Psychosocial Rehabilitation Program Research Articles

Clinical and Psychosocial Impact of Psychoeducational Groups for Psychosis

IntroductionIndividuals with mental health disorders often lack access to appropriate care, including psychosocial rehabilitation programs, which are considered essential for their recovery. In 2019, as part of the intervention by the Community and Mental Health Service, at Hospital de Magalhães Lemos, we initiated a psychoeducational group for patients with psychotic spectrum disorders, with the purpose of providing our patients with comprehensive information about their condition and effective management strategies. Our 8-week program consisted of 16 sessions, including icebreaker activities, discussion of certain themes, sharing of experiences and practice of stress management techniques.ObjectivesThe aim of this study was to assess and quantify the impact of our 2023 program.MethodsOut of a total of 20 patients interviewed for our program in 2023, 16 began the program and 12 completed it. The program’s evaluation was based on several assessment tools, including a sociodemographic questionnaire, a knowledge assessment questionnaire, the Positive and Negative Syndrome Scale (PANSS), the Insight and Treatment Attitudes Questionnaire (ITAC), the World Health Organization Quality of Life (WHOQOL), and the Medication Adherence Rating Scale (MARS). We also created a health agenda to organize an individual plan of care.ResultsOur findings indicated an improvement in insight and attitudes towards treatment by 8.6%, an enhancement in treatment adherence by 5%, and an increase in knowledge by 11.9%. In terms of quality of life, we observed a slight improvement in the psychological domain by 0.6% and in the social domain by 1.2%. Regarding the impact on psychotic symptomatology, there was an average decrease in 4 points in the negative subscale and in 3 points in the general psychopathology subscale, whereas the positive subscale remained unchanged. None of the patients required hospitalization during this period.Conclusions Our study revealed some improvement in nearly all the evaluated parameters. There was an improvement of the therapeutic relationship, which we believe has contributed to lower scores in the negative symptoms and general psychopathology subscale. As for the study limitations, we acknowledge that we will need to expand our sample through additional programs in the next years, to include it in early intervention psychosis programs and to re-evaluate our patients’ outcomes after a more extended follow-up period, particularly if they continue to participate in our monthly mutual support group. Additionally, we must consider potential study biases, including the subjectivity of PANSS evaluations and the influence of other confounding factors, such as changes in treatment regimens during the program.Disclosure of InterestNone Declared

Evaluation of the effectiveness of psychosocial rehabilitation: an innovative approach based on the analytic hierarchy process

IntroductionIn psychosocial rehabilitation (PSR), rank scales are widely used to assess the severity of functional disorders in patients. The main problem of evaluating the effectiveness of PSR is related to the methods of processing data obtained using psychometric scales used to evaluate the effectiveness of interventions within PSR. The proof of the non-numerical nature of ranks was obtained by J. Pfanzagl (1968). Incorrect processing of rank information obtained in the framework of psychosocial research leads to contradictions in the assessment of the patient’s condition. Consequently, rank processing does not allow classical mathematical operations (summation, average), which makes it impossible to correctly estimate the effectiveness of PSR numerically.ObjectivesDevelopment of algorithms for numerical evaluation of PSR efficiency based on rank information processing using the analytic hierarchy process (AHP) [1].MethodsClinical, psychometric, AHP algorithmsResultsThe analysis of the problems of assessing the patient’s conditions on the basis of categorical and psychometric (rank) scales and subscales shows that these problems can be presented in the form of appropriate hierarchies, the structure of which must be taken into account when processing the initial information.According to the results of the analysis of the data of preliminary studies, the main areas of impaired functioning of patients affecting the evaluation of the effectiveness of PSR have been identified. Rank estimates of changes in the relevant areas of the patient’s dysfunction after the PSR program compared to the initial level are the basis for the conclusion about the effectiveness of the PSR components. Algorithms of the AHP normative approach were used to translate rank information into numerical information [2]. The weight of the areas of the patient’s functioning disorders was used in the formation of integral estimates of the effectiveness of PSR.The fundamental difference between AHP-based assessments and rank assessments is due to the fact that numerical estimates of the weight of the criteria and the corresponding changes in the patient’s condition are obtained, which depend on the qualifications of specialists, the characteristics of the scales used to measure violations in the relevant areas and the procedures of the PSR.ConclusionsObtaining the results of processing rank information in a numerical scale allows to obtain the correct integration of the patient’s personal characteristics when considering PSR procedures and to obtain correct prognostic models of the patient’s condition. 1. Saaty T. European Journal of Operational Research.1990; 48(1):9-26. https://doi.org/10.1016/0377-2217(90)90057-I 2. Mitikhin V.G., Solokhina T.A. et al. Psychiatry, 2022; 20(2): 51-59. DOI: 10.30629/2618-6667-2022-20-2-51-59Disclosure of InterestNone Declared

