Psychiatric Rehabilitation Research Articles

Changes in Exercise Performance in Patients During a 6-Week Inpatient Psychiatric Rehabilitation Program and Associated Effects on Depressive Symptoms

Background/Objectives: The impact of exercise on affective disorders has been demonstrated in various studies. However, almost no data are available on performance effects. Therefore, this study investigated exercise performance related to the severity of depression symptoms in a pre–post within-subjects design in a 6-week standard inpatient psychiatric rehabilitation program. Methods: A total of 53 individuals (20 female; mean age, 40.98 ± 11.33) with a primary diagnosis of depression performed a cardiopulmonary exercise test (CPX) to obtain maximal oxygen uptake (VO2max), maximal power output (Pmax), and the first and second ventilatory threshold (VT1, VT2) at the start and the end of the rehabilitation. Degree of depression was assessed by Becks Depression Inventory (BDI) and the Brief Symptom Inventory test (BSI). Overall activity was measured by accelerometer step-counts. Results: Mean total step-count per day during rehabilitation was high (12,586 ± 2819 steps/day). Patients’ BDI and BSI at entry were 21.6 ± 8.83 and 65.1 ± 6.8, respectively, and decreased significantly (p < 0.001) following rehabilitation, to 10.1 ± 9.5 and 54.5 ± 11.3, respectively. Pmax and VO2max increased significantly (p < 0.001) from entry values (182.6 ± 58.7 W, 29.74 ± 5.92 mL·kg−1·min−1) following rehabilitation: by 11.91 ± 12.09 W and 1.35 ± 2.78 mL·kg−1·min−1, respectively. VT1 and VT2 showed a similar behavior. An increase in physical performance could predict improvement in BDI (R2 = 0.104, F(1,48) = 5.582, p = 0.022) but not in BSI. Conclusions: The program was associated with improved mental health status in all patients and increased performance in the majority of patients, although increases were small. Since improvements in exercise performance may be positively related to depression symptoms and comorbidities, it is recommended to individualize and tailor exercise programs, which could yield larger effects.

Depression, anxiety and insomnia among isolated covid-19 patients: tele occupational therapy intervention vs. conventional one: a comparative study.

COVID-19 is known to cause psychological problems. Psychological rehabilitation can be performed to reduce anxiety, depression, and insomnia. Facing patients with infectious diseases can be difficult for medical staff. Therefore, this study compared the effects of psychiatric tele-rehabilitation (TR) and conventional psychiatric rehabilitation (CR) in isolated patients with COVID-19. This randomized controlled study, conducted at a single community-based hospital, included 40 patients (24 in the psychiatric tele-rehabilitation group [TRG] and 16 in the conventional psychiatric rehabilitation group [CRG]) with COVID-19 were recruited from November 18, 2021, to April 7, 2022. Psychiatric rehabilitation is an occupation-based intervention in which patients perform meaningful activities and tasks. Patients in the TRG selected activities, received counseling, and underwent monitoring over the phone, while those in the CRG participated in face-to-face sessions. The interventions were conducted for 50min each day during an isolation period of 7 days in both groups, and all participants received the interventions individually. The primary outcome was anxiety assessed using the Visual Analog Scale (VAS) and the Zung Self-Rating Anxiety Scale (SAS). Secondary outcomes include the Visual Analog Scale (VAS) and the Patient Health Questionnaire-9 (PHQ-9) to evaluate depression, the Multidimensional State Boredom Scale-8 (MSBS-8) to assess boredom. The Korean version of the Insomnia Severity Index (ISI-K) was used to assess the quality of sleep, and the World Health Organization Quality of Life Assessment Instrument-BRIEF (WHOQOL-BREF) was used to evaluate quality of life. Questionnaires were administered at admission, discharge, and at the 6-month follow-up. In the time × group analysis, the SAS total score (p = .033) and the VAS score for depression (p = .012) in the CRG were significantly lower than those in the TRG at the time of discharge. The VAS score for anxiety (p = .007), total SAS score (p = .050), and VAS score for depression (p = .003) in the CRG were also significantly lower than those in the TRG at the 6-month follow-up. The PHQ-9, MSBS-8, ISI-K, and WHOQOL-BREF scores showed no significant interactions in the time × group analysis. TR was effective in reducing anxiety and improving quality of life during hospitalization, but had no remained effects after discharge. Otherwise, CR was more effective than TR for anxiety and depression during hospitalization and had remained effects at 6-month follow-up. However, considering the characteristics of infectious conditions that involve risk in contact, TR will still play an important role, and efforts will be needed to improve the effect that remained. The trial was registered with the Korea Clinical Trials Registry (KCT0006714, Date of registration 08/11/2021).

