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The Effect of Psychoeducation Based on Motivational Interview Techniques on Medication Adherence, Hope, and Psychological Well-Being in Schizophrenia Patients
Abstract
This study was conducted to determine the effect of psychoeducation based on motivational interview techniques on medication adherence, hope, and psychological well-being in schizophrenia patients. There are many studies using Motivational Interviewing for individuals with schizophrenia. However, there are no studies on whether the concept of “adherence to treatment,” which is clearly shown to be corrected with 6 to 8 weeks of motivational interviewing, will positively affect concepts such as “hope and well-being,” which require longer interventions, in a shorter time. In this context, there are not enough studies in which motivational interviewing techniques are integrated into psychoeducational interventions that can be organized with more individuals. The study was conducted with a pretest-posttest control group design. The sample size of the study was determined as 150 schizophrenia patients including 75 in the experimental group and 75 in the control group based on power analysis. The researcher provided the patients in the experimental group with a six-session psychoeducation program based on motivational interview techniques. A “Descriptive Characteristics Form,” the “Herth Hope Index,” the “Morisky Medication Adherence Scale,” and the “Psychological Well-Being Scale” were used to collect the data. In the study, psychoeducation based on motivational interview techniques created a statistically significant difference in the medication adherence, hope and psychological well-being levels of the patients in the experimental and control groups ( p < .05). Psychoeducation based on motivational interview techniques provided for schizophrenia patients was found to be effective in enhancing their medication adherence, hope, and psychological well-being levels.
... Digital health interventions and psychoeducation are approaches to improving adherence to antipsychotic medication (Al Dameery et al., 2023;Harmanci & Budak, 2022). DHI uses digital medicine systems, mobile applications, text messaging, and telepsychiatry to enhance medication adherence among patients diagnosed with schizophrenia (Edwards et al., 2022;Gonzales et al., 2022;Uslu & Buldukoglu, 2020). ...
... In another study, Harmanci and Budak (2022) used a pretest-post-test control group design in Turkey to investigate the impact of motivational interview-based psychoeducation on schizophrenia patients' psychological well-being, hope, and medication adherence. Random assignment was used to place 150 patients with schizophrenia into two groups: 75 in the experimental group and 75 in the control group. ...
... This section will list the measuring tools used in the selected studies to evaluate the effect of psychoeducation and the DHI on medication adherence as a primary outcome in individuals with schizophrenia, including: Medication Refill Adherence (Gonzales et al., 2022), Medication Adherence Rating Scale (Tessier et al., 2023;Uslu & Buldukoglu, 2020), Medication Adherence Rate (Chen et al., 2023), Warning Signals Scale (WSS) (Chukka et al., 2023), Medication Adherence Report Scale (Schulze et al., 2019), Brief Adherence Rating Scale (BARS) (Edwards et al., 2022), the Drug Attitude Inventory-10 (DAI-10) (D' Arcey et al., 2024;Edwards et al., 2022;Xu et al., 2019), the Brief Medication Adherence Report Scale (BMARS) (Iuso et al., 2023), Morisky Medication Adherence Scale (MMAS-4) (Budiono et al., 2021), the adapted scale Indonesian Medication Adherence Scale (IMAS) (Budiono et al., 2021), and 30-item Drug Attitude Inventory (DAI-30) (Harmanci & Budak, 2022;Ventriglio et al., 2021). Two studies used direct statements: the level of patient compliance to medication as reported by families and questions on beliefs and attitudes to treatment (Bröms et al., 2020;Hode et al., 2024). ...
Background: Schizophrenia is a significant global mental health concern. It is associated with substantial disability and psychosis and can have an impact on all aspects of life. Medication is anappropriate and effective treatment; thus, improving adherence remains a main concern among patients with schizophrenia in clinical practice. Several approaches, such as digital health interventions (DHI) and psychoeducational approaches, may enhance medication adherence. Despite several efforts to create and improve these approaches, their impact remains unclear. Objective: Conduct a scoping review to provide an overview of how digital health interventions and psychoeducation impact the medication adherence of individuals with schizophrenia. Method: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines, we screened 435 studies published between 2019 and 2024 from the databases including Springer Link, MEDLINE, Pro-Quest Central, CINAHL Plus, and Google Scholar. All articles were filtered using inclusion criteria to eliminate redundant, irrelevant, and unnecessary content. Results: A total of 14 articles that addressed DHI and psychoeducational interventions for medication adherence in patients with schizophrenia were found to meet the inclusion criteria. Four themes emerged: psychoeducation, mobile applications, telephone interventions, and digital medical systems. DHI and psychoeducation effectively improved medication adherence, with mobile applications being the most popular and successful. Conclusion: The findings of this review should be used by healthcare professionals to direct their clinical practice. Interventions in digital health can provide a wealth of creative ideas for integrating technical advancement with psychotherapies.
... Five studies (29%) had an attrition rate between 0 and 10% (Carl et al., 2020;Freeman et al., 2014;Harmanci and Budak, 2022;Kızılırmak Tatu and Demir, 2021;Priebe et al., 2015), six studies (35%) between 11 and 25% (Chaves et al., 2017;Halverson et al., 2021;Lovell et al., 2018;Sylvia et al., 2013;Tomba et al., 2017;Özdemir and Kavak Budak, 2022), two studies (12%) between 26 and 50% (Farquharson and MacLeod, 2014;Jensen et al., 2019), and three studies (18%) that had >50% attrition (Cuijpers et al., 2022;Valiente et al., 2022;Williams et al., 2019). Davidson et al. (2004) did not report the attrition. ...
... Empirical justifications were provided by nine studies (53%), demonstrating how enhanced wellbeing positively influenced other outcomes, such as improving quality of life (Harmanci and Budak, 2022) and alleviating depression (Chaves et al., 2017). 3.4 What are the reported effects of psychosocial interventions in outpatient treatment on the wellbeing of adults with severe mental illness (SMI)? ...
... In the effect calculations performed here, 29% of the studies demonstrated a positive effect. Particularly, Harmanci and Budak (2022) reported a large effect on wellbeing through psychoeducation. Across all included studies, 71% reported significant positive changes in wellbeing. ...
Introduction
Wellbeing, encompassing hedonic and/or eudaimonic components, provides a two-dimensional framework for evaluating the effects of psychosocial interventions for individuals with severe mental illness (SMI). This study investigates how this conceptualization of wellbeing is reflected in existing research on psychosocial interventions for people with SMI. This is the first systematic review to assess the effects of psychosocial interventions on wellbeing as a purely positive phenomenon in this population. The study was registered in PROSPERO (CRD42024598954).
Method
A systematic review was conducted on intervention studies involving adults with SMI receiving psychosocial interventions in an out-patient setting, with a control condition and a wellbeing outcome aligned with a wellbeing framework. Five databases were searched, supplemented by manual searches, yielding 2,842 potential studies. Due to considerable heterogeneity (I² = 94%), interventions were analyzed independently, with results summarized based on the proportion of studies reporting significant effects. The study followed PRISMA guidelines.
Results
Seventeen studies met the inclusion criteria. Only one study (6%) provided a full rationale for using a wellbeing measure as the primary outcome. Over 70% reported a significant positive effect on wellbeing. In 13 studies effect size could be calculated, 29% in reference to all 17 studies demonstrated a positive effect (ranging from small to large). Clinical implications of the wellbeing construct were discussed in 47% of the studies, including an increased emphasis on positive functioning. Fewer than 50% received a high-quality rating, and only three studies reporting significant effects used Intention-To-Treat (ITT) data.
Conclusion
Research on two-dimensional wellbeing is a promising yet underprioritized field, providing a renewed focus on abilities and generating significant clinical implications. Wellbeing ought to be a prioritized outcome in out-patient treatment policies, but today no recommendation as to which interventions are most effective are possible due to insufficient data. The implications of detecting changes in wellbeing in individuals with SMI, along with recommendations for future research, are discussed.
... CBT is considered to improve medication adherence by enabling patients to identify their treatment beliefs and hesitations about medication, restructure their cognitive abilities, discover their automatic thoughts and build alternative thinking skills against thereof and practise managing their medications (Miller and Rollnick 2013;Velligan et al. 2009). The studies have indicated that psychoeducation provided through cognitive and behavioural techniques improves medication adherence in individuals who are diagnosed with schizophrenia (Harmanci and Budak 2022;Ertem and Duman 2019;Shehu et al. 2022;Kızılırmak Tatu and Demir 2021). ...
... Power 3.1.9.2' software was used and the sample size was calculated. With α = 0.05 for a 95% confidence interval and power of 0.9, the resultant minimum sample size was determined as 60 individuals (30 in the control group and 30 in the experimental group) (Harmanci and Budak 2022). Individuals from Artuklu CMHC were assigned to the control group and individuals from Kızıltepe CMHC were assigned to the experimental group included by drawing lots. ...
Introduction
It is known that treatment compliance is low and aggression is higher in individuals diagnosed with schizophrenia compared to the normal population. Cognitive behavioural therapy (CBT) is known to reduce relapse and hospitalisation and increase well‐being in individuals diagnosed with schizophrenia. However, there are almost no studies on increasing treatment compliance and decreasing aggression.
Aims
This study was conducted to determine how CBT–based psychoeducation affects medication adherence and aggression in individuals diagnosed with schizophrenia.
Methods
The study was conducted as a quasi‐experimental model with the pre‐test–post‐test control group with 73 schizophrenic patients (33 experimental, 40 control) between June 2022 and July 2023. Data were collected using the Descriptive Characteristics Form, Morisky Medication Adherence Scale (MMAS) and Buss–Perry Aggression Questionnaire (BPSQ). The schizophrenic patients in the experimental group were given eight sessions of CBT‐based psychoeducation, while the schizophrenic patients in the control group were not given any training. The data were analysed using mean, standard deviation, chi‐squared test, dependent samples t ‐test and independent samples t ‐test.
Results
It was determined that the aggression level of the experimental group before the training was 80.51 ± 19.38, and after the CBT‐based psychoeducation, it was 73.12 ± 15.28. It was determined that the aggression level of the control group before the training was 84.22 ± 12.13, and after the post‐test, it was 85.60 ± 11.72. It was determined that the medication adherence level of the experimental group before the training was 2.75 ± 1.25, and after the CBT‐based psychoeducation, it was 3.57 ± 0.67. It was determined that the medication adherence level of the control group before the training was 2.05 ± 1.33, and after the post‐test, it was 2.17 ± 1.36. The psychoeducation based on CBT caused a statistically significant difference ( p = 0.001) in medication adherence and aggression levels in the experimental group.
