Psychosocial Rehabilitation Approach Research Articles

Cognitive enhancement interventions are effective for schizophrenia: why not provide them early?

Cognitive enhancement interventions are effective for schizophrenia: why not provide them early?

Psychosocial rehabilitation of individuals with schizophrenia: a scoping review protocol

BackgroundThe psychosocial rehabilitation of an individual with mental illness is an evidence-based approach to reducing the burden of the illness and the associated stigma globally. Specifically, in Africa, it has promising scope for African life and the African economy. Psychosocial rehabilitation is described as a set of approaches that aim to assist an individual in achieving restoration from a state of dependency caused by schizophrenia to a state of being an independent decision-maker. However, there seems to be a dearth of literature and implementation of psychosocial rehabilitation in Africa. Therefore, it is necessary to map studies on how psychosocial rehabilitation is conducted for people living in Africa with the most chronic form of mental illness, schizophrenia.MethodsThis study will adopt the Arksey and O’Malley scoping review framework to search and compile relevant studies. This process will involve three steps: title screening, to be performed solely by the principal investigator, followed by abstract and full-text screening, to be performed independently by two reviewers (the principal investigator and co-investigator). Rayyan QCRI, a systematic reviews web app, will be used for tracking the screening records, and data charting form will be used to extract basic data of included studies. The risk of bias in the articles identified for screening will be assessed by the Mixed Method Appraisal Tool (MMAT). Finally, the content analysis of the screened studies will be performed with NVivo.Expected outcomeThis study has the likelihood of revealing a research gap in psychosocial rehabilitation approaches and methods. The review results will constitute part of the available evidence that the researchers aim to adopt in the broader part of the project, which aims to develop implementation strategies for the psychosocial rehabilitation of chronic mental illnesses, specifically schizophrenia, in Sub-Sahara Africa. The implementation process also encompasses disseminating the findings of this review to stakeholders, which will enhance their knowledge of the current state of Sub-Saharan Africa and may stimulate support for the implementation of rehabilitation strategies.

The French Integrative Psychosocial Rehabilitation Assessment for Complex Situations (FIPRACS): Modelization of an Adapted Assessment Method Toward Long-Term Psychiatric Inpatients With Disabling, Severe and Persistent Mental Illness.

For the past forty years, the generalization of community-based approaches has prompted psychiatry into promoting a deinstitutionalization movement and a psychosocial rehabilitation approach (PSR) for individuals with schizophrenia and related difficulties. Unfortunately, this approach generally does not involve the most severe cognitive and psycho-affective clinical situations among this population despite an increasing number of publications advocating that all individuals should be included in PSR and deinstitutionalization programs. In this context, considering the absence of an assessment battery designed for French individuals with particularly disabling, severe, and persistent mental illness (IDSPMI), we constructed an integrative assessment model adapted to this specific population. To select the most suitable tools for this population, a literature review (inspired by the PRISMA protocol) and a systematic review were combined with a clinical assessment study. The literature review first identified the cognitive and psycho-affective functions which mainly influence the day-to-day life adaptation of individuals engaged in a PSR/deinstitutionalization program. The systematic review then gathered all of the useable French validated tools to assess the initially selected dimensions (n = 87). To finish, for each dimension, the selected 87 tools were included in a clinical assessment study performed within a French psychiatric hospital. The authors collected and verified the characteristics of each tool (validity, French norms, French version, the average speed of the test, ease of use, ability to assess other dimensions). Their suitability was also assessed when applied to IDSPMI. Based on this final clinical evaluation, the authors selected one tool per function to create the French Integrative Psychosocial Rehabilitation Assessment for Complex Situations (FIPRACS). This battery is an assessment tailored to the neurocognitive and psycho-affective potentials of IDSPMI. While further validation studies of this battery are ultimately required, the practical/clinical implications of this battery are presented and discussed.

