Development of family resource indicators for people with schizophrenic disorder in community by modified Delphi method in Beijing, China.

INTRODUCTION: Most people with schizophrenia in China are supported by their family members in community. The patient's family is confronted with severe care burden and pressure, which directly affects the caregiver's own health and social life, and indirectly affects the patient's rehabilitation. Adequate family resources can reduce the burden and pressure on families. But there is an absence of systematic family resource indicators for people with schizophrenic disorder in China. OBJECTIVES: This study aimed to develop a set of family resource indicators for people with schizophrenic disorder in China. DESIGN: Preliminary family resource indicators were generated and refined by literature review and an expert consultation meeting. Two rounds of email-based Delphi survey were carried out to identify family resource indicators. SETTING: Two rounds of email-based Delphi survey were performed from July to September 2021 in Beijing, China. PARTICIPANTS: There were 15 mental health doctors from community health service centres and four psychiatrists from tertiary hospitals, and two primary care researchers from universities in the first and second rounds Delphi survey. RESULTS: All the 21 experts participated in both rounds of Delphi survey. A total of 46 indicators achieved consensus for inclusion in the final set of indicators after two rounds of Delphi survey. The final set of indicators was grouped into 10 domains: financial support (three indicators), psychological and spiritual support (eight indicators), medical treatment (three indicators), information and education (three indicators), structural support (two indicators), external family resources included social resources (five indicators), cultural resources (two indicators), economic resources (seven indicators), environmental resources (four indicators) and medical resources (nine indicators). CONCLUSIONS: A set of 46 family resource indicators for people with schizophrenic disorder in community was identified by an iterative Delphi process in Beijing, China. However, the indicators still need to be validated by testing in further studies.

A Group Intervention for Motivational Deficits: Preliminary Investigation of a Blended Care Approach Using Ambulatory Assessment.

Motivational deficits are an important predictor of functional outcomes in individuals with a serious mental illness such as schizophrenia and mood spectrum disorders. The aim of the present study was to explore the feasibility, acceptability, and preliminary efficacy of a group version of "Switch," an intervention that targets motivational deficits, enriched with an ecological momentary intervention (EMI) approach (i.e., prompts on the participants' smartphone to encourage the use of trained strategies in their daily life). Eight participants with schizophrenia, schizoaffective, or major depressive disorder entered the study. The intervention took place twice a week for 2 months. Assessment measures included traditional evaluations of motivational negative symptoms, apathy, quality of life and daily functioning, in addition to ambulatory assessment methods strategies, including the experience sampling method (ESM) to assess motivation and related processes, and actigraphy (daily step-count) to assess participants' activity level. Four participants were considered as non-completers (followed less than 2/3 of the program) and four were considered as completers. Only completers presented a decrease in amotivation/apathy and an improvement in functional outcomes after the intervention and at follow-up. Furthermore, mixed-effects ESM models showed significant interaction effects on multiple processes related to motivation, indicating improvements only in completers: heightened motivation, increased engagement in meaningful and effortful activities, better mood, higher levels of confidence, increased frequency of projection into the future (pleasure anticipation), and of positive reminiscence. This preliminary investigation provides evidence that Switch may be an effective intervention, with specific effects on motivation and associated processes.

Clinical, societal and personal recovery in schizophrenia spectrum disorders across time: states and annual transitions.

BACKGROUND: Recovery in schizophrenia is a complex process, involving clinical, societal and personal recovery. Until now, studies analysed these domains separately, without examining their mutual relations and changes over time. AIMS: This study aimed to examine different states of recovery and transition rates between states. METHOD: The Pharmacotherapy Monitoring and Outcome Survey (2006-2017) yearly assesses patients with schizophrenia in the Northern Netherlands. Data from 2327 patients with one up to 11 yearly measurements on clinical, societal and personal recovery were jointly analysed with a mixture latent Markov model (MLMM). RESULTS: The selected MLMM had four states that differed in degree and pattern of recovery outcomes. Patients in state 1 were least recovered on any domain (16% of measurements), and partly recovered in states 2 (25%; featured by negative symptoms) and 3 (21%; featured by positive symptoms). Patients in state 4 (38%) were most recovered, except for work, study and housekeeping. At the subsequent measurement, the probability of remaining in the same state was 77-89%, transitioning to a better state was 4-12% and transitioning to a worse state was 4-6%; no transitions occurred between states 1 and 4. Female gender, shorter illness duration and less schizophrenia were more prevalent in better states. CONCLUSIONS: Quite a high recovery rate was present among a substantial part of the measurements (38%, state 4), with a high probability (89%) of remaining in this state. Transition rates in the other states might increase to a more favourable state by focusing on adequate treatment of negative and positive symptoms and societal problems.

