Effects of Naikan-Mindfulness Therapy on Psychiatric Rehabilitation for Chronic Schizophrenia.

Objective: To explore the effect of Naikan mindfulness therapy on psychiatric rehabilitation for chronic schizophrenia. Methods: 100 chronic schizophrenic patients in a third-class psychiatric hospital from July 2020 to August 2021 were selected as the research object. The following criteria were adopted: a clinician clearly diagnosed chronic schizophrenia, the patient was between 18 and 65 years old, and the patient agreed to participate in the study and signed an informed consent form.The random mathematical table method divided them into the control group (50 cases treated with Naikan therapy) and the experimental group (50 cases treated with Naikan mindfulness therapy). The LSIA(Life Satisfaction Index in Schizophrenia) score, SSFPI (Social Satisfaction and Functioning in Patients with Schizophrenia)score and satisfaction of psychiatric rehabilitation nursing were compared between the two groups. Result: In terms of LSIA score, there was no significant difference in baseline score between the two groups (P > .05). At 6 and 12 weeks after the intervention, the scores of the two groups increased, but the scores of the experimental group at 6 and 12 weeks after the intervention were higher than those of the control group, the difference was statistically significant (P < .05). In terms of SSFPI score, there was no significant difference in baseline score between the two groups (P < .05); At 6 and 12 weeks after the intervention, the scores of the two groups increased, but the scores of the experimental group at 6 and 12 weeks after the intervention were higher than those of the control group, the difference was statistically significant (P < .05). In terms of satisfaction with psychiatric rehabilitation nursing, there was no significant difference between the experimental group and the control group 6 weeks after intervention (P > .05); 12 weeks after the intervention, the satisfaction scores of the two groups increased significantly, and the scores of the experimental group were significantly higher than those of the control group (P < .05). Naikan mindfulness therapy led to significant improvements in LSIA scores, SSFPI scores, and satisfaction with psychiatric rehabilitation nursing at both 6 and 12 weeks. Conclusion: The life satisfaction, social function, and the satisfaction of psychiatric rehabilitation nursing of the chronic schizophrenics can be improved by the combination of Naikan mindfulness therapy. This study found that by using Naikan therapy, we can improve life satisfaction, social functioning, and satisfaction with psychiatric rehabilitation care in patients with chronic schizophrenia. This has important practical implications for patient treatment and care, including improving quality of life, enhancing social integration, improving rehabilitation outcomes, and reducing the burden on medical staff. This research provides a useful method for comprehensive care of patients with schizophrenia and is expected to have a positive impact on improving patients' lives and recovery in the future.

A nomogram to predict the risk of cognitive impairment in patients with depressive disorder.

This study was to describe the cognitive function status in patients with depressive disorder and to construct a nomogram model to predict the risk factors of cognitive impairment in these patients. From October 2019 to February 2021, a total of 141 patients with depressive disorder completed the survey in two hospitals. The Montreal cognitive assessment (MoCA) was used with a cutoff score of 26 to differentiate cognitive impairment. Univariable and multivariable logistic regression analyses were conducted to identify independent risk factors. A nomogram was then constructed based on the results of the multivariable logistic regression analysis. The patients had an average MoCA score of 23.99 ± 3.02. The multivariable logistic regression analysis revealed that age (OR: 1.096, 95% CI: 1.042-1.153, p < 0.001), education (OR: 0.065, 95% CI: 0.016-0.263, p < 0.001), depression severity (OR: 1.878, 95% CI: 1.021-3.456, p = 0.043), and sleep quality (OR: 2.454, 95% CI: 1.400-4.301, p = 0.002) were independent risk factors for cognitive impairment in patients with depressive disorder. The area under receiver operating characteristic (ROC) curves was 0.868 (95% CI: 0.807-0.929), indicating good discriminability of the model. The calibration curve of the model and the Hosmer-Lemeshow test (p = 0.571) demonstrated a well-fitted model with high calibration. Age, education, depression severity, and sleep quality were found to be significant predictors of cognitive function. A nomogram model was developed to predict cognitive impairment in patients with depressive disorder, providing a solid foundation for clinical interventions.

Mental health literacy of Chinese nurses from public general and psychiatric hospitals: a cross-sectional study.

