Community-Based Psychosocial Rehabilitation and Prospective Change in Functional, Clinical, and Subjective Experience Variables in Schizophrenia (original) (raw)
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2021
Background: Schizophrenia is a chronic mental illness that results in significant disability. Many patients have difficulties in self-care, communication, and employment. The study assessed the effectiveness of a psychiatric rehabilitation program in reducing disability and improving quality of life (QOL) in patients with schizophrenia residing in long-stay homes. Methods: Forty-two patients with schizophrenia who were inmates of two long-stay homes were the subjects. A rehabilitation program consisting of training in activities of daily living, social skills, medication self-adherence, cognitive training, and psychoeducation was imparted for 6 months. Pre-and post-intervention evaluations were done using IDEAS and WHOQOL-BREF. Wilcoxon signed-rank test was used to assess the significance of the change in outcomes. Results: Scores in self-care, interpersonal activities, communication, and work domain of IDEAS showed a significant reduction with large effect sizes. Domains one, two, and four of WHOQOL-BREF also showed significant improvements with medium to large effect sizes. Conclusion: The rehabilitation program reduces disability and improves the QOL in patients with chronic schizophrenia. Our model of rehabilitation is inexpensive and can be delivered by lay health workers under supervision.
Predictors of Participation in Community Outpatient Psychosocial Rehabilitation in Schizophrenia
Community Mental Health Journal, 2011
This study investigated demographic, clinical and neurocognitive factors predicting drop-out from an intensive, community outpatient psychosocial rehabilitation program for people with schizophrenia or schizoaffective disorder. One-hundred and twenty-seven outpatients with DSM-IV schizophrenia or schizoaffective disorder participated. Demographic variables of age, sex, education and race/ethnicity were recorded and formal symptom measures and a neurocognitive assessment consisting of measures of crystallized verbal ability, sustained visual vigilance, verbal learning, verbal fluency and problem-solving were administered at study entry. Thirty-seven percent of the sample dropped-out of the program. In a final multivariate model, younger age, and lower verbal fluency scores in clients with a history of a high number of hospitalizations predicted a greater likelihood of drop-out. The implications of these findings are discussed.
Psychological Medicine, 2009
Background. This study examined the magnitude of neurocognitive change during 1 year of community-based psychosocial intervention, whether neurocognitive change and functional change were linked, and how neurocognitive change combined with service intensity to facilitate functional change. Method. A total of 130 individuals diagnosed with schizophrenia were recruited upon admission to four community-based psychosocial rehabilitation programs. Subjects were assessed at baseline, 6 and 12 months on role functioning and symptom measures. Neurocognition was measured at baseline and 12 months. Service intensity was the number of days of treatment attendance during the study period. Latent mean difference tests and Latent Growth Curve Models (LCGMs) were used to examine the study hypotheses. Results. There was statistically and clinically significant functional improvement over 12 months. Neurocognition improved significantly over time. Seventy-six (58 %) of the sample showed neurocognitive improvement and 54 (42 %) did not. There was a significant rate of functional enhancement in the neurocognitive improver group. There was a non-significant rate of functional change in the neurocognitive non-improver group. Neurocognitive improvers showed functional improvement that was 350 % greater than neurocognitive non-improvers. Service intensity did not vary between neurocognitive improvers and non-improvers but there was a strong interaction between neurocognitive improvement, service intensity and rate of functional improvement such that service intensity was strongly related to functional improvement for neurocognitive improvers but not for neurocognitive non-improvers. Medication usage and symptomatology did not confound these findings. Conclusions. These findings suggest that neurocognitive improvement may be a foundation for functional change and treatment responsiveness during community-based psychosocial rehabilitation for individuals with schizophrenia.
Social Psychiatry and Psychiatric Epidemiology, 1999
Background: Outpatient-based treatments for patients suering from chronic schizophrenia inadvertently exclude a signi®cant proportion of subjects because they are often too poorly motivated to attend for treatment. In addition there are also concerns about whether the skills that are learnt in a hospital setting will generalise to situations when the individuals are at home. This study attempted to redress some of these potential de®ciencies and followed on from an earlier local study which found that a community-based team met more of the needs of patients suering from chronic schizophrenia. Method: Seventy-®ve patients suering from chronic schizophrenia were allocated randomly to receive traditional outpatient-based or home-based rehabilitation from a clinical psychologist and an occupational therapist. They were assessed before and after 9 months of treatment on a range of clinical, social and quality of life outcomes. Distress to carers was also assessed. Readmission to hospital was recorded for each subject. Results: There were signi®cant reductions in socially embarrassing behaviour (SBS), increases in interpersonal functioning and recreational activities and a trend for quality of life to improve in the home-based group. There were fewer admissions in the home-based group but the dierences, although ®nancially substantial, were not statistically signi®cant. Conclusions: The home-based rehabilitation service was well received by the majority of patients suering from chronic schizophrenia and led to some improvement in social behaviour, interpersonal functioning, recreational activities and quality of life.