Recurrence of mental disorders: Evidence from surveillance analysis

Psychosis is a psychiatric disorder characterized by hallucinations and delusions and include schizophrenia spectrum disorders and mood disorders such as depression and bipolar disorders. Treatment for psychosis lasts a long time with increased likelihood of hospitalization. Surveillance is used to monitor trends in mental disorders to predict and prevent recurrence. The objective of this paper was to the benefits of surveillance to prevent recurrence of mental disorders. The method consisted of a search for Google scholar, PubMed, NIHR and Research Gate. Ten articles obtained, while six were suitable for analysis based on suitability of purpose of the study. The results showed that surveillance variables consisted of risk factors, protective factors, triggers factors, and mental health indicators. The impact included socio-economic, disability, and the risk of suicide/self-harm. It is recommended to include surveillance activities in community-based psychosocial rehabilitation programs, so that recording signs or symptoms of relapse can be carried out routinely.

The relational institution: an ethnographic study of recovery orientation and relational engagement on a psychiatric rehabilitation ward in London

BackgroundIn the UK, inpatient psychiatric rehabilitation services for complex psychosis aim to provide recovery-orientated treatment to patients, with the goal of supporting sustained stepdown into community living. The extent to which rehabilitation services uphold this recovery orientation is associated with better outcomes. However, few studies have been able to ascertain what promotes or prevents recovery orientation in inpatient settings.MethodsWe conducted an ethnographic study of treatment on a National Health Service (NHS) psychiatric rehabilitation ward in London over six months during August 2022-February 2023. Data were collected through participant observation and semi-structured interviews with 9 patients and 14 staff members. Fieldnotes and interview transcripts were analysed using situational analysis.ResultsOur analysis highlights the importance of what we term ‘relational engagement’ between staff and patients to nurture and sustain recovery-orientated treatment. This relational engagement was embodied through small acts of genuine human connection grounded in mutual acceptance and affective bonding; close attention to detail that communicated curiosity and respect; and recognition, appreciation, and encouragement of the slow and gradual progress that characterises recovery in complex psychosis. Yet, this relational engagement was often limited or foreclosed by the social environment of the ward and the wider institutional context. Limiting elements included the dominance of hospital logics geared towards high-throughput acute treatment and risk management; the presence of audit culture that led to a level of standardisation curtailing more genuine human connection; and staff demoralisation driven by events on and off the ward, including system-wide crises and more localised conflicts and disturbances. Some of these conflicts involved discrimination, most prominently anti-Black racism and homophobia, reflecting wider structural inequalities that characterise inpatient psychiatric populations and the healthcare workforce.ConclusionRelationships, often under-prioritised in mental health services, were a key cornerstone of recovery-orientated treatment on a psychiatric rehabilitation ward. The shaping of therapeutic relationships amounted to an active process of relational engagement, which may be afforded or constrained by complex social elements requiring careful consideration in inpatient psychiatry. These social elements go beyond more surface-level factors such as staff training, knowledge, or attitudes and may require structural and system-level interventions.

Users' Experience of Treatment and Coercion in an Inpatient Medium-Stay Psychiatric Rehabilitation Unit: A Mixed Methods Study.

