Text Messaging for Psychiatric Outpatients: Effect on Help-Seeking and Self-Harming Behaviors.

A mobile phone intervention was developed and tested with 30 psychiatric outpatients with mental illness, who had high ideation for suicide. The intervention involved promoting help-seeking behaviors by sending text messages, including information about social welfare services and reminders about medical appointments, for 6 months. After the intervention period, the number of participants who used social services significantly increased, and more than 80% of participants reported that the text messaging service was helpful and useful. Compared to baseline, participants' self-harming behaviors decreased and the attending psychiatrists rated their suicide ideation as weaker. This is the first intervention study to promote psychiatric patients' help-seeking using text messaging, and although it was not a randomized controlled trial, this intervention has practical value and may lead to the prevention of suicide.

Improvement of functional independence of patients with acute schizophrenia through early occupational therapy: a pilot quasi-experimental controlled study.

OBJECTIVE: To clarify whether early occupational therapy for patients with acute schizophrenia improves their functional independence. DESIGN: Quasi-experimental controlled study. SETTING: A university hospital in Japan. SUBJECTS: Forty-six out of 85 eligible patients with schizophrenia. INTERVENTION: Participants were allocated into an intervention group or a control group according to the month of admission. Activities in one-on-one and mainly non-verbal occupational therapy were provided for the intervention group immediately after admission, and not for the control group. MAIN MEASURES: Functional independence was measured using the Functional Independence Measure (FIM), at admission, at one month and at three months after admission. Psychiatric symptoms were also measured by the Brief Psychiatric Rating Scale. RESULTS: Patients in both groups showed improved FIM total scores at one month and three months after admission. In the intervention group, the medians (interquartile ranges) were 89.0 (44.5) at admission, 113.0 (18.5) at one month, and 121.0 (6.5) at three months. In the control group, they were 88.0 (32.0), 107.0 (39.5), and 111.0 (17.0). At three months, the total FIM scores were significantly higher in the intervention group than in the control group (p = 0.016). In the FIM cognitive domain, the scores were significantly higher in the intervention group than in the control group at one month (p = 0.038) and, three months (p = 0.012). Both groups showed improvement in Brief Psychiatric Rating Scale total scores, while no significant differences were observed between the groups at any points. CONCLUSION: The results suggest that early occupational therapy may improve functional independence in patients with acute schizophrenia.

Reliability and validity of a brief self-rated scale of health condition with acute schizophrenia.

AIM: The aim of this study was to develop a new Brief Scale of Self-rated Health Condition with Acute Schizophrenia (BsHAS) and to examine its reliability, validity and correlation to psychiatric symptoms. METHODS: We examined the reliability and validity of the BsHAS consisting of four items (physical health condition, mood, interpersonal fatigue and interest) for 199 inpatients with acute schizophrenia and compared the patients' subjective health conditions as assessed by the BsHAS with their objective psychiatric symptoms. RESULTS: Cronbach's α coefficient was 0.79, indicating that the reliability of the scale was sufficient. These four items chosen from the previous studies were approved by an expert panel, which suggested that the scale has content validity. The BsHAS total score was significantly improved at discharge. However, the effect size was only -0.24. In particular, improvement was not recognized in the interpersonal fatigue item. These findings suggest that some patients weredischarged without realizing the improvement of their health condition. The patients answered all questions without subsequently showing deteriorating symptoms, suggesting that the scale can be applied to acute-phase patients with schizophrenia. No obvious relation was recognized between the patients' subjective health condition as assessed by the BsHAS and their objective psychiatric symptoms. This result suggests that the BsHAS can provide additional information to the objective assessment of psychiatric symptoms. CONCLUSION: These results show that the BsHAS can help psychiatric professionals to know patients' subjective health conditions, and that the longitudinal use of this scale may be useful for evaluating the degree of recovery from schizophrenia.

Prevention of mothers' mental illness deterioration: can their attitudes toward self-care and childcare prevent mental deterioration?

BACKGROUND: Women with severe mental illness experience many kinds of problems during childcare and have a high risk of relapse. Previous studies have not revealed methods for preventing deterioration of mothers' illness. In this study, we retrospectively investigated mothers with severe mental illness, and we attempted to identify characteristics of mothers whose condition did not deteriorate and who did not require hospitalization during childcare. METHODS: Data were collected from a self-administered questionnaire filled out by female outpatients who had experienced childcare and were diagnosed with schizophrenia, schizoaffective disorder, bipolar affective disorder or depression with psychotic symptoms. The questionnaire asked about attitudes toward childcare during the first three years following the first childbirth. It was composed of six sections on A) living situation, B) psychiatric medication, C) sleep, D) subjective symptoms of deterioration, E) resting time, and F) advice for other mothers with mental illness. The subjects were split into two groups: those that were admitted to a hospital within three years following the first childbirth (hospital group, n=16) and those that were not hospitalized (non-hospital group, n=19). RESULTS: The two groups showed no significant differences in their responses to the questions in sections A-E of the questionnaire. In section F, the non-hospital group wrote significantly more comments than the hospital group. The non-hospital group described concrete ways for taking care of their mental health, while the hospital group did not. DISCUSSION: Our results suggest that whether or not mothers need admission during childcare depends on their assertiveness and ability to communicate.

Scale for measuring self-recoverability in daily life for people with schizophrenia.

AIM: A new scale has been developed to assess the self-recoverability in the daily life of people with schizophrenia. Self-recoverability in daily life includes coping with stress events and taking care of one's mental and physical health. The new scale, called Self-Recoverability in Daily Life (SRDL), is a semi-structured instrument with 10 items. The aim of the present study was therefore to test the scale accordingly. METHODS: A total of 57 subjects who were outpatients with a diagnosis of schizophrenia or schizoaffective disorder as defined by DSM-IV, were enrolled in the study. The SRDL scale was assessed with four other scales: the World Health Organization Quality Of Life (WHO-QOL)-26, the Visual Analog Scale (VAS) for health state, the Drug-Induced Extrapyramidal Symptoms Scale (DIEPSS) and the Brief Psychiatric Rating Scale (BPRS). RESULTS: The mean total score of the SRDL scale was positively correlated with both the WHO-QOL-26 and VAS, while the SRDL scale was negatively correlated with the BPRS total score. CONCLUSION: The SRDL scale may be useful for assessing living skills in the daily life of people with schizophrenia.