La esquizofrenia y su concepto transcultural / Schizophrenia and it's cross-cultural concept

En la actualidad, la mente humana no es posible valorarla de forma directa, pues el campo del inconsciente todavía es un área muy desconocida, debido a la complejidad de los procesos cognitivos y subjetivos que alberga. Si la salud se concibe como el bienestar biopsicosocial de la persona, los profesionales de la salud mediante su trabajo deben hacer frente a las innumerables necesidades que pueden presentar las personas [Fragmento de texto] (AU)

Structure and predictors of in-hospital nursing care leading to reduction in early readmission among patients with schizophrenia in Japan: A cross-sectional study.

Schizophrenia is a disorder characterized by psychotic relapses. Globally, about 15%-30% of patients with schizophrenia discharged from inpatient psychiatric admissions are readmitted within 90 days due to exacerbation of symptoms that leads to self-harm, harm to others, or self-neglect. The purpose of this study was to investigate the structure and predictors of in-hospital nursing care leading to reduction in early readmission among patients with schizophrenia. A new questionnaire was developed to assess the extent to which respondents delivered in-hospital nursing care leading to reduction in early readmission among patients with schizophrenia. This study adopted a cross-sectional research design. The survey was conducted with the new questionnaires. The participants were registered nurses working in psychiatric wards. Item analyses and exploratory factor analyses were performed using the new questionnaires to investigate the structure of in-hospital nursing care leading to reduction in early readmission. Stepwise regression analyses were conducted to examine the factors predicting in-hospital nursing care leading to reduction in early readmission. Data were collected from 724 registered nurses in Japan. In-hospital nursing care leading to reduction in early readmission was found to consist of five factors: promoting cognitive functioning and self-care, identifying reasons for readmission, establishing cooperative systems within the community, sharing goals about community life, and creating restful spaces. In-hospital nursing care leading to reduction in early readmission was predicted by the following variables: the score on the nursing excellence scale in clinical practice, the score on therapeutic hold, and the participation of community care providers in pre-discharge conferences. Japanese psychiatric nurses provide nursing care based on these five factors leading to reduction in early readmission. Such nursing care would be facilitated by not only nurses' excellence but also nurses' environmental factors, especially the therapeutic climate of the ward and the participation of community care providers in pre-discharge conferences.

[The setting up of advanced practice nursing with patients with schizophrenia]. / L'implantation d'une IPA auprès de patients atteints de schizophrénie.

The first advanced practice nurses in psychiatry and mental health are being deployed across the country. Such is the case at Paris XV psychiatric university hospital, which is working to gradually integrate an advanced practice nurse into medico-psychological centres to work with patients with schizophrenia. The role also comprises time devoted to research and teaching.

Care difficulties and burden during COVID-19 pandemic lockdowns among caregivers of people with schizophrenia: A cross-sectional study.

AIMS: The purpose of this study was to retrospectively investigate care difficulties experienced by caregivers of people with schizophrenia during COVID-19 pandemic lockdowns in Japan (April 7-May 25, 2020) and examine associations between these care difficulties during lockdowns and daily caregiver burden. METHODS: Data were collected from 132 participants of the LINE Schizophrenia Family Association using an online survey. RESULTS: Caregivers were mostly concerned about who would care for people with schizophrenia if caregivers become infected with COVID-19. A significant association was found between higher daily caregiver burden and more difficult care experiences during COVID-19 pandemic lockdowns (B = 0.58, 95% confidence interval, 0.40-0.75, P < .01, adjusted R-squared = .34). CONCLUSIONS: Further studies and supports for caregivers of people with schizophrenia are needed.

Impact of aerobic exercise on cognitive function in patients with schizophrenia during daily nursing: A protocol for systematic review and meta-analysis.

