Group arts therapies for patients with schizophrenia: a protocol of systematic review and meta-analysis.

INTRODUCTION: Schizophrenia, a chronic mental problem, significantly impacts cognition, emotion and social functioning. Conventional pharmacotherapy faces challenges including numerous side effects, low adherence to medication and substantial costs. In this context, group arts therapies (GATs) emerge as a promising complementary approach for symptom alleviation in schizophrenia patients. Nonetheless, the effectiveness and safety of GATs are yet to be firmly established. This study aims to systematically assess the therapeutic impact of all group-based artistic interventions as complementary treatments for schizophrenia, focusing on their potential benefits. METHODS AND ANALYSIS: This study will search four English-language databases (PubMed, Web of Science, Cochrane Library and Embase), two Chinese databases (Wanfang Data and China National Knowledge Infrastructure) and three Korean databases (RISS, Korean Citation Index and DBpia) from their inception until October 2023. It will include all randomised controlled trials that compare GATs for schizophrenia with standard rehabilitation methods. The primary outcome is the improvement in patients' positive and negative symptoms. Methodologies such as bias risk assessment, data synthesis, sensitivity analysis and subgroup analysis will be implemented using Review Manager V.5.4. Study results with high heterogeneity will be merged using a random-effects model (I 2>50% or p<0.1). In cases where meta-analysis is not viable due to significant clinical and methodological heterogeneity, a qualitative summary of the findings will be provided. ETHICS AND DISSEMINATION: The data used in this systematic review are anonymised, devoid of any private information, eliminating the requirement for ethical approval. Dissemination of the research findings will be conducted via peer-reviewed publications. PROSPERO REGISTRATION NUMBER: CRD42023471583.

Effect of individualized occupational therapy on cognition among patients with schizophrenia: A randomized controlled trial.

This study aimed to evaluate the feasibility and efficacy of individualized occupational therapy (IOT) plus group occupational therapy (GOT) as standard care for cognition compared to GOT alone, and to determine which IOT component has the greatest effect on cognitive outcome in patients with schizophrenia. This study was conducted at 14 clinical sites across Japan and enrolled recently hospitalized patients with schizophrenia. The IOT consisted of motivational interview, self-monitoring, individualized visits, craft activities, individualized psychoeducation, and discharge planning. Among the 68 patients who were randomized to the GOT + IOT group (n = 34) and GOT alone group (n = 34), 67 completed the trial (GOT + IOT group, n = 34; GOT alone group, n = 33). There were significant improvements in change from baseline to post-treatment between the groups in verbal memory, working memory, verbal fluency, attention, executive function domains, and the composite score of the Brief Assessment of Cognition in Schizophrenia (BACS). The BACS composite score was significantly associated with the number of craft activity sessions. The addition of IOT to GOT has a favorable feasibility profile and efficacy for cognition in schizophrenia. Craft activity is the most effective IOT component in improving cognition.

Videogame training increases clinical well-being, attention and hippocampal-prefrontal functional connectivity in patients with schizophrenia.

Recent research shows that videogame training enhances neuronal plasticity and cognitive improvements in healthy individuals. As patients with schizophrenia exhibit reduced neuronal plasticity linked to cognitive deficits and symptoms, we investigated whether videogame-related cognitive improvements and plasticity changes extend to this population. In a training study, patients with schizophrenia and healthy controls were randomly assigned to 3D or 2D platformer videogame training or E-book reading (active control) for 8 weeks, 30 min daily. After training, both videogame conditions showed significant increases in sustained attention compared to the control condition, correlated with increased functional connectivity in a hippocampal-prefrontal network. Notably, patients trained with videogames mostly improved in negative symptoms, general psychopathology, and perceived mental health recovery. Videogames, incorporating initiative, goal setting and gratification, offer a training approach closer to real life than current psychiatric treatments. Our results provide initial evidence that they may represent a possible adjunct therapeutic intervention for complex mental disorders.

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.

Changes in cognitive function after a 12-week POWER rehabilitation in older adults with schizophrenia and frailty.

