al uso de medidas de contención física. Métodos. Se realizó un estudio cuasi-experimental con evaluación de pre y post-intervención de un grupo de enfermeros que trabajaban en un entorno de atención terciaria de salud mental en Dharwad (India). Durante tres días consecutivos, se hizo educación sobre el manejo de la contención física (un total de 6 horas, dos horas por día) con una evaluación de seguimiento después de un mes. Los cuestionarios estándar sobre conocimientos, actitudes y prácticas con respecto a la contención física se utilizaron como herramientas para medir el impacto del programa en servicio. Las sesiones se llevaron a cabo en grupos de cinco a seis enfermeras a la vez. La enseñanza se realizó mediante el método de conferencias, debates en grupo y demostraciones. Resultados. De los 52 enfermeros que participaron en el estudio, el 52% eran hombres, el 58.5% tenía un título de bachillerato en enfermería (formación profesional de 4 años). La edad media de los encuestados fue de 33.3 años, con una experiencia laboral media de 6.7 años. Los hallazgos del estudio revelaron que las puntuaciones medias en el conocimiento sobre restricciones físicas aumentaron después de la educación en el servicio de 6.4 a 8.2 (p<0.001). Las puntuaciones medias de actitud mejoraron de 18.5 a 23.1 (p<0.001). También se observó una diferencia significativa en las puntuaciones medias de práctica entre las fases pre y post-intervención (23.7 versus 25.4). Hubo una correlación significativa entre los puntajes de conocimientos, actitudes y prácticas posterior a la prueba. Conclusión. El programa de educación en el servicio mejoró el conocimiento, las actitudes y las prácticas auto-reportadas de los enfermeros, lo que puede conducir a un manejo más efectivo de la contención física por parte de los enfermeros psiquiátricos.

Objetivo. Avaliar a eficácia em curto prazo de um programa de educação em serviço para enfermeiros que buscam aprimorar conhecimentos, atitudes e práticas autorreferidas em relação ao uso de medidas de contenção física. Métodos. Foi realizado um estudo quase experimental com avaliação pré e pós-intervenção de um grupo de enfermeiras trabalhando em um ambiente terciário de saúde mental em Dharwad (Índia). Educação sobre o manejo da contenção física (um total de 6 horas, duas horas por dia) foi dada por três dias consecutivos com uma avaliação de acompanhamento após um mês. Questionários padronizados sobre conhecimentos, atitudes e práticas em relação à contenção física foram usados como ferramentas para medir o impacto do programa em serviço. As sessões foram realizadas em grupos de cinco a seis enfermeiras de cada vez. O ensino era feito por meio de palestras, discussões em grupo e demonstrações. Resultados. Dos 52 enfermeiros que participaram do estudo, 52% eram homens, 58.5% tinham o título de bacharel em enfermagem (4 anos de formação profissional). A idade média dos entrevistados era de 33.3 anos, a experiência de trabalho média era de 6.7 anos. Se realizou o teste t pareado para encontrar a diferença média entre a educação pré e pós-formação em serviço. Os resultados do estudo revelaram que as pontuações médias no conhecimento sobre restrições físicas aumentaram após a educação em serviço de 6,4 para 8,2 (p<0.001). As pontuações médias de atitude melhoraram de 18.5 para 23.1 (p<0.001). Uma diferença significativa também foi observada nas pontuações médias de prática entre as fases pré e pós-intervenção (23.7 versus 25.4). Houve uma correlação significativa entre as pontuações de conhecimento, atitude e prática pós-teste. Conclusão. O programa de educação em serviço melhorou os conhecimentos, atitudes e práticas autorreferidas dos enfermeiros, o que pode levar a um gerenciamento mais eficaz das restrições físicas pelos enfermeiros psiquiátricos

Effectiveness of therapeutic milieu intervention on inpatients with depressive disorder: A feasibility study from North India.

PURPOSE: This study examined therapeutic milieu interventions on self-esteem, socio-occupational functioning, and depressive symptoms among inpatients with depressive disorders. METHODS: A pretest-posttest nonequivalent control group quasi-experimental design was adopted. Sixty participants with depression who got admitted to the general hospital psychiatric ward were assigned to a control (Treatment as Usual) group and an experimental (therapeutic milieu intervention) group nonrandomly using a convenience sampling technique. We evaluated the following outcome measures: self-esteem, socio-occupational functioning, and depressive symptoms for both groups at baseline, 4th, 8th, and 12th weeks. RESULTS: Therapeutic milieu interventions improved self-esteem, socio-occupational functioning, and reduced depressive symptoms. The findings provided initial evidence for practice. IMPLICATIONS: Psychiatric nurses can implement simple, milieu therapy interventions in any setting, which will enhance the clinical outcomes and socio-occupational functioning of depressive patients.

