A randomized controlled trial of a targeted support program for informal caregivers in adult psychiatry.

Background: The importance of informal caregivers for persons with severe mental illness has been demonstrated. However, this role may cause a high care burden that considerably affects caregiver health. The Ensemble program is a five-session brief individual intervention designed to support informal caregivers. This trial aimed to assess the efficacy of the program versus SAU (support as usual) for participants with a high care burden. Methods: A single-center randomized controlled trial including 149 participants was conducted. Caregivers in the intervention arm participated in the Ensemble program. The effects of the intervention were assessed using mixed models for repeated measures analysis of variance on improvements in informal caregivers' psychological health status, optimism levels, burden scores, and quality of life at three time points (T0 = pretest; T1 = posttest at 2 months, and T2 = follow-up at 4 months). Results: Analysis of the Global Psychological Index showed no significant effect at the two endpoints in favor of the Ensemble group. However, the Brief Symptom Inventory-Positive Symptom Distress Index was significantly lower at the two-month follow-up. A significant reduction in burden on the Zarit Burden Interview was observed post-intervention, along with an increase in optimism levels on the Life Orientation Test-Revised at follow-up in the Ensemble group. No significant differences were observed in quality of life. Clinical improvements in both psychological health status and burden levels were also identified. Conclusion: The Ensemble program offers an inclusive approach based on a recovery perspective that significantly reduces symptom distress and burden and increases optimism among informal caregivers.Clinical trial registration: https://clinicaltrials.gov/, NCT04020497.

Integration of a peer practitioner in a hospital unit for patients with psychotic disorders: an exploratory qualitative study.

Introduction: Studies on the integration of peer mental health practitioners (PMHP) in hospitals are sparse, despite significant benefits being reported for patients and professionals. The integration of PMHP requires the consideration of several parameters and a change in the culture of care. This study aims to understand the impact of the integration of a PMHP in a hospital unit caring for patients with psychiatric disorders. Methods: A qualitative content analysis of three focus groups with the interdisciplinarity team were conducted. A consulting PMHP was integrated into the entire research process. Results: Data analysis revealed five main themes: the importance of integration, benefits for patients linked to the identification process, benefits for the team and institution, potentials risks, and perspectives. Discussion: The study was conducted in a hospital setting with patients suffering from severe psychiatric disorders associated with behavioral disturbances. The benefits reported in the results outline the feasibility of PMHP integration in an acute psychiatric care setting. Nevertheless, further formalization of the PMHP role is required to minimize possible areas of tension between respective fields of activity of each professional.

Women involvement in the informal caregiving field: A perspective review.

The patient recovery process of individual with mental health disorder is reinforced if they are connected with their community and supported by relatives. The literature has shown that caregivers are important, although their roles can lead to alterations in their own health; and women are the most involved in this role. The present review investigated women's involvement in the informal caregiver scientific field. A literature review indicated gender differences; researchers who are women are more interested in this field than men. Even with a good representation of women in this scientific field, the results showed a statistically significant gender difference for the first and second authors, whereas there was no significant gender difference among the last authors. More efforts must be made to recognize the importance of women's involvement in research because they raise a specific important field. Family caregivers are key players in the healthcare system, but to date, there has been little recognition of their enormous contribution. Our results also indicated the informal caregiver role is filled more by women than by men, which creates social inequalities in many domains, especially in opportunities at the professional level. Tailored interventions are required to address the specific needs and issues of family caregivers. A better redistribution of unpaid work, such as informal caregiving, compared to paid work must be made to respect gender in social existence.

Ability to Care for an Ill Loved One During the First COVID-19 Lockdown: Mediators of Informal Caregivers' Stress in Europe.

