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1.
Schizophr Res Cogn ; 16: 25-28, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30671352

RESUMO

The Work Behavior Inventory (WBI) is a widely used and validated assessment of work functioning in people with schizophrenia. WBI ratings are based on workplace observation and interview with work supervisors. Workplace observation may not be acceptable in all employment settings. A WBI assessment based only on supervisor interview may offer more utility. The current study evaluated the psychometric properties of a modified WBI among individuals with schizophrenia participating in VA vocational rehabilitation programs - similar to the original WBI validation study. Results suggest evidence for reliability, validity and sensitivity to change for an interview only format. Limitations and future research directions are discussed.

2.
Psychiatr Serv ; 70(1): 19-25, 2019 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-30353790

RESUMO

OBJECTIVE: Many adults with serious mental illness have significant medical illness burden and poor illness self-management. In this study, the authors examined Living Well, a group-based illness self-management intervention for adults with serious mental illness that was cofacilitated by two providers, one of whom has lived experience with co-occurring mental health and medical conditions. METHODS: Adults with serious mental illness (N=242) were randomly assigned to Living Well or an active control condition. Participants completed assessments of quality of life; health attitudes; self-management behaviors; and symptoms at baseline, posttreatment, and follow-up. Emergency room use was assessed by means of chart review. Mixed-effects models examined group × time interactions on outcomes. RESULTS: Compared with the control group, adults in Living Well had greater improvements at posttreatment in mental health-related quality of life (t=2.15, p=.032), self-management self-efficacy (t=4.10, p<.001), patient activation (t=2.08, p=.038), internal health locus of control (t=2.01, p=.045), behavioral and cognitive symptom management (t=2.77, p=.006), and overall psychiatric symptoms (t=-2.02, p=.044); they had greater improvements at follow-up in physical activity-related self-management (t=2.55, p=.011) and relationship quality (t=-2.45, p=.015). No effects were found for emergency room use. The control group exhibited greater increases in physical health-related quality of life at posttreatment (t=-2.23, p=.026). Significant group differences in self-management self-efficacy (t=2.86,p=.004) and behavioral and cognitive symptom management (t=2.08, p= .038) were maintained at follow-up. CONCLUSIONS: Compared with an active control group, a peer-cofacilitated illness self-management group was more effective in improving quality of life and self-management self-efficacy among adults with serious mental illness.

3.
Psychiatr Rehabil J ; 41(2): 135-140, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29708366

RESUMO

OBJECTIVE: The purpose of this study was to determine the feasibility of implementing a recovery education program in a Veterans Affairs medical center. METHOD: This case study describes development and implementation of a mental health and wellness curriculum offered through a centralized location. Referral and utilization data (n = 781) from the first 18 months of implementation were used to evaluate feasibility. FINDINGS: Access to programming with zero exclusion was prioritized and average time from referral to enrollment was 9.6 days. Fifty-six percent of veterans admitted to mental health services during the 18-month evaluation period were referred to the program, and this level of utilization continued to be sustained. A broad range of classes was available. Opportunities to change classes as recovery goals evolved was encouraged and data indicate veterans actively tailored their individual recovery curriculum. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Educational recovery programming was easily incorporated into a large integrated health facility, was well received, and offered greater opportunity for choice and individualization of recovery curriculum. (PsycINFO Database Record


Assuntos
Transtornos Mentais/reabilitação , Serviços de Saúde Mental , Educação de Pacientes como Assunto/métodos , Desenvolvimento de Programas/métodos , Avaliação de Programas e Projetos de Saúde/métodos , Veteranos , Adulto , Idoso , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos , United States Department of Veterans Affairs
4.
J Dual Diagn ; 8(1): 2-12, 2012 Feb 13.
Artigo em Inglês | MEDLINE | ID: mdl-22518096