Personalized assessment of the effectiveness of psychosocial rehabilitation: an innovative approach based on the process of analytical hierarchy

IntroductionIn psychosocial rehabilitation (PSR), rank scales are widely used to assess the severity of functional disorders in patients. The main problem of evaluating the effectiveness of PSR is related to the methods of processing data obtained using psychometric scales used to evaluate the effectiveness of interventions within PSR. J. Pfanzagl (1968) obtained the proof of the non-numerical nature of ranks. Incorrect processing of rank information obtained in the framework of psychosocial research leads to contradictions in the assessment of the patient’s condition. Consequently, rank processing does not allow classical mathematical operations (summation, average), which makes it impossible to correctly estimate the effectiveness of PSR numerically.ObjectivesDevelopment of algorithms for numerical evaluation of PSR efficiency based on rank information processing using the analytic hierarchy process (AHP) [1].MethodsClinical, psychometric, AHP algorithms.ResultsThe analysis of the problems of assessing the patient’s conditions on the basis of categorical and psychometric (rank) scales and subscales shows that these problems can be presented in the form of appropriate hierarchies [2], the structure of which must be taken into account when processing the initial information.According to the results of the analysis of the data of preliminary studies, the main areas of impaired functioning of patients affecting the evaluation of the effectiveness of PSR have been identified. Rank estimates of changes in the relevant areas of the patient’s dysfunction after the PSR program compared to the initial level are the basis for the conclusion about the effectiveness of the PSR components. Algorithms of the AHP normative approach were used to translate rank information into numerical information [2]. The weight of the areas of the patient’s functioning disorders was used in the formation of integral estimates of the effectiveness of PSR.The fundamental difference between AHP-based assessments and rank assessments is due to the fact that numerical estimates of the weight of the criteria and the corresponding changes in the patient’s condition are obtained, which depend on the qualifications of specialists, the characteristics of the scales used to measure violations in the relevant areas and the procedures of the PSR.ConclusionsObtaining the results of processing rank information in a numerical scale allows to obtain the correct integration of the patient’s personal characteristics when considering PSR procedures and to obtain correct models of the patient’s state. 1. Saaty T. European Journal of Operational Research.1990; 48(1):9-26. https://doi.org/10.1016/0377-2217(90)90057-I 2. Mitikhin V.G., Solokhina T.A. et al. Psychiatry, 2022; 20(2): 51-59. DOI: 10.30629/2618-6667-2022-20-2-51-59Disclosure of InterestNone Declared

Self-Stigma in Patients with Endogenous Mental Disorders: A Cross-Sectional Comparative Study.