Background: Mental health literacy (MHL) is crucial to address issues related to mental illness. Nurses' MHL is even more important because they are expected to deal with both the physical and psychological consequences of mental disorders. Objective: This study investigated the level, discrepancy, and characteristics of MHL among Chinese nurses from both public general and psychiatric hospitals; identified influential factors; and explored the relationship between MHL and mental health status. Methods: Using a stratified cluster sampling method to select participants, a cross-sectional survey was conducted to describe the MHL of 777 nurses from 13 general and 12 psychiatric hospitals using the Chinese version of the Mental Health Literacy Scale, Patient Health Questionnaire-2, Generalized Anxiety Disorder-2, and a demographic questionnaire. A multiple regression analysis was used to determine the factors influencing MHL among the nurses recruited. Results: The participants' total score on the Chinese version of the Mental Health Literacy Scale was 93.25 (SD = 10.52). Multiple regression analysis revealed that nurses who worked in psychiatric or higher-level hospitals, with higher professional titles or higher education had higher levels of overall MHL and core MHL, while those working in general hospitals, with shorter work duration, or who were unmarried had higher social acceptance of patients. Nurses' MHL was closely correlated with their mental health status. Conclusion: The overall and core MHL of Chinese nurses were at a moderate level, with social acceptance remaining at a relatively low level. There is an urgent need for MHL promotion programs to improve the MHL of clinical nurses. The focus must be given to overall MHL, especially core MHL, for non-psychiatric nurses to enhance their competence in mental health promotion and identification; more emphasis should be placed on the social acceptance of patients with mental illnesses for psychiatric nurses to improve their provision of professional services. Better MHL would be a formula for improving nurses' own mental health and their mental health service competence.

A Psychological Intervention Program for Patients with Cerebral Infarction.

INTRODUCTION: Cerebral infarction is one of the most common cerebrovascular diseases. The sequelae caused by cerebral infarction, including limb paralysis, crooked mouth corners, language barriers, etc., seriously affect the patient's physical and mental health and enthusiasm for rehabilitation training. Therefore, psychological intervention has important positive significance for the rehabilitation and nursing of patients with cerebral infarction. METHODS: This is a single-blind controlled study. 168 patients with cerebral infarction who met the inclusion criteria and visited our hospital from January 2018 to January 2020 were randomly divided into a control group (n = 84) and an intervention group (n = 84). The patients in the intervention group received an additional 3-month psychological treatment on the basis of the patients in the control group. The National Institutes of Health Stroke Scale (NIHSS), Activities of Daily Living (ADL) scale, Mini-Mental State Examination (MMSE), and Hamilton Depression Rating Scale (HAMD) were measured before and after the psychological intervention. RESULTS: The 3-month psychological intervention we designed significantly reduced the NIHSS and HAMD scores of patients with cerebral infarction compared with traditional rehabilitation care for cerebral infarction, implying that our psychological intervention courses can improve patients' cognitive function and suppress patients' depression. Consistently, our psychological intervention also significantly improved ADL and MMSE scores 3 months after the onset of cerebral infarction patients, implying that this psychological intervention helped patients recover their daily functions relative to conventional care. CONCLUSION: Psychological intervention can be used as an adjunct therapy in the treatment and nursing of patients with cerebral infarction.

Network analysis of somatic symptoms in Chinese patients with depressive disorder.

Introduction: Network theory conceptualizes somatic symptoms as a network of individual symptoms that are interconnected and influenced by each other. In this conceptualization, the network's central symptoms have the strongest effect on other symptoms. Clinical symptoms of patients with depressive disorders are largely determined by their sociocultural context. To our knowledge, no previous study has investigated the network structure of somatic symptoms among Chinese patients with depressive disorders. The aim of this study was to characterize the somatic symptoms network structure in patients with depressive disorders in Shanghai, China. Method: A total of 177 participants were recruited between October 2018 and June 2019. The Chinese version of the Patient Health Questionnaire-15 was used to assess somatic symptoms. In order to quantify the somatic symptom network structure, indicators of "closeness," "strength," and "betweenness" were employed as identifiers for network-central symptoms. Result: The symptoms of "feeling your heart pound or race," "shortness of breath," and "back pain" had the highest centrality values, indicating that these symptoms were central to the somatic symptom networks. Feeling tired or mentally ill had the strongest positive correlation with insomnia or other sleep problems (r = 0.419), followed by chest pain and breathlessness (r = 0.334), back pain, and limb or joint pain (r = 0.318). Discussion: Psychological and neurobiological research that offers insights into somatic symptoms may focus on these central symptoms as targets for treatment and future research.

Experiences and coping strategies of somatic symptoms in patients with depressive disorder: A qualitative study.

