Efficacy of technology-based interventions in psychosis: a systematic review and network meta-analysis.

BACKGROUND: Technology-based interventions (TBIs) are a useful approach when attempting to provide therapy to more patients with psychosis. METHODS: Randomized controlled trials of outcomes of TBIs v. face-to-face interventions in psychosis were identified in a systematic search conducted in PubMed/Ovid MEDLINE. Data were extracted independently by two researchers, and standardized mean changes were pooled using a three-level model and network meta-analysis. RESULTS: Fifty-eight studies were included. TBIs complementing treatment as usual (TAU) were generally superior to face-to-face interventions (g = 0.16, p ≤ 0.0001) and to specific outcomes, namely, neurocognition (g = 0.13, p ≤ 0.0001), functioning (g = 0.25, p = 0.006), and social cognition (g = 0.32, p ≤ 0.05). Based on the network meta-analysis, the effect of two TBIs differed significantly from zero; these were the TBIs cognitive training for the neurocognitive outcome [g = 0.16; 95% confidence interval (CI) 0.09-0.23] and cognitive behavioral therapy for quality of life (g = 1.27; 95% CI 0.46-2.08). The variables educational level, type of medication, frequency of the intervention, and contact during the intervention moderated the effectiveness of TBIs over face-to-face interventions in neurocognition and symptomatology. CONCLUSIONS: TBIs are effective for the management of neurocognition, symptomatology, functioning, social cognition, and quality of life outcomes in patients with psychosis. The results of the network meta-analysis showed the efficacy of some TBIs for neurocognition, symptomatology, and quality of life. Therefore, TBIs should be considered a complement to TAU in patients with psychosis.

Cognitive behavioural therapy plus standard care versus standard care for persistent aggressive behaviour or agitation in people with schizophrenia.

BACKGROUND: Schizophrenia and other psychoses are thought to be associated with a substantial increase in aggressive behaviour, violence and violent offending. However, acts of aggression or violence committed by people with severe mental illness are rare and circumscribed to a small minority of individuals. We know little about the frequency and variability of violent episodes for people with schizophrenia who present chronic or recurrent aggressive episodes, and of available interventions to reduce such problems. A psychological intervention, cognitive behavioural therapy (CBT), aims to challenge dysfunctional thoughts and has been used since the mid-1970s to improve mental health and emotional disorders. CBT includes different interventional procedures, such as cognitive therapy, elements of behavioural therapy, problem-solving interventions, and coping skills training, among others. Although CBT presents much diversity, interventions are characteristically problem-focused, goal-directed, future-oriented, time-limited (about 12 to 20 sessions over four to six months), and empirically based. CBT has shown clinically beneficial effects in persistent positive and negative symptoms of schizophrenia and its use as an add-on therapy to medication in the treatment of schizophrenia is supported by treatment guidelines. However, several Cochrane Reviews recently concluded that, due to the low quality of evidence available, no firm conclusions can currently be made regarding the effectiveness of adding CBT to standard care for people with schizophrenia, or about CBT compared to other psychosocial treatments for people with schizophrenia. Whereas CBT is not an emergency or crisis intervention that acts immediately on the known or unknown triggers underlying aggressive behaviour, might be a timely treatment used to manage persistent aggression or repeated aggressive episodes in people with schizophrenia. OBJECTIVES: To assess the efficacy and safety of cognitive behavioural therapy (CBT) plus standard care versus standard care alone for people with schizophrenia and persistent aggression. SEARCH METHODS: On 18 January 2023, we searched the Cochrane Schizophrenia Group's Study-Based Register of Trials which is based on CENTRAL, CINAHL, ClinicalTrials.Gov, Embase, ISRCTN, MEDLINE, PsycINFO, PubMed, and WHO ICTRP. We also inspected references of all identified studies for more studies. SELECTION CRITERIA: All randomised controlled trials comparing CBT plus standard care with standard care alone for people with schizophrenia and persistent aggression. DATA COLLECTION AND ANALYSIS: We independently inspected citations, selected studies, extracted data and appraised study quality. For binary outcomes, we calculated risk ratios (RR) and their 95% confidence intervals (CIs). For continuous outcomes we calculated mean differences (MD) and their 95%CIs for outcomes reported with the same measurement scale. Post hoc, for counts over person-time outcomes, we calculated incidence rate ratios (IRRs) and their 95%CIs. If feasible, we combined study outcomes with the random-effects model. We assessed the risk of bias for included studies and created a summary of findings table using the GRADE approach. MAIN RESULTS: We included two studies with 184 participants with psychotic disorder (mainly schizophrenia) and violence. The studies were run in forensic units and prison. Both studies were at high risk of bias on blinding (performance and detection bias). CBT plus standard care as compared with standard care may result in little to no difference in the frequency of physical violence at end of trial (IRR 0.52; 95% CI 0.23 to 1.18) and follow-up (IRR 0.86; 95% CI 0.44 to 1.68). The confidence interval did not exclude the null effect, and the certainty of the evidence is very low due to lack of blinding and to the small sample size. One study reported no deaths in both arms and zero serious and other adverse events. The other study did not report any figure for deaths or adverse events. CBT plus standard care as compared with standard care may result in little to no difference in leaving the study early for any reason (RR 1.04; 95% CI 0.53 to 2.00). Confidence interval did not exclude the null effect and the certainty of the evidence is low due to lack of blinding and the small sample size. AUTHORS' CONCLUSIONS: Whereas the evidence from only two studies with 184 participants suggests the use of CBT plus standard care may reduce some aggressive behaviours in patients with schizophrenia, the grading of the certainty of the evidence is very low. It implies that there is not yet reliable evidence to guide clinical decisions and therefore more evidence is needed to get a more precise estimate of the effect of the intervention. Currently, we have very little confidence in the effect estimate, and the true effect could be substantially different from its estimate.