Coercion influences mental health services users' experience of care and can hinder their recovery process, so it is essential to understand how it is perceived in rehabilitation settings oriented towards recovery. To describe and measure users' experience of coercion and explore their perception of the treatment received in an inpatient medium-stay psychiatric rehabilitation unit (IMSPRU). This study, in which 75 service users participated, used a mixed methods approach. Twenty participants were administered a semistructured interview and completed quantitative measures for coercion and 55 additional service users completed the quantitative measurements only. The perception of coercion was measured using the Coercion Experience Scale. The content analysis of qualitative data resulted in two main themes: treatment received and experience of coercion in the IMSPRU. The participants made a distinction between good treatment and mistreatment or unfair treatment. Experience of coercion in the IMSPRU included the feeling of freedom or lack thereof in the unit, forms of formal and informal coercion, and the positive or negative impact of rules on the unit. The quantitative data revealed a low perception of formal coercion among the users. Individuals had different views of what it meant to be treated well, but all agreed on the importance of communication and the need to feel respected. Informal coercion was the most frequent type of coercion identified, but users were often unaware of its existence. Knowledge of how IMSPRU users experience the treatment received from nursing staff and how they perceive coercive situations will help to lay the foundations of a system of care oriented towards good treatment and noncoercive practices.

NURSING CARE FOR PATIENTS WITH LEPROSY TREATED BY PRIMARY CARE: INTEGRATIVE REVIEW

Leprosy is a chronic infectious disease caused by Mycobacterium leprae. Its predilection for the skin and peripheral nerves gives this disease particular characteristics, making its diagnosis simple. Brazil continues to be the second country in the world in terms of the number of cases, after India. Approximately 94% of known cases in the Americas and 94% of newly diagnosed cases are reported in Brazil. The disease manifests itself in two stable and opposing poles (virchowian and tuberculoid) and two unstable groups (indeterminate and dimorphic). In another classification, the disease is divided into tuberculoid, borderline or dimorphic forms, which are divided into dimorphic-tuberculoid, dimorphic-dimorphic and dimorphic-lepromatous and lepromatous forms. Microscopic examination of smears is the most useful complementary test for diagnosis. Treatment of leprosy includes: specific chemotherapy, suppression of reactive eruptions, prevention of physical disability, physical and psychosocial rehabilitation. Polychemotherapy based on rifampicin, dapsone and clofazimine has proven to be very effective and the prospects for controlling the disease in Brazil are real in the short term.

Clinical Outcomes and Cost Implications of a Community Psychosocial Rehabilitation Service for Severe and Persistent Mental Illness in Nova Scotia, Canada.

Introduction: Individuals with severe and persistent mental illness (SPMI) present distinct challenges in mental healthcare due to the chronic and complex nature of their conditions. This study was conducted to assess the clinical efficacy and potential cost-effectiveness of a multidisciplinary community-based psychosocial rehabilitation team serving individuals with SPMI in Nova Scotia, Canada. Method: This study was conducted to evaluate the effects of a community-based psychosocial rehabilitation program on individuals with severe and persistent mental illness (SPMI) in Nova Scotia, Canada. This research focused on clinical outcomes and potential cost savings following a one-year intervention, offering critical insights into the benefits of community-based care for this population. A cohort of 137 clients accepted into the community rehabilitation service (Connections Dartmouth) between September 2016 and September 2020 was analyzed. Each participant received one year of community rehabilitation intervention. Using data from the Canadian Medical Service Insurance (MSI) billing system, this research compared the use of inpatient services and Emergency Department visits in the year prior to and the year following the intervention. The findings provide valuable evidence on the role of community rehabilitation in reducing healthcare utilization for individuals with SPMI. Results: The results demonstrated a statistically significant reduction in mean admission rates and length of inpatient admissions in the year following rehabilitation compared to the pre-rehabilitation year. A substantial percentage of patients experienced no inpatient admissions (88% vs. 60%) or Emergency Department visits (82% vs. 67%) in the post-rehabilitation year, compared to the pre-rehabilitation year. There was a significant reduction in inpatient days by 90%, translating into substantial cost savings. The findings highlight the potential economic benefits of community rehabilitation for people with SPMI. Conclusions: This uncontrolled study suggests that community rehabilitation is associated with positive clinical outcomes for individuals with SPMI in terms of reduced inpatient service use and associated costs. Further research, including controlled studies and cost-effectiveness studies, into the community psychosocial rehabilitation services in the Canadian setting is needed.