Self-stigma remains one of the most vexing issues in psychiatry. It complicates the treatment and social functioning of patients with endogenous psychiatric disorders. Identifying the specific features of self-stigma depending on the type and duration of the endogenous mental illness can help solve this problem. The aim of this study was to establish the level and specific features of self-stigma in patients with various types of chronic endogenous psychiatric disorders at different disease stages and to establish the correlation between the level of self-stigma and the attitude of the patient to his/her disease and treatment. Clinical psychopathology assessment, psychometric scales and questionnaires: "Positive and Negative Syndrome Scale" (PANSS), "Questionnaire for Self-Stigma Assessment in Mentally Ill Patients", and Russian versions of the "Insight Scale for Psychosis" (ISP), and "Drug Attitude Inventory" (DAI-10). The cross-sectional study included 86 patients with endogenous mental illnesses (bipolar affective disorder and schizophrenia spectrum disorders. The analysis of the results of the "Questionnaire for Self-Stigma Assessment in Mentally Ill Patients" showed that at the initial disease stages the highest level of self-stigma is observed in patients with bipolar affective disorder (M±σ=1.22±0.73; Me [Q1; Q3]=1.10 [0.83; 1.60]), while the lowest level was observed in patients with schizophrenia spectrum disorders (M±σ=0.86±0.53; Me [Q1; Q3]=0.77 [0.31; 1.25]). Patients with schizophrenia and schizoaffective disorder and a disease duration more than five years participating in a long-term comprehensive psychosocial rehabilitation program also demonstrated high rates of self-stigma (M±σ=1.20±0.57, Me [Q1; Q3]=1.26 [0.89; 1.47]). The study groups showed differences in terms of the structure of components of self-stigma and their severity; significant correlations were uncovered between the self-stigma parameters and the attitude of patients to their disease and therapy. The results of this study contribute to a better understanding of the specific features of self-stigma in patients with various endogenous disorders at different stages of the disease. These data can be used as part of a comprehensive psychosocial treatment program for this patient cohort, as well as for future research.

Approval of a comprehensive psychosocial rehabilitation program for patients with negative symptoms in schizophrenia

The aim of the work is to develop and evaluate the effectiveness of a comprehensive program of psychosocial rehabilitation of patients with negative symptoms in schizophrenia. Materials and methods. The study involved 168 patients with negative symptoms of schizophrenia: 94 patients who underwent a comprehensive psychosocial rehabilitation program (main group) and 74 patients who underwent a course of therapy according to the traditional scheme (control group). The criteria that evaluated the effectiveness of a comprehensive program of psychosocial rehabilitation in patients with negative symptoms in schizophrenia were: clinical dynamics of negative disorders, the degree of improvement/deterioration of compliance and social functioning, and the degree of restoration of basic life functions. Psychometric (Social Avoidance and Distress Scale (SADS), Personal and Social Functioning (PSP), Level of Compliance questionnaire, and the Severity of Negative Symptoms (SANS)) and statistical research methods were used to assess effectiveness. Results. The proposed scheme of a complex program of psychosocial rehabilitation is based on the principles of a complex, individually oriented and differentiated approach, and its targets are defined as clinical manifestations of negative symptoms in schizophrenia, impaired social adaptation, communication skills, decreased motivational sphere, compliance and impaired social functioning. Rehabilitation is implemented in four stages: diagnostic, therapeutic, rehabilitation and preventive. The effectiveness of the proposed scheme of psychosocial rehabilitation of patients with negative symptoms in schizophrenia was proven, which consisted in a more pronounced reduction of clinical manifestations of abulia, anhedonia, inattention, reduction of distress and social avoidance, improvement of social functioning in the main spheres of life, and improvement of social and behavioral compliance. Conclusions. The developed comprehensive program of psychosocial rehabilitation of patients with negative symptoms in schizophrenia has shown its effectiveness and can be used in psychocorrective measures aimed at treating patients with negative symptoms in schizophrenia.

Unveiling the relationship between psychological adaptation and problem-solving skills in gifted intermediate school students: A Saudi Arabian perspective

This study examines the relationship between psychological adaptation and the problem-solving skills of gifted students at the intermediate school stage in Saudi Arabia to determine the difference in the level of influence according to gender and grade. The study involved a random sample of 187 gifted students, whose responses were received through an online questionnaire. This quantitative study used a T-test, one-way analysis of variance, two-way analysis of variance and regression analysis. The findings indicated a positive effect of psychological adaptation on all dimensions of problem-solving skills. In addition, substantial differences were observed between males and females in the four dimensions of psychological adaptation. The results also showed no differences between males and females regarding the problem-solving skill dimensions of problem definition and decision making. However, there were significant differences between the remaining dimensions and the total general dimension of problem-solving skills. The study recommends that psychological aspects be included as the core and cognitive objectives when planning care programmes for the gifted, intensifying the role of psychosocial counselling and rehabilitation programmes for teachers and educational mentors.

Contribution of socio-demographic and clinical characteristics to predict initial referrals to psychosocial interventions in patients with serious mental illness.

