Psychosocial Rehabilitation, Disability, and Quality of Life in Patients with Schizophrenia Residing in Long-Stay Homes Original Article (original) (raw)
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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.
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.
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.
Schizophrenia Bulletin, 2000
In a previous study, we found that the intensity, specificity, and longitudinality of community-based psychosocial rehabilitation services were related to superior functional outcomes for individuals diagnosed with schizophrenia. The purpose of this study was to assess the degree to which the intensity and longitudinality of services were related to improvements in subjective experience and clinical outcomes, and to examine the relationships among prospective changes in functional, clinical, and subjective experience variables. One hundred seventy-two individuals diagnosed with a schizophrenia spectrum disorder were followed for 36 months in three distinct models of community-based care. Functional, clinical, and subjective experience outcome data were gathered every 6 months over a 3-year period. Data were analyzed using hierarchical linear modeling (HLM) and P-technique factor analysis. The results indicated that (1) greater service intensity and the longitudinality of services were associated with improvement in client selfesteem; (2) there was evidence for three distinct factors of prospective rehabilitative change that corresponded to the conceptual domains of clinical, functional, and subjective experience outcomes; and (3) there was no differential program impact on symptom levels or the intrapsychic deficits. In addition, the three-factor model of outcome consisting of functional change, clinical change, and subjective experience change was similar to Strauss and Carpenter's "open-linked" system of outcome in schizophrenia. The implications of these findings for research and practice in the area of community-based rehabilitation for individuals with schizophrenia are discussed.
International Journal of Child Development and Mental Health, 2018
This research and development study aimed to develop and test the effectiveness of an integrative cognitive rehabilitation program for persons with schizophrenia. The study consisted of four main steps. The first step was situation analysis of cognitive impairment and treatment for persons with schizophrenia. Relevant documents and focus group interviews with schizophrenic patients, caregivers, healthcare providers and experts were collected for the content analysis. These findings were used to establish a first draft program in the second step. Content validity was tested, with an Index of Item-Objective Congruence of 0.77. The second draft program was developed by adjusting the first draft, and then was pilot tested and adjusted again to become the third draft. In the third step, the third draft was tested for its effectiveness on cognition, attention, memory, executive functions, and personal and social performance in 32 persons with schizophrenia. Outcome measures were the Montr...
Disability and Rehabilitation Needs of Persons with Schizophrenia
Indian Journal of Psychiatric Social Work, 2018
Schizophrenia is one of the most severe mental illnesses [1] which affect one per cent of the general population. It imposes significant disability which has a measurable impact on many aspects of a person's life. Disability is the disadvantage or restriction of activity caused by a society which takes little or no account of people who have impairments and thus excludes them from [2] mainstream activities. A person with schizophrenia (PWS) experiences deficits in a variety of functional domains of everyday life. People with milder forms of schizophrenia are able to work and live independently. Unfortunately a large percentage of PWS experience severe to moderate symptoms which can be helped with medical treatment [3] partially only. Lifelong disability of varying degrees can significantly affect both persons with schizophrenia [3] and their families. Severe disability is the result of both ORIGINAL RESEARCH PAPER
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.
Journal of Psychosocial Rehabilitation and Mental Health, 2018
Schizophrenia causes significant cognitive deficits, negative symptoms and functional impairment. These symptoms persist in certain patients in spite of evidence based pharmacological treatment. Many of these patients remain confined in welfare homes run by government or non-governmental organisations. Intervention modules to improve the condition of patients in these homes are scarce in India. We designed an activity based group intervention and assessed its effectiveness in patients with chronic schizophrenia in a welfare home. Participants were patients with chronic schizophrenia who were inmates of a welfare home for persons with mental illness. All of the subjects underwent evaluations that assessed clinical symptoms and functional outcomes at baseline and after 6 months. The evaluation was done using PANSS and RTI-E. The intervention was multimodal. The patients showed significant improvement in negative symptoms (effect size r =-0.39). They showed improvement in activities of daily living (r = 0.88), communication (r =-0.82) and instrumental activities of daily living (r =-0.59). The current intervention resulted in reducing negative symptoms and improving functional outcome in patients with schizophrenia. These findings advocate the integration of rehabilitation programs into the standard treatment protocol for schizophrenia in welfare homes.