BACKGROUND: The effectiveness of isolated resistance training (RT) on cognitive function among older adults with schizophrenia is insufficiently investigated. This study investigated the effectiveness of 12-weeks POWER rehabilitation, a novel RT regimen, on cognitive function among older patients with schizophrenia and frailty. METHODS: Thirty-two older adults with schizophrenia and frailty were enrolled and randomized to receive either a 12-week, twice weekly POWER rehabilitation, or without add-on training. Cognitive functioning was assessed using mini-mental state examination (MMSE), digit symbol substitution test, color trail task (CTT), and digit span task (DST). Physical performance was assessed by walking speed and hand grip strength. The generalized estimating equations was used to compare pre- and post-training outcome measure between groups. RESULTS: Between-group analysis revealed significant improvement in CTT1 and hand grip strength in the intervention group compared to the controls. Subgroup analyses showed CTT1 performance significantly improved after 12 weeks of POWER rehabilitation in the intervention group (time, p < .001), independent of age, educational level, global cognition, depressive symptoms, and psychotropic medication use. Increased hand grip strength was significantly associated with improved performance in MMSE, CTT1, and DST forward at study endpoint. CONCLUSION: A 12-week POWER rehabilitation for older patients with schizophrenia and frailty is safe and feasible, and may benefit physical and some domains of cognitive functioning.

Impacts of a Self-directed Social Resources Study Program on Negative Symptoms and Quality of Life in Schizophrenia Outpatients: A Randomized Controlled Trial.

To clarify whether a self-directed study program on social resources improves negative symptoms, quality of life (QOL), and social participation among outpatients with schizophrenia. Eighty-six participants were randomly divided into intervention and control groups. In addition to the usual day programs, the intervention group participated in a self-directed study program on social resources once a week for eight weeks. The control group participated only in the usual day programs. Negative symptoms and QOL were assessed at baseline and post-intervention using the Positive and Negative Syndrome Scale (PANSS) and the WHO Quality of Life-BREF (WHOQOL-BREF), respectively. Social participation was also assessed. After the intervention, there were no significant differences in the PANSS negative symptoms and WHOQOL-BREF total scores between the two groups. Within-group, PANSS negative symptom scores significantly improved in the intervention group (p < 0.05), but not in the control group. The WHOQOL-BREF physical health subscale scores improved significantly only in the intervention group (p < 0.05). Social participation remained unchanged between the intervention and control groups. The results suggest that a self-directed study program on social resources may be useful for improving negative symptoms and physical QOL in outpatients with schizophrenia. The findings highlight the potential of such interventions to bridge the existing gap in psychosocial rehabilitation strategies for this population.

Factors associated with recovery during schizophrenia and related disorders: A review of meta-analysis.

BACKGROUND: The spectrum of schizophrenia disorders (SSD) is a severe mental disorder. It is one of the main medical causes of disability that generates high health and social costs. OBJECTIVE: To analyze the factors associated with clinical recovery (CR) (symptomatic remission-SR and functional recovery-FR) and personal recovery (PR) in people diagnosed with SSD. METHODS: 14 meta-analyses focused on recovery were reviewed following the PRISMA model statements. 95 % of CI was established. RESULTS: Shorter Duration of Untreated Psychosis (Zr = 0.24, [0.17, 0.30]) and total Duration of Untreated Illness (Zr = 0.34, [0.20, 0.48]) were related to greater SR and general functioning, respectively. Resilience was the variable with the greatest effect on FR (Zr = 0.67, [0.63, 0.71]). Premorbid adjustment (Zr = 0.34, [0.18, 0.49]) and physical intervention (Zr = 0.71, [0.55, 0.86]) had the greatest effect on occupational and social functioning, respectively. Less severe affective symptoms were related to greater PR (Zr = 0.46, [0.42, 0.50]). There are differences between affective SR and the other types of SR (Zr(SR-A - SR-) = 0.13, Qb = 6.51, p = 0.011), (Zr(SR-A - SR+) = 0.20, Qb = 8.52, p = 0.004), (Zr(SR-A - SR) = 0.18, Qb = 19.29, p = 0.0001). In all, resilience was associated with greater recovery (Zr = 0.67, [0.53, 0.80]), with the global effect being greater on PR than on CR (Zr(PR-CR) = 0.07, Qb = 3.45, p = 0.05). CONCLUSIONS: Resilience was the variable most strongly associated with recovery. Symptomatic or functional improvement obtained less statistical weight.