Elements that enhance therapeutic alliance and short-term outcomes in metacognitive reflection and insight therapy: A session-by-session assessment.

OBJECTIVE: Preliminary evidence has found metacognitive capacity is associated with therapeutic alliance and with other outcomes in psychotherapy among persons with schizophrenia. The current study explored: (a) before to after changes in clients' metacognition capacity following Metacognitive Reflection and Insight Therapy (MERIT) and (b) whether the use of specific therapeutic elements of MERIT were followed by higher ratings of therapeutic alliance at the end of each session as well as with short-term outcome as measured prior to the next session, in a session-by-session intensive data collection. METHOD: Two hundred twenty-one sessions of 10 completers with schizophrenia who took part in an ongoing MERIT trial were analyzed. Measures of therapeutic alliance (short version of the Working Alliance Inventory), general outcome (Outcome Rating Scale), and metacognition (Metacognition Assessment Scale-Abbreviated) were used. RESULTS: Findings showed significant change in 2 domains of metacognition, self-reflectivity and mastery, following therapy. In addition, the presence of 2 specific MERIT elements, the introduction of the therapist's mind and reflecting on the progress in therapy within a given session, were related to better outcomes in the following week. Finally, reflecting on the progress was also followed by higher therapeutic alliance. CONCLUSIONS: Metacognitively oriented therapy may positively affect both therapeutic alliance and short-term outcome. Specifically discussing the therapist's and client's experiences of what is occurring in therapy may positively affect short-term outcome and could be applicable to other psychotherapy approaches. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Using Patient-Centered Assessment in Schizophrenia Care: Defining Recovery and Discussing Concerns and Preferences.

Syndromal recovery, satisfactory quality of life, and adequate functionality are relevant goals that define successful treatment of schizophrenia. Recovery requires effective symptom control in multiple clinical domains but also sufficient self-care and social and educational/vocational functionality. The finding that residual negative and cognitive symptoms have been related strongly to inadequate levels of functioning in people with schizophrenia is related to the fact that current pharmacologic agents tend to be most effective for the positive symptoms of the disease. Additional challenges include psychiatric comorbidities and adverse events related to medication that can lead to secondary negative and cognitive symptoms and nonadherence, all of which can worsen outcomes. Treatment modalities that target cognition and functional rehabilitation without introducing tolerability issues are needed. In general, pharmacologic interventions should be combined with evidence-based nonpharmacologic treatments, and patient-reported outcomes as well as measurement-based care should be employed, ideally in a coordinated specialty care framework. To facilitate positive treatment decisions, a combined shared decision and motivational interviewing approach should be implemented.

Desire to Quit Smoking in an Outpatient Population of Persons with Serious Mental Illness.

National survey data indicates that about 32% of adults with any mental illness smoke, compared with 23% of adults without a psychiatric disorder. Smoking rates are higher in clinical populations, where up to 53% of persons with serious mental illnesses (schizophrenia and bipolar disorder) are estimated to smoke. Despite higher rates of smoking among persons with mental illnesses, motivation to quit in this population is similar to that of the general population of smokers. Nevertheless, smoking cessation rates in the USA have been significantly lower among persons with mental illnesses than among persons without a mental illness. Advising patients to quit is among the most basic approaches to smoking cessation used by health care professionals, and there is evidence that the likelihood of cessation increases with even minimal advising. Indeed, advising is the second of five smoking cessation activities recommended in the US Department of Health and Human Services clinical guideline, Treating Tobacco Use and Dependence, which promotes physician intervention activities in steps known as the five A's (ask, advise, assess, assist, and arrange). A randomized, state-wide survey was used to estimate the smoking prevalence among psychiatric outpatients served in Ohio's publicly funded behavioral health care system. A follow-up survey explored a self-selected sample's exposure to cessation advising by health care practitioners and the relationship between that advising and subjects' desire to quit.

Spanish versions of assessment tools for functioning and activities daily living in schizophrenia: What do they measure?