Psychosocial protective factors and suicidal ideation: Results from a national longitudinal study of veterans

BackgroundThis study investigates the empirical association between psychosocial protective factors and subsequent suicidal ideation in veterans. MethodsWe conducted a national longitudinal survey in which participants were randomly drawn from over one million U.S. military service members who served after September 11, 2001. Data were provided by a total of 1090 veterans representative of all 50 states and all military branches in two waves of data collection one year apart (79% retention rate). ResultsIn chi-square analyses, psychosocial protective factors at wave 1 (employment, meeting basic needs, self-care, living stability, social support, spirituality, resilience, and self-determination) were significantly related to lower suicidal ideation at wave 2. In multivariable analyses controlling for covariates at wave 1 including suicidal ideation, the total number of protective factors endorsed at wave 1 significantly predicted reduced odds of suicidal ideation at wave 2. In multivariable analysis examining individual risk and protective factors, again controlling for covariates, results showed that money to cover basic needs and higher psychological resilience at wave 1 were associated with significantly lower odds of suicidal ideation at wave 2. LimitationsThe study measured the link between psychosocial protective factors and suicidal ideation but not suicide attempts, which would be an important next step for this research. ConclusionsThe results indicate that psychosocial rehabilitation and holistic approaches targeting financial well-being, homelessness, resilience, self-care, social support, spirituality, and work may offer a promising avenue in both veteran and non-veteran populations for treatment safety planning as well as suicide risk management and prevention.

Deinstitutionalization and psychosocial rehabilitation

IntroductionBarbacena is a Brazilian city with 140,000 inhabitants, which was known as the “city of madmen” because of the excessive number of patients in psychiatric hospitals. In 2000 it began a deinstitutionalization process, and the patients were transferred to assisted residential services.ObjectiveDescribe the process of deinstitutionalization and social rehabilitation of psychiatric patients.MethodologyThe following characteristics were studied: sex, age, medication use, psychiatric diagnosis and the development of social skills.ResultsIn each therapeutic residence (RT) lives eight patients, supervised by upper and mid-level professionals. Since the implementation of RTs about 400 patients leave the psychiatric hospitals. Most had mental retardation (51.0%), followed by schizophrenia (31.0%). More than half (58.5%) were men. The age ranged from 29 to 97 years, with a average of 64.8 ± 12.4. A decrease in the average dose of neuroleptics was seen after deinstitutionalization. Direct observation of patients in the RT, and the reporting of caregivers has shown that patients have developed wide range of social performance, such as dating, started at professional courses, attending exercise classes, travelling and learn how to use money.ConclusionIn despite of difficulties in the psychiatric reform process, the community-based treatment and psychosocial rehabilitation approach are the principal models of psychiatric care presently, and the residential services play an important role in this process. The authors emphasize the importance of community support, professional staff and rehabilitation programs as a condition for good outcomes.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Qualitative participatory evaluation of a psychosocial rehabilitation program for individuals with severe mental illness

ABSTRACTClubhouse International is a nonprofit organization that supports the creation of community-based clubhouses around the world. Using a psychosocial rehabilitation approach, clubhouses provide individuals living with mental illness opportunities to successfully live and work in their communities through a variety of programs including employment opportunities, housing support, case management, and social programs. Progress Place, an accredited clubhouse located in Toronto, Ontario, Canada, partnered with evaluators to better understand their psychosocial rehabilitation approach for individuals with severe mental illness. The purpose of the present study was to undertake a participatory evaluation in order to identify mechanisms of change and recovery outcomes that occur for clubhouse members at Progress Place. In the first phase, six focus groups with staff, members, and board members, were conducted. In the second phase, 11 semistructured group interviews were used to confirm and provide feedback on the mechanisms and outcomes that were found. Analysis of responses revealed specific mechanisms (e.g., elevated sense of respect, autonomy, and purpose) and recovery outcomes (e.g., personhood, feeling at peace, acquiring skills) that occur for clubhouse members. Participants reported that themes accurately represented their experience and felt understood by the evaluators. The present study fills a gap in the psychosocial rehabilitation literature by identifying mechanisms of change that lead to recovery outcomes for members who utilize these programs. This study also provides clear direction for future research examining the breadth of outcomes and change mechanisms.