Durability of Effects of Cognitive Remediation on Cognition and Psychosocial Functioning in Schizophrenia: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.

OBJECTIVE: Cognitive remediation provides substantial improvements in cognitive performance and real-world functioning for people living with schizophrenia, but the durability of these benefits needs to be reassessed and better defined. The aims of this study were to provide a comprehensive assessment of the durability of the benefits of cognitive remediation for cognition and functioning in people living with schizophrenia and evaluating potential moderators of effects. METHODS: A systematic search was conducted in PubMed, Scopus, and PsycINFO, and reference lists of included articles and Google Scholar were inspected. Eligible studies were randomized clinical trials of cognitive remediation in patients diagnosed with schizophrenia spectrum disorders in which follow-up assessments were included. Screening and data extraction were performed by at least two independent reviewers. Cohen's d was used to measure outcomes. Primary outcomes were changes in cognition and functioning from baseline to conclusion of follow-up. Moderators of the durability of effects were assessed. RESULTS: Of 2,840 identified reports, 281 full texts were assessed and 130 reports on 67 studies with 5,334 participants were included. Cognitive remediation produced statistically significant positive effects that persisted at the end of follow-up in global cognition (d=0.23) and in global functioning (d=0.26). Smaller study samples and single-center studies were associated with better cognitive outcomes; longer treatment and follow-up duration, techniques for transferring cognitive gains to the real world, integration with psychiatric rehabilitation, group format of delivery, and more female participants in the sample were associated with better functional outcomes. CONCLUSIONS: Cognitive remediation provides durable improvements in cognition and functioning in schizophrenia. This finding corroborates the notion that cognitive remediation should be implemented more widely in clinical and rehabilitation practice.

Cognitive remediation for schizophrenia: Clinician perspectives on implementation barriers and facilitators.

OBJECTIVES: Neurocognitive deficits in schizophrenia have a major impact on functioning; however, they remain poorly targeted by available treatment offerings. Cognitive remediation (CR) is effective in improving neurocognition and functioning. Despite clinical guidelines for schizophrenia recommending CR, it is still not readily available in clinical services and sizeable attrition rates are reported in clinical trials. METHOD: To elucidate the barriers and facilitators of CR access and engagement, we conducted a mixed methods qualitative-dominant study with 12 clinicians in Australia, in 2021, with 1 hr interviews and additional rating scales completed. RESULTS: Thematic analysis highlighted four themes (cognitive symptoms, CR intervention, motivation and engagement in CR, and CR implementation), and 14 subthemes. Clinicians emphasized the broad impact of cognitive deficits and outlined pros and cons of different CR approaches. Several factors were suggested as impacting engagement, including motivation assessments/techniques, neurocognitive insight, illness, and demographic factors. Lack of routine implementation in Australia was unanimously espoused and partly explained by a need for cost-effectiveness analyses, remote and flexible delivery, and increasing service resource provision and staff training in CR. CONCLUSIONS: This study offers key insights into CR access, while recommending methods for optimizing CR implementation and dissemination to improve recovery outcomes of people diagnosed with schizophrenia. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Differential associations between insight and quality-of-life dimensions among individuals with schizophrenia.