Burnout Syndrome Among Catholic Clergy: A Systematic Review.

Burnout syndrome implies exhaustion, loss of motivation, low performance, and absenteeism. Catholic clergy are not exempt. This systematic review compiles and analyzes evidence related to burnout in Catholic clergy and potential modulating variables. Following the PRISMA methodology, systematic searches in different scientific databases identified 17 studies, revealing that burnout is related to age, personality traits, and type of priesthood. No relation between burnout and social support, self-care, spiritual practice, or workload was detected. It is necessary to adapt conceptual models to the peculiarities of burnout among clergy, extending assessment strategies and introducing working and organizational perspectives in the analysis of modulating variables, and in the development of prevention and intervention programs.

Remotely delivered information, training and support for informal caregivers of people with dementia.

BACKGROUND: Many people with dementia are cared for at home by unpaid informal caregivers, usually family members. Caregivers may experience a range of physical, emotional, financial and social harms, which are often described collectively as caregiver burden. The degree of burden experienced is associated with characteristics of the caregiver, such as gender, and characteristics of the person with dementia, such as dementia stage, and the presence of behavioural problems or neuropsychiatric disturbances. It is a strong predictor of admission to residential care for people with dementia. Psychoeducational interventions might prevent or reduce caregiver burden. Overall, they are intended to improve caregivers' knowledge about the disease and its care; to increase caregivers' sense of competence and their ability to cope with difficult situations; to relieve feelings of isolation and allow caregivers to attend to their own emotional and physical needs. These interventions are heterogeneous, varying in their theoretical framework, components, and delivery formats. Interventions that are delivered remotely, using printed materials, telephone or video technologies, may be particularly suitable for caregivers who have difficulty accessing face-to-face services because of their own health problems, poor access to transport, or absence of substitute care. During the COVID-19 pandemic, containment measures in many countries required people to be isolated in their homes, including people with dementia and their family carers. In such circumstances, there is no alternative to remote delivery of interventions. OBJECTIVES: To assess the efficacy and acceptability of remotely delivered interventions aiming to reduce burden and improve mood and quality of life of informal caregivers of people with dementia. SEARCH METHODS: We searched the Specialised Register of the Cochrane Dementia and Cognitive Improvement Group, MEDLINE, Embase and four other databases, as well as two international trials registries, on 10 April 2020. We also examined the bibliographies of relevant review papers and published trials. SELECTION CRITERIA: We included only randomised controlled trials that assessed the remote delivery of structured interventions for informal caregivers who were providing care for people with dementia living at home. Caregivers had to be unpaid adults (relatives or members of the person's community). The interventions could be delivered using printed materials, the telephone, the Internet or a mixture of these, but could not involve any face-to-face contact with professionals. We categorised intervention components as information, training or support. Information interventions included two key elements: (i) they provided standardised information, and (ii) the caregiver played a passive role. Support interventions promoted interaction with other people (professionals or peers). Training interventions trained caregivers in practical skills to manage care. We excluded interventions that were primarily individual psychotherapy. Our primary outcomes were caregiver burden, mood, health-related quality of life and dropout for any reason. Secondary outcomes were caregiver knowledge and skills, use of health and social care resources, admission of the person with dementia to institutional care, and quality of life of the person with dementia. DATA COLLECTION AND ANALYSIS: Study selection, data extraction and assessment of the risk of bias in included studies were done independently by two review authors. We used the Template for Intervention Description and Replication (TIDieR) to describe the interventions. We conducted meta-analyses using a random-effects model to derive estimates of effect size. We used GRADE methods to describe our degree of certainty about effect estimates. MAIN RESULTS: We included 26 studies in this review (2367 participants). We compared (1) interventions involving training, support or both, with or without information (experimental interventions) with usual treatment, waiting list or attention control (12 studies, 944 participants); and (2) the same experimental interventions with provision of information alone (14 studies, 1423 participants). We downgraded evidence for study limitations and, for some outcomes, for inconsistency between studies. There was a frequent risk of bias from self-rating of subjective outcomes by participants who were not blind to the intervention. Randomisation methods were not always well-reported and there was potential for attrition bias in some studies. Therefore, all evidence was of moderate or low certainty. In the comparison of experimental interventions with usual treatment, waiting list or attention control, we found that the experimental interventions probably have little or no effect on caregiver burden (nine studies, 597 participants; standardised mean difference (SMD) -0.06, 95% confidence interval (CI) -0.35 to 0.23); depressive symptoms (eight studies, 638 participants; SMD -0.05, 95% CI -0.22 to 0.12); or health-related quality of life (two studies, 311 participants; SMD 0.10, 95% CI -0.13 to 0.32). The experimental interventions probably result in little or no difference in dropout for any reason (eight studies, 661 participants; risk ratio (RR) 1.15, 95% CI 0.87 to 1.53). In the comparison of experimental interventions with a control condition of information alone, we found that experimental interventions may result in a slight reduction in caregiver burden (nine studies, 650 participants; SMD -0.24, 95% CI -0.51 to 0.04); probably result in a slight improvement in depressive symptoms (11 studies, 1100 participants; SMD -0.25, 95% CI -0.43 to -0.06); may result in little or no difference in caregiver health-related quality of life (two studies, 257 participants; SMD -0.03, 95% CI -0.28 to 0.21); and probably result in an increase in dropouts for any reason (12 studies, 1266 participants; RR 1.51, 95% CI 1.04 to 2.20). AUTHORS' CONCLUSIONS: Remotely delivered interventions including support, training or both, with or without information, may slightly reduce caregiver burden and improve caregiver depressive symptoms when compared with provision of information alone, but not when compared with usual treatment, waiting list or attention control. They seem to make little or no difference to health-related quality of life. Caregivers receiving training or support were more likely than those receiving information alone to drop out of the studies, which might limit applicability. The efficacy of these interventions may depend on the nature and availability of usual services in the study settings.