Effectiveness and cost-effectiveness of a self-management training for patients with chronic and treatment resistant anxiety or depressive disorders: design of a multicenter randomized controlled trial.

BackgroundMany patients with anxiety or depressive disorders achieve no remission of their symptoms after evidence-based treatment algorithms. They develop a chronic course of the disorder. Current care for these patients usually consists of long-term supportive contacts with a community psychiatric nurse and pharmacological management by a psychiatrist. Data on the effectiveness of these treatments is lacking. A psychosocial rehabilitation approach, where self-management is an increasingly important part, could be more suitable. It focuses on the restoration of functioning and enhancement of patients’ autonomy and responsibility. Treatment with this focus, followed by referral to primary care, may be more (cost-)effective.MethodsA multicenter randomized controlled trial is designed for twelve participating specialized outpatient mental health services in the Netherlands. Patients with chronic and treatment resistant anxiety or depressive disorders, currently receiving supportive care in specialized outpatient mental health care, are asked to participate. After inclusion, patients receive the baseline questionnaire and are randomized to the intervention group or the usual care control group. The intervention focuses on rehabilitation and self-management and is provided by a trained community psychiatric nurse, followed by referral to primary care. Measurements take place at 6, 12, and 18 months after baseline. This study evaluates both the effectiveness (on quality of life, symptom severity, and empowerment), and cost-effectiveness of the intervention compared to usual care. In addition, a questionnaire is designed to get insight in which self-management strategies patients use to manage their disorder, and in the experiences of patients with the change of care setting.DiscussionIn this study we evaluate the effectiveness and cost-effectiveness of a self-management intervention for patients with chronic and treatment resistant anxiety or depressive disorders in specialized outpatient mental health care. The results of this study may provide a first ‘proof-of-concept’ in this under-researched but important field, and might be relevant for a large group of patients in the context of a transition of the Dutch health care system.Trial registrationNetherlands Trial Register: NTR3335, registered 7 March 2012.

Şizofreni tanısı ile izlenen bir olgunun işlevselliğinin artırılmasında bireysel danışmanlığın rolü

The role of individual assessment on increasing the functionality of a person with schizophrenia Schizophrenia is a chronic disease that often reduces quality of life and functionality by causing disabilities in many areas like interpersonal relationships and social communication. Solely medical treatment is inadequate to prevent symptoms and recurrences that impairs quality of life. Therefore psycho-social rehabilitation approach which is important for continuousness of recovery, reducing disability and increasing treatment compliance and quality of life should be integrated with pharmacological treatment. In this case report, we present a schizophrenia patient and her rehabilitation process who gains skills for living independently after rehabilitation program as a result of decreasing frequency of relapses and

A psychosocial rehabilitation approach for a case of persistent urogenital sinus with ambiguous genitalia in a female adult

Objective: Urogenital Sinus is a rare congenital deformity which overture to preclude of normal embryonic vaginal progression. We report a case of urogenital sinus with ambiguous genitalia in a female adult. Case Report: An unmarried young female aged 26 years presented to our hospital with amenorrhea of 6 months and history of urinary incontinence from childhood. The diagnostic features of this case include normal haemogram with mildly elevated blood urea and creatinine, normal 17 ketosteroids, serum testosterone and DHEA; bilateral moderate hydronephrosis with uterus of size 6.8 x 4.6 x 5.3 cm; urogenital sinus with partial separation of bladder and vagina-vaginal type; bilateral hydrouretronephrosis with mild renal cortical scarring and bicornuate unicollis uterus cervix opening into the urogenital sinus. She was diagnosed with persistent urogenital sinus (Vaginal type) without congenital adrenal hyperplasia, but with associated mullerian anomaly. Treatment option was a U-shaped vaginoplasty with an aim of widening vaginal introitus and advancement of hypospadiac external urethral meatus to prevent micturition into vagina. Conclusion: Though the possible treatment options were discussed, this case study emphasizes the need of psycho social rehabilitation for the proper treatment of ambiguous genitalia. DOI: http://dx.doi.org/10.3126/ajms.v6i4.10107 Asian Journal of Medical Sciences Vol.6(4) 2015 89-91