PURPOSE/OBJECTIVE: In schizophrenia, insight, the recognition that one has a medical illness that requires treatment, has long been related to deteriorated quality of life. Yet, insight and quality of life are broad constructs that encompass several dimensions. Here, we investigated differential associations between insight and quality-of-life dimensions using a psychological network approach. RESEARCH METHOD/DESIGN: We extracted data from the French network of rehabilitation centers REHABase (January 2016 to December 2022, N = 1,056). Our psychological network analysis modeled insight and quality of life as a network of interacting dimensions: three insight dimensions (awareness of illness, reattribution of symptoms to the disease, and recognition of treatment need) and eight quality-of-life dimensions (autonomy, physical and psychosocial well-being, relationships with family, friends and romantic partners, resilience, and self-esteem). RESULTS: Insight was negatively associated with quality of life. Our psychological network analysis revealed a strong negative association between awareness of disease and self-esteem. Both dimensions were the strongest nodes in the overall network. Our network analysis also revealed a significant but positive connection between recognition of treatment needs and resilience. CONCLUSION/IMPLICATIONS: While insight and quality of life are overall negatively associated, we found both negative and positive connections between insight and quality-of-life dimensions. The negative relationship between insight and quality of life may reflect the deleterious effects of diagnostic labeling on a patient's self-esteem. Yet, acknowledgment of treatment needs may have positive effects on quality of life and may promote recovery, perhaps because it emphasizes the need for support rather than labels and abnormalities. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

"It's Tough to Be a Black Man with Schizophrenia": Randomized Controlled Trial of a Brief Video Intervention to Reduce Public Stigma.

BACKGROUND AND HYPOTHESIS: Racial discrimination and public stigma toward Black individuals living with schizophrenia create disparities in treatment-seeking and engagement. Brief, social-contact-based video interventions efficaciously reduce stigma. It remains unclear whether including racial identity experiences in video narrative yields greater stigma reduction. We hypothesized that we would replicate findings showing sustained stigma reduction in video-intervention groups vs control and that Black participants would show greater stigma reduction and emotional engagement than non-Black participants only for a racial-insights video presenting a Black protagonist. STUDY DESIGN: Recruiting using a crowdsourcing platform, we randomized 1351 participants ages 18-30 to (a) brief video-based intervention, (b) racial-insights-focused brief video, or (c) non-intervention control, with baseline, post-intervention, and 30-day follow-up assessments. In 2-minute videos, a young Black protagonist described symptoms, personal struggles, and recovery from schizophrenia, with or without mentioning race-related experiences. STUDY RESULTS: A 3 × 3 ANOVA showed a significant group-by-time interaction for total scores of each of five stigma-related domains: social distance, stereotyping, separateness, social restriction, and perceived recovery (all P < .001). Linear mixed modeling showed a greater reduction in stigma from baseline to post-intervention among Black than non-Black participants in the racial insights video group for the social distance and social restriction domains. CONCLUSIONS: This randomized controlled trial replicated and expanded previous findings, showing the anti-stigma effects of a brief video tailored to race-related experiences. This underscores the importance of personalized, culturally relevant narratives, especially for marginalized groups who, more attuned to prejudice and discrimination, may particularly value identification and solidarity. Future studies should explore mediators/moderators to improve intervention efficacy.

Independence through community access and navigation: A supported leisure intervention for individuals with negative symptoms.

OBJECTIVE: Promoting leisure participation requires a collaborative approach that emphasizes personal interests, strengths, and motivations. The purpose of this article was to test the effectiveness of the Independence through Community Access and Navigation (ICAN) intervention on community participation, recreation participation, and positive emotions among individuals with schizophrenia spectrum disorders. Using motivational interviewing and an individualized placements and support framework, the ICAN intervention focuses on working with participants to identify and participate in personally meaningful leisure activities by connecting with personal motivations and mainstream community opportunities. METHOD: This randomized controlled trial was conducted with 74 participants diagnosed with schizophrenia with assessments conducted at baseline and posttreatment. Intervention effects were examined with repeated-measures analysis of variance (ANOVA). Multiple regression analysis was also performed using a change score as an outcome variable and baseline negative symptoms score, condition, and interaction as predictors. RESULTS: There was no significant main effect of ICAN on positive emotions, recreation participation, or community participation; however, among those in the experimental group, those with impairments in motivation and pleasure experienced improvements in community participation. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: For individuals experiencing greater negative symptoms, a supported leisure intervention may be an effective strategy to explore personal motivations and increase leisure participation. Future research should test the intervention effectiveness specifically targeting a larger sample of individuals with more severe negative symptoms. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Functional recovery in older adults with schizophrenia: A national interRAI study.

