Experiencias de usuarios y familiares sobre la atención recibida en centros de salud mental comunitaria de Lima y Callao durante la pandemia de la COVID-19 / Experiences of users and family members on the care received at community mental health centers in Lima and Callao during the COVID-19 pandemic

Objetivos. Comprender las experiencias de usuarios nuevos y continuadores de los Centros de Salud Mental Comunitaria (CSMC) de Lima y Callao, y de sus familiares, en relación a la atención en salud mental que recibieron durante la pandemia de la COVID-19. Materiales y métodos. Estudio cualitativo realizado entre septiembre del 2021 y febrero del 2022, en el que se entrevistó a 24 usuarios y familiares que interactuaron con los servicios brindados por tres CSMC de Lima y uno del Callao, durante la pandemia de la COVID-19. Se realizó un análisis temático de las entrevistas transcritas. Resultados. Los informantes percibieron que la pandemia exacerbó los síntomas de las personas con problemas de salud mental. Durante la pandemia, las atenciones de salud mental se apoyaron en el uso de tecnología, principalmente de llamadas telefónicas, las que sirvieron para monitorear el estado emocional y el tratamiento farmacológico de los usuarios, así como para programar y recordar citas. Los usuarios destacan que las llamadas telefónicas frecuentes les hicieron sentirse acompañados y resaltan el compromiso de los trabajadores de los CSMC. Como dificultades, reportan el incremento en la demanda de atención, problemas para acceder a videollamadas, y menor calidad en las atenciones virtuales. Conclusiones. La COVID-19 impactó emocionalmente a las personas con problemas de salud mental, a su vez, los servicios de los CSMC vieron afectada la modalidad (presencial o virtual), recursos, frecuencia, tiempo y calidad de la atención, encontrando limitaciones y beneficios en el uso de la tecnología.

Objective. To understand the experiences of new and continuing users of Community Mental Health Centers (CMHC) of Lima and Callao, and their relatives, regarding the mental health care they received during the COVID-19 pandemic. Materials and methods. Qualitative study conducted between September 2021 and February 2022, in which we interviewed 24 users and family members who interacted with the services provided by three CMHCs in Lima and one in Callao during the COVID-19 pandemic. We carried out a thematic analysis of the transcribed interviews. Results. Participants perceived that the pandemic exacerbated the symptoms of people with mental health problems. During the pandemic, mental health care relied on the use of technology, mainly telephone calls, which were used to monitor the emotional state and pharmacological treatment of users, as well as to schedule and remember appointments. The users emphasized that frequent telephone calls made them feel accompanied and highlighted the commitment of the CMHC workers. Among the difficulties, they reported an increase in the demand for care, problems in accessing video calls, and low quality in virtual care. Conclusions. COVID-19 had an emotional impact on people with mental health problems; in turn, CMHC services were affected by the type of care (face-to-face or virtual), resources, frequency, time and quality of care, finding limitations and benefits in the use of technology.

The Effectiveness on Prevention of Rehospitalization with Long-Term Psychosocial Interventions for Patients with Major Psychiatric Disorders / 대한정신분열병학회지

OBJECTIVES: This study aimed to elucidate the effectiveness of long-term psychosocial intervention in reducing the disabling period of patients with major psychiatric disorders by their rehospitalization rate. METHODS: Of the 210 patients with major psychiatric disorders received psychosocial interventions in a Mental Health and Welfare Center, 192 patients (147 with schizophrenia spectrum disorders, 45 with mood disorders) who received interventions more than 6 months were selected. Review of case management records was conducted to obtain information. RESULTS: The number and length of hospitalization and the hospital days per year significantly decreased after psychosocial intervention. Additional analysis of 102 patients followed up for more than 5 years suggested that the effectiveness of the intervention persisted for a sufficient period. However, no significant difference was observed in the number of rehospitalization in 45 patients with mood disorders, though the length of hospitalization significantly decreased. In addition, the hospital days per year of 21 patients with mood disorder followed up for more than 5 years also showed no significant decrease. CONCLUSION: Long-term psychosocial intervention had a significant effect on reducing the number and length of hospitalization for patients with major psychiatric disorder and the effectiveness maintained for more than 5 years.