Nurse-Led Body-Mind-Spirit Based Relapse Prevention Intervention for People With Diagnosis of Alcohol Use Disorder at a Mental Health Care Setting, India: A Pilot Study.

BACKGROUND: Alcohol dependence is associated with alcohol-related problems and persistent vulnerability to relapse. Despite newer medications, frequent relapses continue to occur. Hence, there is a need to look at holistic approaches to deal with this problem. OBJECTIVE: Evaluate the effectiveness of nurse-led body-mind-spirit (BMS)-based relapse prevention intervention on craving and quantity and frequency of alcohol consumption among alcohol-dependent individuals. METHODS: Randomized control trial was adopted, and the study was conducted at a mental health care setting in India. Sixty individuals with alcohol use disorder were randomly assigned to a BMS group (n = 30) and a treatment-as-usual (TAU) group (n = 30) between June 2017 and March 2018. Subjects of both groups were initially assessed for craving and quantity and frequency of alcohol consumption. BMS subjects received seven sessions of BMS intervention and routine treatment at de-addiction wards. The interventions comprise of body, mind, and spirit strategies that aid in handling triggers, accept responsibility for their own well-being and take charge of self health. TAU group subjects received only routine treatment. All the participants were followed up over 3 months postdischarge. RESULTS: Over 3 months of follow-up, BMS group subjects (vs. TAU group) reported significantly lesser quantity of alcohol consumption (F = 9.74, p < .001, η = .144), fewer drinking days (F = 14.04, p < .001, η = .195), lower relapse rates (14 vs. 28), and lesser craving (F = 14.01, p < .001, η = .195). Regression analysis showed that number of previous attempts (>1) and increased baseline drinking were associated with relapse. CONCLUSION: Findings provide evidence of BMS intervention in reducing craving and drinking outcomes among alcohol-dependent individuals in India.

Effectiveness of Milieu Therapy in reducing conflicts and containment rates among schizophrenia patients.

OBJECTIVES: To evaluate effectiveness of Milieu Therapy in reduction of conflict and containment rates among schizophrenia patients. METHODS: This study utilized quasi experimental non-equivalent control group pre-post design. One hundred schizophrenia patients admitted in acute psychiatric wards were non-randomly assigned to either of the experimental (n=50) or control group (n=50). The experimental group received both milieu therapy and routine hospital treatment. The Milieu Therapy intervention Included environmental modification and structuring ward activities, establishing effective interaction with patient, and teaching caregivers on managing conflict behavior of patient. The control group received only routine treatment in the hospital. Outcome measures on conflict and containment rates were evaluated for both the groups at baseline and at 2nd, 3rd and 15th day. The Patient-Staff Conflict Checklist Shift Report (PCC-SR) was used to collect information about rates of conflict and containment. RESULTS: Compared with control group, the experimental group participants showed decrease in aggressive behavior, self-harm behavior and general rule breaking behavior at baseline and 2nd, 3rd and 15th day (F=4.61, p < 0.004, η2=0.04; F=11.92, p < 0.001, η2=0.11; F=6.94, p < 0.001, η2=0.06) over seven days interval. CONCLUSIONS: The present study findings provided evidence for the effectiveness of integrating Milieu Therapy in psychiatric acute wards in reducing conflict behaviors among schizophrenia patients. Milieu therapy should be considered as an integral part of psychiatric care settings in these patients.

Effectiveness of Milieu Therapy in reducing conflicts and containment rates among schizophrenia patients