Informal caregivers are overlooked, healthcare actors. They are at particular risk of distress and suffer from poor mental health. This study aimed to investigate the perceived stress and modulating factors during the first COVID-19 lockdown in Europe, regardless of the illness that care recipients suffer from. Sociodemographic data, coping resources, and perceived stress level using the Perceived Stress Scale (PSS-10) questionnaire were assessed using a web-based survey in Switzerland, France, and Belgium with 232 informal caregivers. Mediation analyses were used to identify the factors that modulate stress. Higher perceived stress among informal caregivers was associated with a younger age for the care recipient, family relationship with the care recipient, cohabitation, and female sex of the informal caregiver. These associations were partially mediated by the fear of getting ill (age, cohabitation), the conviction that lockdowns had a negative impact on health (age, kinship), and the perceived deterioration of the care recipient's health (gender). The fear of losing the ability to cope with caregiving tasks due to an illness (COVID-19 and/or other) and the negative impact of the lockdown on care recipients' health, particularly on the mental health of young care recipients, increased the stress of informal caregivers. Our results emphasize the importance of informal caregiving support to prevent heightened stress in lockdown conditions, regardless of care recipient illness or kinship.

An Evaluation of an Online Training Platform for Teaching Positive Emotions for People With Schizophrenia.

BACKGROUND: The dissemination of new interventions in clinical practice remains challenging. E-learning may provide wide access in various settings and allow tailored learning trajectories and an adapted training pace. This study evaluates an online platform to train professionals to lead the Positive Emotion Program for Schizophrenia (PEPS) for patients with anhedonia. This study aims to test the reception provided by clinicians to the platform and its perceived usefulness and investigate whether e-PEPS training improves knowledge about the facilitation of PEPS. MATERIALS AND METHODS: Participants were recruited through advertisements. All participants provided their informed consent on a registration form and completed two pre-test questionnaires, a knowledge test on negative symptoms in schizophrenia, learning strategies and the partnership relationship, and a test on the ability to savor pleasant moments. After the training, they completed the same questionnaire and an evaluation form of the training and its application in personal and professional life. RESULTS: Two-hundred and ten participants were registered to participate into the study, 185 received the access to the platform, and 101 participants completed the training and the post-test assessments. Satisfaction with training was high. The results showed that the participants significantly improved their knowledge about PEPS and increased the skills taught in their personal repertoire after the training. The training allows most clinicians to plan to lead a PEPS group in the year following training. DISCUSSION: As a result of this study, training has been improved and is now freely available to all interested clinicians.

The Joint Crisis Plan: A Powerful Tool to Promote Mental Health.

Purpose: The Joint Crisis Plan (JCP) has received growing interest in clinical and research settings. JCP is a type of psychiatric advance statement that describes how to recognize early signs of crisis and how to manage crises. The purpose of the present study, to our knowledge the first to be conducted on this topic in the French-speaking context and to include inpatients, was to describe the content of JCPs and how they are perceived by patients and the providers. Methods: The study used an exploratory, mixed, sequential method. Existing JCPs were retrospectively collected in several clinical contexts (hospital, community settings, and sheltered accommodation). Based on their analyses, we conducted semi-structured interviews including some rating scales on the perception of the JCPs among patients and providers in these settings. For the qualitative analyses, content analyses were conducted with a hybrid approach using NVivo 12 software. Data were double-coded and discussed with a third researcher until agreement was reached. Results: One hundred eighty-four JCPs were collected retrospectively and 24 semi-structured interviews were conducted with 12 patients and 12 providers. No relatives could be included in the research process. The content of the studied JCPs was relevant and indicated that patients had good knowledge of themselves and their illness. Improvements in the quality of the therapeutic relationship, respect for patients' choices and wishes, and a greater sense of control of their illness were reported. The JCP was perceived as a very useful tool by patients and providers. Concerning JCP limitations, lack of staff training, difficulties with the shared decision-making process, and the poor availability of the JCPs when needed were reported. Conclusion: The study highlights that JCPs may be used with patients suffering from a large variety of psychiatric disorders in different care settings. The JCP is perceived as very useful by both patients and providers. The promising results of this study support the promotion of the wide use of JCPs with patients who have experienced crises. It is important to continue to research JCPs through impact studies that include family members.

Measuring the paradox of self-stigma: psychometric properties of a brief scale.