RESUMO

OBJECTIVE: This study examined patterns and predictors of changes in substance use over one year in individuals with schizophrenia and affective disorders. We examined patterns of cocaine use over time, baseline predictors of continued cocaine use over one year, and predictors of transitions into and out of drug use and treatment. METHODS: We recruited 240 individuals with schizophrenia and affective disorders who met DSM-IV criteria for current cocaine dependence or cocaine dependence in early full or sustained full remission, and assessed them five times over twelve months. RESULTS: There was no change over time in either the proportion of the sample with at least one day of cocaine use in the past month or in the average number of days of cocaine use among those who reported any use. Baseline variables tapping actual substance use were found to predict a decreased likelihood of cocaine use. Several variables tapping actual substance use - including self- reported use of cocaine, positive urinalysis for marijuana, and positive urinalysis for cocaine - were predictive of transitions into and out of outpatient substance abuse treatment. Readiness to change variables such as self-efficacy and temptation to use drugs showed different predictive patterns for the schizophrenia and affective disorder groups. CONCLUSIONS: These findings illustrate how drug use may show a cyclical pattern for those with serious mental illness, in which more severe use - characterized by greater frequency of use and associated problems - is followed by decreased use over time.

5.
Schizophr Bull ; 36(1): 48-70, 2010 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-19955389

RESUMO

The Schizophrenia Patient Outcomes Research Team (PORT) psychosocial treatment recommendations provide a comprehensive summary of current evidence-based psychosocial treatment interventions for persons with schizophrenia. There have been 2 previous sets of psychosocial treatment recommendations (Lehman AF, Steinwachs DM. Translating research into practice: the Schizophrenia Patient Outcomes Research Team (PORT) treatment recommendations. Schizophr Bull. 1998;24:1-10 and Lehman AF, Kreyenbuhl J, Buchanan RW, et al. The Schizophrenia Patient Outcomes Research Team (PORT): updated treatment recommendations 2003. Schizophr Bull. 2004;30:193-217). This article reports the third set of PORT recommendations that includes updated reviews in 7 areas as well as adding 5 new areas of review. Members of the psychosocial Evidence Review Group conducted reviews of the literature in each intervention area and drafted the recommendation or summary statement with supporting discussion. A Psychosocial Advisory Committee was consulted in all aspects of the review, and an expert panel commented on draft recommendations and summary statements. Our review process produced 8 treatment recommendations in the following areas: assertive community treatment, supported employment, cognitive behavioral therapy, family-based services, token economy, skills training, psychosocial interventions for alcohol and substance use disorders, and psychosocial interventions for weight management. Reviews of treatments focused on medication adherence, cognitive remediation, psychosocial treatments for recent onset schizophrenia, and peer support and peer-delivered services indicated that none of these treatment areas yet have enough evidence to merit a treatment recommendation, though each is an emerging area of interest. This update of PORT psychosocial treatment recommendations underscores both the expansion of knowledge regarding psychosocial treatments for persons with schizophrenia at the same time as the limitations in their implementation in clinical practice settings.


Assuntos
Medicina Baseada em Evidências , Esquizofrenia/reabilitação , Psicologia do Esquizofrênico , Comitês Consultivos , Alcoolismo/reabilitação , Terapia Comportamental , Terapia Cognitivo-Comportamental , Terapia Combinada , Serviços Comunitários de Saúde Mental , Readaptação ao Emprego , Terapia Familiar , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Esquizofrenia/diagnóstico , Socialização , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Reforço por Recompensa , Perda de Peso
6.
Am J Psychiatry ; 167(2): 170-80, 2010 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-20008941