Discussion
It was determined that CBT applied to individuals diagnosed with schizophrenia was effective on increasing their medication adherence and reducing their aggression. It is recommended for psychiatric nurses to include CBT‐based psychoeducation in their nursing practices in order to increase medication adherence and reduce aggression in individuals with schizophrenia.
Implications for Practice
The findings emphasise that CBT‐based psychoeducation increases treatment adherence and significantly decreases the level of aggression in individuals diagnosed with schizophrenia. Psychiatric nurses should include CBT‐based psychoeducation in their treatments.
... 7,8 Interventions aimed at improving adherence, such as motivational interviewing and cognitive-behavioral strategies, have been effective in enhancing treatment persistence in these patients. 9 Furthermore, the use of long-acting injectable (LAIs) antipsychotics has been associated with improved adherence rates, as these formulations reduce the frequency of dosing and the burden of daily medication management. 10 LAIs offer additional advantages such as 1) sustained clinical stability leading to improved level of daily functioning, thus allowing more time for psychosocial and other recovery-oriented interventions, 2) patients who may struggle with memory problems and cognitive dysfunction do not have to remember to take daily medication and 3) the injectables are administered during visits by a mental health professional ensuring persistence and continuity as well as assertive follow up when and as needed. ...
Background
Patient satisfaction and perceived treatment effectiveness play a critical role in healthcare outcomes and overall well-being. Understanding patient experiences can help identify barriers to adherence and guide improvements in therapy. Previous studies, such as those conducted with PP3M and PP1M, have highlighted the importance of patient satisfaction in optimizing the management of chronic conditions, demonstrating that satisfaction is linked to better adherence and overall treatment success. Nonetheless, there was no data available with patients treated with paliperidone 6-month (PP6M). Therefore, we aimed to evaluate the perspectives, including the perceived effectiveness and satisfaction of patients, their relatives and mental health professionals on the twice-yearly treatment with PP6M in usual clinical practice.
Methods
The cohort of patients derived from the P2Y study. This is a multicenter, prospective study across different sites in Europe. Patients, relatives and psychiatrists were asked for satisfaction, by using the Medication Satisfaction Questionnaire (MSQ), and perceived effectiveness. We included all patients who were initiated or switched to PP6M and completed one year of treatment.
Results
A total of 233 patients were included in this study, of which 9 (4%) discontinued PP6M at 12 months. Most patients were male (69%, 160 participants), 66% (156 patients) carried a diagnosis of schizophrenia and 16% (38 patients) of comorbid substance use disorder. Furthermore, 22% (51 patients), 70% (164 patients) and 8% (19 patients) were treated with PP1M, PP3M and other oral/LAIs antipsychotics, respectively. The majority of patients (81.5%, n = 190/233), relatives/carers (81.1%, n = 189/233) and clinicians (90.9%, n = 212/233) were extremely satisfied, very satisfied or satisfied 1 year after switching from PP1M, PP3M and other antipsychotic to PP6M with similar findings between patients diagnosed with schizophrenia and other diagnoses. Last, 42% of patients, 45% of their relatives and 40% of clinicians perceived PP6M as more effective compared to the previous treatment. In contrast, only 3% of patients, relatives and clinicians perceived PP6M as less effective.
Conclusion
Patients, their carers and relatives as well as mental health professionals reported a high satisfaction rate with PP6M, and equally good or even better perceived effectiveness compared to PP1M, PP3M or other oral or LAIs antipsychotics in the majority of cases. Improved patient experience with PP6M could improve treatment continuity and reduce hospitalization rates.
... [4][5] Psychoeducation based on motivational interview techniques provided for schizophrenia patients was found to be effective in enhancing their medication adherence, hope, and psychological well-being levels. [6][7][8] Thus, the aim of the study was to assess the efficacy of a brief psychoeducation module on medication adherence and the quality of life of caregivers of individuals with schizophrenia. ...
Background: Schizophrenia is a complex psychiatric disorder that affects both individuals and their
families, with psychoeducation playing a crucial role in enhancing patients' understanding of their
illness and treatment. Aim: This study examined the impact of caregiver psychoeducation on
medication adherence, and quality of life among individuals with schizophrenia. Methods: A quasi
experimental research design with a control group was used, involving 60 participants purposively
selected from the inpatient and outpatient departments of the Psychiatry Department at Sassoon
General Hospital and the Maharashtra Institute of Mental Health, Pune. Assessment tools included the
Self-Designed Socio-Demographic questionnaire, WHOQOL-BREF, and the Medication Adherence
Rating Scale. Results: Findings showed a highly significant improvement in medication adherence,
and quality of life after psychoeducation (p < .001). Conclusion: The study concludes that integrating
psychoeducation with standard treatment can significantly enhance outcomes for individuals with
schizophrenia compared to routine care.
... and/or medication, as well as psychosocial functioning in those who don't take their antipsychotic drugs as prescribed. (Harmanci P, 2022) Developed by clinical psychologists, motivational interviewing (MI) is a directive tool for strengthening the intrinsic drive to change through ambivalence resolution. MI was once intended to be a therapeutic strategy for treating alcohol and other substance abuse. ...
... Кроме того, больные с давностью заболевания до 5 лет с параноидной и аффективно-параноидной симптоматикой были менее привержены терапии по сравнению с пациентами с ведущим галлюцинаторно-параноидным синдромом. Исходя из этого, данные категории пациентов нуждаются в дополнительных мероприятиях, повышающих приверженность к лекарственной терапии: использование АПП и АВП пролонгированного действия, проведение когнитивно-поведенческой психотерапии, включение в психообразовательные программы не только самих больных, но и их близких родственников [19,20,21]. Ограничения настоящего исследования: малочисленность выборки, использование одного опросника для оценки приверженности к лечению, отсутствие последующего анализа приверженности к терапии на амбулаторном этапе. ...
... Similarly, 45% negative symptoms severity was reduced by this program These findings are consistent with the findings of the previous study, which reflects that psychoeducation program can play an important role in developing insight and reduction in symptoms severity (53). Moreover, this psychoeducation program 59% successfully improved patients' help-seeking attitude toward treatment (54) and 50% this program remain helpful to improve patients' level of motivation for treatment (55). ...
Introduction
Schizophrenia is typically treated with medication as the first approach, but additional strategies are necessary to enhance the effectiveness of this treatment for better outcomes. However, it is crucial to explore methods, alongside medication, that promote a positive attitude towards seeking mental health support and alleviate symptom severity among non-institutionalized individuals of different age groups in Pakistan. Thus, this pilot study aimed to utilize a psychoeducation program to enhance patients’ motivation and attitudes toward seeking treatment, decrease symptom severity, and investigate the role of financial factors in their illness journey.
Methods
In this preliminary investigation, our focus was on individuals who had been diagnosed with schizophrenia and were receiving treatment from various hospitals and primary care clinics. Following a thorough screening process, 255 participants met the eligibility criteria, and 220 completed the psychoeducation program. The study included both male and female participants, with 143 (56.08%) being men and 112 (43.82%) being women. Regarding marital status, 123 (48.24%) were single, 98 (38.43%) were married, and 34 (13.33%) were divorced widowers or widows. The age range of the respondents varied from 18 to 52 years, with a mean age of 35.45 and a standard deviation of 10.27.
Results
The results indicated a decrease in symptom severity following a 16-week psychoeducation program. The psychoeducation program significantly reduced the positive symptoms, negative symptoms, and general psychopathological symptoms among patients. Similarly, significant improvement was observed in patients’ motivation toward treatment and they actively participated in treatment after getting psychoeducation about the treatment. Similarly, after the psychoeducation program significant improvement was seen in patients’ attitudes towards help-seeking and perceived mental health functioning.
Conclusion
In summary, the findings suggest that our psychoeducation program has the potential to positively impact the motivation and help-seeking attitudes of schizophrenia patients towards treatment. Moreover, there is a need for further exploration of psychoeducation programs for schizophrenia, particularly in countries facing economic challenges. This study paves the way for the development of an indigenous psychoeducation program tailored to Pakistani schizophrenia patients, with potential applicability for Urdu-speaking individuals.
Clinical Trial Registration
https://www.thaiclinicaltrials.org/show/TCTR20210208003, identifier TCTR20210208003.
... The positive results obtained indicate the need for more research on the effects of this motivational and self-empowerment approach (both cognitive and emotional focus) on different patient outcomes in terms of not only the severity of symptoms and recurrence of the disease, but also patient medication adherence, knowledge about the disease. and/or medication, and psychosocial functioning in those with poor adherence to antipsychotic medication [17]. ...
Adherence will have an impact on therapy because schizophrenia is a chronic mental disorder that requires long-term treatment. One strategy to improve adherence to medications is motivational interviewing (MI), although more study is needed to see how well it works and whether it has any other effects on schizophrenia. The study aimed to assess the effectiveness of motivational interviews in improving adherence to medications and other positive impacts on PwS. A literature review using PubMed, Science Direct, Springerlink, and google scholar databases from 2010-2023 focused on keywords adherence, schizophrenia, and motivational interviewing. The results showed that MI has inconsistencies in their effect on improving medication adherence in PwS, but some studies found evidence of an association between MI and other outcomes, such as improvement in psychotic symptoms and decreased hospitalisation rates. Differences in patient characteristics and MI interventions in each study, the to perform MI techniques, and the trusting relationship built by the counsellor with the patient will affect the impact of MI on adherence. MI showed inconsistencies in improving medication adherence in people with schizophrenia. Several factors will affect the effectiveness of MI. However, MI also has the potential to improve psychosis symptoms and reduce hospitalisation rates, although more research is needed.
... The hope level was assessed using the Herth hope index (HHI) scale (Herth, 1992) in this study. The scale is widely used and has been proven to have good reliability and validity (Ni et al., 2021;Harmanci and Budak, 2022). The HHI scale consists of three dimensions: attitude towards reality and future, positive action, and keep interconnectedness with others. ...
Objective: This study aimed to explore the prevalence and associated factors of medication adherence among infertile women undergoing frozen-thawed embryo transfer (FET) cycle.
Methods: A cross-sectional study was conducted with 556 infertile women undergoing FET cycle in total. The Self-efficacy for Appropriate Medication Use Scale (SEAMS), Herth Hope Index (HHI) scale, and Social Support Rating Scale (SSRS) were used to evaluate the patients. Data were described by univariate and multivariate analyses. Logistic regression method was performed to analyse the factors potentially associated with medication adherence.