ANTECEDENTES: Muchas personas con demencia son atendidas en casa por cuidadores informales no remunerados, generalmente miembros de la familia. Los cuidadores pueden sufrir una serie de efectos perjudiciales físicos, emocionales, económicos y sociales, que a menudo se describen colectivamente como una carga para el cuidador. El grado de carga que se experimenta está asociado con las características del cuidador, como el género, y con las características de la persona con demencia, como la etapa de la demencia, y la presencia de problemas de comportamiento o trastornos neuropsiquiátricos. Es un fuerte predictor del ingreso en una residencia para personas con demencia. Las intervenciones psicoeducativas pueden prevenir o reducir la carga del cuidador. En general, tienen como objetivo mejorar los conocimientos de los cuidadores sobre la enfermedad y su cuidado; aumentar el sentido de competencia de los cuidadores y su capacidad para afrontar situaciones difíciles; aliviar los sentimientos de aislamiento y permitir que los cuidadores atiendan sus propias necesidades emocionales y físicas. Estas intervenciones son heterogéneas y varían en su marco teórico, sus componentes y sus formatos de administración. Las intervenciones que se realizan a distancia, utilizando material impreso, el teléfono o las tecnologías de vídeo, pueden ser particularmente adecuadas para los cuidadores que tienen dificultades para acceder a los servicios de forma presencial debido a sus propios problemas de salud, al escaso acceso al transporte o a la falta de un cuidado alternativo. Durante la pandemia de covid­19, las medidas de contención en muchos países exigían que las personas estuvieran aisladas en sus hogares, incluidas las personas con demencia y sus familiares cuidadores. En tales circunstancias, no hay alternativa a la realización de intervenciones a distancia. OBJETIVOS: Evaluar la eficacia y la aceptabilidad de las intervenciones realizadas a distancia con el fin de reducir la carga y mejorar el estado de ánimo y la calidad de vida de los cuidadores informales de personas con demencia. MÉTODOS DE BÚSQUEDA: El 10 de abril de 2020 se realizaron búsquedas en el Registro especializado del Grupo Cochrane de Demencia y trastornos cognitivos (Cochrane Dementia and Cognitive Improvement Group), MEDLINE, Embase y otras cuatro bases de datos, así como en dos registros internacionales de ensayos. También se examinaron las bibliografías de documentos de revisión pertinentes y de ensayos publicados. CRITERIOS DE SELECCIÓN: Sólo se incluyeron los ensayos controlados aleatorizados que evaluaron la administración a distancia de intervenciones estructuradas para los cuidadores informales que atendían a personas con demencia que vivían en el domicilio. Los cuidadores debían ser adultos no remunerados (parientes o miembros de la comunidad de la persona). Las intervenciones se podían realizar utilizando materiales impresos, el teléfono, la internet o una mezcla de estos, pero no podían implicar un contacto presencial con profesionales. Los componentes de la intervención se clasificaron como información, formación o apoyo. Las intervenciones de información incluyeron dos elementos clave: i) proporcionaron información estandarizada, y ii) el cuidador desempeñaba un papel pasivo. Las intervenciones de apoyo promovieron la interacción con otras personas (profesionales o iguales). Las intervenciones de formación entrenaron a los cuidadores en habilidades prácticas para proporcionar la atención. Se excluyeron las intervenciones que consistieron principalmente en psicoterapia individual. Los desenlaces principales fueron la carga del cuidador, el estado de ánimo, la calidad de vida relacionada con la salud y el abandono por cualquier motivo. Los desenlaces secundarios fueron los conocimientos y aptitudes de los cuidadores, la utilización de los recursos de atención sanitaria y social, el ingreso de la persona con demencia en una institución y la calidad de vida de la persona con demencia. OBTENCIÓN Y ANÁLISIS DE LOS DATOS: Dos autores de la revisión realizaron de forma independiente la selección de los estudios, la extracción de los datos y la evaluación del riesgo de sesgo de los estudios incluidos. Se utilizó la Template for Intervention Description and Replication (TIDieR) para describir las intervenciones. Los metanálisis se realizaron mediante un modelo de efectos aleatorios para obtener las estimaciones del tamaño del efecto. Se utilizaron los métodos GRADE para describir el grado de certeza sobre las estimaciones del efecto. RESULTADOS PRINCIPALES: En esta revisión se incluyeron 26 estudios (2367 participantes). Se compararon (1) las intervenciones que incluyeron formación, apoyo o ambos, con o sin información (intervenciones experimentales) con el tratamiento habitual, una lista de espera o el control de la atención (12 estudios, 944 participantes); y (2) las mismas intervenciones experimentales con el suministro de información solamente (14 estudios, 1423 participantes). La calidad de la evidencia se redujo por las limitaciones de los estudios y, en el caso de algunos desenlaces, por la falta de consistencia entre los estudios. Hubo un riesgo frecuente de sesgo debido a la autocalificación de los desenlaces subjetivos por parte de participantes que no estaban cegados a la intervención. Los métodos de asignación al azar no siempre se informaron bien y hubo un posible sesgo de desgaste en algunos estudios. Por lo tanto, toda la evidencia fue de certeza moderada o baja. En la comparación de las intervenciones experimentales con el tratamiento habitual, una lista de espera o el control de la atención, se encontró que las intervenciones experimentales probablemente tienen poco o ningún efecto sobre la carga del cuidador (nueve estudios, 597 participantes; diferencia de medias estandarizada [DME] ­0,06; intervalo de confianza [IC] del 95%: ­0,35 a 0,23); los síntomas depresivos (ocho estudios, 638 participantes; DME ­0,05; IC del 95%: ­0,22 a 0,12) o la calidad de vida relacionada con la salud (dos estudios, 311 participantes; DME 0,10; IC del 95%: ­0,13 a 0,32). Las intervenciones experimentales probablemente dan lugar a poca o ninguna diferencia en el abandono por cualquier motivo (ocho estudios, 661 participantes; razón de riesgos [RR] 1,15; IC del 95%: 0,87 a 1,53). En la comparación de las intervenciones experimentales con una condición control de información sola, se encontró que las intervenciones experimentales pueden dar lugar a una leve reducción de la carga del cuidador (nueve estudios, 650 participantes; DME ­0,24; IC del 95%: ­0,51 a 0,04); probablemente dan lugar a una leve mejoría de los síntomas depresivos (11 estudios, 1100 participantes; DME ­0,25; IC del 95%: ­0,43 a ­0,06); podrían dar lugar a poca o ninguna diferencia en la calidad de vida relacionada con la salud de los cuidadores (dos estudios, 257 participantes; DME ­0,03; IC del 95%: ­0,28 a 0,21); y probablemente dé lugar a un aumento de los abandonos por cualquier motivo (12 estudios, 1266 participantes; RR 1,51; IC del 95%: 1,04 a 2,20). CONCLUSIONES DE LOS AUTORES: Las intervenciones realizadas a distancia, como el apoyo, la formación o ambas, con o sin información, podrían reducir ligeramente la carga del cuidador y mejorar los síntomas depresivos del cuidador en comparación con el suministro de información únicamente, pero no en comparación con el tratamiento habitual, una lista de espera o el control de la atención. Parecen dar lugar a poca o ninguna diferencia en la calidad de vida relacionada con la salud. Los cuidadores que recibieron formación o apoyo tuvieron más probabilidades de abandonar los estudios que los que recibieron sólo información, lo que podría limitar la aplicabilidad. La eficacia de esas intervenciones puede depender de la naturaleza y la disponibilidad de los servicios habituales en los ámbitos de estudio.