Physiological Mechanisms of The Relationship Between Memory, Attention, and Arousal in Children Diagnosed with Autism

Autism is a developmental disorder with an early onset and lifelong duration that impairs social interaction and communication, with the condition being repeatedly diagnosed. To gain scientific knowledge about autism, one must observe these patients, perform a series of investigations and examinations, and finally obtain a general title. The first stage of getting to know children diagnosed with autism is one of the most important conditions for studying their psychology and inner world. Therefore, studying the psychology of children diagnosed with autism is also considered a responsible task for psychologists. The article presents the results of assessing the level of anxiety, stress, depression, attention and memory indicators in children with autism, which is an actual problem in recent times, in different age groups. The studies were conducted at two different locations: the Special Support, Special Training and Rehabilitation Centre (Tatvan district of Bitlis, Turkey) and the Psychological Centre Psychosocial Rehabilitation and Development Centre “PRIM” (Baku, Azerbaijan). Conducting studies in two different regions will reveal whether there is a difference between patients diagnosed with autism. The study examined children diagnosed with autism aged 6-12 years of both sexes (44 in Turkey; 51 in Azerbaijan). The results obtained in the study were compared with normal test limits. Psychological testing was conducted on an individual basis, and for the comprehensive study, the same child was tested repeatedly, with a certain frequency and with special attention. Although more boys than girls were included in the confirmed cases, since the aim was not to study gender differences, care was taken to obtain generalisable results. The attempt to clarify a complex topic such as stress in a broad topic such as autism characterises a very complex situation. Therefore, we have endeavoured to obtain more accurate results through the use of comprehensive tests. The main objective of the research work is to obtain certain results by using comprehensive psychological research methods in determining the level of stress and anxiety in children diagnosed with autism and to study the main characteristics of autism by comparing them with psychological indicators considered within the normal range. The results of studies conducted in Turkey and Azerbaijan showed the presence of low levels of attention and memory processes, behavioural disorders, aggressive and depressive behaviour in all age groups against the background of increased arousal. Children diagnosed with autism exhibit similar symptoms regardless of their geographical location, indicating that this disease has common characteristics regardless of national, racial, religious, and regional peculiarities.

Integrative Neuro-social cognitive Strategy Programme for Instilling REcovery (INSPIRE): a community-based cognitive remediation trial-study procotol

BackgroundAdults with schizophrenia experience a range of neurocognitive problems that affect their daily functioning. Evidence for the efficacy of cognitive remediation in schizophrenia has been established, but its implementation in under-resourced community-based settings is less well-studied. In recent years, interventions have also focused on the strategy-learning approach in favor of drill-and-practice. Moreover, there is an increasing recognition to address social cognition and negative symptoms alongside neurocognition.This study attempts to carry out cognitive remediation in a community mental health setting. The Neuropsychological and Educational Approach to Remediation (NEAR) is used as the cognitive remediation intervention. Neurocognitive and social cognitive games will be introduced during the computer-assisted cognitive exercises sessions. In addition, the instructional technique will foster the use of metacognition and cognitive strategies. Moreover, metamotivation training will be the focus of some bridging sessions to enhance motivation to engage in goal-directed learning behaviors.The aims of the study are to 1) investigate the effects of cognitive remediation on neurocognition, social cognition and functional outcomes of participants with schizophrenia/schizoaffective disorders in community mental health settings; and 2) explore the mediators for change (eg: metamotivation, metacognition and negative symptoms) in cognitive performance and functional outcomes.MethodsThis randomized controlled trial will be conducted in three Singapore Anglican Community Services (SACS) centers, where standard psychiatric rehabilitation is delivered. Participants who are randomized to the experimental arm will receive cognitive remediation and psychiatric rehabilitation, while those randomized to the control arm will receive standard psychiatric rehabilitation only. Cognitive remediation is carried out three times a week for 12 weeks. It consists of computer-assisted cognitive exercises, as well as bridging groups to aid transfer of learning to daily living. Baseline, post-intervention and eight-week follow-up measurements will be collected. Group by time differences in cognitive performance, negative symptoms, metamotivation, metacognition, functioning and recovery will be analyzed across the three time points. Mediators for improvement in cognitive performance and functioning will also be explored.DiscussionFindings of this research will add to the body of knowledge about the key therapeutic ingredients within a strategy-based cognitive remediation program and improve its implementation within under-resourced community settings.Trial registrationThis study has been registered with ClinicalTrials.gov (ID: NCT06286202). Date of registration: 29 February 2024. Date of last update: 21 May 2024.