Results: The average score of Self-efficacy for Appropriate Medication Use Scale (SEAMS) was 30.38 ± 6.65, and 65.3% of participants showed non-adherence. Multiple regression analysis indicated that first-time FET cycle, treatment stage, methods of daily medication, social support and hope level were the main associated factors of the medication adherence among infertile women undergoing FET cycle (p < 0.001).
Conclusion: This study revealed the medication adherence is at medium level among infertile women undergoing FET cycle, especially in patients with repeated FET cycles. The study also suggested that improving the hope level and social support of infertile women undergoing FET cycle may increase medication adherence.
... In addition to improving the interest in health education, it can also stimulate the enthusiasm and initiative of patients to receive health education, so as to maximize the effect of health education [9,10]. In addition, diversifying health education approaches and forms of health education can also meet the health education needs of patients with different characteristics and needs [11,12]. In the results of this study, the health knowledge level in the self-care ability score of the observation group that implemented diversified health education was significantly higher than that of the control group that implemented routine nursing intervention, and the improvement of the level of health knowledge further enhanced the sense of Table 3: Comparison of self-care ability between two groups (score, x ± s). ...
Objective:
To explore the application value of diversified health education combined with psychological nursing in the treatment of patients with infectious bone defects by induction membrane surgery.
Methods:
A total of 52 patients with infectious bone defects treated by induction membrane surgery from May 2018 to January 2022 were selected as the research subjects and divided into an observation group (with diversified health education combined with psychological care) and a control group according to the random number table method (routine nursing care). There were 26 patients in each group, and the Hospital Anxiety and Depression Scale (HADS) and Self-Care Ability Scale (ESCA) were compared.
Results:
At admission, there was no significant difference in anxiety dimension, depression dimension, and total score of anxiety and depression between the two groups (P > 0.05). At admission, there was no significant difference in self-care responsibility, self-concept, self-care skills, health knowledge level, and total score between the two groups (P > 0.05). Skills, health knowledge level, and total score were higher than those in the control group (P < 0.05). The total incidence of complications in the observation group was lower than that in the control group (P < 0.05).
Conclusion:
Diversified health education combined with psychological nursing is beneficial to reduce negative emotions, improve self-care ability, and reduce the incidence of complications in the treatment of patients with infectious bone defects by induction membrane surgery.
Objective: to evaluate factors related to medication adherence in patients with mental disorders at a Psychosocial Care Center. Methodology: descriptive cross-sectional cohort study, through analysis of medical records and semi-structured interviews. Results: of the 50 patients, the majority were female, single, black or brown, incomplete primary education, unemployed, aged 50 to 59 years. 58% of patients showed good adherence to medication; 50% forget to take their medication, 84% have clearer thoughts when medicated, and 90% said that their health depended on these medications, preventing the disease from worsening. Haloperidol was the most prescribed medication, at 58% of patients, and the main cause of adverse reactions and drug interactions, in 54% of prescriptions. Furthermore, 40% of patients had difficulty reading the medication packaging. Conclusion: the majority of participants regularly use medications and recognize their importance. They understand that interrupting treatment may worsen the clinical condition. A significant portion of patients did not have good adherence to pharmacotherapy, justified by adverse reactions and side effects, probably aggravated by drug interactions. Low education becomes an important factor in medication adherence.
Purpose
KUPAA is a culturally adapted version of Family Psychoeducation (FPE) that has shown to be beneficial to people living with schizophrenia-spectrum disorders (PLWS), who may experience limitations across multiple functional domains. Family Psychoeducation can lead to improvement in functional outcomes that align with recovery goals; however, the mechanisms of action are unclear. The current study objective is to identify mechanisms by which the KUPAA intervention reduces disability and improves quality of life among care-seeking PLWS in Tanzania.
Methods
This clinical trial was conducted at Muhimbili National Hospital and Mbeya Zonal Referral Hospital and included a total of 66 dyads composed of PLWS ages 18–50 years and their caregivers. A causal mediation framework employing the g-formula was used to estimate the indirect effects of the KUPAA intervention on disability and quality of life, through the mediated pathways of hopefulness, self-stigma and generalized self-efficacy.
Result
A greater decrease in mean disability score and increase in quality of life score was observed among KUPAA participants, compared to controls. We found that generalized self-efficacy mediates 33% of the effect of KUPAA on quality of life and generalized self-efficacy and hope each mediate 36% of the effect of KUPAA on disability.
Conclusion
Results provide preliminary support for the hypothesis that KUPAA can reduce disability and improve quality life by reducing stigma, increasing hope and strengthening self-efficacy. Future psychosocial programs for PLWS should consider tailoring their interventions to focus on reducing stigma, increasing hope and fostering self-efficacy.
Aim: The aim of this quality improvement project was to provide multisession trainings that teach the fundamentals of motivational interviewing (MI) to inpatient behavioral health care workers who lack education and proficiency in these techniques. Background: MI is a therapeutic communication approach that explores a person’s mixed feelings or ambivalence and aims to encourage a positive behavior change. It was first developed for patients struggling with substance use disorders to assist them in making decisions regarding their sobriety. Methods: Participants attended three 2-hour MI educational sessions, which spanned 6 weeks. Instruction was through an interactive online module. After each educational session, participants engaged in role-play scenarios. Participants received ratings on their adherence to MI skills. Prior to the first and following the last educational session, participants completed an anonymous online survey to measure individual knowledge of MI fundamentals. Results: Through role-play adherence ratings, MI consistent fundamental skills, such as open-ended questions and reflective statements, demonstrated proficiency. The remaining MI consistent fundamental skills, MI style or spirit, and affirmations did not reach proficiency. MI consistent complex skills did not reach proficiency but did progressively increase in adherence. MI inconsistent skills that should be avoided all met adherence proficiency, other than close-ended questions. Conclusion: This quality improvement training demonstrated that through multiple internet-based educational sessions and role-play scenarios, proficiency in two MI consistent fundamental skills and knowledge increased. Continued efforts to create more educational and practical opportunities for knowledge retention are encouraged.
Marital concerns can trigger emotional stress, especially among long‐term hospitalised individuals diagnosed with schizophrenia, significantly affecting their treatment and recovery. Unfortunately, rehabilitation programs tend to overlook the marital needs of individuals with diagnosed schizophrenia. This research aimed to investigate the content related to marital concerns of Chinese individuals diagnosed with schizophrenia who were undergoing extended hospitalisation. Fifteen participants diagnosed with schizophrenia were recruited through purposive sampling for face‐to‐face semi‐structured interviews. The gathered data were analysed using Colaizzi's method, revealing three themes: (1) manifestations of marriage‐related concerns, (2) effects of marriage on disease progression, and (3) the need for support from family and the hospital. This study offers new insights into marital concerns among long‐term schizophrenia inpatients and underscores the significance of screening and intervention for such concerns. Healthcare professionals and family members should extend support to patients to foster confidence within their marital relationships.
Aim:
This randomized controlled experimental study determined the effect of motivational interview-based counseling on the coping strategies and perceived social support levels in individuals with amputations due to chronic disease.
Design:
A randomized controlled trial was conducted.
Method:
The study was completed in the orthopedics and traumatology department with 48 patients. Data were collected using a descriptive information form, the Coping Strategies Scale, and the Multidimensional Scale of Perceived Social Support. Independent samples t test, paired t test, and chi-square test were used for data analysis.
Results:
The scores of the Coping Strategies Scale and the Perceived Social Support Scale of individuals in the intervention group significantly increased in the posttest after motivational interview-based counseling compared to their pretest scores. It was determined that the Coping Strategies Scale and Perceived Social Support Scale subdimension scores and total mean scores for individuals in the intervention group in the posttest were higher than the mean scores for individuals in the control group. The difference between the groups was significant.
Conclusion:
The motivational interview-based counseling given to individuals with amputation because of chronic disease increased their coping strategies and perceived social support levels.
Günümüzde özellikle sağlık alanındaki etkinliği bilimsel olarak kanıtlanmış olan motivasyonel görüşme tekniği, sosyal hizmet uzmanlarının mesleki müdahalelerini gerçekleştirirken faydalandığı önemli tekniklerden birisidir. Sosyal hizmet değerleri ile uyumlu bir paradigmaya sahip olan bu teknik; müracaatçı ile iş birliğini, çelişkileri ortaya çıkarmak gerektiğini, empatinin ve kişisel özerkliğin önemini vurgulamaktadır. Ayrıca sosyal hizmet uzmanına dirençli bir müracaatçıyla karşılaştığında neler yapılabileceğine yönelik fikir vermektedir. Yapılan araştırmalar bu görüşme tekniğinin sosyal hizmet alanında alkol ve madde bağımlılığı olan müracaatçıyla, kronik hastalığı olan kişilerle, ailelerle, yaşlılarla, gençlerle, çocuklarla, engellilerle ve farklı kültürden gelen müracaatçıyla çalışırken etkili olarak kullanılabileceğini ortaya çıkarmıştır. Bu derleme çalışmada, sosyal hizmet perspektifinden motivasyonel görüşmenin açıklanması ve bu görüşme tekniğinin sosyal hizmet uygulamalarına nasıl yansımalarının olduğunun ortaya konulması amaçlanmıştır. Çalışmanın mesleki uygulamalarda kullanabilecek teknikler bakımından, tıbbi sosyal hizmet alanında çalışan sosyal hizmet uzmanları başta olmak üzere diğer sosyal hizmet uzmanlarına da yol gösterici olması beklenmektedir.
Medication adherence and recovery rates are <50% among persons with schizophrenia; therefore, this health concern needs attention. Empowerment is a vital element for behavioural change, but previous studies have presented different results and lack specific connotations about empowerment. Therefore, this study systematically reviewed and meta‐analysed the effects of empowerment‐based illness management on the medication adherence and recovery of persons with schizophrenia. The databases searched included the PROSPERO registration network, Cochrane Library, PubMed, Embase, CINAHL, PsycAricle, and Airiti Library. The research steps were based on PRISMA. RoB 2.0 was used for article quality evaluation, the effect size was calculated using RevMan software, and the random‐effect model and standardized mean differences (SMD) were established. Eight randomized controlled trials (RCTs) involving 859 participants were used to investigate the effect of empowerment on medication adherence. The trials involved the use of effective strategies as inducing medication motivation, promoting self‐medication management, and providing support resources. A moderate effect was observed (SMD = 0.58, 95% CI 0.18–0.99). Ten RCTs involving 1473 participants were used to investigate the effect of empowerment on recovery. These trials involved the use of such effective strategies as using self‐strength, connecting external forces, understanding personal needs, and overcoming self‐stigma. A moderate effect was observed (SMD = 0.55, 95% CI 0.10–0.99). Empowerment in illness management can effectively promote the medication adherence and recovery of persons with schizophrenia. In the future, nurses can use self‐strength care to promote medication motivation and connect internal and external forces to assist a person's medication adherence and recovery.