Psychosocial Intervention for Patients with Schizophrenia / 신경정신의학

Treatment of schizophrenia has as its ultimate goals, the functional recovery of the patients and improvement of their quality of life. While antipsychotic medication is the fundamental method for treating schizophrenia, it has certain limitations in terms of treating the illness beyond its positive symptoms. Therefore, psychosocial intervention should be used in tandem with pharmacological methods in treating schizophrenia. The efficacy of several modes of psychosocial intervention for improving outcomes in schizophrenia is well attested. Approximately 10 modes of psychosocial intervention have been recommended based on existing evidence, including family intervention, cognitive behavioral therapy, supported employment, early intervention services, lifestyle intervention for physical health enhancement, treatment of comorbid substance abuse, assertive community treatment, cognitive remediation, social skills training, and peer support. Ideally, these interventions are offered to patients in combination with one another. Over the last decade, increased emphasis has been placed on early detection and intervention, with particular focus on long-term recovery. Early intervention with comprehensive psychosocial interventions should be enacted promptly from the initial detection of schizophrenia.

Characteristics of Patients who Died by Suicide in a Community Mental Health Center / 대한정신분열병학회지

OBJECTIVES: Severe mental illness is a major risk factor for suicide. This study aimed to identify characteristics of patients who died by suicide among subjects who had been received service from a community mental health center. METHODS: We searched individuals who had committed suicide in Gwangju Bukgu Community Mental Health Center since 2006. Sociodemographic and clinical data were gathered from medical records and their case managers and they were compared with those of general members in the center. Characteristics of schizophrenia patients who died by suicide were particularly summarized. RESULTS: Twelve person committed suicide between 2006 and 2016. The characteristics of those who died by suicide were male (67%), diagnosis of schizophrenia (75%), aged below 50 (83%), unemployed (92%), past history of psychiatric hospitalization (100%), recent admission within 3 months (67%), past history of suicidal attempt (78%), family history of schizophrenia (58%), poor adherence to medication (58%), and use of daily rehabilitation program (42%). Ten out of twelve (83%) showed warning sign for suicide. All identified method of suicide in patients with schizophrenia was jumping from high building. Many patients with schizophrenia, who committed suicide, suffered from comorbid depressive symptoms (67%) and auditory hallucination (78%). CONCLUSION: Case managers should pay attention to and carefully manage individuals who showed suicidal warning, particularly with risk factors for suicide, such as unemployment, admission state or recent discharge from psychiatric hospital, poor adherence to medication, family history of schizophrenia, and a history of suicidal attempt.

Characteristics of Patients who Died by Suicide in a Community Mental Health Center / 대한정신분열병학회지

OBJECTIVES: Severe mental illness is a major risk factor for suicide. This study aimed to identify characteristics of patients who died by suicide among subjects who had been received service from a community mental health center. METHODS: We searched individuals who had committed suicide in Gwangju Bukgu Community Mental Health Center since 2006. Sociodemographic and clinical data were gathered from medical records and their case managers and they were compared with those of general members in the center. Characteristics of schizophrenia patients who died by suicide were particularly summarized. RESULTS: Twelve person committed suicide between 2006 and 2016. The characteristics of those who died by suicide were male (67%), diagnosis of schizophrenia (75%), aged below 50 (83%), unemployed (92%), past history of psychiatric hospitalization (100%), recent admission within 3 months (67%), past history of suicidal attempt (78%), family history of schizophrenia (58%), poor adherence to medication (58%), and use of daily rehabilitation program (42%). Ten out of twelve (83%) showed warning sign for suicide. All identified method of suicide in patients with schizophrenia was jumping from high building. Many patients with schizophrenia, who committed suicide, suffered from comorbid depressive symptoms (67%) and auditory hallucination (78%). CONCLUSION: Case managers should pay attention to and carefully manage individuals who showed suicidal warning, particularly with risk factors for suicide, such as unemployment, admission state or recent discharge from psychiatric hospital, poor adherence to medication, family history of schizophrenia, and a history of suicidal attempt.