OBJECTIVES: To assess the effect of aerobic exercise (AE) on cognition function in people with schizophrenia (SZ) during daily nursing. METHODS: The literature search will be conducted via PubMed, Embase, Cochrane Library, and Web of Science. Weighted mean difference (WMD) or standardized mean difference (SMD) and 95% confidence intervals (CIs) will be adopted to calculate the association between AE and cognitive function in patients with SZ. Publication bias will be performed by Begg test. When there is publication bias, "cut-and-fill method" will be adopted to adjust publication bias. Sensitivity analysis will be used to test the stability of the result. When the heterogeneity is large (I2 ≥ 50%), meta regression will be used to explore the source of inter-study heterogeneity. When the heterogeneity is large (I2 ≥ 50%) and the results are statistically significant (P < .05), age, sex, duration of disease, duration of intervention, amount of exercise per week, improvement of cardiopulmonary health, and other factors will be sub-analyzed. CONCLUSION: This meta-analysis will evaluate the impact of aerobic exercise on cognitive function in patients with SZ during daily nursing on the basis of existing evidence. OSF REGISTRATION NUMBER: 10.17605/OSF.IO/C8ABX.

Family Caregivers' Perspective on Factors Affecting Recovery from Schizophrenia.

OBJECTIVE: To explore caregivers' perspective on factors affecting the recovery of their family members diagnosed with schizophrenia. METHODS: A qualitative grounded theory approach was used. A convenience sample of seven male and eleven female family caregivers of patients with schizophrenia were invited from outpatient (n = 6), inpatient (n = 7), and psychiatric rehabilitation (n = 5) services in an Indian mental health institute to participate in semi-structured interviews. Interviews were recorded, transcribed, and analysed. Similar themes were grouped and the main themes identified. RESULTS: Caregivers' perspectives on factors affecting recovery from schizophrenia were categorised to two themes: facilitators and barriers. The nine facilitators were (1) getting into a precise treatment regimen and sticking to it, (2) developing some personal attributes, (3) exercising family's role diametrically, (4) paying attention to basic needs, (5) sharing with the Almighty, (6) adapting to a supportive lifestyle, (7) not being idle… engage in something, (8) coming out, being and sharing with others, and (9) having adequate resources with a good support system. The ten barriers were (1) detrimental treatment practices, (2) hampering illness impacts, (3) off-putting personality elements, (4) unaccommodating family circumstances, (5) caregivers' limitation, (6) flaccid support system and scarce resources, (7) ambiguous treatment outcome or prognosis, (8) futile religious, health, and social belief systems, (9) situational factors, and (10) presence of troubling physical or psychological stressors. CONCLUSION: The recovery process is facilitated through family involvement and support by mental health professionals. Thus, giving a pre-treatment counselling to the caregivers and repeating the same content to the patients after regaining insight can be helpful.

Childhood Schizophrenia.

Editor's note: From its first issue in 1900 through to the present day, AJN has unparalleled archives detailing nurses' work and lives over more than a century. These articles not only chronicle nursing's growth as a profession within the context of the events of the day, but they also reveal prevailing societal attitudes about women, health care, and human rights. Today's nursing school curricula rarely include nursing's history, but it's a history worth knowing. To this end, From the AJN Archives highlights articles selected to fit today's topics and times.For many years, autism was thought to be a type of childhood schizophrenia. In AJN's May 1958 issue, an article entitled "Childhood Schizophrenia" describes the inpatient treatment of children with autism. Some parts of it are difficult to read, not because the actual treatment was painful or torturous, but because experts decided that children needed to be away from their parents in order for treatment to be successful. The authors of this article, a pediatric psychiatrist and a psychiatric nurse educator, write, "Because the mother's role is so significant in the child's development . . . in almost every instance, the schizophrenic [autistic] child must be removed from its 'sick' mother in order that adequate remedial measures may be instituted." To read the full article, go to http://links.lww.com/AJN/A175.Today, autism spectrum disorder (ASD) is recognized as a neurodevelopmental condition that probably begins during the prenatal to early postnatal period. In this issue, authors Deborah Christensen and Jennifer Zubler provide an update on ASD risk factors, epidemiology, diagnosis, and treatment in "From the CDC: Understanding Autism Spectrum Disorder."