The relationship between allergic diseases and internalising and externalising behaviours in Spanish children: A cross-sectional study.

INTRODUCTION AND OBJECTIVES: The relationship between allergic diseases and behavioural disorders is still unclear. The objective of this study was to describe and compare children's behaviour (internalising and externalising) across a sample of children aged 6-11 years with and without allergic diseases. MATERIALS AND METHODS: This was a cross-sectional observational case-control study. A survey to 366 families (194 allergic cases and 172 controls), including a child behaviour checklist (CBCL) and a socio-demographic questionnaire with questions related to family, school education, health conditions and allergy symptoms, was administered. RESULTS: Children with a diagnosis of allergy showed higher scores in the overall CBCL score (standardised mean differences [SMD] = 0.47; confidence intervals [CI]: 0.26-0.68) and in the internalising and externalising factors (SMD = 0.52 and SMD = 0.36, respectively) than non-allergic children. Odds ratio (OR) analyses showed a higher risk (OR = 2.76; 95% CI [1.61 to 4.72]) of developing a behavioural difficulty in children diagnosed with allergies. Age and level of asthma appear as modulatory variables. CONCLUSIONS: Children aged 6-11 years diagnosed with allergies showed larger behavioural problems than non-allergic children, especially in the case of internalising behaviours. These findings suggest the importance of attending to them and treating them in the early stages of diagnosis to avoid future psychological disorders.