BACKGROUND: The concept of recovery for people with schizophrenia (PwS) is still a matter of debate. Growing numbers of PwS living to older age calls for examination of their disease trajectories with a focus on recovery. AIM: To compare two groups of PwS (good wellbeing; poor wellbeing) on several psychosocial variables associated with social wellbeing to identify interventions that support functional recovery. METHOD: Data was drawn from participants from across New Zealand (NZ), who had received a formal diagnosis of Schizophrenia; were living independently in the community, and who had undergone their first International Resident Assessment Instrument (interRAI) assessment from 2012 to 2022. We compared two groups of PwS (good social wellbeing; poor social wellbeing) examining associations with demographic and psychosocial variables. RESULTS: We compared interRAI assessments for: 'poor psychosocial wellbeing' (n = 1,378; 67%; 56% female; 70.5% 65 years and over; 36.1% never married); and 'good psychosocial wellbeing' (n = 693; 33%; 61.1% female; 78.1% 65 years and over; 29.8% never married; n = 549 did not have sufficient social wellbeing data to be included). We found significant associations between social wellbeing and depression, disruptive behaviour, decision making, self-expression, understanding verbal information, activity level, self-reported health and medication adherence. Logistical regression showed depression (ß = .84, p < .001, Wald = 51.01, Exp(B) = 2.31) and mild disruptive behaviour (ß = .63, p = .002, Wald = 9.26, Exp(B) = 0.53) were the only predictors of poor social wellbeing. Those who reported some degree of depressive symptoms were 2.31 (CI [1.84, 2.91]) more likely to be in the poor social wellbeing group. CONCLUSIONS: A significant minority (33.5%) of older PwS enjoy positive social wellbeing. Several psychosocial variables are associated with wellbeing. By addressing the comorbidity of depressive symptoms, we may be able to improve wellbeing for older PwS.

Evidence-based psychosocial interventions in schizophrenia: a critical review.

PURPOSE OF REVIEW: Schizophrenia Spectrum Disorders (SSD) are severe conditions that frequently produce significant impairment in cognitive performance, social skills and psychosocial functioning. As pharmacological treatment alone often provides only limited improvements on these outcomes, several psychosocial interventions are employed in psychiatric rehabilitation practice to improve of real-world outcomes of people living with SSD: the present review aims to provide a critical overview of these treatments, focusing on those that show consistent evidence of effectiveness. RECENT FINDINGS: Several recent systematic reviews and meta-analyses have investigated in detail the acceptability, the effectiveness on several specific outcomes and moderators of response of different psychosocial interventions, and several individual studies have provided novel insight on their implementation and combination in rehabilitation practice. SUMMARY: Cognitive remediation, metacognitive training, social skills training, psychoeducation, family interventions, cognitive behavioral therapy, physical exercise and lifestyle interventions, supported employment and some other interventions can be fully considered as evidence-based treatments in SSD. Psychosocial interventions could be of particular usefulness in the context of early intervention services. Future research should focus on developing newer interventions, on better understanding the barriers and the facilitators of their implementation in clinical practice, and exploring the opportunities provided by novel technologies.

Experiences of returning to work in patients with schizophrenia after treatment: A longitudinal qualitative study.