Objective. To evaluate effectiveness of Milieu Therapy in reduction of conflict and containment rates among schizophrenia patients. Methods. This study utilized quasi experimental non-equivalent control group pre-post design. One hundred schizophrenia patients admitted in acute psychiatric wards were non-randomly assigned to either of the experimental (n=50) or control group (n=50). The experimental group received both milieu therapy and routine hospital treatment. The Milieu Therapy intervention Included environmental modification and structuring ward activities, establishing effective interaction with patient, and teaching caregivers on managing conflict behavior of patient. The control group received only routine treatment in the hospital. Outcome measures on conflict and containment rates were evaluated for both the groups at baseline and at 2nd, 3rd and 15th day. The Patient­Staff Conflict Checklist Shift Report (PCC-SR) was used to collect information about rates of conflict and containment. Results. Compared with control group, the experimental group participants showed decrease in aggressive behavior, self-harm behavior and general rule breaking behavior at baseline and 2nd, 3rd and 15th day (F=4.61, p<0.004, η2=0.04; F=11.92, p<0.001, η2=0.11; F=6.94, p<0.001, η2=0.06) over seven days interval. Conclusion. The present study findings provided evidence for the effectiveness of integrating Milieu Therapy in psychiatric acute wards in reducing conflict behaviors among schizophrenia patients. Milieu therapy should be considered as an integral part of psychiatric care settings in these patients.

Objetivo. Evaluar la efectividad de la terapia Milieu en la reducción de las tasas de conflicto y contención entre los pacientes con esquizofrenia. Métodos. Este estudio utilizó un diseño cuasi experimental con grupo control no equivalente y evaluación pre y posintervención. Cien pacientes con esquizofrenia hospitalizados en salas psiquiátricas en un hospital público en Karnataka (India) se asignaron de forma no aleatoria a los grupos experimental (n=50) y control (n=50). El grupo experimental recibió la terapia de Milieu, además del tratamiento hospitalario de rutina. La terapia de Milieu incluyó la modificación ambiental y la estructuración de las actividades de la sala, el establecimiento de una interacción efectiva con el paciente y la enseñanza a los cuidadores sobre el manejo del comportamiento conflictivo del paciente. El grupo control recibió solamente el tratamiento de rutina en el hospital. Las medidas de resultado (tasas de conflictos y de contención) se evaluaron en ambos grupos en los días de inicio, 2º, 3º y 15º posadmisión. El Patient­Staff Conflict Checklist Shift Report (PCC-SR) se utilizó para la recolección de la información acerca de las tasas de conflicto y contención. Resultados. En comparación con el grupo de control, los participantes del grupo experimental mostraron una disminución en el comportamiento agresivo, el comportamiento de autolesión y el comportamiento de incumplimiento de las reglas generales al inicio y al segundo, tercer y décimo quinto día (F=4.61, p<0.004, η2=0.04; F=11.92, p<0.001, η2=0.11; F=6.94, p<0.001, η2=0.06). Conclusión. Los hallazgos del presente estudio proporcionaron evidencia de la efectividad de la Terapia Melieu en la reducción de comportamientos conflictivos en el paciente esquizofrénico hospitalizado en fase aguda. La Terapia Milieu debe considerarse como una parte integral en los entornos de atención de estos pacientes.

Objetivo. Avaliar a eficácia da terapia Milieu na redução das taxas de conflito e contenção entre pacientes com esquizofrenia. Métodos. Este estudo utilizou um desenho quase-experimental com um grupo controle não equivalente e avaliação pré e pós-intervenção. Cem pacientes com esquizofrenia hospitalizados em salas psiquiátricas em um hospital público de Karnataka (Índia) foram designados não aleatoriamente para os grupos experimental (n = 50) e controle (n = 50). O grupo experimental recebeu terapia Milieu, além de tratamento hospitalar de rotina. A terapia de Milieu incluiu modificação ambiental e estruturação das atividades da enfermaria, estabelecendo uma interação efetiva com o paciente e ensinando os cuidadores sobre o gerenciamento do comportamento conflitante do paciente. O grupo controle recebeu apenas tratamento hospitalar de rotina. As medidas de resultado (taxas de conflito e contenção) foram avaliadas em ambos os grupos nos dias de início, 2, 3 e 15 após a admissão. O Relatório de Mudança de Lista de Verificação de Conflitos entre Pacientes e Funcionários (PCC-SR) foi usado para coletar informações sobre taxas de conflitos e contenção. Resultados. Comparados ao grupo controle, os participantes do grupo experimental mostraram uma diminuição no comportamento agressivo, no comportamento autolesivo e no não cumprimento das regras gerais no início e no segundo, terceiro e décimo quinto dia (F = 4,61, p <0,004, η2 = 0,04; F = 11,92, p <0,001, η2 = 0,11; F = 6,94, p <0,001, η2 = 0,06). Conclusão Os achados do presente estudo forneceram evidências da eficácia da Terapia Melieu na redução de comportamentos conflitantes no paciente esquizofrênico hospitalizado na fase aguda. A terapia Milieu deve ser considerada como parte integrante do ambiente de atendimento desses pacientes.