Neurocognition functioning as a prerequisite to intact social cognition in schizophrenia.

Introduction: There are mixed findings regarding the relationships between neurocognition and social cognition in schizophrenia. This study aims to provide new empirical evidence to help determine the relationships between these constructs in schizophrenia.Methods: 299 stabilised patients with schizophrenia aged 18-65 years old were recruited. After having into account exclusion criteria, final sample was contained 284 patients. The Emotion Recognition Assessment Test (ERAT) was used to assess six basic emotions. To assess the theory of mind (ToM), the Hinting Task and the Faux-Pas Test were used, and the Screen for Cognitive Impairment in Psychiatry (SCIP) was administered to assess cognitive functioning. Bivariate and multivariate analyses (partial correlations, canonical correlation, regression analysis, and confirmatory and exploratory factor analysis) were conducted.Results: Statistically significant relationships were found between the subtests of the SCIP and social cognitive measures. The redundancy coefficient in the canonical analysis was 0.13. The CFA analysis showed that the best model has a two-factor structure, in which neurocognition and social cognition are correlated factors. Less than 10% of patients with impaired cognitive functioning have a performance within normal range on social cognition tests.Conclusions: The findings show that neurocognition and social cognition are independent but related constructs.

Assessing irritability in patients with stroke: psychometric properties of the Irritability Questionnaire.

Objective: Irritability is a very common symptom after stroke and a source of a great deal of distress to patients and caretakers. We evaluated the psychometric properties of the Irritability Questionnaire (IQ) in a sample of patients with stroke.Methods: we recruited 94 participants (47 stroke patients and 47 healthy controls) that participated in a 6-month longitudinal observational study. The IQ includes three dimensions in the assessment: emotion, cognition, and behavior. IQ has two subscales: The Irritability Questionnaire (IRQ) and the Carer's Irritability Questionnaire (CIRQ). Internal consistency, convergent validity, and sensitivity to change were evaluated for both IRQ and CIRQ.Results: Cronbach's alpha for the IRQ was 0.91 (95% CI: 0.76 to 0.87), whereas for the CIRQ was 0.92 (95% CI: 0.89 to 0.94). Convergent validity was good for both subscales. IRQ did not show sensitivity to change at 6 months (p-value = 0.99), while CIRQ showed moderate changes (-0.29, p-value = 0.124).Conclusions: IQ presented good psychometric properties to assess irritability in stroke. The tool detected significant differences between groups (stroke and healthy controls) and can be considered a valid instrument for clinical and research purposes.

Mental health professionals' attitudes towards mental illness: professional and cultural factors in the INTER NOS study.

BACKGROUND: Research shows that personnel working in mental health facilities may share some of the societal prejudices towards mental illness. This might result in stigmatizing behaviours towards people suffering from mental disorders, undermining the quality of their care. AIMS: To describe and compare attitudes towards mental illness across a sample of professionals working in a wide range of mental health facilities in Spain, Portugal and Italy. METHOD: We administered a survey to personnel including two questionnaires related to stigmatizing attitudes: The Community Attitudes toward the Mentally Ill (CAMI) and the Attribution Questionnaire (AQ-27). Data were compared according to professional category, work setting and country. RESULTS: 34.06% (1525) professionals of the surveyed population responded adequately. Psychologists and social therapists had the most positive attitudes, and nursing assistants the most negative, on most factors of CAMI and AQ-27. Community staff had more positive attitudes than hospital-based professionals in most factors on CAMI and in discriminatory responses on AQ-27. CONCLUSIONS: Globally, mental health professionals showed a positive attitude towards mental illness, but also a relative support to coercive treatments. There are differences in attitudes modulated by professional category and setting. Results can guide preventive strategies, particularly for the hospital-based and nursing staff.

Assessment of the consequences of caregiving in psychosis: a psychometric comparison of the Zarit Burden Interview (ZBI) and the Involvement Evaluation Questionnaire (IEQ).

BACKGROUND: The Zarit Burden Interview (ZBI) was originally developed to assess the level of subjective burden in caregivers of people with dementia. The Involvement Evaluation Questionnaire (IEQ) is amongst the leading scales to assess caregiving consequences in severe mental illness. We aimed to compare the psychometric properties of the ZBI, a generic tool, and of the IEQ, a more specific tool to assess the consequences of caregiving in schizophrenia and related disorders. METHODS: Secondary analyses of a 16-week, randomized controlled trial of a psychoeducational intervention in 223 primary caregivers of patients with schizophrenia or schizoaffective disorder. Psychometric properties (internal consistency, convergent and discriminative validity, and sensitivity to change) were evaluated for both ZBI and IEQ. RESULTS: Internal consistency was good and similar for both scales (ZBI: 0.91, 95% CI: 0.89, 0.94; IEQ: 0.86, 95% CI: 0.83, 0.89). Convergent validity was relevant for similar domains (e.g. ZBI total score vs IEQ-tension r = 0.69, 95% CI: 0.61, 0.75) and at least moderate for the rest of domains (ZBI total score, personal strain and role strain vs IEQ-urging and supervision). Discriminative validity against psychological distress and depressive symptoms was good (Area Under the Curve [AUC]: 0.77, 95% CI: 0.71, 0.83; and 0.69, 95% CI: 0.63, 0.78 - for ZBI against GHQ-28 and CES-D respectively; and AUC: 0.72, 95% CI: 0.65, 0.78; and 0.69, 95% CI: 0.62, 0.77 - for IEQ against GHQ-28 and CES-D respectively). AUCs against the reference criteria did not differ significantly between the two scales. After the intervention, both scales showed a significant decrease at endpoint (p-values < 0.001) with similar standardised effect sizes for change (-0.36, 95% CI: -0.58, -0.15 - for ZBI; -0.39, 95% CI: -0.60, -0.18 - for IEQ). CONCLUSIONS: Both ZBI and IEQ have shown satisfactory psychometric properties to assess caregiver burden in this sample. We provided further evidence on the performance of the ZBI as a general measure of subjective burden. TRIAL REGISTRATION: ( ISRCTN32545295 ).