BACKGROUND: Returning to work (RTW) has always been regarded as one of the important indicators to evaluate the therapeutic effect of patients with schizophrenia. The existing studies on RTW in patients with schizophrenia are mostly focused on intervention measures, and the qualitative research on RTW is very limited. The purpose of this study was to evaluate the experience of the RTW after treatment in patients with schizophrenia. METHOD: A longitudinal qualitative study was conducted involving 24 patients with schizophrenia in China. The interviews were held at three time-points during their RTW process, (1) when patients had improved and were close to discharge, (2) within 1 month post-discharge, and (3) 6 months post-discharge. The interview recordings were transcribed by the research team, and transcripts were independently analyzed by two independent coders using reflexive thematic analysis. RESULTS: A total of 24 patients with schizophrenia participated in 72 personal interviews. The thematic framework based on the experience of patients with schizophrenia reveals a three-phases of the process of RTW: improved, being at a loss, and job crisis. The study identified one theme of the first phase: the expectation and optimism. Two themes in the second phase: (1) psychological distress of upcoming work; (2) expectation of assistance pre-work. And four themes in the third phase: (1) tremendous pressure of RTW; (2) lack of medical and social support; (3) social status and interpersonal relationships change; and (4) high level of financial pressure. CONCLUSION: The experience of RTW is a dynamic process with great challenges in each phase, patients with schizophrenia have been deeply affected by what they have experienced. There is an urgent need to ensure that existing community and social support is integrated into daily care to support patients with schizophrenia to RTW successful. The findings of this study also suggest relevant departments and employers should be aware of the barriers to RTW for patients with schizophrenia, and take certain measures to change the current situation.

Contribution of socio-demographic and clinical characteristics to predict initial referrals to psychosocial interventions in patients with serious mental illness.

AIMS: Psychosocial rehabilitation (PSR) is at the core of psychiatric recovery. There is a paucity of evidence regarding how the needs and characteristics of patients guide clinical decisions to refer to PSR interventions. Here, we used explainable machine learning methods to determine how socio-demographic and clinical characteristics contribute to initial referrals to PSR interventions in patients with serious mental illness. METHODS: Data were extracted from the French network of rehabilitation centres, REHABase, collected between years 2016 and 2022 and analysed between February and September 2022. Participants presented with serious mental illnesses, including schizophrenia spectrum disorders, bipolar disorders, autism spectrum disorders, depressive disorders, anxiety disorders and personality disorders. Information from 37 socio-demographic and clinical variables was extracted at baseline and used as potential predictors. Several machine learning models were tested to predict initial referrals to four PSR interventions: cognitive behavioural therapy (CBT), cognitive remediation (CR), psychoeducation (PE) and vocational training (VT). Explanatory power of predictors was determined using the artificial intelligence-based SHAP (SHapley Additive exPlanations) method from the best performing algorithm. RESULTS: Data from a total of 1146 patients were included (mean age, 33.2 years [range, 16-72 years]; 366 [39.2%] women). A random forest algorithm demonstrated the best predictive performance, with a moderate or average predictive accuracy [micro-averaged area under the receiver operating curve from 'external' cross-validation: 0.672]. SHAP dependence plots demonstrated insightful associations between socio-demographic and clinical predictors and referrals to PSR programmes. For instance, patients with psychotic disorders were more likely to be referred to PE and CR, while those with non-psychotic disorders were more likely to be referred to CBT and VT. Likewise, patients with social dysfunctions and lack of educational attainment were more likely to be referred to CR and VT, while those with better functioning and education were more likely to be referred to CBT and PE. CONCLUSIONS: A combination of socio-demographic and clinical features was not sufficient to accurately predict initial referrals to four PSR programmes among a French network of rehabilitation centres. Referrals to PSR interventions may also involve service- and clinician-level factors. Considering socio-demographic and clinical predictors revealed disparities in referrals with respect to diagnoses, current clinical and psychological issues, functioning and education.