Test of the stress process model of family caregivers of people living with schizophrenia in China.

Across the world, people living with schizophrenia (PLS) are often cared for by family caregivers. This is especially true in China where community-based systems of care for PLS are underdeveloped. Thus, family caregivers of PLS may experience emotional distress and burden in the absence of community-based services. Pearlin (1990) proposed a highly influential model for understanding the stress process and its relationship to health and wellbeing. Although the model has been examined worldwide, it has yet to be studied in China for caregivers of PLS. In the present study, we use Pearlin's stress process model to examine the mediating effect of perceived caregiver burden, family functioning, and caregivers' positive feelings about caregiving on PLS global functioning and caregiver depressive symptoms. We also examine whether the model differs for parent and spouse caregivers. A total of 327 primary family caregivers of PLS in Hunan province, China, were assessed cross-sectionally using culturally-validated measures. Bootstrap methods with Hayes's PROCESS Macro were used to test multiple mediation models of global functioning scores of PLS and caregiver depressive symptoms. In this first study of the stress process model of family caregivers of PLS in China, the results generally support the model. Caregiver perceived burden, family functioning, and positive caregiver feelings about caregiving all mediate the relationship between PLS global functioning and caregiver depression, with perceived caregiver burden having the strongest indirect effect. Analyses also show that the stress process differs between parent and spouse caregivers, with perceived caregiver burden a mediator for both groups but family functioning only a mediator for parent depressive symptoms. We discuss implications of these findings for extending the stress process model cross-culturally; suggest hypotheses for future research to examine parent and spouse differences; and discuss fruitful directions for intervention.

[Melting-Pain Therapy for difficult mental health patients]. / L'activité Melting-pain therapy pour les malades mentaux difficiles.

The nurses in the unit for difficult patients at Cadillac hospital have developed an innovative art therapy concept: Melting-Pain Therapy. In this workshop patients produce a collective piece of art created through participants' individual sessions with a nurse. These patients are exclusively men, suffering mainly from schizophrenia, who have been or who are potentially dangerous. The photographs accompanying this article show some examples of these art brut creations.

[Obstacles, difficulties, and facilitators in setting up a research project funded by the Hospital Program for Nursing and Paramedical Research : Lessons learned from a mental health research project] / Freins, difficultés et facilitateurs dans la mise en place d'une recherche financée par le Programme hospitalier de recherche infirmière et paramédicale (PHRIP) : retour d'expérience d'un projet de recherche en santé mentale.

Nursing research continues to grow and become self-sustaining. It was in this context that we received funding from the Hospital Program for Nursing and Paramedical Research for our research project on schizophrenia. Schizophrenia is a mental disorder that affects 1% of the general population, and is a crippling disease both cognitively and socially. Cognitive remediation and therapeutic education are nursing practices deemed suitable for the psychosocial rehabilitation of schizophrenia patients. We hypothesized that a therapeutic education program placed upstream of cognitive remediation would have beneficial effects. We planned to include eighty patients aged eighteen to sixty, randomized into two groups, one combining cognitive remediation and therapeutic education, the second using just cognitive remediation. Each patient was assessed using a range of neuropsychological scales. Due to difficulties encountered in including and following up with participants, our statistical results could not be used. We therefore turned our focus to the factors that facilitate and hinder the setting up of a nursing research project. We organized these factors into three areas : those related to the nurse ; those related to the care facility and the organization ; and those related to the research. The results were consistent with the literature and show how important it is to encourage nurses to be more involved in a scientific approach.