Efficacy of MLC601 on functional recovery after stroke: A systematic review and meta-analysis of randomized controlled trials.

BACKGROUND AND PURPOSE: Traditional Chinese medicine (TCM) MLC601 has shown promising results on functional recovery of patients after stroke. This study aimed to evaluate the pooled effect of its efficacy. METHODS: Systematic review and meta-analysis of randomized controlled trials (RCTs) assessing efficacy of MLC601 vs other TCM compounds or placebo. The pooled effect was the relative risk (RR) combined by random effects model. A prediction effect interval was estimated for new studies and a cumulative meta-analysis was performed. RESULTS: Four studies comprising five RCTs were included. The pooled RR was 1.64 (95% CI = 1.05-2.57; p-value = 0.031) favouring MLC601, but heterogeneity was large (I(2) = 80%; Q-test p-value = 0.0005). Therefore, the prediction interval was wide and consistent with a null effect (RR range = 0.36-7.45). The cumulative meta-analysis showed a decreasing pattern of effect size through time, with higher effects for trials comparing MLC601 vs other TCM and a systematic decrease of the pooled effect when including later trials comparing MLC601 vs placebo. CONCLUSIONS: Evidence on the efficacy of MLC601 has decreased over time and when the comparison arm is placebo instead of other TCM compound. Current evidence suggests MLC601 does not outperform placebo on functional recovery after stroke.

A retrospective study of nursing diagnoses, outcomes, and interventions for patients with mental disorders.

AIM: The aim of this study is to describe the most frequent NANDA-I nursing diagnoses, NOC outcomes, and NIC interventions used in nursing care plans in relation to psychiatric diagnosis. BACKGROUND: Although numerous studies have described the most prevalent NANDA-I, NIC and NOC labels in association with medical diagnosis in different specialties, only few connect these with psychiatric diagnoses. METHODS: This multicentric cross-sectional study was developed in Spain. Data were collected retrospectively from the electronic records of 690 psychiatric or psychogeriatric patients in long and medium-term units and, psychogeriatric day-care centres. RESULTS: The most common nursing diagnoses, interventions and outcomes were identified for patients with schizophrenia, organic mental disorders, mental retardation, affective disorders, disorders of adult personality and behavior, mental and behavioural disorders due to psychoactive substance use and neurotic, stress-related and somatoform disorders. CONCLUSION: Results suggest that NANDA-I, NIC and NOC labels combined with psychiatric diagnosis offer a complete description of the patients' actual condition.

Effectiveness of a psychoeducational intervention group program in the reduction of the burden experienced by caregivers of patients with dementia: the EDUCA-II randomized trial.

We conducted a multicenter, prospective, evaluator-blinded, 2-arm parallel randomized trial to compare the effectiveness of a group psychoeducational intervention (PIP) with that of standard care in dementia caregivers. The primary outcome was the burden experience evaluated by the Zarit Burden Interview. Secondary outcomes were psychological distress evaluated with the scaled General Health Questionnaire-28 items, and quality of life evaluated with the Short-Form Health Survey 12. Effectiveness endpoint was at 4 months since inception. Statistical analyses used complete case and intention-to-treat analysis (ITT). The trial recruited 238 caregivers from 22 research sites (115 randomized to PIP, 123 randomized to standard care). No differences were found in the Zarit Burden Interview scores (complete case analysis: mean difference=-1.02, 95% confidence interval=-4.41 to 2.37; ITT analysis: MD=-0.55, 95% confidence interval=-3.64 to 2.55), the Short-Form Health Survey 12 domain scores (all P>0.05), and total General Health Questionnaire-28 items scores and some of its subscales (all P>0.05) except the anxiety and insomnia subscale for the ITT analysis (P=0.03). In summary, PIP in modality of group intervention was not better than standard care to reduce caregiver burden and overall psychological distress or to improve quality-of-life domains. EDUCA-II trial registry: ISRCTN14411440.

Interventions for caregivers of patients with dementia.