From the psychosocial rehabilitation perspective, the use of instruments based on a theoretical framework to assess the level of functioning in activities of daily living with good clinimetric properties is essential for people diagnosed with schizophrenia. In Spain, scales translated from other languages, usually English, are very frequently used; this involves a process of adaptation, beyond translation. The objective of this study was to review and compare a series of different scales used in psychosocial functioning assessment in the Spanish population focused on daily living activities. The selected instruments have been adapted into Spanish over the last 19 years and are aimed at people diagnosed with a severe mental disorder, usually schizophrenia. The results showed that the number of instruments adapted to the Spanish population was small, with several shortcomings in the adaptation process, either in translation, the confusion of concepts or metric properties of the scale. In conclusion, the conceptualisation and assessment of functioning in this field remains a complex and controversial issue. The development of new instruments based on a theoretical approach, such as the International Classification of Functioning, Disability and Health (ICF)1 may be a great help in improving the psychosocial treatment of people diagnosed with a psychotic disorder.

Ouvidores de vozes de um serviço de saúde mental: características das vozes e estratégias de enfrentamento / Los que oyen voces en un servicio de salud mental: características de las voces y estrategias de enfrentamiento / Voice hearers of a mental health service: voice characteristics and coping strategies

Resumo Objetivou-se compreender a experiência de ouvir vozes a partir das características e conteúdos das vozes, e das estratégias utilizadas por dezesseis ouvidores usuários de um Centro de Atenção Psicossocial do Sul do Brasil. Trata-se de uma pesquisa qualitativa de caráter exploratório. Se deu através de entrevistas semiestruturadas e análise de conteúdo. Evidenciou-se que as características e conteúdos das vozes podem ser determinantes das reações emocionais dos ouvidores frente à experiência, sendo mais difícil lidar com ela quando os conteúdos são negativos. Através das estratégias utilizadas pelos ouvidores, percebeu-se uma resistência ao modelo biomédico, mesmo dentro de um serviço de saúde mental. Conclui-se que há uma necessidade de se pensar outras possibilidades de recuperação para as pessoas que ouvem vozes, que deem conta da complexidade da experiência e que sejam condizentes com o modelo de atenção psicossocial.

Resumen El estudio objetivó comprender la experiencia de oír voces a partir de las características y contenidos de las voces y las estrategias utilizadas por dieciséis oyentes que utilizan un Centro de Atención Psicosocial en el sur de Brasil. Esta es una investigación exploratoria cualitativa. Se llevó a cabo mediante entrevistas semiestructuradas y análisis de contenido. Se destacó que características y contenidos de las voces pueden ser determinantes de reacciones emocionales de los oidores delante la experiencia, siendo más difícil ocuparse de ella cuando los contenidos son negativos. A través de estrategias utilizadas por los oidores, se notó una resistencia al modelo biomédico, aunque dentro de un servicio de salud mental. Se concluye que hay una necesidad de pensar otras posibilidades de recuperación para las personas que oyen voces, que aporten la complejidad de la experiencia y que sean compatibles con el modelo de atención psicosocial.

Abstract The study aimed to understand the experience of hearing voices from the analysis of the characteristics and contents of the voices, and of the strategies used by sixteen voice hearers who use a Psychosocial Care Center in Southern Brazil. This is a qualitative exploratory research, conducted through semi-structured interviews and content analysis. It was evidenced that the characteristics and contents of the voices can be determinant of the hearer's emotional reactions to the experience, being more difficult to deal with when those are negative. By analyzing the strategies used by the hearers, resistance to the biomedical model was perceived even within a mental health service. It was concluded that there is a need to think about other possibilities of recovery for people who hear voices, possibilities that take into account the complexity of the experience and that are consistent with the psychosocial care model.

Exploring the potential cost-effectiveness of a vocational rehabilitation program for individuals with schizophrenia in a high-income welfare society.

BACKGROUND: Over the past decades research has shown that employment has a positive impact on quality of life, global functioning and recovery in individuals with schizophrenia. However, access to vocational rehabilitation services for this group is limited and unemployment rates remain high. In this study we explore the potential cost-effectiveness of a novel vocational rehabilitation program (The Job Management Program - JUMP) earmarked for individuals with schizophrenia in Norway. METHODS: The JUMP study was a vocational rehabilitation program augmented with either cognitive behaviour therapy or cognitive remediation. In addition to the JUMP protocol, we extracted treatment cost data from comprehensive and mandatory health and welfare registers. The costs over a two-year follow-up period were compared with the costs over the two-year period prior to inclusion in the study. We also compared the cost-effectiveness of JUMP with a treatment as usual group (TAU). RESULTS: We identified significant reductions in inpatient services in the JUMP group, both for those who obtained employment and those who did not. Significant reductions were also found in the TAU group, but adjusted for baseline differences the total cost for JUMP participants were € 10,621 lower than in the TAU group during the follow-up period. CONCLUSION: In addition to supporting individuals with schizophrenia obtain employment, JUMP appears to have reduced the reliance on mental health services, which should be of interest to stakeholders. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01139502 . Retrospectively registered on 6 February 2010.