Psychosocial rehabilitation (PSR) is at the core of psychiatric recovery. There is a paucity of evidence regarding how the needs and characteristics of patients guide clinical decisions to refer to PSR interventions. Here, we used explainable machine learning methods to determine how socio-demographic and clinical characteristics contribute to initial referrals to PSR interventions in patients with serious mental illness. Data were extracted from the French network of rehabilitation centres, REHABase, collected between years 2016 and 2022 and analysed between February and September 2022. Participants presented with serious mental illnesses, including schizophrenia spectrum disorders, bipolar disorders, autism spectrum disorders, depressive disorders, anxiety disorders and personality disorders. Information from 37 socio-demographic and clinical variables was extracted at baseline and used as potential predictors. Several machine learning models were tested to predict initial referrals to four PSR interventions: cognitive behavioural therapy (CBT), cognitive remediation (CR), psychoeducation (PE) and vocational training (VT). Explanatory power of predictors was determined using the artificial intelligence-based SHAP (SHapley Additive exPlanations) method from the best performing algorithm. Data from a total of 1146 patients were included (mean age, 33.2 years [range, 16-72 years]; 366 [39.2%] women). A random forest algorithm demonstrated the best predictive performance, with a moderate or average predictive accuracy [micro-averaged area under the receiver operating curve from 'external' cross-validation: 0.672]. SHAP dependence plots demonstrated insightful associations between socio-demographic and clinical predictors and referrals to PSR programmes. For instance, patients with psychotic disorders were more likely to be referred to PE and CR, while those with non-psychotic disorders were more likely to be referred to CBT and VT. Likewise, patients with social dysfunctions and lack of educational attainment were more likely to be referred to CR and VT, while those with better functioning and education were more likely to be referred to CBT and PE. A combination of socio-demographic and clinical features was not sufficient to accurately predict initial referrals to four PSR programmes among a French network of rehabilitation centres. Referrals to PSR interventions may also involve service- and clinician-level factors. Considering socio-demographic and clinical predictors revealed disparities in referrals with respect to diagnoses, current clinical and psychological issues, functioning and education.

Psychological conditions in patients with pulmonary tuberculosis and mental disorder

The article presents the spectrum of psychological conditions in patients with pulmonary tuberculosis in combination with a mental disorder. The purpose of assessing the psychological status of individuals with pulmonary tuberculosis and mental disorders is to create a psychological portrait of these patients. Identification of psychological characteristics makes it possible to select an adequate, targeted program of psychosocial rehabilitation for this category of patients, taking into account their emotional state. Results of psychological assessment of personality: the study has shown that a fairly high percentage of patients with comorbid pathology (pulmonary tuberculosis and mental disorder) have psychological features manifested in anxiety, irritability, suspiciousness, dejection, and immersion in their illness. To a lesser extent, the following were noted: loss of interest in everything or, on the contrary, “going into illness”, a careless attitude towards the disease or extreme suspicion of others. Conclusion. Taking into account the results of the study, in case of such patients, in addition to the main anti-tuberculosis therapy, it is necessary to carry out measures aimed at optimizing the individual’s attitude towards the disease, oneself, the environment, etc. The result of the implementation of targeted rehabilitation, in particular psychotherapeutic work, is the complete satisfaction of the patient’s needs. Individuals in the studied category should feel full-fledged members of society with an adequate attitude towards their disease and towards themselves. In terms of providing medical care, it is necessary to pay special attention to the organization and implementation of complex treatment of patients with comorbid disorders and to carry it out jointly with TB specialists, psychiatrists, and psychologists.

A cross-sectional observational study to estimate the psychosocial adjustment in patients with schizophrenia