INTRODUCTION: With the aging of the population, an increasing number of people have dementia, most of whom are receiving home care. Caregivers are exposed to a variety of stressors, which may lead to feeling burdened, or to depression and anxiety. Various programs or structured interventions have been developed to prevent or lessen these negative consequences. The efficacy of these interventions is debated, mainly due to methodological differences between studies. Review studies so far have presented important discrepancies, thus perpetuating a lack of clarity regarding this important geriatric care problem. The effectiveness of interventions designed to prevent or reduce the burden and/or symptoms of anxiety and depression in informal caregivers are reviewed precisely and rigorously. METHODS: A systematic review of randomized controlled studies assessing the efficacy of structured interventions on the variables of burden, depression and anxiety in informal caregivers of patients with dementia. RESULTS: The literature search yielded 997 references, of which 35 met the screening criteria. Of these studies, 51.4% had results that were statistically favorable to intervention. The methodology used varied widely between studies. CONCLUSIONS: Overall, the available evidence favors the implementation of structured intervention programs, although the results are heterogeneous. Psychoeducational interventions yield better results and can be better adapted to the needs of caregivers.

Unidimensional 12-item Zarit Caregiver Burden Interview for the assessment of dementia caregivers' burden obtained by item response theory.

OBJECTIVES: To develop a one-dimensional version of the 22-item Zarit Caregiver Burden Interview (ZBI) by applying item response theory approaches. METHODS: The answers to the 22-item ZBI of 241 caregivers participating in a clinical trial were analyzed 1) with a Mokken nonparametric item response theory analysis to ascertain the dimensional structure underlying the scale and obtain a one-dimensional reduced version, 2) with the Samejima's graded response model to assess the item characteristics of the reduced version, and 3) with confirmatory factor analysis to confirm the unidimensionality of the reduced ZBI version and assess the item loadings to the burden latent variable. RESULTS: Mokken analysis resulted in a major one-dimensional scale comprising 12 items directly related with burden. All items showed scalability indices over 0.30. The scalability for the overall scale was 0.44 defining a medium scale according to Mokken's criteria. An unconstrained Samejima's graded response model showed appropriate fit, and most items of the reduced 12-item ZBI presented pertinent difficulty and discrimination parameters. The results of the 12-item ZBI confirmatory factor analysis fitted to a one-dimensional latent structure for burden (comparative fit index=0.975; root-mean-square error of approximation=0.067; weighted root mean square residual=0.677). All factor lodgings were above 0.40 with items 9 (strained by the relative) and 22 (overall feeling of burden) presenting the highest loadings. CONCLUSIONS: The reduced 12-item ZBI fits a one-dimensional latent variable of burden. Further psychometric studies, focusing on its equivalence for different populations, sensitivity to change, and minimal important difference are warranted.

Cognitive Enhancers in Schizophrenia: A Systematic Review and Meta-Analysis of Alpha-7 Nicotinic Acetylcholine Receptor Agonists for Cognitive Deficits and Negative Symptoms.

Background: Schizophrenia is a severe and enduring disease and is one of the leading causes of disability worldwide. Cognitive impairment is a core clinical symptom that plays a crucial role in functional outcomes and prognosis, thus making it a relevant treatment target. The aim of this study was to assess the efficacy of alpha-7 nicotinic acetylcholine receptor agonists (α7 nAChR) as adjunctive treatment to enhance cognition and ameliorate negative symptoms in patients with schizophrenia. Methods: A search strategy was developed for MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials up to May 2019. We included randomized controlled trials (RCTs) that compared antipsychotic treatment plus α7 nAChR agonists with antipsychotic treatment plus placebo and determined their effects on the main cognitive domains proposed by the MATRICS initiative and on negative symptoms. Two authors independently reviewed study eligibility and data extraction and assessed the risk of bias of the studies included. According to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework, we used a random-effects model and assessed the quality of the evidence. Results: Thirteen studies were included in the quantitative analysis. No differences were found in any of the cognitive domains assessed in four RCTs (n = 414). In contrast, nine RCTs (n = 978) presented a small effect in support of α7 nAChR agonists for negative symptoms [standardized mean difference -0.28, 95% CI (-0.56 to -0.00); P = 0.05], even though the confidence to support this evidence is low according to the GRADE system. Conclusions: Current evidence is too weak to consider α7 nAChR agonists as an effective add-on treatment to antipsychotics to enhance cognition and negative symptoms.

A randomized study on the efficacy of the Social Cognition Training Program-brief version in a sample of patients with schizophrenia.

OBJECTIVE: In recent years, various interventions have been developed to train social cognition in schizophrenia, which have been shown to be effective in improving emotional processing, theory of mind and social perception, as well as community functioning. One of these interventions is the Social Cognition Training Program (SCTP), a program consisting of 24 sessions. For the present study we developed a brief version of 12 sessions with the aim to improve its applicability. To evaluate the effectiveness of this version, a randomized controlled trial was conducted comparing the SCTP to a neurocognitive training. METHOD: The trial was conducted with a sample of 299 patients with schizophrenia, with assessments conducted at baseline, posttreatment, and 6- and 12-month follow up. The assessment protocol included tests of emotion recognition, theory of mind, attributional style, symptomatology, community functioning, and neurocognitive functioning. RESULTS: The results obtained showed that the patients of the experimental group improved in the recognition of the emotions of sadness, anger, and fear, and in the first- and second-order theory of mind. However, no significant improvement was observed in the measures of community functioning. Improvements in first- and second-order theory of mind but not emotion recognition persisted at follow ups. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Results obtained showed that deficits in social cognition can be ameliorated, although it could be necessary to have booster sessions to maintain the benefits of the training and to complement the SCPT with another type of interventions aimed specifically at transferring the benefits of social cognition training to "real" life. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Emotion recognition in patients with schizophrenia: The role of sex.