Consent to voluntary antipsychotic drug treatment-Is it free and informed?

The present research investigates the dynamics of consent in the context of antipsychotic drug therapy, with a particular emphasis on the essential attributes that constitute free and informed consent within medical treatment scenarios. Twenty individuals treated with antipsychotic drugs with consent underwent semistructured interviews. The following major themes were identified: (a) lack or total absence of information regarding the treatment, emphasizing side effects, risks, chances of success, and treatment alternatives. (b) A subjective experience of the lack of free choice that was sometimes also accompanied by the conditioning of psychiatric rehabilitation services or receiving treatment in an open ward by taking antipsychotic medication. The research findings may indicate a problem in obtaining informed consent for antipsychotic treatment that should be addressed. The themes highlight the need to examine the interface between rehabilitation services and psychiatric treatment from the legal and ethical perspective of the autonomy of individuals receiving care. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The growth and diversity of the evidence base for the clubhouse model.

The Clubhouse Model is a long-standing form of psychosocial rehabilitation that has been in existence for over 75 years. Today, over 350 Clubhouse programs in 33 countries affiliate with Clubhouse International and operate as nonclinical community-based recovery centers for adults and young adults living with mental illness. Clubhouses provide a strengths-based approach to recovery and offer participants, referred to as members, a variety of supports and services including assistance with obtaining and maintaining community-based employment, education, housing, social integration, outreach and advocacy, wellness and health promotion activities, and linkages to medical and psychiatric services. There is evidence and support for the Clubhouse Model in improving quality of life and social functioning, reducing hospitalization(s) and/or psychiatric symptoms, and promoting employment. This special issue has nine articles that highlight ongoing research collaborations from across the globe that examine the impact of the Clubhouse Model on a variety of novel outcomes. While more research is needed, the articles in this special issue reflect the growth and diversity of the evidence base for the Clubhouse Model. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Expanding community-based participatory action research practices to clubhouses through sustainable research activities.

There is growing utilization and acknowledgement of the benefits of community-based participatory action research (CBPAR) in advancing health practices and equity. However, the sustainability and full impact of CBPAR in health care settings faces many obstacles and limitations. The present article examines the synergies between CBPAR and Clubhouse programs, presents the demonstration and ongoing implementation of sustainable CBPAR practices at Fountain House in New York City, and offers lessons learned for other Clubhouses and similar programs seeking to integrate CBPAR. Alignment in practice and principles between CBPAR and Clubhouse programs are presented. The innovation and ongoing sustainable CBPAR practices in the Fountain House Clubhouse program are examined with a contribution of practice guidance for other Clubhouse and similar programs in further adopting and learning CBPAR into participatory health practices. Clubhouse psychosocial rehabilitation programs present structurally conducive settings for the success and sustainability of CBPAR activities and projects. The Fountain House examination and demonstration of integrating CBPAR sustainably into core Clubhouse programming presents opportunities for further integration, research, and practice guidance in uniquely leveraging features of the Clubhouse model to advance health equity and rehabilitative outcomes through CBPAR. The opportunity for incorporating structural CBPAR activities within Clubhouse programs can be informed by the experience, processes, and lessons applied in the Fountain House example. Further research into the rehabilitation, program, and equity benefits of Clubhouse and CBPAR integration could uniquely contribute to the advancement of sustainable participatory research practices across the mental health field generally. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Factors encouraging participation in social activities after hospital discharge in people with severe mental illness who received occupational therapy.