Improving the quality of life of people with schizophrenia through community based rehabilitation in Yogyakarta Province, Indonesia: A quasi experimental study.

OBJECTIVE: The persistent disability and low Quality of Life (QoL) are the impacts of schizophrenia. Community-Based Rehabilitation (CBR) is recommended for people with schizophrenia. The objective of this study is to analyze the effectiveness of CBR to improve the quality of life of people with schizophrenia. METHODS: It was a quasi-experimental study, conducted in February-December 2017, in Yogyakarta, Indonesia. Subjectwere people with schizophrenia, 18-56 years old, with their caregiver. CBRintervention using psychoeducation module and social skill module during 12 weeks. It was conducted by local health workers, sub district social welfare workers, community health workers (called Kader in Indonesia) and supervised by a psychiatrist. The QoL was assessed using a validated measuring instrument at the baseline and at the week 16. Hypothesis test using Wilcoxon test RESULTS: There were 100 people with schizophrenia involved in the study. They were divided into intervention group and control group. Every group consists of 50 subjects. Both groups had similar characteristics at the baseline. The intervention group received CBR, whereas the control group didn't. Thirty-four people (68%) of intervention group increased their QoL, whereas in the control group there were twenty-three people (46%) increased their QoL. The QoL decrease occurred in one subject (4%) from the control group. Other subjects had constant QoL. Improvement of QoL in the intervention group is higher than the control group (p < 0.05). CONCLUSIONS: CBR is effective for improving the QoL of people with schizophrenia in the community. CBR is conducted by the health worker and sub-district social welfare worker.

Promoting Personal and Social Recovery in Older Persons with Schizophrenia: The Case of The New Club, a Novel Dutch Facility Offering Social Contact and Activities.

Many older community-living persons with schizophrenia report unmet psychological and social needs. The Amsterdam-based New Club is a novel facility that intends to foster self-reliance and social participation in this group. To explore participants' and staff perceptions, a naturalistic qualitative study combined participant observation with interviews. The results illustrate how the New Club contributes to the personal and social recovery of its participants. At the personal level, attending the facility, activation and feeling accepted were valued positively. At the social level, engaging with others, experiencing a sense of community, and learning from one another's social skills were positive contributors. Next, various environmental factors proved important. The New Club demonstrates the feasibility of creating a facility that offers an accepting and non-demanding social environment to older community-living individuals with severe mental illnesses. It may offer a suitable alternative for the more demanding psychotherapeutic interventions offered to younger populations.

Caregivers of individuals with schizophrenia: who are they and what are their challenges?

PURPOSE OF REVIEW: To better understand the overall burden of schizophrenia, we aimed to explore informal caregivers' experiences by evaluating the current evidence on caregiver and patient characteristics, the type of care provided by caregivers, and the impacts of caregiving on caregivers' lives. RECENT FINDINGS: Caregivers provide direct care, assistance with activities of daily living, and emotional, social, and financial support to individuals with schizophrenia. Increased duration of illness and of care, severe or persistent schizophrenia symptoms, criticism of the care recipient, financial burden, and patient disability intensify caregiver burden. Caregivers of individuals with persistent symptoms often feel overwhelmed, stressed, drained, burdened, frustrated, or angry. Financial impacts of caregiving include treatment costs for care recipients, providing financial support, and lost productivity and income. Depression and anxiety are common health impacts for caregivers, who also have increased physical healthcare resource use relative to healthy controls. Caregiver burden is reduced by formal support programs to improve caregivers' stress management and coping skills and informal sources of social support. SUMMARY: Targeted efforts to improve access to care and provide additional support for caregivers are needed to alleviate caregiver burden and improve outcomes for individuals with schizophrenia.

Relationship between Mental Health and Burden among Primary Caregivers of Outpatients with Schizophrenia.