Background
Trials studying Motivational Interviewing (MI) to improve medication adherence in patients with schizophrenia showed mixed results. Moreover, it is unknown which active MI-ingredients are associated with mechanisms of change in patients with schizophrenia. To enhance the effect of MI for patients with schizophrenia, we studied MI's active ingredients and its working mechanisms.
Methods
First, based on MI literature, we developed a model of potential active ingredients and mechanisms of change of MI in patients with schizophrenia. We used this model in a qualitative multiple case study to analyze the application of the active ingredients and the occurrence of mechanisms of change. We studied the cases of fourteen patients with schizophrenia who participated in a study on the effect of MI on medication adherence. Second, we used the Generalized Sequential Querier (GSEQ 5.1) to perform a sequential analysis of the MI-conversations aiming to assess the transitional probabilities between therapist use of MI-techniques and subsequent patient reactions in terms of change talk and sustain talk.
Results
We found the therapist factor “a trusting relationship and empathy” important to enable sufficient depth in the conversation to allow for the opportunity of triggering mechanisms of change. The most important conversational techniques we observed that shape the hypothesized active ingredients are reflections and questions addressing medication adherent behavior or intentions, which approximately 70% of the time was followed by “patient change talk”. Surprisingly, sequential MI-consistent therapist behavior like “affirmation” and “emphasizing control” was only about 6% of the time followed by patient change talk. If the active ingredients were embedded in more comprehensive MI-strategies they had more impact on the mechanisms of change.
Conclusions
Mechanisms of change mostly occurred after an interaction of active ingredients contributed by both therapist and patient. Our model of active ingredients and mechanisms of change enabled us to see “MI at work” in the MI-sessions under study, and this model may help practitioners to shape their MI-strategies to a potentially more effective MI.
This study compares levels and psychosocial predictors of well-being among 73 persons diagnosed with a schizophrenia spectrum disorder (SSD) and 80 matched non-clinical (NC) controls. Findings show that the NC group scored higher on well-being, experiences of parental care, and couple relationship satisfaction; whereas the SSD group scored higher on both avoidant and anxious attachment styles, parental overprotection, and parental differential treatment (reporting being favored more than their siblings). Low scores on insecure attachment and parental care were key predictors of well-being among the NC group; couple relationship satisfaction mediated the association between avoidant attachment and well-being in both groups. The results warrant interventions that factor in attachment styles when patients diagnosed with SSD begin therapy that aims to improve their well-being.
There have been no intervention studies of psychoeducation programs for schizophrenia that focus on improving subjective well-being or studies to determine the factors influencing such effects. This study aimed to examine the effects of a psychoeducation program combining traditional psychoeducation with a focus on providing knowledge and information and a new intervention to raise patients' subjective well-being and to clarity the factors affecting the program's efficacy. Subjects were 117 patients who participated in a psychoeducation program for schizophrenia between 2012 and 2018. In addition to comparing subjective well-being (Subjective Well-being under Neuroleptic Drug Treatment Short Form, Japanese version, SWNS-J) and attitudes towards drugs (Drug Attitude Inventory-10, DAI-10) before and after the program, basic information such as psychiatric symptoms was surveyed. The factors influencing the effects of the program were assessed with multiple regression analysis. Scores for SWNS-J subscales and total SWNS-J score increased significantly after the program. Higher total scores on subjective well-being after the program were significantly associated with having less severe negative symptoms and higher total subjective well-being before the program, and with more positive attitudes toward drugs after the program. These results suggest that intervention with a focus on improving subjective well-being can be an effective part of psychoeducation programs for patients with schizophrenia. The results also suggest that the level of improvement in subjective well-being gained from the program may be higher in patients with milder negative symptoms and patients with a better understanding of drug treatment.
Background:
Motivational interviewing (MI) may be an effective intervention to improve medication adherence in patients with schizophrenia. However, for this patient group, mixed results have been found in randomized controlled trials. Furthermore, the process of becoming (more) motivated for long-term medication adherence in patients with schizophrenia is largely unexplored.
Method:
We performed a qualitative multiple case study of MI-sessions to analyse the interaction process affecting motivation in patients with schizophrenia. Fourteen cases of patients with schizophrenia, who recently experienced a psychotic relapse after medication-nonadherence, were studied, comprising 66 audio-recorded MI-sessions. In the MI-sessions, the patients expressed their cognitions on medication. We used these cognitions to detect the different courses (or patterns) of the patients' ambivalence during the MI-intervention. We distinguished successful and unsuccessful cases, and used the cross-case-analysis to identify success factors to reach positive effects of MI.
Results:
Based on the expressed cognitions on medication, we found four different patterns of the patient process. We also found three success factors for the intervention, which were a trusting relationship between patient and therapist, the therapist's ability to adapt his MI-strategy to the patient's process, and relating patient values to long-term medication adherence.
Conclusions:
The success of an MI-intervention for medication adherence in patients with schizophrenia can be explained by well-defined success factors. Adherence may improve if therapists consider these factors during MI-sessions.
Background:
Internalized stigma has negative consequences on subjective and objective aspects of the recovery in people diagnosed with mental disorders. Despite its relevance, it has been poorly studied in patients with schizophrenia.
Methods:
A sample of 71 outpatients with a diagnosis of schizophrenia who attended Psychosocial Rehabilitation Centers of Gran Canaria, Spain, were evaluated. We assessed the prevalence of internalized stigma and its possible association with sociodemographic, clinical, psychological and psychopathological variables, as well as suicidal behaviour and suicidal ideation.
Results:
21.1% of the patients had internalized stigma. Internalized stigma was associated with higher prevalence of suicidal ideation during the last year, higher number of suicide attempts, higher current suicidal risk, worse self-compassion, higher self-esteem, higher scores on depression, higher prevalence of depression and higher hopelessness. After multivariate analysis, hopelessness and the existence of depression were independently associated with internalized stigma, although depression showed trend towards significance.
Conclusions:
The association between internalized stigma and higher hopelessness, depression and higher suicidal risk suggests the necessity to systematically assess internalized stigma in patients with schizophrenia, and to intervene to reduce it.
Background
The object of this study was to investigate the effects of group integrative arts therapy based on social skill training on communication, social adaptive function, and subjective well-being in inpatients with chronic schizophrenia.
Methods
Among the 125 patients who had been hospitalized in the H mental hospital in S city after being diagnosed with schizophrenia by psychiatrists according to DSM-IV, 72 patients were selected by inclusion criteria and 48 patients were randomly assigned into an experimental group(n=16), comparative group(n=16), and control group(n=16). During this study, 4 patients from each group dropped out. The final subjects of each groups were 12 patients. The experimental group followed a 60 minutes long social skill training based on group integrative arts therapy program for twice a week and 20 times in total. The Comparative group followed a social skill training program only for 60 minutes twice a week for 20 times in total. The control group received no treatment. To assess the social adaptive function, empowerment, subjective well-being of the subjects, Communication Competence Scale(CCS), Empowerment Scale(ES) and Korean Modification of Subjective Well-Being Scale(KmSWN) were used as subjective measuring. Assertiveness Observation Evaluation Scale(AOES), Social Adaptive Functioning Scale(SAFS), and Nurses’ Observation Scale of Inpatient Evaluation-30(NOSIE-30) were also used as objective measuring that were rated by nurses or social workers at the mental hospital. One-way ANOVA and Chi-Square Test were performed to check differences among groups homogeneity. Mixed ANOVA and Sheffe test were used to find the effect of group integrative arts therapy in the differences among groups.
Results
First, there was no statistically significant difference except non-verbal communication of CCS among three groups in homogeneity test of sociodemographic and clinical variables.
2nd, the group integrative arts therapy based on social skill training was found to significantly increase the communication of experimental group more than comparative group, and that of comparative group more than the control group.
3rd, the group integrative arts therapy based on social skill training was found to significantly increase the assertiveness of the experimental group and comparative group more than control groups.
4th, the group integrative arts therapy based on social skill training was found to significantly increase the social adaptive functioning of the experimental group more than comparative group, and that of the comparative group more than the groups.
5th, the group integrative arts therapy based on social skill training was found to significantly increase the NOSIE-30 of the experimental group and the comparative group more than control group. NOSIE-positive and irritability of NOSIE-30 in the comparative group was increased more than those of the experimental and the control groups.
6th, the group integrative arts therapy based on social skill training was found to significantly increase the empowerment of the experimental group more than that of the comparative and the control group.
7th, the group integrative arts therapy based on social skill training was found not to significantly increase the subjective well-being in all of the experimental, comparative and control groups.
Discussion
The group integrative arts therapy based on social skill training is found to significantly enhance the social adaptive function and empowerment of inpatients with chronic schizophrenia than social skill training. These results suggest that group integrative arts therapy could be utilized as effective mental rehabilitation intervention program for inpatients with chronic schizophrenia.
Background
According to the projections of the World Health Organization, 15% of all disabilities will be associated with mental illnesses by 2020. One of the mental disorders with the largest social impacts due to high personal and family costs is psychosis. Among the most effective psychological approaches to treat schizophrenia and other psychotic disorders at the world level is cognitive behavioral therapy. Recently, cognitive behavioral therapy has introduced several tools and strategies that promote psychological processes based on acceptance and mindfulness. A large number of studies support the effectiveness of mindfulness in dealing with various mental health problems, including psychosis. This study is aimed at determining the efficiency of a mindfulness-based program in increasing cognitive function and psychological well-being in patients with a first episode of schizophrenia and a high risk mental state (those at risk of developing an episode of psychosis).
Methods and design
This is an experimentally designed, multi-center randomized controlled trial, with a 3-month follow-up period. The study participants will be 48 patients diagnosed with schizophrenia (first episode) and 48 with a high-risk mental state, from Santiago, Chile, aged between 15 and 35 years. Participants will be submitted to a mindfulness-based intervention (MBI), which will involve taking part in eight mindfulness workshops adapted for people with psychosis. Workshops will last approximately 1.5 hours and take place once a week, over 8 weeks. The primary outcome will be the cognitive function through Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) and the secondary outcome will be psychological well-being measured by self-reporting questionnaires.
Discussion
The outcomes of this trial will add empirical evidence to the benefits and feasibility of MBIs for the psychotherapeutic treatment of patients with schizophrenia and high-risk mental states in reducing cognitive impairment in attention, working memory, and social cognition, as well as increasing the psychological well-being by empowering the patients’ personal resources in the management of their own symptoms and psychotic experiences.