Abstract Context: Psychosocial dysfunction is the dysfunction in the various psychosocial areas, such as personal, vocational/occupational, familial, and social, which ultimately depends on the cognitive functioning of an individual. Any disturbances and failure to adjust in one or more areas have a sufficient impact on the patient’s quality of life and daily living. For everyday living and maintaining a good quality of life, the influence of the level of dysfunction in different areas needs to be understood, and psychosocial interventions and rehabilitation programs must be designed accordingly to facilitate better psychosocial adjustment. Aims: The aim of this study was to estimate the psychosocial adjustment of individuals with Schizophrenia presenting at the psychiatry outpatient department (OPD) of a teaching hospital. Materials and Methods: A cross-sectional study was conducted at the psychiatry OPD of a tertiary care teaching hospital. Eligible subjects were aged between 18 and 65 years and diagnosed with Schizophrenia according to the International Classification of Diseases-10. Sociodemographic characteristics and current treatment details were obtained. The psychosocial adjustment was assessed using the Psychosocial Adjustment to Illness Scale-interview version. Results: Sixty subjects were included, all with some impairment in one or the other social functioning domain. The domain with the highest proportion of subjects showing marked/severe degrees of disability is the vocational environment. Moderate-to-severe impairment of functioning is seen in the domains of domestic environment, social environment, sexual relationship, and extended family relationships. In the health-care environment, mild impairment is seen among most subjects. Only mild psychological distress was found among those with impaired functioning in this domain. It was also found that individuals with mild adjustment problems had a shorter duration of illness. Variables that showed significant statistical associations (P < 0.05) with poor/severe social adjustment were marital status and duration of illness. Age and Gender had a statistically significant association with psychosocial dysfunction in the social environment domain. Conclusion: This study shows that there is definite and substantial psychosocial dysfunction in definitive areas of personal, familial, social, and vocational spheres in patients with schizophrenia. Psychosocial interventions, along with antipsychotics, are needed to target these areas to improve the overall quality of life of patients with schizophrenia.

Association between psychosocial rehabilitation and recovery center service receipt and reported internalized stigma among veterans.

Internalized stigma, also known as self-stigma, is negatively associated with a person's willingness to seek mental health services and follow their treatment plan. This can hinder a person's recovery, exacerbate their mental health illnesses, and reduce their quality of life. A primary directive of the Veteran Affairs Psychosocial Rehabilitation and Recovery Center (PRRC) program is to help veterans overcome their internalized stigma. This study is the first to evaluate the association between receiving PRRC services over time and veteran reported levels of internalized stigma based on Internalized Stigma of Mental Illness-Brief-10 scores using longitudinal PRRC Forms Data. The analysis was performed using a random-effects ordered logistic regression adjusting for veteran sociodemographic and clinical characteristics. Our study cohort consisted of 2,774 veterans who received PRRC services between fiscal years 2018 and 2021 and who had an intake form at the start of the PRRC service and at least one follow-up form. Our study found that veterans had lower odds of having a higher level of internalized stigma at the first follow-up relative to their intake (OR: 0.80; 95% CI [0.70, 0.92]), and these odds continued to decrease with each subsequent follow-up. These results potentially indicate the effectiveness of the PRRC program in reducing levels of internalized stigma among the veterans. Our study also suggests the need for greater clinical attention and resources for subgroups such as older veterans, male veterans, and veterans with posttraumatic stress disorder, anxiety, or personality disorders, who reported higher levels of internalized stigma. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Mental health care delivery and quality of service provision in Brazil

Public mental health system in Brazil is structured through “The Psychosocial Care Network (Rede de Atenção Psicossocial, RAPS)". This coordinated system comprises primary care, specialized mental health care, crisis management services, inpatient units, deinstitutionalization initiatives, and psychosocial rehabilitation programs. In this narrative review, we aim to provide an overview of mental health care delivery in Brazil by assessing three aspects of the RAPS: structure, operationalization, and current state. For reviewing its structure, we start by overviewing the public health system, then examining the psychiatric reform, as well as the law and policy that established the components of the community-based mental health system in the country. Regarding the operationalization, we review recommendations for how the different components of the system should be coordinated, as well as directions for practices at the assistance level. Finally, we review the results of the mental health system, including official data and academic publications assessing coverage, funding, and quality of care. Drawing on the results from this review, we highlight fragilities that indicate three future directions for strengthening the mental health provision in Brazil: establishing appropriate mechanisms for systematic assessment of the mental health system, improving the recommendations regarding the coordination and integration of services, and promoting evidence-based practices across the different levels of care provision.