Occupational therapy (OT), a vital part of psychiatric rehabilitation, encourages participation in social activities, which is critical for the recovery of people with severe mental illnesses (SMI). However, the effects of OT on the subsequent social activities of patients with SMI have not been fully clarified. We aimed to identify the factors that encourage post-discharge social activity participation among patients with SMI who received OT. Patients who underwent OT at the Kyorin University Hospital between April 2016 and March 2020 were retrospectively examined for baseline data during hospitalization and social activity status 1 year after discharge. Occupational support, group adaptation, artistic activities, and exercise programs were considered. Activities requiring social interaction were defined as social activities, including employment, schooling, sheltered work, and volunteer work. Multiple logistic regression analyses using demographic and medical data, prehospitalization social activity status, and OT participation rates as independent variables were used to examine the factors encouraging social activity participation after discharge. Decision tree analysis was conducted to identify patients who specifically needed to increase OT participation. Of 524 eligible patients, 247 were included in the study. The number of patients who were socially active at admission and after discharge was 116 and 188, respectively. Multiple logistic regression analyses revealed that the following factors were likely to encourage social activity participation after discharge: higher rates of OT participation to facilitate group adaptation (OR = 1.015, 95% CI 1.003-1.027), being socially active at admission (OR = 4.557, 95% CI 2.155-9.637), and no marital history (OR = 0.293, 95% CI 0.130-0.661). Decision tree analysis showed that for patients who were socially inactive at admission and had a history of marriage, increasing OT participation to 52.6% or higher may ensure social activity participation after discharge. This study identified patients whose social participation after discharge could be boosted by OT that facilitates group adaptation. Our findings would facilitate the development of individualized add-on rehabilitation based on the effects of real-world OT practices.

Exploring the Quality-of-Care Dynamics of Inpatient Psychosocial Rehabilitation in Community-Based Mental Health Services: A Comprehensive Analysis.

This study aims to investigate the intricacies of inpatient psychosocial rehabilitation by examining a community-based mental health inpatient rehabilitation service in Nova Scotia, Canada. It provides a comparative analysis with national standards using the Quality Indicator for Rehabilitative Care (QuIRC) and offers recommendations for improvement. The study will link findings to research on enhancing specific domains, focusing on strategies to address identified challenges and leverage opportunities to meet or exceed national benchmarks in promoting recovery and social inclusion. This study utilizes the QuIRC as a primary assessment tool to evaluate the quality of care in psychiatric and psychosocial rehabilitation care unit. The QuIRC assessment findings reveal crucial insights across several domains, including the living and therapeutic environment, treatments and interventions, self-management and autonomy, social interface, human rights, and recovery-based practices. The study identifies strengths and areas for improvement by comparing unit scores with national averages in Canada, offering a detailed examination of the quality of care provided in a community-based psychosocial rehabilitation service. Using the QuIRC identifies strengths and areas for improvement of current care provided, opening opportunities for positive change and improved quality of care. By highlighting the critical indicators of the quality of care and best practices derived from the QuIRC assessment, this study provides practical insights that can be directly applied by practitioners, policymakers, and stakeholders, fostering an understanding of essential elements that support effective mental health rehabilitation within community settings.

