Psychosis Literacy Among Latinos With First-Episode Psychosis and Their Caregivers.

OBJECTIVE: The study examined psychosis literacy among Latinos with first-episode psychosis (FEP) and their caregivers. The authors tested a model that knowledge of psychosis and attribution of illness to psychosis predicted professional help seeking in a cross-sectional design. METHODS: The sample (N=148) consisted of 79 Latino consumers who met criteria for a clinical diagnosis of a psychotic disorder and 69 family caregivers. Participants watched a four-minute narrative about a woman with psychosis and were asked to identify the symptoms of serious mental illness (knowledge of psychosis), describe the character's problem and whether she had a serious mental illness (illness attribution), and offer suggestions about what the parents should do (help seeking). Responses to the open-ended questions were reliably coded by two trained raters. RESULTS: Consumers reported low psychosis literacy across all indices (e.g., only 8% included delusions in their knowledge of serious mental illness). Compared with consumers, caregivers reported significantly greater psychosis literacy across most indices, although relatively few reported knowledge of delusions (28%) and disorganized speech (36%). Logistic regression analyses found that caregivers were more than twice as likely as consumers to suggest that the parents seek professional help. Among both consumers and caregivers, greater knowledge of psychosis and attribution of symptoms to serious mental illness were associated with increased likelihood of recommending professional help seeking. CONCLUSIONS: Community campaigns and psychoeducation interventions within clinical settings are needed to improve psychosis literacy among Latinos with FEP. Increasing knowledge of psychosis and facilitating attributions of psychotic symptoms to serious mental illness have the potential to promote professional help seeking.

Report on ISCTM Consensus Meeting on Clinical Assessment of Response to Treatment of Cognitive Impairment in Schizophrenia.

If treatments for cognitive impairment are to be utilized successfully, clinicians must be able to determine whether they are effective and which patients should receive them. In order to develop consensus on these issues, the International Society for CNS Clinical Trials and Methodology (ISCTM) held a meeting of experts on March 20, 2014, in Washington, DC. Consensus was reached on several important issues. Cognitive impairment and functional disability were viewed as equally important treatment targets. The group supported the notion that sufficient data are not available to exclude patients from available treatments on the basis of age, severity of cognitive impairment, severity of positive symptoms, or the potential to benefit functionally from treatment. The group reached consensus that cognitive remediation is likely to provide substantial benefits in combination with procognitive medications, although a substantial minority believed that medications can be administered without nonpharmacological therapy. There was little consensus on the best methods for assessing cognitive change in clinical practice. Some participants supported the view that performance-based measures are essential for measurement of cognitive change; others pointed to their cost and time requirements as evidence of impracticality. Interview-based measures of cognitive and functional change were viewed as more practical, but lacking validity without informant involvement or frequent contact from clinicians. The lack of consensus on assessment methods was viewed as attributable to differences in experience and education among key stakeholders and significant gaps in available empirical data. Research on the reliability, validity, sensitivity, and practicality of competing methods will facilitate consensus.

GAP-REACH: a checklist to assess comprehensive reporting of race, ethnicity, and culture in psychiatric publications.

Growing awareness of health and health care disparities highlights the importance of including information about race, ethnicity, and culture (REC) in health research. Reporting of REC factors in research publications, however, is notoriously imprecise and unsystematic. This article describes the development of a checklist to assess the comprehensiveness and the applicability of REC factor reporting in psychiatric research publications. The 16-item GAP-REACH checklist was developed through a rigorous process of expert consensus, empirical content analysis in a sample of publications (N = 1205), and interrater reliability (IRR) assessment (N = 30). The items assess each section in the conventional structure of a health research article. Data from the assessment may be considered on an item-by-item basis or as a total score ranging from 0% to 100%. The final checklist has excellent IRR (κ = 0.91). The GAP-REACH may be used by multiple research stakeholders to assess the scope of REC reporting in a research article.

A qualitative inquiry into the Taiwanese mentally ill persons' difficulties living in the community.

Community care has been a paradigm shift for psychiatric treatment worldwide; however, it has not been successfully implemented in many developing countries, including Taiwan. This qualitative study aimed to explore the Taiwanese mentally ill persons' difficulties living in the community. Social disadvantages and illness adaptation were recognized as two domains of difficulties encountered by Taiwanese mentally ill patients living in the community, while six themes were identified: getting a "shameful" illness, unmet needs for community care, being overcome by a distorted world, denying the illness, living with the illness, and adapting to changed level of functioning. Related cultural issues were also discussed.

Research issues for improving treatment of U.S. Hispanics with persistent mental disorders.

This article reports on the outcome of an expert consensus meeting in August 2005 sponsored by the National Institute of Mental Health, which assembled 15 senior researchers with a background in treatment and services research with the Hispanic population. The purpose of the workshop was to identify research issues most pertinent for improving quality and effectiveness of treatment for Hispanics experiencing persistent mental disorders, defined as psychiatric syndromes that are of sufficient severity and duration to cause long-term impairment in social and occupational functioning and significant disability. The spectrum of ideas and recommendations advanced at the one-day meeting was wide and overlapping; therefore, the rich body of material was subsequently organized into five topics: diagnosis, quality of care and culturally appropriate services, psychosocial intervention development, psychopharmacologic interventions, and access to care. Although the authors recognize that the review was broad and the agenda presented is ambitious and in many instances generalizes to priority areas in overall mental health services and treatment research, the recommendations are intended to stimulate research for addressing the unique problems and research deficits that affect Hispanics with persistent mental disorders.

Disease management in Latinos with schizophrenia: a family-assisted, skills training approach.

This study evaluated the effectiveness of a skills training program designed to teach disease management to Latinos with schizophrenia treated at a community mental health center. Ninety-two Latino outpatients with schizophrenia and their designated relatives were randomly assigned to 3 months of skills training (ST) versus customary outpatient care (CC) and followed for a total of 9 months. The skills training approach was culturally adapted mainly by including the active participation of key relatives to facilitate acquisition and generalization of disease management skills into the patients' natural environment. There was a significant advantage for the ST group over the CC group on several symptom measures, skill acquisition and generalization, level of functioning, and rates of rehospitalization. There were no significant differences between the groups on quality of life or caregiver burden. Skills training had a direct effect on skill acquisition and generalization, and utilization of disease management skills led to decreased rates of rehospitalization. Incorporating an intensive, culturally relevant generalization effort into skills training for Latinos with schizophrenia appeared to be effective in teaching disease management and viable in a community mental health center.