BACKGROUND: Exposure to public stigma can lead to stereotype endorsement and resignation, which are constructs related to self-stigma. This latter phenomenon has well-documented deleterious consequences for people living with mental illness. Paradoxically, it can also lead to the empowering reactions of righteous anger and coming out proud. AIM: The aim of this study was to develop and validate a brief tool to measure stereotype endorsement, righteous anger, and non-disclosure across different groups of stigmatized persons. This process was conducted in collaboration with users. METHOD: Using focus groups with mental health professionals and people living with mental illness, 72 items were developed to measure various aspects of self-stigma. The Paradox of Self-Stigma scale (PaSS-24) containing 24 items and three subscores (stereotype endorsement, non-disclosure, and righteous anger) resulted from a calibration phase using factor analysis. This structure was cross-validated on an independent sample. Internal consistency, test-retest reliability, and convergent validity were also evaluated. RESULTS: 202 patients were assessed. The PaSS-24 demonstrated good internal validity. Internal consistency, test-retest reliability, and convergent validity estimates were also good. CONCLUSIONS: The PaSS-24 is a short but psychometrically rigorous tool designed to measure self-stigma and related constructs in French language, developed in collaboration with users. The development and validation of the PaSS-24 represent a first step towards implementing and evaluating programs aimed at reducing negative consequences of self-stigma.

Ensemble programme for early intervention in informal caregivers of psychiatric adult patients: a protocol for a randomised controlled trial.

INTRODUCTION: Informal caregivers play a major role in the support and maintenance of community patients with severe psychiatric disorders. A pilot study showed that an individualised brief intervention such as the Ensemble programme leads to significant improvements in psychological health state and optimism. METHODS AND ANALYSIS: This randomised controlled trial aims to compare the efficacy of using Ensemble in improving informal caregivers' psychological health states and the ability to play an active role in their situations with that of support as usual. Improvements on the psychological health global index will be measured three times (T0-pre, T1-post and T3 2 months follow) with standardised questionnaires (the Global Severity Index of Brief Inventory Symptoms, the Life Orientation Test-Revised, the 36-item Medical Outcome Study Short-Form Health Survey and the French Zarit Burden Interview). Differences between groups in post-test and pretest values will be examined using an analysis of covariance for each outcome variable. The severity of illness measured by the Social and Occupational Functioning Assessment Scale will also be collected at T0 and T2 to compare eventual patient improvements. At the end of the programme, the experiences of the 20 patients participating in the Ensemble programme will be evaluated qualitatively. ETHICS AND DISSEMINATION: The research protocol received full authorisation from the Human Research Ethics Committee of the Vaud state, Switzerland. The principal paper will concern the results of the experimental design used to test the Ensemble programme. The research team will prioritise open access publications. TRIAL REGISTRATION NUMBER: NCT04020497.

Temporal regularity of cerebral activity at rest correlates with slowness of reaction times in intellectual disability.

OBJECTIVE: Intellectual disability (ID) is described as a general slowness in behavior and an inadequacy in adaptive skills. The present study examines whether behavioral slowness in ID could originate from abnormal complexity in brain signals. METHODS: Participants (N = 29) performed a reaction times (RTs) task assessing their individual information processing speeds. Half of the participants had moderate intellectual disability (intelligence quotient (IQ) < 70). Continuous electroencephalogram recording during the resting period was used to quantify brain signal complexity by approximate entropy estimation (ApEn). RESULTS: For all participants, a negative correlation between RTs and IQ was found, with longer RTs coinciding with lower IQ. This behavioral slowness in ID was associated with increased temporal regularity in electrocortical brain signals. CONCLUSIONS: Behavioral slowness in ID subjects is closely related to lower brain signal complexity. SIGNIFICANCE: Brain signal ApEn is shown to correspond with processing speed for the first time: in ID participants, the higher the regularity in brain signals at rest, the slower RTs will be in the active state. ID should be understood as a lack of lability in the cortical transition to the active state, weakening the efficiency of adaptive behavior.

Does the Beck Cognitive Insight Scale predict change in delusional beliefs?