Percepción y sentimientos ante la estigmatización de personas con esquizofrenia / Perception and feelings towards stigmatization of people with schizophrenia

OBJETIVO: conocer qué piensan y sienten las personas con esquizofrenia ante la autopercepción del estigma de su enfermedad. MÉTODO: se realizó un estudio cualitativo con enfoque fenomenológico. La población de estudio fueron los usuarios del Centro de Día de la Asociación Morea (Asociación de familiares y enfermos mentales) de Ourense. El muestreo fue intencional, seleccionándose siete personas mayores de edad con diagnóstico de esquizofrenia (DMS-5), con una evolución mínima de dos años. Para la recogida de los datos se utilizó entrevista semiestructurada individual (dos entrevistas consecutivas al mismo sujeto), efecuada por dos entrevistadores, que fueron grabadas y transcritas. Se llevó a cabo análisis temático (identificación y categorización de los principales ejes de significado subyacentes en los datos). RESULTADOS: tras el análisis de las entrevistas se detectaron cinco categorías temáticas: "culpabilidad", "roles sociales", "miedo al rechazo y peligrosidad", "responsabilidad" y "pérdida de capacidades y control". Todos los participantes son conscientes de su enfermedad, de su cronicidad y de que tendrán que tomar tratamiento de por vida. Manifiestan haber perdido relaciones con amigos e incluso familia a raíz de su enfermedad. La mayoría percibe que el resto de la población les tiene miedo. Todos consideran que la enfermedad les ha hecho perder capacidades como la memoria, la atención y la autonomía para algunas facetas de la vida. CONCLUSIONES: las personas con esquizofrenia se sienten estigmatizadas por la sociedad. A colación de los resultados obtenidos parece necesario aumentar la información y educación en la población para disminuir el estigma y los prejuicios hacia las personas que padecen esquizofrenia y poder así facilitar su plena integración en la sociedad

OBJECTIVE: to understand the feelings and thoughts of people with schizophrenia faced with their own perception of the stigma associated with their disease. METHODS: a qualitative study with phenomenological approach. The study population was the users of the Morea Association Day Centre (Association of mental patients and relatives) in Ourense. The sample was intentional, and seven persons of age with diagnosis of schizophrenia were selected (DMS-5), with a minimum two-year evolution. Individual semi-structured interview was used for data collection (two consecutive interviews with the same subject), conducted by two interviewers, which were recorded and transcribed. Thematic analysis was conducted (identification and classification of the main axes of meaning underlying in data). RESULTS: after the analysis of the interviews, five thematic categories were detected: "guilt", "social roles", "fear of rejection and danger", "responsibility" and "loss of abilities and control". All participants were aware of their disease, its chronicity and that they would have to take life-long treatment. They stated that they had lost contact with friends and even relatives due to their disease. Most of them perceived that the rest of the population was afraid of them. All of them considered that their disease had led them to lose abilities such as memory, attention, and independence for some aspects in life. CONCLUSIONS: people with schizophrenia feel stigmatized by society. Based on the results obtained, it seems necessary to increase information and education among the population in order to reduce the stigma and prejudices towards people who suffer schizophrenia, and thus facilitate their complete integration into the society

A Qualitative Systematic Review of Caregivers' Experiences of Caring for Family Diagnosed with Schizophrenia.

Objective: To synthesise qualitative research that explored caregivers' experiences of caring for family diagnosed with schizophrenia.Methods: Electronic databases including PsycINFO, PubMed, CINAHL and Scopus were searched to identify relevant journal articles published from 2000 to March 2019. Quality was assessed and thematic synthesis of the qualitative research evidence undertaken. Papers were screened and independently appraised by two reviewers using The Critical Appraisal Skills Programme (CASP) for Qualitative Studies Checklist. The review was guided by Thomas and Harden's framework for thematic synthesis of qualitative research evidence.Results: The breadth of information across the 43 papers was noteworthy. Review of the findings noted that almost all of what was discussed fell into three broad themes: the 'feelings' of the caregiver towards their role, the patient and others, including the health system; the 'impacts' of the diagnosis and their caregiving role on the caregiver; and the 'needs' of the caregiver to improve the patient's quality of life and thereby the caregiver's quality of life. Within needs also came recommendations for future changes.Conclusion: Studies have shown that the caregiving process is a complex one, with both negative and positive emotional reactions, societal barriers, such as stigma and isolation, and unmet needs, such as timely, relevant and helpful information. Meeting the needs identified by caregivers has the capacity to address the impacts of the illness and caregiving and thereby reduce the negative feelings associated with the caregiver role.