BACKGROUND: Depressive disorder is the most prevalent mental illness and is characterised by the presence of mental and somatic symptoms, with the latter affecting 65.0% to 98.2% of patients with their general function and quality of life. PURPOSE: The purpose of this study aimed to explore the experiences and coping strategies of somatic symptoms in Chinese patients with depressive disorder, and to gain new insight into the illness and the health care provided to patients. METHODS: Semi-structured, in-depth interviews were conducted with 15 patients diagnosed with depressive disorder according to international classification of diseases 10th revision. The interviews were transcribed verbatim and the thematic analysis was adapted to the data. MAXQDA10 software was used to organise, encode, classify, induce, and extract themes. RESULTS: Four major themes were extracted from the interviews: (1) descriptions of symptoms; (2) perceptions of the symptoms; (3) symptom disturbance; and (4) coping strategies of symptoms. Within the first theme, patients identified the following sub-themes: complex experiences of somatic symptoms, which were mainly in the neuromuscular system, circulatory respiratory system, gastrointestinal system and some symptoms without obvious systemic classification; difficulty in locating symptoms accurately; and being not consistent with examination results. The second theme included patient's inadequate understanding of somatic symptoms; and denial of the link between physical discomfort and depression. Disturbance of somatic symptoms embraced three sub-themes: (1) Uncertainty about somatic symptoms; (2) Struggling with daily life; (3) Impact on social activities; (4) feeling a decrease in family support. Lastly, coping strategies taken by patients in the face of various symptoms mainly included relying on drug treatment, avoiding stressors, diverting attention, and compromise or acceptance. CONCLUSIONS: Patients with depressive disorder experience a variety of somatic symptoms that have a negative impact on social function and reduce their quality of life. Patients did not have an adequate understanding of their physical discomfort and lacked effective coping strategies for these somatic symptoms. Professional staff should pay more attention to patients' somatic symptoms and focus on targeted symptom management to facilitate patient recovery.

Characteristics of somatic symptoms among Chinese patients diagnosed with major depressive episode.

PURPOSE: This study aimed to describe the clinical features of somatic symptoms among Chinese patients diagnosed with major depressive episode (MDE). METHODS: A total of 213 inpatients with MDE from two mental health hospitals were recruited and investigated using the Somatic Symptom Inventory (SSI), Hamilton rating scale for depression, Hamilton rating scale for anxiety, and a demographic questionnaire. RESULTS: The participants included 142 patients with unipolar depression and 71 patients with bipolar depression. The mean SSI score of all participants was 49.30 (SD = 14.80). "Feeling fatigued, weak, or tired all over" was found to be the most common somatic symptom (61.0% reported moderate levels or above), followed by "feeling of being not in as good physical health as most of your friends" (56.3%), and "feeling weak in parts of the body" (49.3%). "Headache" and "soreness in muscles" were common painful symptoms. Both patients with unipolar and bipolar depression had similar somatic symptoms, including painful and non-painful ones. The somatic symptoms of all participants were closely correlated with the severity of depression and anxiety (P < 0.01). Patients with anxiety, older age, low education, and negative life events in the last year had more somatic symptoms. CONCLUSIONS: Inpatients with MDE of somatic symptoms are common, which were significantly correlated with the severity of depression and anxiety. Further efforts should focus on early recognition and integrated care model management of patients based on their characteristics to improve their quality of life and treatment outcomes.

Validation and Psychometric Testing of the Chinese Version of the Mental Health Literacy Scale Among Nurses.

The Mental Health Literacy Scale (MHLS) is the most widely used and strong theory-based measurement tool to gain an understanding of mental health knowledge and ability. This study aimed to test the psychometric properties of the Chinese version of the Mental Health Literacy Scale (MHLS-C) and to document the norm and its influential factors of mental health literacy among nurses. The MHLS was translated following Brislin's translation model and tested with a sample of 872 clinical registered nurses. The Jefferson Scale of Empathy-Health Professionals (JSE-HP), Patient Health Questionnaire-2 (PHQ-2), and Generalized Anxiety Disorder-2 (GAD-2) were administered to assess convergent validity. The minimum average partial test, parallel analysis and confirmatory factor analysis supported 4 first-order 2 second-order structure. The 4 factors were named "knowledge of mental disorder," "ability to seek information and help," "recognition of mental disorder," and "acceptance of patients with mental illness," with factor 1-3 were summarized into MHLS-Core (Core literacy subscale) and factor 4 as MHLS-SA (Social acceptance subscale). The MHLS-C was moderately negatively correlated with the PHQ-2 and GAD-2 (-0.111, -0.081) and highly positively correlated with JSE-HP (0.492). The Cronbach's α was 0.85 for the overall scale and 0.89 and 0.93 for two subscales. The test-retest reliability was good, with intraclass correlation coefficients (ICCs) of 0.80 for the whole scale, and 0.79 and 0.94 for two subscales. As an approximately normal distribution, the 50 th percentile for the MHLS-C was 99, with 50 th percentiles of 74 and 20 for MHLS-Core and MHLS-SA. Higher position, higher professional credentials, higher hospital hierarchy, other specialist hospital, psychiatric hospital and unmarried status were positive predictors. The 29-item MHLS-C, with two subscales of MHLS-Core and MHLE-SA, is a stable and validated tool to measure mental health literacy. MHLS-Core could be used independently to measure the core content of mental health literacy. It may be applicable for Chinese health professionals, but need further validation among the general public. MHL curriculum and a targeted culturally appropriate program for acceptance for health professionals, especially for those in general hospitals and with less working tenure, may be recommended.