OBJECTIVES: The Beck Cognitive Insight Scale (BCIS) is composed of two subscales, self-reflectiveness and self-certainty, assessing reflectiveness and openness to feedback, and mental flexibility. Delusions have previously been associated with low cognitive insight. The aim of this study was to determine whether changes in BCIS scores predict changes in delusional beliefs. METHODS: The study is a secondary analysis of a previously published randomized controlled trial. All participants had a psychotic disorder diagnosis and received treatment as usual, with half of them also receiving the cognitive restructuring intervention 'Michael's game'. Participants were assessed at three different times: at baseline (T1), at 3 months (T2), and at 9 months (T3). Cognitive insight was measured with the BCIS, belief flexibility with the Maudsley assessment of delusions schedule (MADS), and psychotic symptoms with the Brief Psychiatric Rating Scale (BPRS). RESULTS: A total of 172 participants took part in the trial. After using generalized estimating equation (GEE) modelling, we observed (1) significant main effects of BCIS self-certainty and Time and (2) significant Time × BCIS self-certainty and Time × treatment group interaction effects on belief flexibility. Improvements in self-certainty (i.e., decrease in scores) were associated with more changes in conviction over time, more accommodation, improved ability in ignoring or rejecting a hypothetical contradiction and increased use of verification of facts. Medication and BPRS total scores were controlled for in the GEE analyses at their baseline values. CONCLUSIONS: Overall improvement in BCIS self-certainty scores over time predicted better treatment outcomes as assessed with MADS items. PRACTITIONER POINTS: Treatments for patients with psychosis should focus on improving cognitive insight as this seems to improve overall treatment outcomes and recovery. The Beck Cognitive Insight Scale can be used to measure changes during treatment and can predict treatment outcomes.

Impact of Positive Emotion Regulation Training on Negative Symptoms and Social Functioning in Schizophrenia: A Field Test.

Background: The poor efficacy of drug or psychological treatments on the primary negative symptoms of schizophrenia has led to the development of new interventions. The Positive Emotions Program for Schizophrenia (PEPS) is an emotion regulation strategy training that aims to intensify positive emotions and develop positive performance beliefs. A randomized controlled trial showed that PEPS is effective in reducing the composite score of the reduction of experience syndrome (anhedonia and apathy). The present study is designed to evaluate its feasibility in natural conditions to measure external validity of PEPS. Materials and Methods: Twenty-one participants recruited through the French national network of expert centers followed eight sessions of PEPS and were assessed pre- and posttest with the Scale for Assessment of Negative Symptoms (SANS) and the Personal and Social Performance (PSP). The scales of the SANS were divided into a composite score of the reduction of the ability to experience and a composite score of the reduction of expression. Results: All participants followed the 8 sessions of PEPS, and both composite scores were significantly and clinically improved at posttest. Social functioning assessed with the PSP was also improved. Conclusions: This field test shows that participation in PEPS is accompanied by a reduction of negative symptoms and an improvement of social functioning. Both negative syndromes, reduction of expression and reduction of experience, are improved. Participants are younger than those in previous studies, which may explain this unexpected result. However, this calls for a controlled study with younger participants.

Does Change over Time in Delusional Beliefs as Measured with PDI Predict Change over Time in Belief Flexibility Measured with MADS?

Delusional beliefs and their behavioral consequences are predominant symptoms in patients with psychosis and play an important role in the treatment. Delusional beliefs are a multidimensional concept which can be divided into three components: distress, preoccupation and conviction of delusions. These can be measured using Peters delusions inventory (PDI-21). We question, whether changes in delusional beliefs over time during treatment measured with the PDI-21 can predict changes in belief flexibility measured with the Maudsley assessment of delusions schedule (MADS). We used a group of patients from a randomized controlled trial for a cognitive intervention for psychosis or psychotic symptoms. Aside standard treatment for psychosis, half of the patients took part in a group treatment "Michael's game". Patients were assessed at baseline (T1), at 3 months (T2), and at 9 months (T3). We measured delusional beliefs using PDI-21 and belief flexibility with the MADS. One hundred seventy-two patients were included in the analysis. We measured a main effect of PDI-21scores on belief flexibility measured with MADS. PDI-21 Conviction scores predicted outcomes for all measured MADS items. Increasing PDI Distress and Preoccupation scores were predictors for being more likely to dismiss beliefs and change conviction. Time itself was a predictor for changing conviction and being able to plan a behavioral experiment. Overall the changes in PDI scores predicted outcomes for belief flexibility measured with MADS items. The PDI-21 could be a simple and effective way to measure progress in treatment on delusional beliefs.