[A Nursing Experience Enhancing the Resilience Capacity of a Patient With Chronic Schizophrenia].

The article describes the author's nursing experience providing psychiatric homecare to a patient with chronic schizophrenia using the concept of resilience. Holistic nursing assessments were conducted via clinical observations during home visits every two weeks from May 24th to September 20th, 2018. Through these assessments, the main health problems of the patient were defined as ineffective self-health management, ineffective coping skills, and insufficient resilience. The nursing interventions implemented were designed to establish the patient's capacity to effectively and correctly self-manage health status, achieve emotional accommodation, and reduce parent-child conflicts. In order to enhance the resilience of the patient, the patient was guided to review important support resources over the course of illness, to detect the barriers of returning society, to apply the beneficial skills of health management, and then extend the status of employment and to enhance self-fulfillment.

Factors associated with family functioning among people with a diagnosis of schizophrenia and primary family caregivers.

WHAT IS KNOWN ON THE SUBJECT?: Families act not only as the primary support for people with a diagnosis of schizophrenia but also as partners in the healthcare system. Families who have members with mental disorders, particularly schizophrenia, experience challenges in family functioning. Research on families in relation to schizophrenia primarily focuses on the determinants that affect family functioning from primary family caregivers' perspectives. WHAT DOES THE PAPER ADD TO EXISTING KNOWLEDGE?: This report provides evidence that there is a concordance between family functioning and inpatient psychiatric rehabilitation facilities for the patient-caregiver dyad; both care-receivers and primary family caregivers considered family functioning as poor. Care-receivers with lower education levels, increased number of previous hospitalizations and poor quality of family-centred care experienced unhealthy family functioning. Primary family caregivers and care-receivers with higher education levels, lower suicidality and greater quality of family-centred care experienced healthier family functioning. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Understanding the degree of family functioning, particularly its concordance and correlates as perceived by patients and primary family caregivers, may serve as a platform for inculcating assessment of family functioning to achieve holistic patient care. Open dialogue in family-focused care planning is essential to facilitate collaborative partnerships and improve family functioning among people with a diagnosis of schizophrenia and their primary family caregivers. Further research on culturally relevant, evidence-based family interventions to enhance the functioning of affected families is warranted, especially for families with members in inpatient psychiatric rehabilitation facilities. ABSTRACT: Introduction Families provide frontline caregiving support for people with a diagnosis of schizophrenia. However, research primarily addresses correlates of family functioning from primary family caregivers' perspectives. Aim To examine perceived family functioning, particularly its concordance within patient-caregiver dyads and associated factors in families of people living with schizophrenia. Methods A cross-sectional, descriptive correlational design was used. A total of 133 dyads of patients and primary family caregivers from inpatient psychiatric rehabilitation services participated. Descriptive statistics, independent-sample t test, one-way ANOVA, Pearson's correlation coefficients, intraclass correlation coefficient and stepwise multiple linear regression analyses were applied. Results Family functioning was perceived as impaired by patient-caregiver dyads, and there existed a concordance in this regard. Patients' and family caregivers' education levels, patients' suicidality, number of previous hospitalizations and quality of family-centred care correlated with patients' and primary family caregivers' family functioning. Discussion Findings highlight the importance of patient- and family-reported family functioning with implications to address individual and collective concerns. Implications for Practice Evidence-based family interventions are crucial for assisting vulnerable families in promoting family functioning. Mental health nurses should facilitate collaboration and open dialogue concerning perspectives of patients and families to improve delivery of comprehensive mental health care.

Experiences of caregivers of family member with schizophrenia in China: A qualitative study.

