Efficacy of electrical cranial stimulation for treatment of psychiatric symptoms in patients with anxiety: A systematic review and meta-analysis.

Background: Therapeutic effects of electrical cranial stimulation (CES) in patients suffering from anxiety remained unclear. This meta-analysis aimed at investigating acceptability and therapeutic efficacy of CES against anxiety, depression, and insomnia for patients who experienced symptoms of anxiety. Methods: Major electronic databases were searched from inception until December 10, 2022 for randomized controlled trials (RCT) focusing on therapeutic effectiveness of CES in patients whose primary complaints included anxiety. Effect sizes (ES) for different treatment outcomes were estimated by using generic inverse variance method. Results: Eight RCTs were identified including a total of 337 participants. The therapeutic effectiveness of CES was significantly better than that in the control groups for anxiety (ES=-0.96, p <0.00001, eight trials, 337 patients), depression (ES=-0.69, p=0.003, five trials), and insomnia (ES=-1.02, p = 0.0006, three trials) in those who presented with symptoms of anxiety. Subgroup analyses found that CES was equally effective regardless of comorbid presentation of depressive symptoms (ES=-0.94 in patients with anxiety only vs. ES=-1.06 in those with depression and anxiety) and whether CES was used as monotherapy or add-on therapy to medications (ES = -0.88 vs. ES = -1.12, respectively). Moreover, subgroup analysis of RCTs using the same device "Alpha-Stim" for CES was more effective in alleviating anxiety than sham controls (ES = -0.88, p < 0.00001, four trials, 230 patients). Regarding acceptability, the use of CES did not increase the risk of treatment-related dropout compared to the control group (RR = 1.26, p = 0.57, I2 = 0%, four trials, 324 patients). Conclusion: Our study supported the use of CES for symptoms of anxiety, depression, and insomnia in those suffering from anxiety with fair acceptability and demonstrated the efficacy of "Alpha-Stim", the most commonly used device for CES, in this patient population. Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier: CRD42022382619.

Changes in family functioning among primary family caregivers of patients with schizophrenia.

INTRODUCTION: Family functioning, particularly among primary family caregivers for patients with schizophrenia, is a global concern that poses unprecedented challenges. The family unit is a pivotal agent for the preservation of the integrity of individual members. Little attention has been paid to the changes in family functioning and their predictors in primary family caregivers. This study aimed to examine the changes in and the correlates of family functioning in primary family caregivers of individuals with schizophrenia over a 6-month post-discharge period. DESIGN: A prospective, longitudinal study was conducted. METHODS: A total of 58 primary family caregivers of patients with schizophrenia were recruited from two psychiatric hospitals in Taiwan. Data were collected four times, including 1 week before hospital discharge and at 1-, 3-, and 6-month intervals post-discharge. Demographic and clinical questionnaires, the Affiliate Stigma Scale, the Family Empowerment Scale, and the General Functioning subscale were used to collect data. Generalized Estimating Equations were applied for data analysis. RESULTS: Approximately 59.6%-77.6% of primary family caregivers presented unhealthy family functioning during the 6-month post-discharge period. Significant reductions in family functioning of primary family caregivers were noted in the group with unhealthy family functioning; however, family functioning of primary family caregivers remained unchanged in the group with healthy family functioning over 6 months. Affiliate stigma and family empowerment significantly accounted for the changes in family functioning of primary family caregivers in the groups with unhealthy and healthy family functioning, respectively. CONCLUSION: This study highlights affiliate stigma and family empowerment as long-term predictors of changes in family functioning for primary family caregivers and as pivotal targets of mental health care. CLINICAL RELEVANCE: Family-centered interventions with a focus on ameliorating affiliate stigma and enhancing family empowerment are recommended to improve family functioning for primary family caregivers of patients with schizophrenia at different periods after hospital discharge.

The symptoms, resourcefulness and quality of life in community-based patients with schizophrenia.

AIMS AND OBJECTIVES: To test Zauszniewski's resourcefulness and quality of life theory in community-based patients with schizophrenia. The objectives were to: (a) examine the relationship among psychotic symptoms, resourcefulness and quality of life, and (b) explore the determinants of quality of life. BACKGROUND: According to Zauszniewski's resourcefulness and quality of life theory, for patients, the skills constituting resourcefulness should centre on helping oneself or the use of resources to achieve their health. While the significant associations between resourcefulness and quality of life have been consistently delineated in published research, little is known about resourcefulness in patients with schizophrenia. DESIGN: A cross-sectional study design was used in this study. METHODS: A total of 120 patients were recruited with convenience sampling who received home care service and community rehabilitation programme. The participants were assessed with the Brief Psychiatric Rating Scale, the Resourcefulness Scale and the World Health Organization Quality of Life Scale-BREF. The psychotic symptoms were rated by the researchers with structured face-to-face interviews. Resourcefulness and quality of life were assessed through self-reporting. STROBE checklist was followed. RESULTS: The data were analysed using one-way analysis of variance, t test, Pearson's correlation coefficients and stepwise multiple regression analysis. Results showed that employment status and psychotic symptoms were correlated with resourcefulness, while employment status, psychotic symptoms and resourcefulness were correlated with quality of life. Resourcefulness and psychotic symptoms were the determinants of quality of life. CONCLUSION: Patients with employment and less psychotic symptoms had greater resourcefulness. In addition, patients with employment, less psychotic symptoms and greater resourcefulness had better quality of life. RELEVANCE TO CLINICAL PRACTICE: Community rehabilitation programmes should include supported employment, symptom management and resourcefulness skills training to enhance patients' resourcefulness and quality of life.