There is growing recognition that caring for a patient with schizophrenia often results in high levels of perceived burden and poorer overall mental health for caregivers. A quantitative cross-sectional design and standardized instruments were used to collect data from 355 primary caregivers of adults in outpatient care with schizophrenia in China. Structural equation modeling was used to examine the association between caregiver burden and mental health among primary caregivers and whether this association is influenced by personality, coping style, and family functioning, based on a diathesis-stress perspective. Goodness-of-fit indices (χ2 /df = 1.406, GFI = 0.919, CFI = 0.957, etc.) confirmed that the modified model fit the data well. In line with the diathesis-stress model, and with this study's hypotheses, we found that caregiver burden was significantly related to mental health outcomes directly. The final model showed that personality traits, coping style, and family function influenced the relationship between caregiver burden and mental health. The neuroticism personality traits have a direct effect on caregiver burden and family functioning in this sample. Coping style had a direct effect on the caregiver burden, and family functioning had a direct effect on the caregiver burden. Our final model about primary caregivers can be applied clinically to predict mental health outcomes from caregiver burden.

Cada vez se reconce más que cuidar a un paciente con esquizofrenia generalmente resulta en niveles altos de sobrecarga percibida y en una peor salud mental general para los cuidadores. Se utilizó un diseño transversal cuantitativo e instrumentos estandarizados para recopilar datos de 355 cuidadores principales de adultos con esquizofrenia en atención extrahospitalaria en China. Se utilizaron modelos de ecuaciones estructurales para analizar la asociación de la sobrecarga del cuidador y la salud mental entre cuidadores principales, y si esta asociación está influenciada por la personalidad, el estilo de afrontamiento y el desempeño familiar sobre la base de una perspectiva diátesis-estrés. Los índices de bondad de ajuste (χ2 /df = 1.406, GFI = 0.919, CFI = 0.957, etc.) confirmaron que el modelo modificado se ajustó bien a los datos. De acuerdo con el modelo de diátesis-estrés y con las hipótesis de este estudio, descubrimos que la sobrecarga del cuidador estuvo considerablemente relacionada con las consecuencias en la salud mental directamente. El modelo definitivo demostró que los rasgos de la personalidad, el estilo de afrontamiento y el desempeño familiar influyeron en la relación entre la sobrecarga del cuidador y la salud mental. Los rasgos de personalidad de neuroticismo tienen un efecto directo en la sobrecarga del cuidador y el desempeño familiar en esta muestra. El estilo de afrontamiento tuvo un efecto directo en la sobrecarga del cuidador y el desempeño familiar tuvo un efecto directo en la sobrecarga del cuidador. Nuestro modelo definitivo acerca de los cuidadores principales puede aplicarse clínicamente para predecir las consecuencias de la sobrecarga del cuidador en su salud mental.

Family burden predicts functional outcome in the early course of schizophrenia beyond psychiatric symptoms and baseline functioning.

The goal of this study was to determine if family burden experienced by the families of individuals with a recent-onset of schizophrenia is associated with whether the individual is able to work or attend school during the first year of treatment. Forty-one participants with a recent first episode of schizophrenia and their families enrolled in two NIMH-funded protocols through the UCLA Aftercare Research Program completed a measure of family burden at baseline. Amount of work during this time was also recorded. Baseline family burden was associated with work status (no work, part-time work, or full-time work) at both the six-month, r = -0.321, p = .04, and one-year time point, r = - 0.47, p = .002. Family burden was also associated with hours participated in work/school hours at the six-month time point, r = -0.390, p = .012, and at the one-year time point, r = -0.492, p = .01. Further exploration into the family burden measure shows that family perceived limited opportunities resulting from the individual's psychiatric disorder was associated with worse functional outcome at all three time points beyond psychiatric symptoms and baseline functioning. Missed opportunities due to a family member's illness may reduce the level of support provided to the individual and thus impact their psychosocial functioning. Our findings suggest that this dimension of family burden is highlighting the importance of and need for more balanced family support to boost functional outcome.