RESUMO

OBJECTIVE: There is considerable interest in cognitive remediation for schizophrenia, but its essential components are still unclear. The goal of the current study was to develop a broadly targeted computer-assisted cognitive remediation program and conduct a rigorous clinical trial in a large group of schizophrenia patients. METHOD: Sixty-nine people with schizophrenia or schizoaffective disorder were randomly assigned to 36 sessions of computer-assisted cognitive remediation or an active control condition. Remediation broadly targeted cognitive and everyday performance by providing supportive, graduated training and practice in selecting, executing, and monitoring cognitive operations. It used engaging computer-based cognitive exercises and one-on-one training. A total of 61 individuals (34 in remediation group, 27 in control group) engaged in treatment, completed posttreatment assessments, and were included in intent-to-treat analyses. Primary outcomes were remediation exercise metrics, neuropsychological composites (episodic memory, working memory, attention, executive functioning, and processing speed), and proxy measures of community functioning. RESULTS: Regression modeling indicated that performance on eight of 10 exercise metrics improved significantly more in the remediation condition than in the control condition. The mean effect size, favoring the remediation condition, was 0.53 across all 10 metrics. However, there were no significant benefits of cognitive remediation on any neuropsychological or functional outcome measure, either immediately after treatment or at the 3-month follow-up. CONCLUSIONS: Cognitive remediation for people with schizophrenia was effective in improving performance on computer exercises, but the benefits of training did not generalize to broader neuropsychological or functional outcome measures. The evidence for this treatment approach remains mixed.


Assuntos
Transtornos Cognitivos/terapia , Instrução por Computador , Esquizofrenia/terapia , Cognição , Transtornos Cognitivos/reabilitação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Psicóticos/reabilitação , Transtornos Psicóticos/terapia , Análise de Regressão , Esquizofrenia/reabilitação , Psicologia do Esquizofrênico
7.
J Nerv Ment Dis ; 197(8): 631-4, 2009 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-19684503

RESUMO

Several investigations of cognitive functioning in individuals with schizophrenia and co-occurring cocaine use have yielded mixed results when compared with samples with schizophrenia only. However, no studies have specifically compared remitted and current cocaine dependence in schizophrenia. Such an analysis could help clarify the degree and type of cognitive impairment associated with cocaine dependence in schizophrenia. Two samples of individuals with schizophrenia - those with current cocaine dependence (n = 72) and those with cocaine dependence in remission (n = 48) were compared on a brief neuropsychological test battery. Parallel current dependent and remitted samples with affective disorder (n = 65 and n = 55) were also included in the analyses. Results yielded few neuropsychological differences between remitted and current dependent states across the SZ and AD groups. These findings suggest that cognitive impairment may be relatively static in these populations.


Assuntos
Transtornos Relacionados ao Uso de Cocaína/diagnóstico , Transtornos Cognitivos/diagnóstico , Testes Neuropsicológicos/estatística & dados numéricos , Esquizofrenia/diagnóstico , Adulto , Transtornos Relacionados ao Uso de Cocaína/epidemiologia , Transtornos Relacionados ao Uso de Cocaína/psicologia , Transtornos Cognitivos/epidemiologia , Transtornos Cognitivos/psicologia , Comorbidade , Diagnóstico Duplo (Psiquiatria) , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Humanos , Estudos Longitudinais , Masculino , Escalas de Graduação Psiquiátrica , Psicometria , Esquizofrenia/epidemiologia , Psicologia do Esquizofrênico , Índice de Gravidade de Doença
8.
Psychiatr Serv ; 59(6): 655-62, 2008 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-18511586

RESUMO

OBJECTIVE: This study used a survey to assess the information and educational needs of family members of adults with mental illness and their preferences regarding how to address those needs. METHODS: Recruitment was attempted through two sources: local mental health treatment facilities and the Maryland chapter of the National Alliance on Mental Illness (NAMI). Inadequate contact information and low response rate produced only 16 responses from family members of consumers recruited through local mental health facilities. Thus results are reported for a family needs assessment survey mailed to NAMI members (308 of 962 possible responses). Bivariate and multivariate analyses were used to summarize relationships between characteristics of the family member, characteristics of the ill relative, experience of stigma by the family member, and information needs of the family members. RESULTS: On average, family members reported a substantial number of unmet needs (mean+/-SD of 7.09+/-4.71 needs; possible number of needs ranges from 0 to 16), often despite prior receipt of information. Family members' experiences of stigma and having an ill relative with a more recently occurring condition (for example, a younger relative or a shorter length of illness) or with a disabling condition (for example, recent hospitalization) were significantly associated with a greater number of unmet needs. Family members preferred that a mental health provider (63%) address their needs on an as-needed basis (58%). CONCLUSIONS: The needs and preferences of family members of adults with mental illness are diverse and varied. Consequently, these families may benefit from ongoing provision of information and support tailored to meet the families' individual needs. Continued efforts should be made to understand and address consumer and family needs, potential barriers to participation in family services, and the relationship between stigma and family need.