Conocimiento del tratamiento en esquizofrenia y trastorno esquizoafectivo y su relación con la no adherencia / Knowledge of the treatment in schizophrenia and schizoaffective disorder and its relationship with nonadherence

Introducción. El conocimiento del tratamiento ha sidoescasamente estudiado en pacientes con psicosis, a pesar de su potencial importancia para la adherencia. Evaluamos la posible asociación entre el conocimiento del tratamiento y la no adherencia, no adherencia no intencional (NANI) y no adherencia intencional (NAI). Metodología. Se incluyeron 106 pacientes con diagnóstico de esquizofrenia o trastorno esquizoafectivo que ingresaron consecutivamente. Las evaluaciones se realizaron durante la hospitalización y a los seis meses de seguimiento. Se incluyeron variables sociodemográficas, clínicas, psicopatológicas y relacionadas con el tratamiento. La adherencia se definió como la concurrencia de adherencia al tratamiento antipsicótico y adherencia al seguimiento ambulatorio durante ese periodo de seis meses. Establecimos dos subtipos de no adherencia dependiendo del motivo principal de no adherencia: NANI y NAI. Resultados. El 45,3% de los pacientes mostraron un inadecuado conocimiento del tratamiento. Los pacientes adherentes, comparados con los no adherentes, no mostraron diferencias en el conocimiento del tratamiento (mediana 77 vs. 77, respectivamente; p = 0,232). Sin embargo, los pacientes NANI presentaron peor conocimiento del tratamiento comparados con los pacientes adherentes (mediana 62 vs. 77 respectivamente; p < 0,001), mientras que los pacientes NAI presentaron mejor conocimiento del tratamiento comparados con los pacientes adherentes (mediana 86 vs. 77, respectivamente; p = 0,026). Conclusión. Un alto porcentaje de los pacientes con esquizofrenia y trastorno esquizoafectivo no tienen un adecuado conocimiento del tratamiento. Además, nuestros resultados sugieren que un inadecuado conocimiento del tratamiento puede contribuir a la no adherencia en pacientescon no adherencia no intencional. (AU)

Background and objectives. Despite its potential importance for adherence, knowledge of the treatment has been little studied in patients with psychosis. We performed this study to assess the possible association between knowledge of the treatment and nonadherence, unintentional nonadherence (UNA) and intentional nonadherence (INA). Methods. We assessed 106 consecutively admitted patients diagnosed with schizophrenia or schizoaffective disorder. Evaluations were carried out during hospitalization and after six-months of follow-up. This included sociodemographic, clinical, psychopathologic variables and those related to treatment. Adherence was interpreted as the concurrence of adherence to antipsychotic treatment and adherence to outpatient follow-up over the course of the six-month period. We established two subtypes according to the main reason for nonadherence: unintentional and intentional nonadherence. Results. Inadequate knowledge of the treatment was detected in 45.3% of patients. Adherent patients, as compared to nonadherent patients, showed no difference regarding knowledge of the treatment (median 77 vs. 77, respectively; p = 0.232). Nevertheless, UNA patients showed worse knowledge of the treatment as compared to adherent patients (median 62 vs. 77 respectively; p < 0.001), whereas INA patients showed better knowledge of the treatment as compared to adherent patients (median 86 vs. 77, respectively; p = 0.026). Conclusions. A large number of patients with schizophrenia or schizoaffective disorder did not have an appropriate knowledge of their treatment. More importantly, our results suggest that inadequate knowledge of the treatment may contribute to nonadherence in patients with unintentional nonadherence. (AU)

Factors Affecting Employability of Patients with Schizophrenia who had First Participated in Vocational Training: A Pilot Study.

While vocational training may offer financial and health benefits for patients with schizophrenia (PwS), further empirical research is required to investigate the effectiveness of this intervention for PwS, as well as the factors influencing their employability. This study aimed to (i) identify the factors affecting the employability of PwS who had participated in vocational training and (ii) examine the effectiveness of vocational training. This prospective cohort study was conducted in a community rehabilitation center attached to a psychiatric hospital in southern Taiwan that provides vocational training. The participants completed two questionnaires: (i) a pre-test that served as the study's baseline; (ii) a post-test during a follow-up 12 months later. The questionnaire was divided into three parts: (i) participants' basic information, (ii) the work performance scale, and (iii) the mental state measure. The participants included 35 males and 30 females, with the average age being 45.85 years. The significant factors affecting their employability were social support, work behavior, thinking disorder, and cognitive impairment. In other words, participants with better social support, work behavior, and fewer thought disorders and cognitive impairment were more employable. Their work attitude and ability were found to have significantly improved after having participated in vocational training for 12 months. In conclusion, when conducting vocational training in the future, it is necessary to pay attention to individual participants' social support and work behavior and reduce thinking disorders and cognitive impairments. This may help improve the employability of PwS.