Academic stress among Indian adolescent girls.

CONTEXT: Academic learning is the main source of stress among adolescents and is associated with mental health problems; finding its determinants helps to know the risk factors that influence stress. AIM: The main aim of the study was to assess the educational stress and their predictors among adolescent girls. SETTINGS AND DESIGN: A cross-sectional study was conducted in ten colleges involving adolescent girls pursuing preuniversity and university studies at Dharwad city, India. SUBJECTS AND METHODS: The study included 314 randomly selected adolescent girls aged between 16 and 19 years. The study was approved by the institutional ethics committee. Data were collected by employing random sampling technique. Self-administered questionnaires were administered which included sociodemographic data sheet, personality inventory, intelligence quotient (IQ) assessment, and educational stress scale for adolescents. RESULTS: Mean educational stress was 50.04 ± 10.82 (range 16-80). There was a significant association between educational stress and religion, father education, number of siblings, combination of subjects, type of personality, and IQ. Regression analysis revealed that number of siblings and extrovert neuroticism personality negatively predicted stress (beta = -0.115, P = 0.037; beta = -0.242, P = 0.001) and considered as protective factors. Introvert neuroticism, Hindu religion, illiterate father, and commerce combination of subjects positively predicted stress among adolescent girls (beta = 0.160, P = 0.026; beta = 0.119, P = 0.028; beta = 0.125, P = 0.017; and beta = 0.278, P < 0.001) and considered as risk factors. CONCLUSIONS: Findings help in better understanding of educational stress factors among adolescent girls and consider them while developing stress prevention programs.

Social competence among children of alcoholic and nonalcoholic parents.

BACKGROUND OF THE STUDY: A child's social competence depends on a number of factors including family atmosphere. Parental alcoholism effects the development of child directly or indirectly. Children of alcoholics (COAs) may have lower social competence. Addressing this problem at the earliest can significantly reduce the problems in future. The objective of the study is to compare the social competence between COAs and non-COA. METHODS: A cross-sectional comparative study design was used. The study was conducted at a selected government high school located in Bengaluru urban. One hundred COA and 100 non-COA were recruited for the study by using simple random sampling technique. Children of Alcoholic Screening Test (modified) and Social Competence Scale were used in the study. RESULTS: Results show that there is statistically significant difference between COAs and non-COAs with regard to prosocial attitude, social competition, social leadership, social tolerance, social maturity, social skills, and overall skills. CONCLUSION: The study concludes that COAs have low level of social competence.

Quality of life among people living with HIV/AIDS and its predictors: A cross-sectional study at ART center, Bagalkot, Karnataka.

BACKGROUND: Human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) emerged as one of the most important public health issues of the late twentieth and early twenty- first centuries. Quality of life (QoL) of people living with HIV/AIDS (PLHIV) is affected by multiple variables including depression as a major predictor of QoL. AIMS: To assess the QoL of PLHIV and its predictors. SETTINGS AND DESIGN: This cross-sectional study included a sample of 450 PLHIV attending the ART center, District Government Hospital, Bagalkot. METHODS AND MATERIALS: Data were collected using self-report method and Hospital's records. Tools used for data collection included sociodemographic questionnaire, WHOQOLHIV-BREF scale, and Centre for Epidemiologic Studies Depression Scale (CES-D Scale). Bivariate associations were observed through Pearson's correlations, analysis of variance (ANOVA), and t-tests. Multiple linear regression analysis was performed to find the significant predictors of QoL. RESULTS: Findings revealed a significant negative correlation between the QoL and depression (r = -0.751, P < 0.001). A significant regression equation was found (F14, 435= 57.76, P < 0.001, adjusted R 2 = 0.64) when all the variables are considered together for finding the significant predictors of the QoL. Male gender, being graduated, not knowing the mode of transmission have positively predicted the QoL. On the other hand, having primary education, being in nuclear family, having HIV-positive wife, having HIV-positive children, HIV infection through homosexual relationships, history of suicidal attempts, and history of alcohol intake negatively predicted the QoL of PLHIV. Depression was the strongest negative predictor of the QoL of PLHIV (ß = -0.672, P < 0.001). CONCLUSIONS: Interventions aimed at management of depression among PLHIV attending the ART centers would result in enhancing their QoL.