PURPOSE: To explore the experience of caregivers of family members with schizophrenia. DESIGN AND METHODS: A qualitative approach was adopted to examine the experience of caregivers of people with schizophrenia. The researcher conducted semi-structured interviews with 16 participants recruited through purposive sampling. FINDINGS: The change findings encompassed five major themes: (a) loss of personal life, (b) mixed emotions, (c) changes in family relationships, (d) the need for professional support and help, and (e) coping strategies. PRACTICE IMPLICATIONS: Clinicians, including nurses, must be aware of the cultural importance of mental illness, particularly the widespread cultural beliefs and patterns of help-seeking behaviors, to provide culturally sensitive health care and develop empirical strategies for helping both these caregivers and their dependents.

Validation of the distress thermometer for caregivers of children and adolescents with schizophrenia.

AIM: To develop and psychometrically test the distress thermometer for caregivers (DT-C) and document the distress level in primary caregivers of children and adolescents diagnosed with schizophrenia. DESIGN: A validation diagnostic accuracy study and descriptive cross-sectional survey. METHODS: DT-C was adopted based on Harverman's distress thermometer for parents. The cut-off score was detected by using receiver operating characteristic analysis with the Depression Anxiety Stress Scale-21 as a reference standard in a sample of 324 caregivers of children and adolescents diagnosed with schizophrenia in China collected between Jan 2017 and Feb 2018. RESULTS: One-item DT of DT-C indicated a good retest reliability (r = 0.86) and one-item DT and the Problem List (PL) indicated good convergent validity (r = 0.67-0.88). Overall and individual PL domains showed good internal consistency (KR 20 values ranged from 0.70-0.90). Setting seven as the cut-off score, the values of sensitivity (0.72-0.81), specificity (0.86-0.90), Youden's index (0.61-0.70), positive predictive value (0.67-0.74), and negative predictive value (0.84-0.92) were most satisfactory and area under curve values showed significantly excellent discrimination (0.88-0.90). The average DT score for the 324 participants was 6.34 (SD 2.49), with 46.9% of the participants above the cut-off. Caregivers above the cut-off score faced significant multiple problems in practical, family/social, cognitive, emotional, and parenting domains. CONCLUSION: The DT-C, with six domains containing 35 items in Problem List and with the cut-off score at seven, can be a rapid screening tool to measure distress in these caregivers. The level of distress in caregivers was relatively high. Psychoeducation on specific needs and a solid mutual support network are recommended for mitigating caregivers' distress. IMPACT: This study adapted a reliable DT-C to measure distress of caregivers, which has the potential to be introduced to caregivers of other types of child and adolescent mental disorders in research, assessments and care planning for health professionals.

Randomized controlled trial of the effects of nursing care based on a telephone intervention for medication adherence in schizophrenia.

PURPOSE: Our aim was to determine the effects of "Telephone Intervention Problem Solving" (TIPS) on medication adherence among individuals diagnosed with schizophrenia. DESIGN AND METHODS: This randomized controlled trial was conducted with 45 patients. TIPS was applied to the intervention group for 2 months, whereas the control group received routine care. FINDINGS: We found that the rate of voluntary continuation of medicine (P < 0.001), belief in the necessity of medication (P = 0.008) and medication adherence scores were higher in the intervention group (P < 0.001). PRACTICAL IMPLICATIONS: This study may serve as a guide for applying telephone communication to clinical interventions in psychiatric nursing.

Effects of a mental fitness positive psychology intervention program on inpatients with schizophrenia in South Korea: A feasibility study.

PURPOSE: This study investigated the effects of a mental fitness positive psychology intervention program on the self-esteem and interpersonal relationship ability of inpatients with schizophrenia. DESIGN AND METHODS: A pretest-posttest nonequivalent control group quasi-experimental design was used. Participants (N = 60) completed scales measuring self-esteem and interpersonal relationship ability. FINDINGS: The program effectively improved participants' self-esteem and interpersonal relationship ability. PRACTICE IMPLICATIONS: Psychiatric nurses can use this program as a nursing intervention to enhance the self-esteem and interpersonal skills of inpatients with schizophrenia in mental health facilities.