“A beautiful mind” – Promoção da literacia em saúde mental / “A beautiful mind” - Promotion of mental health literacy

Introdução: Associado à iliteracia do que fazer para prevenir, retardar e quando procurar ajuda, perante a esquizofrenia, requer-se ao enfermeiro especialista em saúde mental um agir ético, alicerçado no conhecimento empírico, técnico-científico, envolvendo os deveres profissionais: dignidade, individualidade e autonomia. Objetivo: Promover a literacia em saúde mental, através da análise do adoecer de uma pessoa com esquizofrenia e das questões éticas associadas ao cuidar em enfermagem de saúde mental. Metodologia: Estudo de caso – filme “Uma Mente Brilhante”, de natureza qualitativa, exploratória-descritiva. Resultados e Discussão: A esquizofrenia transforma a forma de pensar, de sentir e de relação com as pessoas, conduzindo à estigmatização associada a mitos conectivos entre a doença mental e a violência, contribuindo para a dificuldade/exclusão no emprego, apoio social e procura de ajuda. Conclusão: Salienta-se a promoção da literacia do agir perante uma pessoa com esquizofrenia, e do cuidado ético em enfermagem inerente. (AU)

Introduction: Associated with the illiteracy of what to do to prevent, delay, and when to seek help, in the face of schizophrenia, the nurse specialist in mental health is required to act ethically, based on empirical, technical-scientific knowledge, involving professional duties: dignity, individuality and autonomy. Objective: To promote mental health literacy by analysing the illness of a person with schizophrenia and the ethical issues associated with mental health nursing care. Methodology: Case study – film “A Brilliant Mind”, of a qualitative, exploratory-descriptive nature. Results and Discussion: Schizophrenia transforms the way of thinking, feeling, and relating to people, leading to stigmatisation associated with connecting myths between mental illness and violence, contributing to difficulty/exclusion in employment, social support and seeking help. Conclusion: The promotion of literacy on how to act towards a person with schizophrenia, and the inherent ethical care in nursing, are highlighted. (AU)

Job Retention and Reintegration in People with Mental Health Problems: A Descriptive Evaluation of Supported Employment Routine Programs.

PURPOSE: Striking evidence supports the effectiveness of supported employment (SE) in achieving competitive employment in individuals with mental health problems. Yet, little is known whether SE is effective to maintain employment in individuals at risk of job loss. We aimed to descriptively compare SE for employed clients (SE-retention) and unemployed clients (SE-integration) regarding competitive employment. METHODS: We used administrative data from January 2017 to October 2021 provided by a vocational rehabilitation center in Switzerland including all individuals (≥ 18yrs.) with mental health problems who participated either in SE-retention or SE-reintegration. The outcome was the proportion with competitive employment at discharge. Logistic regression was used to assess time trends and to descriptively compare SE-treatments. We used propensity score weighting, including personal, clinical and program-specific information to reduce group differences. RESULTS: A total of 556 participants primarily diagnosed with mood/stress-related, schizophrenia and personality disorders were included (n = 297 SE-retention, n = 259 SE-reintegration) with median age 41 years and 57% female gender. The overall weighted comparison favored SE-retention over SE-reintegration OR 4.85 (95%-CI 3.10 to 7.58, p < 0.001) with predicted employment of 67.3% and 29.9% for SE-retention and SE-reintegration, respectively. While success for SE-reintegration remained stable over time, SE-retention showed an increase in more recent years. CONCLUSION: SE-retention provides an approach for early work-related support that can prevent labor market exclusion. In contrast, reintegration is likely to require more efforts to achieve employment and may result in less favorable outcomes. It is therefore necessary that further research includes appropriate comparison groups to evaluate the effectiveness of SE-retention programs as well as the economic and individual benefits.