Cognitive Remediation for Schizophrenia: A Review of Recent Findings

Schizophrenia and related psychotic disorders are characterized by deficits in neurocognition. Deficits in domains such as attention, memory, executive functions, and speed of processing, as well as early perceptual processes, typically appear early in the course of the disorder and remain stable over time. Cognitive deficits can cause serious impairments in community functioning (i.e., work, independent living, and social relationships). For this reason, cognitive remediation (CR) is increasingly utilized to improve neurocognition. The empirical support for CR for adults with chronic schizophrenia is encouraging and growing. CR approaches are suitable for widespread dissemination and have been the focus of the majority of recent empirical research in psychoses. There are two broad categories of computerized CR approaches: those that target higher-level cognitive processes, and those that target neuroplasticity using basic auditory and visual processing. Research currently supports the efficacy of both higher-level and neuroplasticity-based CR for improving targeted cognitive domains; however, there is more consistent support for higher-level approaches in terms of generalization to untrained cognitive domains and functional outcomes. To achieve functional outcomes, CR combined with skills training or other psychosocial rehabilitation approaches is likely the most effective approach. The majority of CR interventions allow difficulty to be individually adjusted, which is an important therapeutic feature, and some provide an array of modules to allow personalized interventions. Several CR interventions appear to have durable treatment benefits, but more research is needed to clarify whether booster sessions, pharmacological augmentation, or other treatments should routinely be incorporated into treatment plans.

Protective Factors and Risk Modification of Violence in Iraq and Afghanistan War Veterans

After returning home, a subset of Iraq and Afghanistan War veterans report engaging in aggression toward others. This study is the first to identify variables empirically related to decreased risk of community violence among veterans. The authors conducted a national survey from July 2009 to April 2010 in which participants were randomly drawn from over 1 million US military service members who served after September 11, 2001. Data were collected from a total of 1,388 Iraq and Afghanistan War era and theater veterans. The final sample included veterans from all 50 states and all military branches. One-third of survey respondents self-identified committing an act of aggression toward others during the past year, mostly involving minor aggressive behavior. Younger age, criminal arrest record, combat exposure, probable posttraumatic stress disorder, and alcohol misuse were positively related to violence toward others. Controlling for these covariates, multivariate analyses showed that stable living situation and the perception of having control over one's life were associated with reduced odds of severe violence (R2 = 0.24, χ27 = 145.03, P < .0001). Greater resilience, perceiving positive social support, and having money to cover basic needs were linked to reduced odds of other physical aggression (R2 = 0.20, χ28 = 188.27, P < .0001). The study identifies aggression as a problem for a subset of Iraq and Afghanistan War veterans who endorsed few protective factors. Analyses revealed that protective factors added incremental value to statistical modeling of violence, even when controlling for robust risk factors. The data indicate that, in addition to clinical interventions directed at treating mental health and substance abuse problems, psychosocial rehabilitation approaches aimed at improving domains of basic functioning and psychological well-being may also be effective in modifying risk and reducing violence among veterans.

Stigma Shrinks my Bubble: A Qualitative Study of Understandings and Experiences of Stigma and Bipolar Disorder

Purpose: This study contributes to the stigma and bipolar disorder literature focused on understanding structural, social, and self-stigma experiences from the perspectives of individuals living with bipolar disorder and their family members. Methods: Community-based participatory research (CBPR) principles guided our engagement of individuals with bipolar disorder and community partners in the initiation, development, implementation, and reporting of this study. We collected data through focus groups with individuals living with bipolar disorder (3 groups) and family members (2 groups) during an annual bipolar disorder community engagement event. Thematic analysis was conducted as an iterative process and aided by several research team meetings. Results: Three core themes emerged: (1) explicit and implicit exclusionary practices linked to structural stigma; (2) social stigma (e.g., If my child had leukemia you would all be bringing me lasagna) and; (3) the burden of self-stigma (e.g., What’s wrong with me?) . These findings address issues arising in work, school, social, and health care settings that shape stigma phenomena. Conclusion: Parallels between the present findings and stigma experiences regarding other types of mental illnesses suggest considerable overlap. Individuals with bipolar disorder expressed hope for change that included (a) working with health care professionals who use a psychosocial rehabilitation approach and (b) implementing personal strategies for unloading the burden of self-stigma in their lives. Implications: The conceptualization of stigma as self, social and structural resonated well with the experiences and understandings of study participants. This conceptualization offers a bridge for communication between people with bipolar disorder, their families and health care practitioners and may be a useful framework for guiding efforts to reduce stigma. CBPR principles and lived experiences are crucial elements in stigma reduction endeavors.