Internalized stigma and its correlates among family caregivers of patients diagnosed with schizophrenia in Changsha, Hunan, China.

WHAT IS KNOWN ON THE SUBJECT?: Schizophrenia is a severe and highly stigmatized mental illness. High internalized stigma affects FGs' quality of life and caregiving capacity. Worldwide studies aimed at internalized stigma among patients diagnosed with mental illness or their FGs have reported significant stigma and some correlates, but studies involving FGs that focus on a specific mental illness (e.g. schizophrenia) and report the impact of potential psychosocial variables (e.g. coping and hope) on internalized stigma are limited. WHAT DOES THE PAPER ADD TO EXISTING KNOWLEDGE?: Internalized stigma was common among Chinese FGs of patients diagnosed with schizophrenia and half of them presented at a mild level. Internalized stigma was negatively associated with hope and positively associated with passive coping. FGs, who live with patients, have difficulty supervising medication, or care for a male relative has higher internalized stigma. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Regarding informative support, interventions (e.g. enhancing mental health literacy programs and cognitive therapies) to provide knowledge about schizophrenia, the skills to manage patients' adherence to medications, the benefits of treatment and the possibilities of rehabilitation are necessary for FGs. Regarding psychosocial processes, effective interventions (e.g. group psychoeducation and group social skills training) aimed to enhance hope, social support and coping styles towards internalized stigma should be implemented among FGs. Both informative support and psychosocial interventions used to decrease FGs' internalized stigma can be delivered by healthcare providers or by peer caregivers. ABSTRACT: Introduction Internalized stigma is prevalent among patients diagnosed with schizophrenia. Their family caregivers (FGs) also suffer from internalized stigma, but limited studies have addressed the issue. Aim The aim of this study was to determine the severity of internalized stigma and its correlates among FGs of patients diagnosed with schizophrenia in Changsha, Hunan, China. Methods A consecutive sample of 299 FGs was recruited at the psychiatric outpatient department of a tertiary hospital in Changsha. This study explored the relationships between internalized stigma and potential factors. Results Nearly 50% of the FGs perceived mild internalized stigma, 24% of the FGs reported moderate level, and 6% had a severe level. Internalized stigma was associated with patients' characteristics (severity of illness) and FGs' characteristics (hope, social support, passive coping, age, education background, residence with the patient, caring for a male or a young patient and difficulty in supervising medication). Discussion and implications for practice Informative and psychosocial interventions based on education and contact for FGs such as enhancing mental health literacy programs, cognitive therapies and group psychoeducation can provide FGs with a better understanding of schizophrenia and to promote hope, active coping and social support.

A randomized controlled trial to evaluate the efficacy of metacognitive training for people with schizophrenia applied by mental health nurses: Study protocol.

AIM: To evaluate the efficacy of the Portuguese version of the metacognitive training (MCT) programme for schizophrenia and its effects on psychotic symptoms, insight into the disorder and functionality. DESIGN: This is a randomized controlled trial that will be undertaken in six psychiatric institutions in Portugal. METHODS: This study was approved in March 2019. The sample will consist of people with schizophrenia. The evaluation instruments will include sociodemographic and clinical questionnaires, the Psychotic Symptom Rating Scales, the Beck Cognitive Insight Scale, the World Health Disability Assessment Schedule, and the Personal and Social Performance Scale, applied to both groups at three different times. In the experimental group, the eight MCT modules will be applied over 4 weeks. DISCUSSION: It is expected that at the end of the programme, the experimental group will have reduced severity of psychotic symptoms and improved insight into the disease and functionality. IMPACT: Schizophrenia is a severe mental disorder that, in most cases, leads to the deterioration of cognitive and social functioning as a result of psychotic symptoms. Metacognitive training for schizophrenia has been used in several countries, but its efficacy remains unclear. It is a type of programme that consists of changing the cognitive infrastructure of delusions.