A Preliminary Study of Rehabilitation Needs of In-patients and Out-patients with Schizophrenia
Indian journal of psychiatry, 2004
Assessment of needs of patients with schizophrenia permits practitioners to prioritize, formulate and implement rehabilitation goals. Negative symptoms have been shown to present greater obstacles to effective rehabilitation. The study compared the rehabilitation needs of in and out-patients with schizophrenia, and its relationship with negative symptoms. Thirty each of out patients and short term in-patients who fulfilled DSM-IV criteria for schizophrenia were recruited for the study. Patients currently exhibiting severe unmanageable psychoses and depression were excluded. Tools used for the study were DSM-IV-TR, Rehabilitation Needs Assessment Schedule, SANS, HDRS, BPRS, and UKU. Significant difference across the groups were observed as far as needs regarding requirement of help from a voluntary agency, employment, accommodation, leisure activities and help for family was concerned. Moreover, negative symptoms significantly correlated with rehabilitation needs among both groups of patients. The study also elicited family's expectations of their patients regarding their rehabilitation needs. Further, the implications of the association between some negative symptoms and the felt needs of the patients in their rehabilitation were discussed. A full spectrum of functional behaviours needs to be assessed soon after patients recover from their most recent exacerbation and suitable interventions need to be planned.
Disability and Rehabilitation , 2018
Purpose: With appropriate mental health rehabilitation, schizophrenia is increasingly associated with reports of recovery and stability. However, there is little empirical evidence evaluating the efficacy of services delivering this care. This study evaluated the effectiveness of rehabilitation for improving psychosocial function in consumers with schizophrenia. Methods: An electronic database of standardized assessment instruments mandated and maintained by the health service was retrospectively reviewed to extract ratings of psychosocial function, daily living skills, and mood state from consecutive admissions to an inpatient rehabilitation service. Outcomes were compared at admission, discharge, and one-year follow-up to identify statistically significant change. Individual reliable and clinically significant change was also assessed by comparison with a normative group of clients functioning independently in the community. Results: From admission to discharge the rehabilitation group made statistically significant gains in psychosocial function and daily living skills. Improvements were reliable and clinically significant in one-quarter to one-third of individual consumers. Approximately half sustained their improvements at follow-up, although this represented only a small fraction of the overall cohort. Consumers not demonstrating gains exhibited psychometric floor effects at admission. Conclusions: Rehabilitation can produce statistically and clinically significant immediate improvement in psychosocial function for a sub-set of consumers with elevated scores at admission. The durability of any gains is less clear, and strategies promoting longer-term maintenance are encouraged. Furthermore, currently mandated outcome measures are confounded by issues of sensitivity and reporting compliance, and exploration of alternative instruments for assessing recovery is recommended.
Community mental health journal, 2002
The effectiveness of a rehabilitation intervention (Boston University Model) was investigated in a one-year prospective naturalistic study among 35 clients with mainly psychotic or affective disorders and dependent on mental health care with at least one hospital admission in the past five years. Rehabilitation was successful in goal-attainment after 1 year (46% fully, 34% partly). Although rehabilitation did not make clients less dependent upon care, it decreased the number of needs and had a positive effect on the match between care needed and care provided. No evidence was found for a significant effect of rehabilitation clients' quality of life and functioning, although social functioning became more in line with the seriousness of psychiatric impairment.
Psychiatry and Clinical Neurosciences, 2017
Aim: Recovery, or functional remission, represents the ultimate treatment goal in schizophrenia. Despite its importance, a standardized definition of remission is still lacking, thus reported rates significantly vary across studies. Moreover, the effects of rehabilitative interventions on recovery have not been thoroughly investigated. This study aimed to evaluate recovery in a sample of patients with chronic schizophrenia engaged in rehabilitation programs and to explore contributing factors, with a focus on sociocognitive rehabilitative interventions. Methods: Data from 104 patients with schizophrenia treated either with a standard rehabilitation program, including cognitive remediation (n = 46), or the latter plus a specific sociocognitive intervention (n = 58), and assessed for psychopathology, cognition, social cognition, and Quality of Life Scale, were retrospectively analyzed for this study. Results: Recovery, evaluated with the Quality of Life Scale, was achieved by 56.76% of patients in our sample. While no effects were observed for clinical, cognitive, or sociocognitive variables, participation in the sociocognitive rehabilitative interventions was positively associated with recovery. Conclusion: Our results indicate that high rates of recovery can be achieved in patients treated with psychosocial interventions and suggest that rehabilitative programs targeting social cognition may further facilitate the process of recovery. If confirmed, these results may have relevant implications for daily clinical practice and service provision, allowing clinicians to develop and optimize specific rehabilitation programs in order to promote recovery.
Schizophrenia Bulletin, 2007
The purpose of this study was to assess how neurocognition and social cognition were associated with initial functional level and with rates of functional change in intensive community-based psychosocial rehabilitation interventions that have been shown to yield significant functional change for individuals diagnosed with schizophrenia. We also examined how service intensity was associated with rates of change and whether it served as a moderator of the relationship between functional change and both neurocognition and social cognition. The sample consisted of 125 individuals diagnosed with schizophrenia or schizoaffective disorder who were recruited upon admission to 1 of 4 community-based psychosocial rehabilitation facilities and were followed prospectively for 12 months. One hundred and two subjects completed the 12-month protocol. The findings suggested that (i) the initial level of psychosocial functioning was related to both social cognition and neurocognition at baseline, (ii) when significant rehabilitative change occurs, higher neurocognition and social cognition scores at baseline predicted higher rates of functional change over the subsequent 12 months, (iii) greater service intensity was related to higher rates of improvement in functional outcome over time, and (iv) service intensity moderated the relationship between neurocognition and initial functional level and moderated the relationship between social cognition and the rates of functional change at a trend level. These findings have relevance to our understanding of the heterogeneity in functional rehabilitative outcomes, to our understanding of the conditions of rehabilitative change and for the design of psychosocial interventions in the community.