W04-01 - Psychosocial functioning - relationship to ICF

Schizophrenia and other serious mental illnesses (SMI) are most accurately conceptualized as chronic conditions, in which pattern of functioning rather than diagnosis is often most important in determining what services are needed at any given time. People with SMI have lost the ability to carry out daily tasks, live independently, work, have interpersonal relationships, and engage in leisure pursuits. Much of the focus of treatment is based on needs assessment in these areas rather than on the diagnostic category. To demonstrate how WHO's International Classification of Functioning Disability and Health (ICF) can provide a framework for treatment planning, defining goals, assessing progress and outcomes, and allocating resources for people with SMI. To analyze the ability of the ICF to reflect the functional problems, treatment goals and outcomes of major psychosocial rehabilitation approaches for people with schizophrenia and other forms of SMI. Extended clinical examples will be provided to illustrate the potential application of the ICF in this context. The goals and outcomes of psychosocial rehabilitation approaches including training related to social skills, independent living skills, occupational skills, and illness/wellness management and other approaches such as family-based treatment, neurocognitive therapy, and environmental engineering are a good fit with the conceptual structure, content and descriptive, individualized nature of the ICF. The ICF provides an internationally recognized basis for the specification of treatment goals, evaluation parameters, and health care outcomes, including specific characteristics of mental disorders and broader functional issues likely to be treatment's most important goals.

Recovery From Schizophrenia: With Views of Psychiatrists, Psychologists, and Others Diagnosed With This Disorder

As the concept of schizophrenia began to develop over a century ago, it was accompanied by little hope of recovery. As the second half of the 20th century began, new treatments and changing social conditions resulted in most long-term patients being discharged into the community. Many of these expatients showed more improvement than had been expected. Treatment approaches evolved to help these persons live better lives in the community. In the recent past, psychosocial and psychiatric rehabilitation approaches to treatment have increasingly incorporated perspectives of persons in recovery. These perspectives are explored with emphasis on how they have helped drive federal government and other perspectives on recovery. Particular attention is given to the varying views of psychiatrists, psychologists, and other highly trained persons who have themselves been diagnosed and treated for schizophrenia.

Reforma psiquiátrica e serviços residenciais terapêuticos

OBJETIVO: Apresentar os principais aspectos da reforma psiquiátrica ocorrida em diversos países e no Brasil, destacar a política de reinserção social dos pacientes e descrever os procedimentos da desospitalização ocorridos em Barbacena, Minas Gerais, com ênfase nas residências terapêuticas e nas intervenções de reabilitação psicossocial. MÉTODO: Pesquisa bibliográfica realizada nas fontes eletrônicas Medline e Lilacs (1990 a 2006), com os seguintes descritores: deinstitutionalization, psychiatric reform, community-based treatment, psychosocial rehabilitation. Descrição do processo de implantação das residências terapêuticas (RT) por meio de consulta aos documentos da Prefeitura de Barbacena e de observação direta das residências. RESULTADOS: A maioria dos trabalhos selecionados indicou que pacientes desospitalizados apresentam melhora na autonomia, na interação social, no nível global de funcionamento e na qualidade de vida. A desospitalização implica a existência de serviços comunitários com diversos níveis de atenção e requer a presença de profissionais qualificados e programas de reabilitação efetivos. Em Barbacena, o processo de desospitalização teve início em 2000. Atualmente existem 24 RTs no município. CONCLUSÃO: Apesar das dificuldades na sua implantação, os tratamentos de base comunitária tornaram-se o modelo dominante de cuidados psiquiátricos. Para os pacientes desospitalizados, as RTs têm importante papel no processo de reinserção social.