Professional identity and its work-related factors among psychiatric nurses: A cross-sectional study.

OBJECTIVE: To investigate the level of professional identity among psychiatric nurses and to explore what work-related factors may affect their professional identity. METHODS: Four hundred and twelve nurses were investigated. Two self-report questionnaires were used: (a) Nursing Professional Identity Scale (NPIS, range: 30 ~ 150); and (b) Practice Environment Scale of Nursing Work (PESNW, range: 0 ~ 100) with six dimensions: nursing-related hospital affairs, high-quality nursing care, ability of nursing manager, manpower and material resources, cooperation between nurses and doctors, and salary and social status. Higher scores indicated higher professional identities and better work environments. RESULTS: Three hundred and ninety-one of the participants completed the questionnaires and were analyzed. The mean age of the participants was 32.53 years, and 93.3% of them were female. The mean score of NPIS was 100.03 (SD: 17.44). Multiple linear regression showed that professional identity was significantly and positively associated with two dimensions of PESNW: salary and social status and ability of nursing manager. CONCLUSIONS: Professional identity among psychiatric nurses was at a moderate level. Salary and social status and ability of nursing manager positively contributed to their professional identity. These results may indicate the directors to construct better work environments for psychiatric nursing to improve professional identity.

Development and psychometric evaluation of a Chinese version of auditory hallucination risk assessment scale in patients with a diagnosis of schizophrenia.

AIMS AND OBJECTIVES: To develop a Chinese version of Auditory Hallucination Risk Assessment Scale and evaluate its psychometric properties. BACKGROUND: Auditory hallucination, a common symptom in schizophrenia, has the potential to cause harm to patients and the people around them. However, there has been a paucity of suitable instrument developed in Asian region that can comprehensively and reliably assess its risk and inform interventions. DESIGN: This study involved 2 stages, the development of the Auditory Hallucination Risk Assessment Scale (AHRAS) and testing the psychometric properties of AHRAS. We followed STROBE guidelines in reporting the study. METHODS: Auditory Hallucination Risk Assessment Scale items were developed based on Symptom Management Theory, systematic literature review and findings of a qualitative study on the experience of auditory hallucinations. The items were evaluated by content validity. Auditory Hallucination Risk Assessment Scale was then tested for construct validity, concurrent validity, predictive validity, internal consistency and test-retest reliability in a convenience sample of 156 patients with a diagnosis of schizophrenia. RESULTS: The final version of AHRAS has nine items. Two factors were extracted from AHRAS, which explained 57.74% of the total variance. The score of AHRAS was strongly correlated with that of the Psychotic Symptom Rating Scales-Auditory Hallucinations. The area under the curve was 0.90 for the overall AHRAS score. Sensitivity (86.5%) and specificity (80.0%) were maximal for a mean overall AHRAS score of 13.5, suggesting that this is an appropriate threshold for differentiation. Cronbach's alpha coefficient for internal consistency was 0.82, and intra-class correlation coefficient for test-retest reliability was 0.84. CONCLUSIONS: Auditory Hallucination Risk Assessment Scale has good reliability and validity. It can be used in clinical settings in China and beyond to assess the risk of auditory hallucinations. RELEVANCE TO CLINICAL PRACTICE: Auditory Hallucination Risk Assessment Scale can serve as a tool for nurses and other healthcare professionals to identify patients with high-risk auditory hallucinations, monitor the changes of risk and inform nursing interventions.

A pilot study of iPad-assisted cognitive training for schizophrenia.

In this pilot study, we aimed to examine whether iPad-assisted cognitive training could be beneficial in ameliorating some of the cognitive impairment that accompany schizophrenia. Totally, 20 first-episode schizophrenia patients were randomly assigned to an experiment group (with cognitive training) or to a control group (without cognitive training). The N-back task was assessed at baseline and after intervention, to see what effects iPad-assisted training might have (week 4). The experimental group exhibited significant improvement in the accuracy rate at 2-back, and reaction time at 0, 1 and 2-back tasks. These findings suggest that iPad- or other technically-assisted cognitive training may potentially be a valid strategy for pursuing cognitive rehabilitation among those with schizophrenia.