Description and impact of a structured psychoeducational and salutogenetic approach (InteGRO) to support the recovery of people with severe mental disorders / Descrizione e impatto di un approccio psicoeducativo strutturato (InteGRO) di salutogenesi per sostenere il percorso di recovery delle persone con disturbo mentale grave

Aim: In mental health services there is an increasing attention to the recovery of people with severe mental illness. Consequently there is a growing literature on this topic focused above-all on the description of excellence paths that often include variables related to the organizational aspects of the service. Less attention is given to specific interventions to foster all the goals that are essential to improve the living conditions, including defining and planning goal, emotional perception, effective communication for negotiation, practical interpersonal and intrapersonal problem-solving. The aim of this paper is to describe an innovative and salutogenetic approach and to illustrate the results of the impact after a year of "active intervention". Methods: We used a "quasi-experiment" design-study with a pre-post assessment without a control group on 21 subjects with schizophrenia or bipolar disorder according to DSM-IV-TR criteria. We used to evaluate Functioning, the primary outcome, the Personal and Social Performance Scale. For the secondary outcome measures we used the Stress-Scale, the Modified Five-Point Test for cognitive flexibility, the APEN/G e APEP/G Scale for perceived self-efficacy, the Integrative Hope Scale, the items "subjective and objective load" of the "Aid received, Needs and Burden" self-filled questionnaire. The clinical assessment was made by the Brief Psychyatric Rating Scale, while we used the Repeatable Battery for the Assessment of Neuropsychological Status. Results: Of the 21 subjects included, 18 completed the assessment. Significant improvements were noted for all variables considered, with particular relevance for Personal and Social Functioning (p<0.001). Predictive variables for this dimension were the level of stress and perceived self-efficacy (p<0.05). Conclusions: The observed data confirm the effectiveness of this innovative approach, above all on Personal and Social Functioning where there has been improvement from two or more marked dysfunction areas to one area.

Examining the reliability and factor structure of the Malay version of the Recovery Self-Assessment in a sample of individuals with schizophrenia.

OBJECTIVE: Without a reliable and valid tool, it is neither possible to gauge recovery orientation of persons with serious mental illness nor to evaluate whether existing mental health system encourages recovery in both its policies and current practice in Malaysia. Therefore, the aim of this study was to examine the reliability and factor structure of the Malay version of the Recovery Self-Assessment (RSA-PIRV-M) in a psychiatric sample. METHOD: Psychiatric patients were eligible for recruitment to the study, when they fulfilled the following criteria: a diagnosis of schizophrenia, were aged between 18- and 65-years-old, and were able to give consent themselves. We recruited 118 individuals with schizophrenia. They were selected via systematic random sampling technique. All RSA-PIRV-M items were derived from the parent scale. These items were translated based on established procedures. The reliability estimates of the RSA-PIRV-M were based on Cronbach's alpha. We performed confirmatory factor analyses to examine the factor structure of the RSA-PIRV-M. RESULTS: All Cronbach's alphas for the RSA-PIRV-M subscales were at least .70. With respect to the factor structure of the RSA-PIRV-M, our structural equation modeling findings suggest a five-factor model encompassing life goals, involvement, diversity of treatment options, choice, and individually-tailored services. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The interpretation of our findings is limited by small sample size, unique sample characteristics, and lack of further evidence for convergent validity. Notwithstanding these limitations, the RSA-PIRV-M is a promising tool in bridging gaps between our knowledge on recovery orientation and existing mental health service provision in Malaysia. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

'Recovery' in the Real World: Service User Experiences of Mental Health Service Use and Recommendations for Change 20 Years on from a First Episode Psychosis.

Little is known about how recovery oriented policy and legislative changes influence service users' perceptions of mental health care over time. Although the recovery approach is endorsed in many countries, qualitative research examining its impact on service use experiences has been lacking. This study aimed to explore this impact as well as experiences of service utilisation and suggestions for change with people diagnosed with a First Episode Psychosis between 1995 and 1999. Participants had used services during the 10 year period prior to, and 10 years post, policy and legislative shifts to the recovery approach. Semi-structured interviews were conducted with 10 participants who met criteria for 'full functional recovery' and 10 who did not. Data were analysed using Thematic Networks Analysis to develop Basic, Organising, and Global Themes. Over time, recovered participants perceived an improvement in service quality through the 'humanising' of treatment and non-recovered participants experienced their responsibility in recovery being recognised, but felt abandoned to the recovery approach. Findings suggest the importance of viewing service users as demonstrating personhood and having societal value; examining the personal meaning of psychotic experiences; and matching expectations with what services can feasibly provide. The implementation and the principal tenets of the recovery approach warrant further investigation.

Improving implementation of evidence based practice for people with psychosis through training the wider workforce: Results of the GOALS feasibility randomised controlled trial.