From stress communication to depressive symptoms among couples facing vision impairment: The mediating role of dyadic coping

Vision impairment is considered one of the most common disability worldwide, can induce considerable stress for both patients and their spouses and may subsequently affect couples' psychological functioning. This study examined whether dyadic coping (DC) mediated the association between stress communication (SC) and depressive symptoms among couples coping with one partner's vision impairment. A total of 99 Swiss couples completed questionnaires assessing SC, various types of DC, and depressive symptoms. An Actor-Partner Interdependence Mediation Model was performed. Results showed that (1) the more one partner communicated stress, the less the other partner perceived negative DC and, consequently, the less the partner perceiving negative DC reported depressive symptoms; (2) the more partners communicated stress, the more they and their partners engaged in common DC and, consequently, the less the partner engaging in common DC reported depressive symptoms; (3) the more partners communicated stress, the less they and their partners engaged in protective buffering and, consequently, the less the partner engaging in protective buffering reported depressive symptoms. This pattern of associations occurred similarly for patients and their spouses. Our findings underline the interpersonal experience of vision impairment within couples and the importance of fostering explicit SC and common DC in psychosocial rehabilitation interventions directed at couples facing one partner's vision impairment.

Therapeutic Garden Design at Marzoeki Mahdi Hospital

Abstract Mental disorders is characterized by clinically significant disturbance in a person’s cognition, emotional regulation, or behavior. Dr. H. Marzoeki Mahdi Hospital (RSMM) is one of the mental hospitals that provides psychosocial rehabilitation services. Psychosocial rehabilitation consists of various activities to hone the patient’s ability so that they live independently. One of the activities is vocational and occupational therapy. The hospital garden is a necessity in the patient rehabilitation process so it needs to be designed to make it can be utilized optimally. The research objectives are to identify and analyze activities, user needs, potentials and constraints on the site; determine the design concept and create a therapeutic garden design for psychosocial rehabilitation at Marzoeki Mahdi Hospital. This research uses a descriptive method with stages such as preparation, research and analysis, concept and design. Data was collected through surveys, interviews, questionnaires and literature studies. The proposed design is a therapeutic garden to support psychosocial rehabilitation. The design concept applies one of patients rehabilitaion activities, namely socializing, which is depicted in a circular pattern and rehabilitation activities carried out repeatedly are depicted in a repetitive pattern. In addition, a symmetrical pattern is also applied which illustrates organized life and firmness. Based on this pattern, spaces are designed to support rehabilitation activities, namely the welcome area, active therapy area, passive therapy area and parking area.

A comparison of patient ratings and staff ratings of disability using the World Health Organisation Disability Assessment Schedule in individuals with psychotic spectrum disorders who are forensic psychiatric inpatients.

Psychosocial rehabilitation in forensic psychiatric services requires sound measurement of patient and staff perceptions of psychosocial function. The recommended World Health Organisation Disability Assessment Schedule 2.0 (WHODAS), designed for this, has not been examined with offender patients. To examine patient and staff WHODAS ratings of secure hospital inpatients with psychosis, any differences between them and explore associations with other clinical factors. Seventy-three patients self-rated on the WHODAS after 3months as inpatients. An occupational therapist interviewed the patient's primary nurse and care team at about the same time (staff ratings). Scores were calculated according to the WHODAS manual. WHODAS scores and interview-rated symptom severity, cognitive measures, daily antipsychotic dose and duration of care were compared. Patient ratings indicated less disability than staff ratings for total score and for the domains of understanding and communicating, getting along and life activities. Self-care and participation ratings were similar. Patients were more likely to rate themselves as disabled in getting around (mobility). Only one-fifth of patient- and staff- ratings (16, 22%) were similar, while for nearly a third of the patients (23, 32%) self-ratings were higher than staff ratings. More severe positive symptoms were associated with higher self-rated WHODAS disability after accounting for treatment duration, negative symptoms, cognitive score and antipsychotic dose. No variable accounted for the staff/patient differences in ratings. Our mean WHODAS score findings echoed those in other patient samples-of patient underestimation of disability, linked to severity of symptoms. In this study using the WHODAS for the first time in a forensic mental health secure inpatient service, however, we found that, by comparing individuals, half of the patients reported equivalent or greater disability than did staff. Future research should focus on elucidating from patients what contributes to their self-ratings. Understanding their thought processes in rating may enhance rehabilitation planning.