Psychometric properties of the French-language version of the Coercion Experience Scale (CES).

BACKGROUND: The Coercion Experience Scale (CES) was designed to measure the psychological impact of psychiatric coercive interventions. The French-language CES was adapted using a translation/back-translation procedure. It consists originally of 31 items and 6 subscores. AIM: The goal of this study was aimed to assess the psychometric properties of the French-language CES. METHOD: 146 inpatients were evaluated. Internal validity was assessed using confirmatory factor analysis. Reliability was estimated using internal consistency coefficients and a test-retest procedure. Convergent validity was estimated using correlations between the AES scores and the Coercion Ladder (CL), the MacArthur's Admission Experience Survey (AES) and the World Health Organization Quality of Life (WHOQOL-BREF) scale. Discriminatory power was evaluated by comparing the scores of patients undergoing voluntary or compulsory admission. RESULTS: Although the six-factor original model of the CES showed adequate fit to the data of the French-language version, two factors were almost indistinguishable. A well-defined five-factor alternative was proposed. The CES scores showed good internal consistency. Test-retest reliability varied from good to weak among the five subscores. Correlations between CES and CL, AES and WHOQOL scores suggested good convergent validity for most scores. Two CES scores were significantly higher among patients subject to compulsory psychiatric hospital admission than among those admitted voluntarily. CONCLUSIONS: Overall, the French-language version of the CES is a usable tool to study different aspects of perceived coercion.

The relationship between self-stigma and depression among people with schizophrenia-spectrum disorders: A longitudinal study.

Harmful consequences of self-stigma in schizophrenia are well established in the literature, but its relationship with symptomatology remains unclear. Self-stigma describes the process by which some patients eventually accept, adhere to and apply to themselves the stereotypes associated with schizophrenia. This study aims to describe self-stigma experienced by people with schizophrenia in French-speaking Switzerland and to examine the relationship between self-stigma and depression. This was a longitudinal study including 80 participants. Correlation and regression analyses were used to examine the relationship between self-stigma and depression over three points of time. Correlations between Stigma Scale subdimensions and sociodemographic variables indicated that age and duration of illness were associated with the discrimination subscale. Self-stigma was strongly correlated with depression over time, whereby higher scores of self-stigma were associated with higher depression. More precisely, the more the patient felt discriminated against and the less he or she perceived the positive aspects of his or her illness, the greater the symptoms of depression. This study highlights the severity of self-stigma endorsed by people with schizophrenia in French-speaking Switzerland. The results provide new knowledge about self-stigma and its potential impact on depressive symptoms. Implementation of self-stigma assessment in clinical practice will allow distinctions to be made between the impact of self-stigma and the consequences of schizophrenia to recommend appropriate intervention.

Improving Pleasure and Motivation in Schizophrenia: A Randomized Controlled Clinical Trial.

BACKGROUND: Negative symptoms are frequent in patients with schizophrenia and are associated with marked impairments in social functioning. The efficacy of drug-based treatments and psychological interventions on primary negative symptoms remains limited. The Positive Emotions Programme for Schizophrenia (PEPS) is designed to improve pleasure and motivation in schizophrenia patients by targeting emotion regulation and cognitive skills relevant to apathy and anhedonia. The main hypothesis of this study is that patients who attend 8 one-hour sessions of PEPS and treatment as usual (TAU) will have lower total apathy-avolition and anhedonia-asociality composite scores on the Scale for the Assessment of Negative Symptoms (SANS) than patients who attend only TAU. METHODS: Eighty participants diagnosed with schizophrenia or schizoaffective disorder were randomized to receive either TAU or PEPS + TAU. The participants were assessed by independent evaluators before randomization (T0), in a post-test after 8 weeks of treatment (T1) and at a 6-month follow-up (T2). RESULTS: The post-test results and 6-month follow-up assessments according to an intention-to-treat analysis showed that the apathy and anhedonia composite scores on the SANS indicated statistically greater clinical improvements in PEPS participants than in non-PEPS participants. In the post-test, anhedonia but not apathy was significantly improved, thus favouring the PEPS condition. These results were sustained at the 6-month follow-up. CONCLUSIONS: PEPS is an effective intervention to reduce anhedonia in schizophrenia. PEPS is a short, easy-to-use, group-based, freely available intervention that is easy to implement in a variety of environments (ClinicalTrials.gov ID: NCT02593058).