Trial registration
ISRCTN registration number ISRCTN24327446. Registered on 12 September 2016.
Electronic supplementary material
The online version of this article (doi:10.1186/s13063-017-1967-7) contains supplementary material, which is available to authorized users.
Background: Considered as an important objective in the treatment of patients with schizophrenia, improving patients’ quality of life (QoL) can predict symptomatic remission and recovery. The aim of this study was to examine to what extent resilience, self-esteem, hopelessness and psychopathology are correlated to QoL.
Methods: In this cross-sectional study, 52 Patients diagnosed with schizophrenia according to ICD-10 criteria were recruited on an outpatient basis. Furthermore, 77 healthy controls were recruited from the general community. Psychopathology was assessed by the Positive and Negative Syndrome Scale (PANSS) in schizophrenia patients. The following scales were used in both patients and healthy controls: Berliner Lebensqualitätsprofil to assess QoL, the German versions of the Resilience Scale, the Rosenberg Self-Esteem Scale, and the Beck Hopelessness Scale to assess resilience, self-esteem, and hopelessness, respectively.
Results: QoL, resilience and self-esteem were lower, and hopelessness higher, in patients compared to healthy controls. In patients, QoL correlated moderately with self-esteem, resilience and hopelessness, and weakly with psychopathology. In regards to the latter, depression and positive symptoms correlated negatively with QoL.
Conclusion: Our results suggest that effort should be made to promote self-esteem and resilience and to diminish hopelessness as well as affective and positive symptoms in schizophrenia patients.
Background
Current practice guidelines for schizophrenia care recommend that antipsychotic medication is essential for patients’ long-term maintenance treatment but their non-adherence to this medication is still a main obstacle to relapse prevention. This study evaluated the effects of a motivational-interviewing-based adherence therapy for people with schizophrenia spectrum disorders. Methods
This randomised controlled trial was conducted with 134 outpatients with schizophrenia spectrum disorders; 67 of them received a six-session adherence therapy (in addition to usual care) and 67 received usual psychiatric care alone. Participants’ outcome measures included symptom severity, medication adherence, hospitalisation rates, insight into illness/treatment, and functioning. ResultsThe adherence therapy group reported significantly greater improvements in symptom severity (p < 0.003), insight into illness/treatment (p < 0.001), functioning (p < 0.005), duration of re-hospitalisations (p < 0.005), and medication adherence (p < 0.005) over 18 months follow-up, when compared with usual care alone. Conclusions
Motivational-interviewing-based adherence therapy can be an effective approach to treatment for people with early stage of schizophrenia who poorly adhere to medication regimen. Trial registrationClinicalTrials.gov NCT01780116, registration date January 29, 2013.
Medication nonadherence decreases the success of clinical treatment and the efficient use of resources, thereby creating a barrier to effective health care. In this report, we describe the achievement of treatment collaboration through motivational interviews (MI) in a patient with treatment-resistant schizophrenia. In this case study, we conducted six MIs during which we asked open-ended and reflective questions, established empathy with the patient, and developed discrepancies, leading to ambivalent feelings being revealed. We used the importance, confidence and self-efficacy ruler. The MI method can be used to ensure continued treatment effectiveness, to increase patient awareness about the disease and benefits of treatment, and to increase patients' self-efficacy.
Adherence to treatment in psychiatric populations is notoriously low. In this randomized, controlled, proof-of-concept study, we sought to examine whether motivational interviewing (MI) could be used to enhance motivation for, adherence to, and benefit obtained from cognitive rehabilitation. Dual diagnosis MI, developed specifically for individuals with psychotic symptoms and disorganization, was further adapted to focus on cognitive impairments and their impact. Sixty-four outpatients diagnosed with schizophrenia spectrum disorders completed baseline assessments and were randomized to receive either the 2-session MI focused on cognitive functioning or a 2-session sham control interview focused on assessment and feedback about preferred learning styles. Next, all participants were given 4 weeks during which they could attend up to 10 sessions of a computer-based math training program, which served as a brief analog for a full course of cognitive rehabilitation. As hypothesized, MI condition was associated with greater increases in task-specific motivation along with greater training program session attendance. Moreover, postinterview motivation level predicted session attendance. There were no significant differences in improvement on a measure of cognitive training content, which may have been due to the abbreviated nature of the training. While the literature on the efficacy of MI for individuals with psychosis has been mixed, we speculate that our positive findings may have been influenced by the adaptations made to MI as well as the focus on a nonpharmacological intervention.
The purpose of this research is to study the psychometrical features of the Turkish form of the psychological well-being scale. The sample of the study includes 529 pre-service teachers, 339 (64%) of whom are females and 190 (36%) of whom are males. As a result of the exploratory factor analysis, it was found that the total explained variance was 42% and that the items were grouped under one factor. For criterion validity, psychological well-being scales and a need satisfaction scale were used. The Pearson product moment correlation between psychological well-being scales and a need satisfaction scale was calculated as .56 and .73 (p<.01). The reliability study indicated that the Cronbach alpha coefficient was .80. According to the test retest results, there was a high level of a positive and meaningful relation between the first and second applications of the scale (r= 0.86, p<.01). This study showed that the psychological well-being scale was a valid and reliable instrument to measure psychological well-being.
Non-adherence to antipsychotic medication is commonly found in schizophrenia and other psychotic disorders, thus forming a major obstacle to long-term maintenance treatment and contributing to high relapse rates. With limited evidence on the success of interventions in enhancing medication adherence, this controlled trial was designed to test and evaluate the effectiveness of an adherence therapy (AT) for outpatients with schizophrenia spectrum disorders, based on a motivational interviewing approach over a six-month follow-up period.
A single-blind, randomized controlled trial with a repeated-measures, two parallel groups design was conducted in a random sample of 114 participants with schizophrenia spectrum disorders in one community psychiatric nursing service. After pre-test, the participants were randomly assigned to either an eight-session course of AT plus usual care or usual psychiatric care (n = 57 per group). The main outcomes, including medication adherence, symptom severity, insight into treatment, hospitalization rate, and functioning, were measured at baseline and immediately and six months post-intervention.
A total of 110 participants completed this trial and thus the attrition rate was 3.5 %. Results of repeated-measures analysis of variance followed by Helmert's contrasts test indicated that the AT participants reported significantly greater improvements in their insight into illness and/or treatment, psychosocial functioning, symptom severity, number of re-hospitalizations, and medication adherence (F = 5.01 to 7.45, P = 0.007 to 0.030) over six months follow-up, when compared with usual care.
Motivational interviewing-based AT for people with schizophrenia can be effective to reduce symptom severity and re-hospitalizations, and improve medication adherence, functioning, and insight into illness and/or treatment over a medium term (six months) period of follow-up. Further study on the effects of AT in people with psychotic disorders in terms of diverse sociodemographic and illness characteristics, and a longer term (for example, over 12 months) follow-up period is recommended.
The trial was registered at Clinicaltrials.gov (identifier: NCT01780116 ) on 6 July 2014.
Aims. Third-wave psychological interventions have gained relevance in mental health service provision but their application to people with psychosis is in its infancy and interventions targeting wellbeing in psychosis are scarce. This study tested the feasibility and preliminary effectiveness of positive psychotherapy adapted for people with psychosis (WELLFOCUS PPT) to improve wellbeing.
Methods. WELLFOCUS PPT was tested as an 11-week group intervention in a convenience sample of people with psychosis in a single centre randomised controlled trial (ISRCTN04199273) involving 94 people with psychosis. Patients were individually randomised in blocks to receive either WELLFOCUS PPT in addition to treatment as usual (TAU), or TAU only. Assessments took place before randomisation and after the therapy. The primary outcome was wellbeing (Warwick-Edinburgh Mental Well-Being Scale, WEMWBS). Secondary outcomes included symptoms (Brief Psychiatric Rating Scale), depression (Short Depression-Happiness Scale), self-esteem, empowerment, hope, sense of coherence, savouring beliefs and functioning, as well as two alternative measures of wellbeing (the Positive Psychotherapy Inventory and Quality of Life). Intention-to-treat analysis was performed. This involved calculating crude changes and paired-sample t-tests for all variables, as well as ANCOVA and Complier Average Causal Effect (CACE) Analysis to estimate the main effect of group on all outcomes.
Results. The intervention and trial procedures proved feasible and well accepted. Crude changes between baseline and follow-up showed a significant improvement in the intervention group for wellbeing according to all three concepts assessed (i.e., WEMWBS, Positive Psychotherapy Inventory and Quality of Life), as well as for symptoms, depression, hope, self-esteem and sense of coherence. No significant changes were observed in the control group. ANCOVA showed no main effect on wellbeing according to the primary outcome scale (WEMWBS) but significant effects on symptoms (p = 0.006, ES = 0.42), depression (p = 0.03, ES = 0.38) and wellbeing according to the Positive Psychotherapy Inventory (p = 0.02, ES = 0.30). Secondary analysis adapting for therapy group further improved the results for symptom reduction (p = 0.004, ES = 0.43) and depression (p = 0.03, ES = 0.41) but did not lead to any more outcomes falling below the p = 0.05 significance level. CACE analysis showed a non-significant positive association between the intervention and WEMWBS scores at follow-up (b = 0.21, z = 0.9, p = 0.4).
Conclusions. This study provides initial evidence on the feasibility of WELLFOCUS PPT in people with psychosis, positively affecting symptoms and depression. However, more work is needed to optimise its effectiveness. Future research might evaluate positive psychotherapy as a treatment for comorbid depression in psychosis, and consider alternative measurements of wellbeing.
In this study an exploration was done of the quality of lives of patients with schizophrenia in South Korea and factors related to quality of life, and to develop a model that predicts the quality of their lives.