BACKGROUND AND OBJECTIVES: There is a pressing need to improve access to evidence-based practice for people with psychosis. The primary aim of this study was to assess clinical feasibility of a manualised, evidence-based CBT intervention (GOALS) targeting a personalised recovery goal, delivered by the frontline workforce, following brief training. Secondly, we aimed to conduct preliminary statistical analyses of key outcomes and costs. METHODS: The GOALS study is a feasibility randomised controlled trial (ISRCTN 73188383). 75 participants with current psychosis were recruited and randomly allocated to receive either treatment as usual alone or with GOALS therapy. RESULTS: Brief training enabled frontline staff to deliver the therapy according to protocol and 74% of therapy participants partially or fully achieved their goals. There were significant improvements with a moderate effect size of 0.56 on goal attainment. However, preliminary statistical analyses found no significant differences between groups on our primary outcome of activity levels or other secondary outcomes Health economic analysis found that point estimates of costs, controlling for baseline costs, implied savings (even including intervention costs), but the difference was not statistically significant. LIMITATIONS: The study was designed as a feasibility RCT, and therefore the results of secondary estimates of efficacy effects should be treated with caution. CONCLUSIONS: This approach holds promise in supporting people with psychosis to reach personal recovery goals, cost effectively.

A pilot study of a family cognitive adaptation training guide for individuals with schizophrenia.

OBJECTIVE: There is a paucity of accessible, evidence-based tools for caregivers of individuals with schizophrenia. This study examines changes in the self-assessed and caregiver-assessed outcomes of people with schizophrenia after exposure to a cognitive adaptation training (CAT) guide that addressed pragmatic, in-home approaches to offset the cognitive impacts of the illness. METHOD: This study examined the 4-month, pre-post outcomes of a CAT guide, as compared with a popular, general manual, for families of individuals with schizophrenia. A total of 17 caregiver-supported individual dyads completed all measures, having been randomized to either a CAT-guide group or a support-manual group. Measures included medication adherence, adaptive functioning, quality of life, and caregiver burden. Semistructured interviews assessed use and utility questions. RESULTS: Caregiver-assessed improvements in community functioning with medium-high effect sizes were observed in both study conditions. Self-report ratings by supported individuals did not change from baseline to 4 months and no change was observed in medication adherence or quality of life for either condition. Caregiver-burden ratings significantly declined with a large effect size, again with no difference as a function of manual type. CONCLUSION AND IMPLICATIONS FOR PRACTICE: These findings suggest that there is some promise in providing families with evidence-based information in manual form. Further research informed by this study's findings should include assessments of whether and how environmental cognitive supports can be of specific benefit to families affected by schizophrenia. (PsycINFO Database Record

Cognitive Predictors of Work Among Social Security Disability Insurance Beneficiaries With Psychiatric Disorders Enrolled in IPS Supported Employment.

BACKGROUND: Impaired cognitive functioning is a significant predictor of work dysfunction in schizophrenia. Less is known, however about relationships of cognition and work in people with less severe disorders with relatively normal cognitive functioning. METHODS: This secondary analysis evaluated cognitive predictors of work in Social Security Disability Insurance (SSDI) beneficiaries with a recent work history who were randomized to receive mental health services, supported employment, and freedom from work disincentives over a 2-year study period in the Mental Health Treatment Study. Of the 1045 participants randomized to the treatment package, 945 (90.4%) received a cognitive assessment at study entry. Competitive work activity was evaluated using a computer-assisted timeline follow-back calendar at baseline and quarterly for 24 months. RESULTS: Mood disorders were the most common psychiatric diagnoses (64.9%), followed by schizophrenia or schizoaffective disorder (35.1%). Tobit regression analyses predicting the average number of hours worked per week, controlling for demographic characteristics, diagnosis, and work history indicated that the cognitive composite score (P < .01) and verbal learning subscale scores (P < .001) were associated with fewer hours of weekly work over the study period. CONCLUSIONS: Cognitive functioning predicted work over 2 years in SSDI beneficiaries with mood or schizophrenia-spectrum disorders who were receiving supported employment and mental health interventions, despite a relative absence of cognitive impairment in the study participants. The findings suggest cognitive functioning contributes to competitive work outcomes in persons with psychiatric disorders who have relatively unimpaired cognitive abilities, even under optimal conditions of treatment and vocational support.