Abstract
BackgroundEvidence till date shows different reasons of relapse in schizophrenia around the world. However, there was almost no reliable data from Nepal. We want to report a thematic study based on the reports of 12 patients living with schizophrenia and their family members. These patients were approached during psychoeducation group sessions.MethodsTwelve patients with a diagnosis of schizophrenia as per Diagnostic and Statistical Manual of mental disorders-5 criteria, who were accompanied by their family members were selected. A minimum duration of illness of 5 years was required as inclusion criteria. Semi structured interviews were conducted with patient and family members separately in 1–2 sessions. Questions were mainly related to their knowledge about causes of relapse in patients in their perspective. Interviews were recorded and transcripts were generated. All the transcripts were read separately by the 3 investigators and common themes agreed upon by all the investigators were generated. We used content analysis for the purpose of the study. A total of 36 sessions psychoeducation were taken in in-patients from National Medical College, Birgunj, Nepal. Eight out of 12 patients were males. The group therapy was psycho-education oriented and based on NIMHANS manual for family-based intervention in schizophrenia. We included those patients who were admitted and improving as per PANSS score (more than 50% of the score at admission).ResultsThe patients’ family members told that these sessions were useful because their issues were discussed and addressed and simpler terms were used during the process. The patients showed ability to participate and understand the proceedings though not always. Two of the patients had sub-normal intelligence and so they were not benefited more than being heard about their sufferings. Their family members reported a better understanding of the illness and non-pharmacological approach for these patients after the sessions. Participants were encouraged to make notes out of the discussions in the sessions but few of them did so.Following themes emerged after the analysis of transcribed verbatim from the patients and family members.Themes generated from patient’s versions:1. Residual negative/depressive symptoms2. Critical comments from family members3. Adverse effects of medications4. Improper education about the duration of treatmentThemes generated from family member’s versions:5. Lack of awareness about the illness6. Belief in super natural causes7. Affordability issues8. Poor insight about the illness9. Poor compliance to medications10. StressDiscussionConclusion: Educating our patients can be tiring and mundane during regular out-patient department. However, the psychoeducation sessions are very important part of the treatment. During that process we should anticipate the possible causes of relapse and educate the same for better outcome.
Highlights
Diet is increasingly recognised as a modifiable factor influencing the onset and outcomes of psychiatric disorders
We conducted a systematic review of all published studies comparing blood levels of vitamins and/or mineral in first-episode psychosis (FEP) to healthy control samples; and applied meta-analytic techniques to determine the prevalence and extent of deficiencies across the full spectrum of nutrients examined in this population to date
Random effects meta-analyses found that people with FEP had large, significant reductions in blood levels of vitamin B9 compared to healthy controls(N=6, n=827, g=-0.624, 95% C.I.=-1.176 to -0.072, p=0.027)
Summary
Impaired cognitive functioning is considered a core aspect of schizophrenia and is associated with poorer functional outcomes. While small to moderate effect sizes have been reported, closer examination suggests 40–60% of participants fail to realise a benefit. To improve both efficacy and effectiveness, better understanding of the factors that predict cognitive response to CRT is needed. No systematic review of the evidence base has been conducted. Methods: An electronic database search was conducted across Scopus, Web of Science and PsychINFO databases and the Cochrane Collaboration Controlled Trials Register for all years until 30/09/2017. Reference lists of published meta-analyses and review articles were hand searched. Studies that included a CRT arm, had a majority (≥70%) schizophrenia / schizoaffective disorder participants, had at least one training-distinct pre-post measure of cognition and at least one predictor of cognitive outcome were included.
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