An ethics analysis of antipsychotic dose reduction and discontinuation: Principles for supporting recovery from psychosis.

To examine the evidence and practice of antipsychotic dose reduction from the lens of biomedical ethics (specifically principlism) to support evidence-based practice and patient choice and self-determination. An overview of the evidence from randomized controlled trials of antipsychotic dose reduction versus maintenance is presented. This is followed by a theoretical examination of the four key biomedical ethical principles of autonomy, nonmaleficence, beneficence, and justice and how they apply in the case of antipsychotic dose reduction. Existing clinical trial research is dominated by relapse as the primary outcome, with dose reduction associated with a higher risk of relapse than maintenance. Few studies have measured other patient-centered outcomes but have shown preliminary evidence for superior cognitive functioning, lower negative symptoms, and better functioning following dose reduction. Respect for autonomy is a cornerstone of psychiatric rehabilitation, and this includes the right of people to choose to reduce or discontinue antipsychotic medication. Reduced capacity for treatment decision making can be supported. Autonomy and appraisal of nonmaleficence and beneficence associated with dose reduction can be facilitated through shared or supported decision making. Clinicians should continue to strive for justice through the fair allocation of resources to support all people who request antipsychotic dose reduction. Clinicians have a responsibility to balance the four core ethical principles to the best of their ability when supporting a person in their recovery journey. Exploring, trialing, and supporting antipsychotic dose reduction may be part of this process if that is the patient's choice. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Exploring interests: A pathway to ikigai and eudaimonic well-being among people with serious mental illness.

Ikigai is a Japanese concept of a life worth living and related to eudaimonic well-being. Supporting the pursuit of ikigai is of central importance to recovery-oriented psychiatric rehabilitation for people with serious mental illnesses (SMI). While research suggests that work, leisure, and social relationships are potential sources of ikigai, people with SMI have restricted access to these as they encounter systemic barriers to participating in such activities. This study investigated how people with SMI in Japan pursued sources of ikigai in the face of barriers. A total of 21 community-living individuals who had SMI and were recruited from community psychiatric rehabilitation service providers in Japan participated in the study. Photo-elicitation interviews were conducted, and the interview transcripts were analyzed using reflexive thematic analysis. Three themes were generated: (a) self-determination as a key to ikigai, (b) explorations needed to identify sources of ikigai, and (c) navigating the challenges to engage in the explorations. It was found that a self-determined activity tends to be a source of ikigai. However, participants had to grapple with challenges because identifying a source of ikigai involved the exploration of their personal interests, and the exploration could not be continued without managing the stigma of mental illness. Results suggest that ikigai cannot be achieved instantly. To achieve eudaimonic well-being outcomes, psychiatric rehabilitation professionals should allow consumers to choose activities based on their personal interests and encourage them to try out various activities while they provide continued support to overcome stigma. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Helping Institutionalised Children through a Trusting Relationship-Findings from a One-Year Psychosocial Intervention Programme.

Children growing up in institutions lack a stable relationship-essential for development. A significant proportion of them have disorganised attachment, which is associated with negative outcomes. Therefore, interventions aimed at improving attachment security are needed. We conducted a case series study (involving five participants aged 8-11 years) in a newly established psychosocial rehabilitation daycare centre to describe the changes in attachment security and mental health of institutionalised children after one year of attendance. The intervention consisted of individualised care focusing on staff building a trusting relationship with participants using the principles of Trust-Based Relational Intervention® (TBRI). Measures such as the Child Attachment Interview, SDQ, CBCL6/18, TRF6/18, and clinical interviews were used to follow change. The descriptive data of five participants are presented. All five children improved in mental health, and for two participants, organisation of attachment changed. Three children experienced relational ruptures. The findings suggest that psychosocial interventions that focus on building trusting relationships may be beneficial in institutionalised children. For these children, given their life history, it can be damaging to experience repeated breakdowns. Thus, the practical implication is that any new relationship for them with an adult should be established after an assessment of whether the relationship can be sustained.