Assuntos
Família/psicologia , Necessidades e Demandas de Serviços de Saúde , Transtornos Mentais , Apoio Social , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Maryland , Pessoa de Meia-Idade
9.
J Nerv Ment Dis ; 196(3): 198-206, 2008 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-18340254

RESUMO

An exploratory investigation of behavioral treatment response during inpatient rehabilitation for severe mental illness is presented. Archival data from 26 weeks of behavioral contingency management (CM) programs targeting treatment nonadherence for 2 cohorts of participants were analyzed. For cohort 1 (N = 39), a multivariate analysis of longitudinal behavioral data identified 4 qualitatively and quantitatively distinct patterns of CM response and these groups differed in verbal memory ability. Analysis of cohort 2 (N = 45) replicated the finding of 4 patterns of CM response. We further clarified behavioral heterogeneity in cohort 2 by using hierarchical linear modeling with neurocognitive and social cognitive covariates. Results indicated that memory, attention, and a high external locus of control (LOC) were associated with level of nonadherence at baseline. Reductions in external locus of control were associated with greater CM response during the course of rehabilitation. Implications for understanding individual responses to the rehabilitation process are discussed.


Assuntos
Transtorno Bipolar/epidemiologia , Transtorno Bipolar/reabilitação , Terapia Cognitivo-Comportamental/métodos , Tratamento Farmacológico/métodos , Cooperação do Paciente/estatística & dados numéricos , Esquizofrenia/epidemiologia , Esquizofrenia/reabilitação , Doença Aguda , Adulto , Atenção , Transtorno Bipolar/diagnóstico , Estudos de Coortes , Terapia Combinada , Feminino , Seguimentos , Hospitalização/estatística & dados numéricos , Humanos , Controle Interno-Externo , Masculino , Transtornos da Memória/diagnóstico , Transtornos da Memória/epidemiologia , Testes Neuropsicológicos , Reabilitação Vocacional/estatística & dados numéricos , Esquizofrenia/diagnóstico , Índice de Gravidade de Doença , Percepção Social
10.
Schizophr Res ; 93(1-3): 186-93, 2007 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-17448644

RESUMO

Research in schizophrenia and related severe mental illness (SMI) suggests that psychiatric rehabilitation facilitates recovery of psychosocial functioning although there is considerable heterogeneity in outcomes. The present study used growth mixture modeling (GMM), a longitudinal latent variable modeling strategy, to identify classes of psychosocial functioning recovery trajectories. Archival clinical assessment data representing the first 18 months of an inpatient psychiatric rehabilitation program were analyzed from a sample of participants with schizophrenia spectrum disorders (N=162). Based on a GMM analysis of monthly Nurse Observation Scale for Inpatient Evaluation (NOSIE) scores two classes were identified that differed in overall level of psychosocial functioning, rate and nonlinear shape of change. The identified lower functioning group was characterized by poorer neurocognitive functioning at admission, a history of negative symptoms, more previous inpatient psychiatric days, and a longer length of stay in the rehabilitation program. However, this group showed significantly greater positive change in the NOSIE domains directly targeted by behavioral treatment: daily schedule competence, neatness, and irritability. Methodological and theoretical implications of these modeling strategies are discussed in the context of understanding the rehabilitation process.