Development of Smartphone Application for Cognitive Behavioral Therapy-Based Case Management in Patients with Schizophrenia / 대한정신분열병학회지

OBJECTIVES: This article aims to describe the development of smartphone application for the case management of patients with schizophrenia. METHODS: Gwangju Bukgu-Community Mental Health Center developed and launched a smartphone application (HYM) for cognitive-behavioral case management and symptom monitoring. The development of the application involved psychiatrists, nurses, social workers, psychologists, and software technicians from a software development company (Goosl Corp.). RESULTS: The HYM application for clients includes six main modules including Thought record, Symptom record, Daily life record, Official notices, Communication, and Scales. The key module is the 'Thought Record' for self-directed cognitive-behavioral treatment (CBT). When the client writes and sends the self-CBT sheet to the case manager, the latter receives a notification and can provide feedback in real time. 'Communication' and 'Official notices' are useful for promoting communication between case managers and clients with schizophrenia. Ratings in 'Symptom record', 'Daily life record', and 'Scales' modules are stored in graphic or table form representing changes in them and shared with case managers. CONCLUSION: The interactive function of this application is the key characteristics that distinguishes it from other mobile self-treatment tools. This smartphone application may contribute to the development of a youth- and customer-friendly case management system for individuals with early psychosis.

Changes of Sociodemographic and Clinical Characteristics of Patients Registered in a Community Mental Health Center: Comparing 2008 with 2012 / 대한정신약물학회지

OBJECTIVE: This study was designed to investigate the changes of sociodemographic and clinical characteristics of patients who were registered in a community mental health center. METHODS: The patients enrolled in this study were those registered in Suwon City Community Mental Health Center in 2008 and 2012, and there were 440 and 460 patients, respectively. The authors analyzed demographic data, medical insurance status, registration status of mental disability and clinical characteristics, such as diagnosis, type of medical institution the patients received medical care from, medication, duration of illness, Brief Psychiatric Rating Scale and global assessment function scores. RESULTS: There were more married patients in 2012 than in 2008 (23.1% vs. 34.3%, p<0.001) and the proportion of patients who were employed was larger in 2012 (8.2% vs. 10.2%, p=0.302). Also, in 2012, more patients received Level 1 medical care rather than health insurance (27.9% vs. 35.3%, p=0.007) and the number of patients with registered mental disability increased (27.7% vs. 52.6%, p<0.001). From 2008 to 2012, the number of patients diagnosed with other disorders besides psychotic disorders increased (15.5% vs. 22.9%, p=0.007). Also, more patients tended to receive medical treatment from private mental clinics (38.6% vs. 58.1%, p<0.001), and to be administered with atypical antipsychotics rather than conventional antipsychotics (58.6% vs. 80.4%, p=0.022). CONCLUSION: This study suggests that many characteristics of the patients registered in a community mental health center have been gradually changed. The patients registered in 2012 were likely to be diagnosed with other disorders besides psychotic disorders and to get more atypical antipsychotics compared to patients registered in 2008. This study would contribute to finding out the proper roles and functions of mental health centers, and, as a result, the mental health centers could be able to provide better quality of service to their registered patients.

Comparison between Users of Community Mental Health Services and Psychiatric Patients in Mental Health Related Facilities in Korea / 대한정신분열병학회지

OBJECTIVES: This study was conducted to compare the characteristics of psychiatric inpatients in mental health related facilities and community mental health services-utilizing patients by diverse factors in Korea. METHODS: Questionnaires were sent via mail to 140 standard mental health centers from October to December of 2008. 64 facilities responded and data of 461 mentally disabled who are registered at and utilize the services of these mental health centers were analyzed. T-test and cross-analysis were performed to determine the differences in the averages of the variables and the discrepancy in ratios, respectively. RESULTS: Differences between long-term psychiatric inpatients and community mental health services-utilizing patients were seen in characteristics such as gender, age, type of medical coverage, family support systems, diagnosis, age of onset, duration of hospitalization, community-dwelling period, and clinical symptoms and functions. It was significantly short in length of stay in facilities in users of community mental health services with comparison to institutionalized patients. CONCLUSION: The results of this study suggest that invigoration of community mental health services is an alternative that can help deter long-term hospitalization.