Optimism and the Psychological Recovery Process Among Informal Caregivers of Inpatients Suffering From Depressive Disorder: A Descriptive Exploratory Study.

Background: Informal caregivers of people suffering from depressive disorders go through a psychological recovery process. This process is dynamic, deep, catalyzed by hope and optimism and characterized by stages from which specific needs ensue. This study aimed to describe the stages of the psychological recovery process and the level of optimism among informal caregivers of psychiatric inpatients suffering from depressive disorders in order to provide adapted nursing support and psychoeducation and facilitate a patient's own recovery. Methods: A descriptive exploratory study was conducted using a convenience sample of 29 informal caregivers. Participants filled out a sociodemographic questionnaire, a specially adapted Stages of Recovery Instrument (STORI) and the Life Orientation Test-Revised (LOT-R). Results: A mean optimism score of 16.41 showed that informal caregivers are close to the level of the general European population. The sample included all the stages of the recovery process, with 34.5% of participants being in the growth stage. Informal caregivers' stages in the recovery process were negatively associated with the patient's length of illness (Rho = -.683, p = .000) and positively associated with the caregivers' level of optimism (Rho = .564, p = .001). Conclusion: During the inpatient treatment of a close relative suffering from a depressive disorder, informal caregivers go through an individual psychological recovery process involving several stages. In addition to caring for inpatients, nurses are encouraged to meet and support caregivers as soon as possible in their individual recovery process. Furthermore, the development of a suitably adapted clinical tool would facilitate the assessment of the informal caregiver's stage in the recovery process within care units. A multidisciplinary approach is needed in this domain.

Internal validity of the French version of the Family Coping Questionnaire (FCQ): A confirmatory factor analysis.

Family members of patients with schizophrenia, especially when they assume caregivers' positions, experience difficulties to adapt to the situation. To gain insight into these caregivers' coping style is a challenge to decrease the stress of family members, and in this way, improve patient related outcome. The FCQ (Family Coping Questionnaire) is an adapted clinical assessment tool that focuses on specific ways to cope with dysfunction that characterize the psychotic pathology. The goal of this study was to provide validity evidence about the French version of the FCQ. Swiss and French family members of individuals suffering from schizophrenia (n = 204) responded to the FCQ. A confirmatory factor analysis (CFA) was applied estimating two models. The seven-factor model showed adequate fit to the data while the three-factor model fit was poor. This FCQ internal validation showed an adequate model fit with a French population including various family members (parents, siblings, etc.) of persons with enduring mental illness.

Confirmatory Factor Analysis of the French Version of the Savoring Beliefs Inventory.

The Savoring Beliefs Inventory (SBI) is a measure designed to assess attitudes toward savoring positive experience within three temporal orientations: the past (reminiscence), the present moment (present enjoyment), and the future (anticipation). The aim of this study was to validate the structure of the SBI-French version. The scale was tested with 335 French-speaking participants. Two models were estimated: a one-factor model representing a general construct of savoring and a three-factor model differentiating between anticipation, present enjoyment, and reminiscence. Several indicators of model fit were used: the root mean square error of approximation (RMSEA), the comparison fit index (CFI), the Tucker-Lewis fit index (TLI), and the standardized root mean residual (SRMR). A chi-square difference test was used to compare the two models. The model fit of the three-factor model assessed by the SRMR showed to be excellent, while it could be considered as satisfactory according to the CFI and TLI coefficients. RMSEA, however, was slightly less adequate. The model fit for the one-factor model seemed less adequate than the three-factor solution. Further, the chi-square difference test revealed that the three-factor model had significantly better fit than the one-factor model. Finally, the reliability of the four scores (anticipating pleasure, present moment pleasure, reminiscing pleasure, and total score) was very good. These results show that the French version of the SBI is a valid and valuable scale to measure attitudes regarding the ability to savor positive experience, whether it be in anticipation, reminiscence, or the present moment.