Prevention and reduction of school deviance through programs of psychosocial rehabilitation of pupils

In the school environment, interventions focused on positive things are effective in managing deviant behavior problems among students. The ideal objective is for the school to begin to adopt systemic changes that involve managing problem behaviors in a positive and preventive manner and with the help of the other factors involved, with the aim of fostering a collaborative partnership between adults and children, which encourages the latter to solve the problems that affect their lives. The best solutions must be found to lead to the improvement of communication relationships, to help children, adults learn, and model positive skills related to human nature: empathy, honesty, to help them understand that inappropriate behavior that can affect others and that the solution is to solve problems without conflict.

Collaborating with the people who experience psychosis: From subjects to partners

IntroductionDespite the critical role of motivation in psychosocial treatment and rehabilitation, as well as functional outcomes in schizophrenia, service user voices are not always present in setting research agendas on this topic. This is important since the service user’s involvement in the research process helps prioritize research questions (Wykes et al., 2015).ObjectivesWe have begun a consultation process to bridge the gap between research and practice on ‘motivation in schizophrenia.’ The study’s main objective was to produce the means to increase motivation in schizophrenia from the perspective of users.MethodsIn the current study, we asked the service users about the priorities for ‘motivation and schizophrenia’ research and also suggested involving service users in research itself as partners. Expert Panels with peer leaders previously involved in psychosocial rehabilitation programs took place. A total of 12 Panels (group meetings) were held during the year with three users (schizophrenia spectrum outpatients) aged 45, 47, and 50, male. The reports were analysed using content analysis to generate main themes and findings (Braun & Clarke, 2006).ResultsThe users’ elements of motivation may differ from organizationally defined ones; this may be related to different opinions and ethical standards among clinicians on patients’ autonomy and right to refuse treatment. A discussion of the topics patients have developed to improve the motivation, engagement, and management of patients with schizophrenia in psychosocial treatment and rehabilitation is presented.ConclusionsThe approach successfully generated items for questionnaires that usesr participants declared with a sence of pride in and ownership of. It is, therefore, possible to create measures of motivation that users feel reflect their understanding and experiences. The outcome of this research is that other Russian researchers will be inspired to follow the same patrnership path and encourage service users to participate rather than be subjected to research.Disclosure of InterestNone Declared

Cognitive and emotional-volitional disorders in patients with residual schizophrenia

IntroductionStudies show that patients diagnosed with residual schizophrenia are characterized by cognitive and emotional-volitional disorders that increase with age. They can be the main barrier to treatment, psychosocial rehabilitation, and cause disability.ObjectivesTo identify cognitive and emotional-volitional disorders in patients with residual schizophrenia.MethodsThe BACS and the abbreviated MMPI test were used; 20 patients with residual schizophrenia (ICD-10 F.20.5xx) receiving outpatient treatment (mean age 59.65±14.24 years) were examined. Exclusion criterion: scores more 4 on at least one parameter of positive symptoms according to the PANSS.ResultsPatients with residual schizophrenia show an overall decline in cognitive function (BACS composite score = 31.56±14.24) compared with healthy individuals, as well as compared with patients suffering from other forms of schizophrenia spectrum disorders. The greatest deficiency was revealed in the speed of information processing (subtests “Symbol Coding”=28.01±10.06; “Verbal Fluency”=37.56±11.57) and auditory-speech memory (subtest “Verbal Memory”=33.25±6 .02). These parameters showed significant associations (r=0.56 at p≤0.01) with the disability of such patients. However, this deficit could be compensated by the relative preservation of planning processes and executive functioning (subtest “Tower of London” = 14.91±4.57). Among the emotional and volitional disorders, the most important is the subjective feeling of low mood and paranoid tendencies (MMPI scales “Dp” = 56.38±10.74T, “Pa” = 59.06±14.49T), which can reduce the compliance of patients with residual schizophrenia.ConclusionsMethods for leveling cognitive and emotional-volitional disorders should to include in programs of psychosocial rehabilitation of patients with residual schizophrenia.Disclosure of InterestNone Declared

COVID-19 impact on the provision of psychosocial rehabilitation services in Latin America and the Caribbean

Health care services have been deeply affected worldwide by the COVID-19 pandemic. However, and despite its importance to psychiatric reforms, very little has been written on actual responses to the COVID-19 pandemic in community psychiatry and psychosocial rehabilitation settings. Fifty-two mental health professionals from thirteen countries in Latin America and the Caribbean were interviewed in May and June 2020 and shared their opinions on the state of psychosocial rehabilitation services and programs during the first one-hundred days of the COVID-19 pandemic. Simple quantitative measures were added to a thematic analysis of responses. The results indicated that the disruption of group activities deeply affected psychosocial rehabilitation services, non-core activities (e.g., food and medication supply) became the most relevant aspects of these programs, shifting to remote mode proved to be a significant hurdle for many psychosocial rehabilitation service users, and long-term effect on rehabilitation services is expected by almost 90% of interviewees.