BACKGROUND: Despite the abundant research on emotion recognition in schizophrenia, there are still some issues about which there is no conclusive data. The present study examined one these issues: the role that sex plays in emotion recognition. METHOD: The sample consisted of 440 participants, 220 patients with schizophrenia and 220 controls. Measures of the six basic emotions, psychopathology, and cognitive functioning were taken. The data were analyzed by repeated measures analysis of variance. RESULTS: Controls perceived all emotions, except happiness, better than patients. In the patient group three main results were obtained: 1) men recognized disgust and neutral expressions better than women; 2) happiness and sadness were better recognized on female faces, while disgust and neutral expressions were better recognized on male faces; and 3) a significant interaction was seen between the stimulus sex and the participant sex only for the fear emotion. CONCLUSIONS: The results obtained support the hypothesis that deficits in the recognition of emotions is a core feature of schizophrenia that affects both men and women to the same extent. There is no clear pattern of interaction between the sex of the perceiver and the sex of the photograph used as a stimulus.

Efficacy of 5-nitroimidazole compounds for giardiasis in Cuban children: systematic review and meta-analysis.

Five-nitroimidazole (5-NI) compounds are among the most commonly used medications in the treatment of giardiasis. However, after more than five decades of their initial indication for such treatment, there are some concerns about the efficacy of 5-NIs in giardiasis. This study sought to compare the efficacy of any 5-NI with any other antigiardial drug for the treatment of Cuban children with giardiasis. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs). We searched CUMED, EBSCOhost and PubMed databases. Two reviewers independently assessed trial eligibility, trial quality and extracted appropriate data. The primary outcome was the parasitological cure. The effect estimate was the pooled relative risk (RR) with 95% confidence intervals (CI). We included seven RCTs in the systematic review, involving a total of 1046 children. When the effect of 5-NIs was compared with that of benzimidazole compounds, the pooled effect was significant and favored 5-NIs [the relative risk (RR) is 1.35, 95% CI =1.05 to 1.75], with high heterogeneity (4 studies, I2 =79%). Compared with chloroquine, the pooled effects of the 5-NIs were not significant [RR is 0.96, 95% CI=0.79 to 1.18, (2 studies, I2=68%)]. Our results support the use of 5-NIs (mainly tinidazole) as first-line therapy for Cuban pediatric patients infected with Giardia and may continue being used as reference drugs in future RCTs of giardiasis. These data could help inform policy decisions in Cuba. Caution is needed in extrapolating such data in other settings.

A systematic review of sex-based differences in effectiveness and adverse effects of clozapine.

Clozapine is one of the most widely used antipsychotics for treating psychiatric illnesses such as schizophrenia and bipolar disorder. This drug, however, is associated with adverse effects such as weight gain, metabolic syndrome, and blood dyscrasias. The manifestations of mental illness may differ between men and women. Yet, there is little evidence on the influence of sex on treatment response or the occurrence of AEs. To fill this gap of knowledge, we carried out a systematic review of the literature on sex differences in the effectiveness and adverse effects of clozapine. Scant evidence has been published on differences in effectiveness of clozapine between men and women. Indeed, to the best of our knowledge, this issue has only been addressed in a published study. Regarding adverse effects, males have been reported to be more likely to develop metabolic abnormalities such as cholesterol or triglycerides, hypertension, and cardiovascular risk, while females are at a higher risk for gaining weight, developing diabetes, and needing laxatives. Nevertheless, given the scarcity of sex-based studies on this drug, further studies are needed to explore sex-based differences, as the results obtained may be crucial to clinical practice and help improve the quality of life of patients.

Efficacy of a psychoeducational intervention in caregivers of people with intellectual disabilities: A randomized controlled trial (EDUCA-IV trial).

BACKGROUND: People with intellectual disabilities (ID) are usually cared for by their own parents, families or informal caregivers. Caring for a person with ID can have a negative impact on caregivers' mental health (burden, depression, anxiety). The main aim of the EDUCA-IV trial was testing the efficacy of a psychoeducational intervention program (PIP) versus standard practice and to see whether the PIP intervention would reduce the caregiver's burden at post-intervention (4 months) and at follow-up (8 months). METHOD: This was a multi-centre randomised controlled trial including 194 caregivers (96 randomised to PIP, 98 to control condition). PIP intervention consists of 12 weekly group sessions. The control group received treatment as usual. Primary outcomes measured included the Zarit Burden Interview (ZBI). Secondary outcomes were caregivers' mental health (GHQ-28), anxiety (STAI) and depression (CES-D). RESULTS: The decrease of ZBI scores was not significant at 4 months. There was significant decrease in the GHQ scores at 4 and 8 months. CES-D showed relevant results at follow-up. Intention to treat analyses showed similar results. CONCLUSIONS: The PIP intervention seems not to be effective reducing burden, but appears to have a positive result on general mental health. The program was well received and valued by caregivers.