Nonadherence with medication occurs in all chronic medical disorders. It is a particular challenge in schizophrenia due to the illness’s association with social isolation, stigma, and comorbid substance misuse, plus the effect of symptom domains on adherence, including positive and negative symptoms, lack of insight, depression, and cognitive impairment. Nonadherence lies on a spectrum, is often covert, and is underestimated by clinicians, but affects more than one third of patients with schizophrenia per annum. It increases the risk of relapse, rehospitalization, and self-harm, increases inpatient costs, and lowers quality of life. It results from multiple patient, clinician, illness, medication, and service factors, but a useful distinction is between intentional and unintentional nonadherence. There is no gold standard approach to the measurement of adherence as all methods have pros and cons. Interventions to improve adherence include psychoeducation and other psychosocial interventions, antipsychotic long-acting injections, electronic reminders, service-based interventions, and financial incentives. These overlap, all have some evidence of effectiveness, and the intervention adopted should be tailored to the individual. Psychosocial interventions that utilize combined approaches seem more effective than unidimensional approaches. There is increasing interest in electronic reminders and monitoring systems to enhance adherence, eg, Short Message Service text messaging and real-time medication monitoring linked to smart pill containers or an electronic ingestible event marker. Financial incentives to enhance antipsychotic adherence raise ethical issues, and their place in practice remains unclear. Simple pragmatic strategies to improve medication adherence include shared decision-making, regular assessment of adherence, simplification of the medication regimen, ensuring that treatment is effective and that side effects are managed, and promoting a positive therapeutic alliance and good communication between the clinician and patient. These elements remain essential for all patients, not least for the small minority where vulnerability and risk issue dictate that compulsory treatment is necessary to ensure adherence.
This study evaluated the capacity of the Willingness Scale (WS) to predict changes in depression over the course of a brief inpatient admission. Two cohorts (N = 160) of adult inpatients completed the Willingness Scale along with a measure of depression following admission. Depression severity was assessed approximately 4 days later, prior to discharge. Data were evaluated using structural equation modeling. Higher WS scores predicted greater reductions in depression in both cohorts, and the magnitude of this effect was large. The fits of the models were outstanding, with no significant differences in any parameter estimates across the two cohorts. The WS predicts changes in depression, even within a brief inpatient admission where the treatment is predominantly biological. These results replicate results of previous studies in outpatient populations where CBT was the primary treatment and suggest motivational factors may play an important role in causation and recovery from depression.
Measures of well-being were created to assess psychological flourishing and feelings—positive feelings, negative feelings,
and the difference between the two. The scales were evaluated in a sample of 689 college students from six locations. The
Flourishing Scale is a brief 8-item summary measure of the respondent’s self-perceived success in important areas such as
relationships, self-esteem, purpose, and optimism. The scale provides a single psychological well-being score. The measure
has good psychometric properties, and is strongly associated with other psychological well-being scales. The Scale of Positive
and Negative Experience produces a score for positive feelings (6 items), a score for negative feelings (6 items), and the
two can be combined to create a balance score. This 12-item brief scale has a number of desirable features compared to earlier
measures of positive and negative emotions. In particular, the scale assesses with a few items a broad range of negative and
positive experiences and feelings, not just those of a certain type, and is based on the amount of time the feelings were
experienced during the past 4weeks. The scale converges well with measures of emotions and affective well-being.
KeywordsSubjective well-being-Well-being-Measure-Positive affect-Negative affect-Scales (or Assessment)
Longitudinal data suggest heterogeneity in the long-term course of schizophrenia. It is unclear how older adults with schizophrenia perceive changes in their experience of schizophrenia over the lifespan. We interviewed 32 adults aged 50 years and older diagnosed with schizophrenia (mean duration 35 years) about their perceived changes in the symptoms of schizophrenia and functioning over the lifespan. Interview transcripts were analyzed using grounded theory techniques of coding, consensus, co-occurrence, and comparison. The study was conducted by a research partnership involving a multidisciplinary team of academic researchers, community members, and mental health clients engaged in all aspects of study design, interviewing, and analysis and interpretation of data. Results revealed that, in regard to early course of illness, participants experienced confusion about diagnosis, active psychotic symptoms, and withdrawal/losses in social networks. Thereafter, nearly all participants believed that their symptoms had improved, which they attributed to increased skills in self-management of positive symptoms. In contrast to consistency among participants in describing illness course, there was marked heterogeneity in perceptions about functioning. Some participants were in despair about the discrepancy between their current situations and life goals, others were resigned to remain in supported environments, and others working toward functional attainments and optimistic about the future. In conclusion, middle-aged and older adults with schizophrenia believed that their symptoms had improved over their lifespan, yet there was substantial variability among participants in how they perceived their functioning. Functional rehabilitation may need to be tailored to differences in perceptions of capacity for functional improvement.
This article describes the psychometric validation of a scale designed to measure intrinsic motivation (IM) in schizophrenia. Recent studies have highlighted the relationship between motivation and functional outcome in schizophrenia and identified IM as an important mediating factor between neurocognition and psychosocial outcome. It therefore becomes imperative to have validated measures of IM for empirical use. To that end, we validated a self-report IM scale that gauges the central motivational structures identified by Self-determinism Theory as pertinent to cognitive task engagement, skill acquisition, treatment compliance, and remediation outcome. Participants were schizophrenia outpatients involved in a cognitive remediation study (n = 58), a convenience subsample of clinically stable schizophrenia outpatients (n = 15), and a group of healthy normals (n = 22). The Intrinsic Motivation Inventory for Schizophrenia Research (IMI-SR) is a concise instrument, possessing good internal consistency (alpha = .92) and test-retest reliability (intraclass correlation = .77). Data were analyzed to abridge the original 54 items into a final 21-item questionnaire comprised of 3 domains relevant to motivation for treatments (interest/enjoyment, perceived choice, value/usefulness). The scale was highly associated with germane constructs of motivation for health-related behaviors, including perceived competency for attempting challenging tasks and autonomous treatment engagement. Importantly, the scale was able to distinguish improvers and nonimprovers on a cognitive task and actual learning exercises, delineate high vs low treatment attendance, and demonstrate sensitivity to motivational changes due to intervention variation. The IMI-SR is a viable instrument to measure IM in schizophrenia as part of a cognitive remediation protocol or psychosocial rehabilitation program.
The purpose of this research was to develop and evaluate psychometrically an abbreviated instrument to assess hope in adults in clinical settings. The Herth Hope Index (HHI), a 12-item adapted version of the Herth Hope Scale (HHS), was tested with a convenience sample of 172 ill adults. Alpha coefficient was 0.97 with a 2-week test-retest reliability of 0.91. Criterion-related validity was established by correlating the HHI with the parent HHS (r = 0.92), the Existential Well-Being Scale (r = 0.84) and the Nowotny Hope Scale (r = 0.81). Divergent validity with the Hopelessness Scale was established (r = -0.73). Construct validity was supported through the factorial isolation of three factors: (a) temporality and future; (b) positive readiness and expectancy; (c) interconnectedness. These three factors accounted for 41% of the total variance in the measure.
Adherence to the medical regimen continues to rank as a major clinical problem in the management of patients with essential hypertension, as in other conditions treated with drugs and life-style modification. This article reviews the psychometric properties and tests the concurrent and predictive validity of a structured four-item self-reported adherence measure (alpha reliability = 0.61), which can be easily integrated into the medical visit. Items in the scale address barriers to medication-taking and permit the health care provider to reinforce positive adherence behaviors. Data on patient adherence to the medical regimen were collected at the end of a formalized 18-month educational program. Blood pressure measurements were recorded throughout a 3-year follow-up period. Results showed the scale to demonstrate both concurrent and predictive validity with regard to blood pressure control at 2 years and 5 years, respectively. Seventy-five percent of the patients who scored high on the four-item scale at year 2 had their blood pressure under adequate control at year 5, compared with 47% under control at year 5 for those patients scoring low (P less than 0.01).
We examined relapse after response to a first episode of schizophrenia or schizoaffective disorder.
Patients with first-episode schizophrenia were assessed on measures of psychopathologic variables, cognition, social functioning, and biological variables and treated according to a standardized algorithm. The sample for the relapse analyses consisted of 104 patients who responded to treatment of their index episode and were at risk for relapse.
Five years after initial recovery, the cumulative first relapse rate was 81.9% (95% confidence interval [CI], 70.6%-93.2%); the second relapse rate was 78.0% (95% CI, 46.5%-100.0%). By 4 years after recovery from a second relapse, the cumulative third relapse rate was 86.2% (95% CI, 61.5%-100.0%). Discontinuing antipsychotic drug therapy increased the risk of relapse by almost 5 times (hazard ratio for an initial relapse, 4.89 [99% CI, 2.49-9.60]; hazard ratio for a second relapse, 4.57 [99% CI, 1.49-14.02]). Subsequent analyses controlling for antipsychotic drug use showed that patients with poor premorbid adaptation to school and premorbid social withdrawal relapsed earlier. Sex, diagnosis, obstetric complications, duration of psychotic illness before treatment, baseline symptoms, neuroendocrine measures, methylphenidate hydrochloride challenge response, neuropsychologic and magnetic resonance imaging measures, time to response of the initial episode, adverse effects during treatment, and presence of residual symptoms after the initial episode were not significantly related to time to relapse.
There is a high rate of relapse within 5 years of recovery from a first episode of schizophrenia and schizoaffective disorder. This risk is diminished by maintenance antipsychotic drug treatment.
Objective
Change talk, or client language that is consistent with making a behavioral change, has been found to improve the efficacy of motivational interviewing (MI). It is not known, however, if change talk helps to explain MI’s effect on instigating a quit attempt in smokers with serious mental illness. Methods: We measured change talk in smokers with a serious mental illness (SMI) randomized to receive either a single session adaptation of motivational interviewing or an interactive education intervention. We evaluated relationships between treatment condition, proportion of change talk, and study outcomes of quit attempts and willingness to follow up on treatment provider referrals. Results: Participants receiving the adaptation of motivational interviewing had higher proportions of change talk than participants in the interactive education condition. However, total proportion of change talk did not mediate the relationship between treatment and outcome, nor did it predict making a quit attempt or following up on a referral to contact a treatment provider. Conclusions: Our study found that motivational interviewing has the same change talk augmenting effect in individuals with SMI as those without SMI. Given that anhedonia, negative affect, and depressive symptoms are a major part of serious mental illnesses, it is encouraging that MI can generate change talk in this population. Future smoking cessation intervention trials with larger samples should investigate whether greater amounts of change talk lead to increased quit attempts in this population.
Schizophrenia is a chronic psychiatric disorder characterised by change in a person’s perception, thoughts, behaviour, and cognitive functions. The illness has a chronic course which causes significant disturbance in various aspects of a person’s life including social, occupational, and functional aspects. The effective management of schizophrenia has to be a combined approach including both pharmacotherapy and psychosocial interventions which have to be tailor-made considering the symptomatology and the phase of illness so that the patient and the family get the maximum benefits. Psycho-education is an integral part of the acute as well as long-term management of schizophrenia. Psycho-education improves the level of understanding of people about schizophrenia and ensures active participation of both the patients and their caregivers in the treatment.