Impact of completing a psychosocial rehabilitation programme on inpatient service utilisation in South Africa.

Deinstitutionalisation refers to the process of transferring most of the psychiatric care provision from inpatient state-run institutions to community-based care. However, it has proven difficult to implement and failed to reach its desired targets. New Beginnings (NB) is a transitional care facility that facilitates the transition from in- to outpatient care. To date, no data exist as to whether the intervention provided at NB is effective in reducing psychiatric readmissions. To determine if completing a psychosocial rehabilitation (PSR) programme reduces acute inpatient service utilisation and if this is influenced by sociodemographic or clinic factors. New Beginnings transitional care facility in South Africa. A record review of all NB admissions between January 2011 and December 2015. Demographic and clinical data were collected, including readmissions and days-in-hospital (DIH), 36 months pre- and postindex admission. Patients were divided into a completer group (CG) and a noncompleter group (NCG) for the eight-week PSR programme, and comparative statistical analysis was performed. Completion of the 8-week voluntary inpatient PSR programme led to a significant decrease (p = 0.017) (CG vs. NCG) in DIH during the 36-month period postindex admission. In addition, both groups showed significantly decreased (p < 0.001) DIH postindex in comparison to pre-index admission. This study's findings support that transitional care facilities offering an inpatient PSR programme may reduce inpatient service utilisation for all attendees but especially for those who complete the program. This highlights the need for such facilities that offer interventions tailored for patients with mental illness. This is the first local study highlighting the potentially important role transitional care facilities could play in reducing readmissions.

Effectiveness of Psychosocial Rehabilitation: Innovative Method of Results Assessment

Background: The main problem of evaluating the effectiveness of psychosocial rehabilitation (PSR) is incorrect methods of processing psychometric data obtained with the help of appropriate tools (scales and questionnaires), which are standard used to measure the effectiveness of interventions within the framework of the implementation of PSR procedures. The purpose of the study: 1) а systematic analysis of the problems of assessing the severity of mental disorders and the effectiveness of subsequent PSR; 2) development of cardinal algorithms for processing the initial expert information in order to obtain appropriate numerical criteria for the effectiveness of the PSR. Material and methods: a systematic analysis of domestic and foreign publications, based on the results of their own research on the problems of assessing patients’ conditions, as well as evaluating the effectiveness of a comprehensive long-term PSR program for people with schizophrenia and schizophrenic spectrum disorders in various forms of care (public organization, day hospital, hospital). As methods of information processing, clinical-psychopathological, psychometric, as well as methods of system analysis and the analytic hierarchy process (AHP) were used. Results: an innovative methodology and algorithms for processing expert clinical, psychopathological and psychometric information based on the AHP apparatus have been developed to develop criteria for the effectiveness of PSR. The cardinal difference between the proposed approach and the rank methods of processing initial information is that the results of processing initial expert information are obtained in the fundamental scale of AHP (numerical scale), which ensures the correct integration of psychometric and psychosocial characteristics of patients when considering diagnostic procedures, psychosocial therapy and rehabilitation. Conclusions: the calculations are based on expert assessments of the weight of areas of impaired functioning of patients and the corresponding changes in psychosocial characteristics. This ensures the universality of the methodology and algorithms for evaluating the effectiveness of any rehabilitation interventions: from psychosocial to physiotherapy.