Assuntos
/estatística & dados numéricos , Escalas de Graduação Psiquiátrica/estatística & dados numéricos , Esquizofrenia/reabilitação , Psicologia do Esquizofrênico , Ajustamento Social , Atividades Cotidianas/classificação , Atividades Cotidianas/psicologia , Adulto , Terapia Comportamental , Doença Crônica , Terapia Combinada , Feminino , Humanos , Humor Irritável , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Prognóstico , Psicometria/estatística & dados numéricos , Psicotrópicos/uso terapêutico , Reprodutibilidade dos Testes , Estudos Retrospectivos , Esquizofrenia/diagnóstico
11.
Clin Psychol Rev ; 27(6): 696-714, 2007 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-17343964

RESUMO

The longitudinal dimension of schizophrenia and related severe mental illness is a key component of theoretical models of recovery. However, empirical longitudinal investigations have been underrepresented in the psychopathology of schizophrenia. Similarly, traditional approaches to longitudinal analysis of psychopathological data have had serious limitations. The utilization of modern longitudinal methods is necessary to capture the complexity of biopsychosocial models of treatment and recovery in schizophrenia. The present paper summarizes empirical data from traditional longitudinal research investigating recovery in symptoms, neurocognition, and social functioning. Studies conducted under treatment as usual conditions are compared to psychosocial intervention studies and potential treatment mechanisms of psychosocial interventions are discussed. Investigations of rehabilitation for schizophrenia using the longitudinal analytic strategies of growth curve and time series analysis are demonstrated. The respective advantages and disadvantages of these modern methods are highlighted. Their potential use for future research of treatment effects and recovery in schizophrenia is also discussed.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Esquizofrenia/reabilitação , Psicologia do Esquizofrênico , Antipsicóticos/uso terapêutico , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/psicologia , Transtornos Cognitivos/reabilitação , Terapia Cognitivo-Comportamental/estatística & dados numéricos , Terapia Combinada , Interpretação Estatística de Dados , Seguimentos , Humanos , Modelos Psicológicos , Análise Multivariada , Dinâmica não Linear , Teoria da Construção Pessoal , Esquizofrenia/diagnóstico , Ajustamento Social
12.
Schizophr Res ; 71(2-3): 463-71, 2004 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-15474917

RESUMO

Persistent paranoid symptoms are best understood as having multiple causal mechanisms. An enhanced multidimensional understanding of paranoia may result from the convergence of two distinct measurement paradigms, experimental psychopathology and social cognitive research. This study investigated the role of neurocognitive deficits and emotion misperception bias as they relate to paranoid symptoms at two different time points in a sample of individuals with severe mental illness (primarily schizophrenia spectrum disorders [N=91]) undergoing intensive psychosocial rehabilitation. Before intensive rehabilitation (but after initial stabilization), paranoid symptoms were related to a tendency to misperceive emotion as disgust. The impact of this social cognitive bias was amplified by perseveration (as measured by the COGLAB Card Sorting Task). Perseverative errors were associated with paranoid symptoms at both time points. After 6 months of treatment, there were significant reductions in paranoid symptoms and perseverative errors but no significant changes in emotion misperception biases. This study is one of few to date to evaluate the contribution of both neurocognitive deficits and social cognitive biases to paranoid symptoms. The results demonstrate how social cognitive biases can interact with neurocognitive deficits in expression of paranoid symptoms, and how these relationships change during treatment.


Assuntos
Transtornos Cognitivos/etiologia , Esquizofrenia Paranoide/psicologia , Percepção Social , Adolescente , Adulto , Idoso , Antipsicóticos/uso terapêutico , Escalas de Graduação Psiquiátrica Breve , Clorpromazina/uso terapêutico , Transtornos Cognitivos/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Esquizofrenia Paranoide/diagnóstico , Esquizofrenia Paranoide/tratamento farmacológico , Índice de Gravidade de Doença
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