Introduction
Schizophrenia is a chronic mental illness characterized by symptoms including hearing voices or seeing objects that do not exist, weak emotional reactions, and inadequate social relations. Schizophrenia is a long-term disease that is usually treated with anti-psychotic drugs. However, medication alone is insufficient for the treatment of patients with schizophrenia and alternative methods are needed. The aim of this study was to determine the effect that yoga has on the clinical insight and medication adherence in patients with schizophrenia.
Methods
This randomized controlled trial was conducted at the Community Mental Health Centre (CMHC). The study was conducted using a pretest / posttest and a control group. There were 50 patients with schizophrenia who participated, including 25 in the intervention group and 25 in the control group. The patients in the intervention group participated in group yoga practices every weekday for 8 weeks. No intervention was applied to the control group, and they received the CMHC’s routine care. The Descriptive Characteristics Form, Birchwood Insight Scale, and Morisky Medication Adherence Scale were used to collect data.
Results
The difference between the pretest and posttest mean scores for the insight and medication adherence scales was statistically significant in the intervention group (p < 0.01). There was also a statistically significant difference between the control group and intervention group for the pretest-posttest total mean scores on the insight and medication adherence scales (p < 0.01).
Conclusion
Yoga appeared to be effective for increasing medication adherence and clinical insight in patients with schizophrenia. It is recommended that yoga should be integrated within the rehabilitation period.
Well-being is a critical outcome in the recovery from psychosis and the prevention of symptoms. Previous reviews of the effectiveness of psychological interventions have focused on psychotic symptoms and general psychopathology, not recognising well-being as an essential outcome. This study conducted a meta-analysis of the effects of psychological interventions on the well-being and quality of life (QoL) of people with schizophrenia and analysed some critical moderating factors. A systematic literature search was conducted yielding 12986 published reports, 2043 of which were clinical trials. After a detailed review, 36 articles were included in the analyses. Measures of related concepts, well-being and quality of life were included in the present meta-analysis to reflect the current state of the literature and to ensure the representativeness of RCTs that have evaluated the effect of psychological interventions on the extent to which people with schizophrenia experience a good life. Our findings reflect a significant, small, treatment effect on the outcomes of well-being. Subgroup analysis also suggested a significant moderating effect when the primary aim of the intervention was well-being. These findings suggest that symptom or functional improvement does not necessarily lead to an improvement in well-being and would imply the need to focus specifically on those. We recommend psychological interventions that target well-being as a complementary strategy in mental health promotion and treatment. In addition, we stress the need to include well-being outcome measure in RCT as well as to clearly identify the different domains of well-being being measured.
Schizophrenia is a chronic, debilitating and costly illness. The course of illness is often exacerbated by relapses which are associated with negative outcomes including rehospitalisation. The most important risk factor associated with relapse is medication nonadherence. Medication nonadherence is not specific to schizophrenia and is an issue across all of medicine. The objective of this paper is to present a narrative review which synthesizes the rates and predictors of medication nonadherence, as well as associated interventions, across schizophrenia, first episode psychosis and general medicine. Given the breadth of these topics, this paper does not aim to present a complete review of the data but rather a concise synthesis of several lines of research in order to provide a general framework for approaching this important topic. Overall, this paper identifies that rates and risk factors of nonadherence in schizophrenia are similar to those reported in general medicine. Rates of adherence are estimated at 50% for both. Predictors of nonadherence were also quite similar between various illnesses, with lack of insight, poor family support and substance abuse often being highlighted. Well studied approaches of improving adherence include simplifying medication regimens, psychoeducation, engaging family support and use of long-acting injectable antipsychotics. Emerging interventions included text-message reminders, financial incentives and MyCite technology. Additionally, several evidence based interventions were identified in general medicine that may have applicability in schizophrenia and first episode psychosis. Lastly, avenues of future research were identified including the need to further characterize the dichotomy between adherence, partial adherence and nonadherence.
Background
We investigated the effect of motivation interviewing using group art therapy on the negative symptoms of schizophrenia.
Methods
Participants were patients with chronic schizophrenia admitted to the D psychiatric wards in D city, Korea. There were 17 and 18 patients in the experimental and control groups, respectively. The data collection period was from November 28, 2016 to January 28, 2017. Motivation interviewing using group art therapy was conducted twice per week over 6 weeks (12 sessions in total).
Results
The significance of the intervention effects were confirmed via measures of negative symptoms, motivation and pleasure, interpersonal relationships, personal hygiene, and hospital program attendance. The experimental group exhibited significantly greater improvements in negative symptoms, motivation and pleasure, interpersonal relationships, personal hygiene, and hospital program attendance than did the control group.
Conclusions
The results showed that the motivation interviewing using group art therapy was an effective nursing intervention for the negative symptoms of schizophrenia.
1 Purpose
To examine the effect of motivational interview (MI) on treatment adherence and insight of the patients diagnosed with schizophrenia at a hospital in Turkey.
2 Design and Methods
Individuals with schizophrenia, who match with the sample characteristics, were assigned to intervention (20) and control groups (20) according to the randomization schedule. Personal Information Form, Morisky's Questions‐Self‐Report Measure of Adherence, and Schedule for Assessing the Three Components of Insight were used.
3 Findings
Group‐wise examinations showed that mean scores of “three component scales of insight” yielded statistically significant difference for the intervention group. Analysis of the Morisky Adherence Scale Mean Scores showed a significant difference for interval mean scores of the intervention group.
4 Practice Implications
Both the pyschiatric patients and the health institutions can benefit from increased levels of treatment adherence and insight by the adoption of the MI methods starting with a patient's first registration to a psychiatric outpatient clinic.
5 Implications for Nursing Practice
MI can be included during any of the patient visits to establish treatment collaboration with psychiatric patients at psychiatric facilities, outpatient clinics, and community mental health centers.
Traditional mental health care emphasises living with fewer symptoms; mental health recovery may be seen as living well with illness and wellbeing as simply living well. Within this spectrum of aims, this chapter describes the evolution of the Collaborative Recovery Model (CRM) from its origins around the year 1998 until now. The CRM is a conceptual model and training/coaching resource designed to support (a) mental health service provision to become more recovery-oriented and (b) mental health organisational development consistent with mental health recovery values. Th rough training and coaching, the CRM assists mental health staff and consumers to emphasise hope for recovery, personal meaning and growth in the lives of both people living with mental illness and the staff of the services. Evaluation of this program has been supported by National Health and Medical Research Council and Australian Research Council funding. To maximise quality distribution and sustainability, Neami National, a nongovernmental mental organisation in Australia, was granted a ten-year exclusive license to use the IP from the CRM suite of programs in order to provide training services to other agencies in Australia. Since the license was granted, Neami National has provided training to over 700 practitioners in Australia, on top of the previous 2000 practitioners trained by the University of Wollongong in Australia, China and Canada. CRM involves two guiding principles and four components. The first guiding principle, 'recovery as an individual process', is underpinned by a model of psychological recovery. In the following chapter psychological recovery is described and contextualised in relation to established theories of wellbeing. The overall CRM is then described, with reference to both the staff training/coaching version referred to as "Coach" and the assisted peer support version referred to as "Flourish". The chapter concludes with reflections upon the challenges of implementation and organisational change within mental health services. © Mike Slade, Lindsay Oades and Aaron Jarden 2017. All rights reserved.
Schizophrenia is a chronic disease that has destructive psychopathological effects causing profound impairments in thoughts, feelings and behaviors in individuals. Along with the physiological problems caused by disease, the patients with schizophrenia also faces prejudice, stigmatization and alienation problems caused by misinformation and beliefs in society regarding the disease. All these problems reduce the positive expectations patients with schizophrenia for the future and cause widespread despair among these patients. Hope is considered to be one of the most important determinants of healing that increases the effectiveness of the treatment, enabling patients with schizophrenia to fight against the disease. Nurses are the most prominent health care professionals, which are close the patients in the diagnosis, treatment, and rehabilitation stages of the schizophrenia disease. Therefore, interventions used for increasing hope should be known by nurses well. The aim of this review is to guide nurses to perform interventions to determine and increase the levels of hope of the patients with schizophrenia as well as raising awareness in this regard.
Empathy is a complex construct, thought to contain multiple components. One popular measurement paradigm, the Interpersonal Reactivity Index (IRI), has been used extensively to measure empathic tendencies in schizophrenia research across four domains: empathic concern, perspective-taking, personal distress, and fantasy. However, no recent meta-analysis has been conducted for all four factors of this scale. The goal of this meta-analysis was to examine self-reported empathic tendencies for each factor of the IRI in people with schizophrenia as compared to healthy controls. A literature search revealed 32 eligible schizophrenia studies. The Hedges’ g standardized difference effect size was calculated for each component using a random effects meta-analytic model. Compared to healthy controls, schizophrenia samples reported significantly reduced tendencies for empathic concern, perspective-taking, and fantasy, but significantly greater tendencies for personal distress. Duration of illness significantly moderated the results for perspective-taking such that those with a longer duration exhibited greater deficits; percent female significantly moderated the results for personal distress such that samples with more females exhibited reduced effect sizes. Future work is needed to examine the impact of heightened personal distress on the empathic tendencies and abilities of those with schizophrenia, including the possible role of emotion regulation.
Resilience is becoming an important topic in people with schizophrenia since there is evidence that it increases the probability for long-term recovery. The current study investigated transcultural differences in resilience across schizophrenia patients from two different geographical regions, Austria and Japan. Another objective was to examine transcultural differences in internalized stigma, self-esteem, and hopelessness, which can be expected to be relevant in this context, as well as the interrelations between these subjective elements of recovery and symptom severity. To this end, patients from outpatient mental health services in Innsbruck, Austria (N = 52) and Tokyo, Japan (N = 60) as well as 137 healthy comparison subjects from both countries were included into this cross-sectional study. Notably, we detected a significant country effect with markedly lower resilience (F = 74.4, p < 0.001) and self-esteem scores (F = 226.0, p < 0.001) as well as higher hopelessness scores (F = 37.4, p < 0.001) among Japanese subjects in general. In addition, both Austrian and Japanese patients indicated significantly lower degrees of resilience (F = 57.5, p < 0.001), self-esteem (F = 51.8, p < 0.001), and hope (F = 29.5, p < 0.001) compared to healthy control subjects. The inter-correlations between subjective elements of recovery were comparable in size in the two patient samples, but the inter-correlations between these issues and residual symptoms of schizophrenia as objective domains of recovery were markedly higher in Austrian subjects. This suggests that schizophrenia patients from Western European and Japanese cultures may have different needs to achieve recovery. In conclusion, it will be critical to develop culture-specific psychosocial programs and to examine their feasibility and effectiveness among these patients.