“Giros de Rua” - Revitalize physical and mental health in people with HIV through a psychosocial intervention program: a study protocol

IntroductionGiven the negative social representation attributed to mental illness, it is urgent to reconfigure its representation, not as an individual problem, but also as a collective. Several solutions have been indicated to improve the skills and quality of life (QoL) of these individuals. Among these, psychosocial rehabilitation programs stand out to keep individuals inserted in society reaching a level of independent functioning.ObjectivesThis study aims to: - assess the level of QoL, social support, treatment adherence, mental health status and mental health literacy of Portuguese people with HIV integrated into a community intervention program “InPulsar - Giros na Rua” program [which aims to contribute to the improvement of the socio-sanitary conditions of people who use psychoactive substances and to their social and therapeutic referral, as well as promoting risk reduction by intervening in a public space]; - improve mental health literacy levels, adherence to therapeutic regimen and QoL in individuals with HIV, after 12 months of implementation of a psychosocial rehabilitation program [biweekly sessions].MethodsWe will perform a single-group pre-experimental study with pre- and post-intervention evaluation, supported by the participatory methodology in health.ResultsThis study has received ethical approval from the local IRB. Data collection will start in November 2021 and will be completed in November 2022.ConclusionsThrough a multidisciplinary approach, this study will allow the development of health interventions articulated with psychosocial interventions based on various educational and behavioural strategies, promoting literacy and adherence to the therapeutic regimen.DisclosureNo significant relationships.

A cardinal approach to evaluating the effectiveness of psychosocial rehabilitation based on the analytical hierarchy process

IntroductionThe approach to evaluating the effectiveness of psychosocial rehabilitation (PSR) of mentally ill patients implies a multidimensional, hierarchical consideration of mental pathology with the inclusion of clinical and psychopathological, socio-environmental and personal indicators when setting goals and objectives of PSRObjectivesDevelopment of algorithms and models for evaluating the effectiveness of PSR taking into account: clinical, socio-demographic, psychological characteristics of the patient and the characteristics of the family environment, as well as factors of psychiatric care.MethodsClinical, statistical, algorithms of the analytical hierarchy process (AHP) [1].ResultsNumerical estimates of changes (before and after the PSR program) in the main areas of patient’s functioning disorders, such as motivation, cognition, compliance, coping strategies, family, skills, immediate environment, and others, are proposed as particular criteria for evaluating the effectiveness of PSR. Quantitative estimates for particular criteria are obtained on the basis of rank estimates, which are converted into numerical ones based on AHP algorithms [1]. Quantitative integral estimates of the effectiveness of PSR are obtained on the basis of partial estimates, taking into account the weight of the corresponding areas of impaired functioning of patients.ConclusionsThe developed approach opens up prospects for obtaining numerical, partial and integral estimates based on various rank scales, which are of interest from the point of view of forming criteria-indicators (markers) of the effectiveness of psychosocial, rehabilitation, psychoeducational and psychotherapeutic measures.

Experience of using telecare in carrying out a program of psychosocial rehabilitation of patients with schizophrenia and their relatives during the Covid-19 pandemic

IntroductionDuring the Covid-19 pandemic, patients with mental illness turned out to be one of the most vulnerable groups of the population, since the forced self-isolation regime was a decrease in the availability of psychiatric care. During this period, the use of telemedicine increased to provide timely assistance.ObjectivesTo analyze the experience of telecare in program of psychosocial rehabilitation of patients with schizophrenia and their relatives and to evaluate its effectiveness.Methods80 schizophrenia patients in remission of varying quality and 41 relatives participated in rehabilitation program. To assess the effectiveness of telecare, PANSS, SF-36, URICA, PHQ-9, ISI, PSS-10, GAD-7 scales were used.ResultsPsychosocial interventions through telecare were carried out for 12 months. Patients and relatives participated in video sessions on Zoom and Skype Internet platforms, as well as in instant messengers. Rehabilitation program for patients included psychoeducation, skills training, art-therapy, music therapy, bibliotherapy, psychological counseling. Relatives were provided with psychoeducation and psychological counseling. The analysis showed that the use of telecare contributed to increase in the availability of psychotherapeutic assistance, the participation of patients with low motivation and prompt problem solving. Within the studied period, only 5% of patients (4 persons) developed relapses, two patients (2.5%) were hospitalized. Patients and relatives showed a high level of satisfaction with the care provided, positive dynamics of psychological indicators.ConclusionsThe effectiveness of psychosocial rehabilitation program through telecare has been proven. The possibility of carrying out various psychosocial interventions in online format has been shown.DisclosureNo significant relationships.