Treating learned helplessness in the elderly dementia patient: preliminary inquiry.

Learned helplessness is the psychological state that results when an individual who is unable to exercise reasonable mastery in one situation incorrectly assumes that he or she is then unable to exercise reasonable control in other situations as well. This may complicate the delivery of health interventions since the individual with learned helplessness may assume that no care provider or treatment intervention can be of assistance. Elderly patients with Alzheimer's disease and other dementias are not immune to this stance of learned helplessness. This paper presents one possible psychosocial rehabilitation approach, the Project SMART (Stress Management and Relaxation Training) program, to the problem of learned helplessness. Based on the skills of adaptive stress-resistant problem solvers, Project SMART can be adapted to the needs of the elderly demented. The clinical and research implications are discussed.

The House of Bethel and Consumer-Run Businesses: An Innovative Approach to Psychiatric Rehabilitation

This article reports on a psychosocial rehabilitation approach which is used by Bethel House in Urakawa, a town in the Hidaka district of northern Japan. This approach is unique in that its primary focus is community development, as opposed to therapeutic work. By starting its own businesses, the Bethel community has: (a) created many employment opportunities for people with mental illness and for members of the larger community; (b) brought about important changes in the attitudes of members of the community, and the hospital staff, towards the mentally ill; (c) improved the relationships among members of Bethel and the Urakawa community; and (d) significantly enhanced the town economy. Bethel success clearly illustrates a broader potential for creative approaches to psychosocial rehabilitation and community development.

Gold award: A community-based program providing a successful alternative to acute psychiatric hospitalization.

Gold award: A community-based program providing a successful alternative to acute psychiatric hospitalization.

Outcomes of four treatment approaches in community residential programs for patients with substance use disorders.

Treatment approaches used in community residential facilities for patients with substance use disorders were identified, and patients' participation in treatment and case-mix-adjusted one-year outcomes for substance use, symptoms, and functioning in facilities with different treatment approaches were examined. A total of 2,376 patients with substance use disorders treated in a representative sample of 88 community residential facilities were assessed at entry to and discharge from the facility and at one-year follow-up. The community residential facilities were classified into four types based on the major emphasis of the treatment program: therapeutic community, psychosocial rehabilitation, 12-step, and undifferentiated. Patients in programs that used the therapeutic community, psychosocial rehabilitation, and 12-step approaches had comparable one-year outcomes in symptoms and functioning that were better than those of patients in undifferentiated programs. A more directed treatment orientation, a longer episode of care, and completion of care were independently related to better one-year outcomes. These findings held for patients with only substance use disorders and for patients with both substance use and psychiatric disorders. Community residential programs that have a more directed treatment orientation and that motivate patients to complete treatment have better substance use outcomes. As an increasingly important locus of specialized care, community residential facilities need to develop and maintain more differentiated and distinctive treatment orientations.

Psychosocial rehabilitation nurses: taking our place on the multidisciplinary team.

Nurses have been working in the AMI/ABLE ISA for the past 6 years as part of a multidisciplinary team. The nursing contribution is important to the Team, not only because of nursing expertise in providing psychiatric mental health care, but also because nurses can provide services unique to nursing, such as health assessments and education, and medication support (Fur-long-Norman, Palmer-Erbs, & Jonikas, 1997). More than 80 people who are disabled by mental illnesses have been served by this innovative program since 1991, and members' hospitalization rates have been cut approximately in half by integrating services and reducing fragmentation, and by using aggressive outreach and a psychosocial rehabilitation approach. Psychosocial rehabilitation nursing has become a subspecialty that has expanded the profession. Experience in the AMI/ABLE program demonstrates that nurses, as fully integrated members of multidisciplinary teams, adapt to working in partnerships with clients and their families, in nontraditional settings.