This literature review addresses the question of whether motivational interviewing (MI) is effective at improving medication adherence in patients with schizophrenia. The databases PsycINFO, OVID Medline, and PubMed were searched using the keywords “schizophrenia,” “medication adherence,” and one of the following: “motivational interviewing,” “adherence therapy,” or “compliance therapy.” Relevant studies from the last ten years were included, resulting in six studies being included in this literature review. One study presented evidence for a direct relationship between motivational interviewing and medication adherence. Most studies did not support this relationship. Some studies found evidence for a relationship between motivational interviewing and other outcomes such as improved psychotic symptoms and decreased re-hospitalization rates. Motivational interviewing may be beneficial for some patients with schizophrenia but should not be considered a first line therapy. Clinicians not already using motivational interviewing in providing care to their patients with schizophrenia should not implement it for this population.
The current study aimed to (a) evaluate the effectiveness of motivational interviewing, as applied by a community mental health team (CMHT) based in Singapore; (b) reduce hospital admissions and length of hospital stay; and (c) improve global functioning and satisfaction of individuals with mental illness. The current study used a quasi-experimental method. A convenience sample of 120 participants was selected from the caseload of the CMHT. Participants received motivational interviewing sessions at least once every month for 1 year. Data on the number of hospital admissions, length of hospitalization, Global Assessment of Functioning, and patient satisfaction were collected at baseline and 6 and 12 months. Participants who underwent the CMHT services with motivational interviewing were more compliant to treatment, resulting in significant reduction in hospitalization and improvement in functionality. Motivational interviewing is effective in facilitating better illness management for patients in the community. Adoption of the motivational interviewing approach may potentially provide significant benefits for psychiatric support services in the community. [Journal of Psychosocial Nursing and Mental Health Services, xx(x), xx-xx.].
This qualitative study used semi-structured interviews to explore the meaning of sense of belonging and hope in the lived experiences of 20 persons with chronic schizophrenia-spectrum disorders receiving acute inpatient treatment. Experience of treatment was also explored. Sense of belonging and hope were both identified as valuable or even vital, yet the experiences of not belonging and/or feeling hopeless was more prevalent. Participants frequently felt like an outsider and experienced loneliness and isolation, suggesting a need for further exploration of the impact of sense of belonging and hope on recovery and even treatment adherence in persons with schizophrenia.
Purpose
– Non-participation in outpatient dual diagnosis services presents a challenge for providers assisting clients in their recovery. To better understand factors that facilitate participation, the purpose of this paper is to examine positive recovery states – hope, meaning, and empowerment – as they relate to motivational interviewing (MI) and service use.
Design/methodology/approach
– Six dually diagnosed adults completed four baseline assessments, four MI sessions, a post-MI tape-assisted recall interview, and one-month follow-up measures. Simulation modeling analysis of phone survey responses, comparisons of baseline and intervention phase data, and grounded theory analysis of interviews were conducted to determine MI's relationship to the dependent variables.
Findings
– MI was associated with modest improvement in levels of participation, hope, empowerment, and with greater change in life purpose. Key recovery themes were: positive sense of self, increased self-efficacy, and improved relationships. Feelings of safety and trust were tied to greater self-disclosure while more active emotions were more closely linked to the discussion of recovery progress.
Research limitations/implications
– The paper's finding are limited by small sample size and phone survey response sets.
Practical implications
– To better help dually diagnosed clients sustain treatment involvement, MI practitioners should pay special attention to recovery accomplishments, values, abilities, and self-esteem, while linking these attributes to service participation where appropriate and creating a safe, valuing atmosphere conducive to self-disclosure.
Originality/value
– This is the first paper to measure key recovery constructs within MI process, and to explore the role of positive emotions related to MI, recovery, and service participation.
Objective This article explores the training and counselling experiences of 20 nurses, aiming to identify key elements in the process of learning and applying motivational interviewing (MI) counselling skills with adherence to protocols.
Setting/method The nurses were recruited from 10 primary health care units in Östergötland, Sweden. The study was carried out after the nurses had been practicing MI counselling in daily clinical work for about a year. Data were collected by means of semi-structured interviews, based on an interview guide, which contained questions on factors that past research has identified as important for effective training in and practicing of MI.
Results The interviews revealed several key factors for successfully learning and applying MI. Extensive training and close integration of training and practice were seen as crucial aspects to effective learning of MI skills. A barrier to satisfactory learning of the MI counselling skills was the difficulty of adjusting to the new way of thinking required when practicing this technique, since it contrasted with the authoritarian expert approach that the nurses were used to. Another difficulty was achieving effective communication with patients who were unwilling to accept responsibility for their own health.
Conclusion Effective learning and application of MI skills with adherence to protocols is fraught with many problems, requiring a considerable amount of time and effort for practice as well as the adoption of a new frame of mind with regard to the health care providers' relationships with the patients.
Persons with schizophrenia are widely recognized to experience potent feelings of hopelessness, helplessness, and a fragile sense of well-being. Although these subjective experiences have been linked to positive symptoms, little is known about their relationship to neurocognition. Accordingly, this study examined the relationship of self-reports of hope, self-efficacy, and well-being to measures of neurocognition, symptoms, and coping among 49 persons with schizophrenia or schizoaffective disorder. Results suggest that poorer executive function, verbal memory, and a greater reliance on escape avoidance as a coping mechanism predicted significantly higher levels of hope and well being with multiple regressions accounting for 34% and 20% of the variance (p < .0001), respectively. Self-efficacy predicted lower levels of positive symptoms and greater preference for escape avoidance as a coping mechanism with a multiple repression accounting for 9% of the variance (p < .05). Results may suggest that higher levels of neurocognitive impairment and an avoidant coping style may shield some with schizophrenia from painful subjective experiences. Theoretical and practical implications for rehabilitation are discussed.
A necessary first step in the psychosocial treatment of persons with severe mental illness is helping them identify their goals. Unfortunately, goal assessment is often viewed as a categorical process in which individuals list needs for which they require services. Motivational interviews provide a more sophisticated approach in which persons specify the costs and benefits to each of the needs in the list. Benefits define the reasons why a person should pursue a goal; costs define barriers to achieving that goal. The basic mechanisms for understanding and implementing motivational interviews are summarized. Ways to circumvent barriers to motivational interviews are also discussed.
To assess baseline predictors and consequences of antipsychotic adherence during the long-term treatment of schizophrenia outpatients, data were taken from the 3-year, prospective, observational, European Schizophrenia Outpatients Health Outcomes (SOHO) study, in which outpatients starting or changing antipsychotics were assessed every 6 months. Physician-rated adherence was dichotomized as adherence/non-adherence. Regression models tested for predictors of adherence during follow-up, and associations between adherence and outcome measures. Of the 6731 patients analysed, 71.2% were adherent and 28.8% were non-adherent over 3 years. The strongest predictor of adherence was adherence in the month before baseline assessment. Other baseline predictors of adherence included initial treatment for schizophrenia and greater social activities. Baseline predictors of non-adherence were alcohol dependence and substance abuse in the previous month, hospitalization in the previous 6 months, independent housing and the presence of hostility. Non-adherence was significantly associated with an increased risk of relapse, hospitalization and suicide attempts. In conclusion, non-adherence is common but can partly be predicted. This may allow strategies to improve adherence to be targeted to high-risk patients. Also, reversal of some risk factors may improve adherence. Non-adherence is associated with a range of poorer long-term outcomes, with clinical and economic implications.
Methadone-maintained (MM) clients who engage in excessive alcohol use are at high risk for HIV and hepatitis B virus (HBV) infection. Nurse-led hepatitis health promotion (HHP) may be one strategy to decrease alcohol use in this population.
To evaluate the impact of nurse-led HHP, delivered by nurses compared to motivational interviewing (MI), delivered by trained therapists in group sessions or one-on-one on reduction of alcohol use.
A three-arm randomized, controlled trial, conducted with 256 MM adults attending one of five MM outpatient clinics in the Los Angeles area. Within each site, moderate-to-heavy alcohol-using MM participants were randomized into one of three conditions: (1) nurse-led hepatitis health promotion group sessions (n=87); (2) MI delivered in group sessions (MI-group; n=79), or (3) MI delivered one-on-one sessions (MI-single, n=90).
Self-reported alcohol use was reduced from a median of 90 drinks/month at baseline to 60 drinks/month at 6-month follow-up. A Wilcoxon sign-rank test indicated a significant reduction in alcohol use in the total sample (p<.05). In multiple logistic regression analysis controlling for alcohol consumption at baseline and other covariates, no differences by condition were found.
As compared to two programs delivered by MI specialists, a culturally-sensitive and easy to implement nurse-led HHP program produced similar reductions in alcohol use over 6 months. Employing nurse-led programs may allow cost savings for treatment programs as well as a greater integration of alcohol reduction counseling along with a more comprehensive focus on general health-related issues than previously conducted.
We sought to identify whether schizophrenia during pregnancy is associated with adverse perinatal outcomes. A population-based study comparing women with and without schizophrenia and schizoaffective disorders was performed. Stratified analysis using multiple logistic regression models was performed to control for confounders. During the study period, there were 186,554 deliveries, of which 97 occurred in patients with schizophrenia and schizoaffective disorders. The schizophrenic patients were significantly older (mean age 30.6 versus 28.6, P = 0.001), with higher prevalence of diabetes mellitus as compared with the comparison group (13.4% versus 6.7%, P = 0.009). The need for induction and augmentation of delivery, congenital malformations, and low birth weight (<2500 g) were significantly increased among schizophrenic patients. No significant differences were noted between the groups regarding labor complications such as cesarean delivery (16.5% versus 13.2%, P = 0.337) and placenta previa and placental abruption (1% versus 4%, P = 0.333 and 1% versus 0.7%, P = 0.51, respectively). Using a multivariable logistic regression model, schizophrenia and schizoaffective disorders during pregnancy were independent risk factors for congenital malformations (odds ratio 2.1; 95% confidence interval, 1.1 to 3.9, P = 0.027). Schizophrenia and schizoaffective disorders are independent risk factors for congenital malformations.
Historically, nursing care plans have been utilized in nursing education to identify actual and potential health problems. The rigid structure of these plans often makes it challenging for students to assimilate data to identify and understand the many diverse patient problems. To promote critical thinking, improve problem-solving skills and foster understanding of the interrelationships among patient's health concerns, second year baccalaureate students developed and implemented concept maps using the nursing process in the clinical setting. An overview of what concept maps are, how the concept maps were developed and utilized in the clinical setting, implications for clinical teaching and outcomes of the experience are highlighted.