Terapia floral como modalidad terapéutica en el trastorno por déficit de atención con hiperactividad / Flower therapy as therapeutic modality in attention deficit disorder with hyperactivity

Se realizó un estudio experimental, del tipo ensayo comunitario, no enmascarado y no aleatorizado, de 60 niños y adolescentes entre 5 y 19 años de edad, de ambos sexos, con trastorno por déficit de atención con hiperactividad, pertenecientes a los policlínicos "Camilo Torres Restrepo" y "Carlos J. Finlay", atendidos en el Centro Comunitario de Salud Mental del Distrito "26 de Julio" de Santiago de Cuba, desde septiembre de 2010 hasta abril de 2011, a fin de evaluar la eficacia de la terapia floral de Bach en el tratamiento de estos pacientes. Se conformaron 2 grupos de tratamiento: uno de estudio y otro de control, con 30 integrantes en cada caso. En los que componían el primero, tratados con terapia floral asociada al tratamiento farmacológico, se logró una mayor disminución de las alteraciones conductuales y emocionales.

An unblinded nonrandomized experimental study of community trial was conducted in 60 children and adolescents between 5 and 19 years of age, of both sexes, with attention deficit disorder and hyperactivity, belonging to "Camilo Torres Restrepo" and "Carlos J. Finlay" Polyclinics, attended at the Community Center of Mental Health of "26 of Julio" District in Santiago de Cuba, from September 2010 to April 2011, in order to evaluate the effectiveness of Bach's flower therapy in these patients. Two treatment groups were formed: study group and control group with 30 members each. In the first group treated with flower therapy associated with medical treatment a greater reduction of behavioral and emotional disorders was obtained.

Factors Influencing Quality of Life in People with Mental Disabilities using Mental Health Centers / 정신간호학회지

PURPOSE: The study was done to identify factors influencing the quality of life of people with mental disabilities who use mental health centers. METHODS: Data were collected by questionnaires from 288 people with mental disabilities in Busan and Kyungnam Provience. Data were analyzed using t-test, ANOVA, Pearson correlation coefficients, multiple linear regression with the SPSS/WIN 14.0 program. RESULTS: The mean score for quality of life was 11.3+/-1.70, and the mean empowerment score was 59.7+/-8.44. The significant factors influencing quality of life were gender, age, residential status, number of support people, side-effects of drugs, service type, and empowerment. These factors explained 43.9% of the variance. CONCLUSION: The results suggest that in development and practice of program to increase the quality of life of people with mental disabilities a variety of factors should be considered.

Service Priority and Standard Performance of Community Mental Health Centers in South Korea: A Delphi Approach

OBJECTIVE: The role of community mental health centers (CMHCs) in Korea is quite different than that of these centers in Western countries due to nation-specific health care system characteristics. For example, CMHCs of Korea are expected to provide services for serious mental illness in addition to other services in response to community needs, such as internet addiction of adolescents. Consequently, it is important to determine service priorities of CMHCs and to define standard service performances in order to maximize their effectiveness with limited resources. The present study aimed to generate expert consensus on service priorities and to identify standard service performances of CMHCs in South Korea. METHODS: Forty-five mental health professionals participated as experts in a Delphi survey. We made a survey questionnaire based on Korean and international data and guidelines of some countries such as the UK and Australia. Experts answered the first and second round questionnaires and their answers were analyzed using frequency analysis. RESULTS: For the question about future directions of CMHCs, twenty-two experts (49%) answered that the growth of services for serious mental illness should be preferred to other areas. The service for chronic mental illness was thought to be the most important service area (27.1%) and, early psychosis (10.5%) is included, the services for serious mental illness should be regarded as the most important service area of Korean CMHCs. It is followed by child and adolescent services (13.2%) and mental health promotion services (10.8%). The relative importance of service performances on each service domain were given by answers of experts. CONCLUSION: CMHCs in Korea should focus their priority on the management of serious mental illness. Service standardization by the relative importance of service performances on each service domain is needed.

A Day Care Model for Chronic Psychotic Patients in Community Mental Health Center / 신경정신의학

OBJECTIVES: The purposes of this study were as follows: introducing general structure and management of a day care model practiced in Community Mental Helth Center where a psychiatrist participates weekly as a consultant analyzing; the results after performing this model and then verifying appropriateness and validity; brooding the possibility of generalization as an effective day care model in Community Mental Health Service of a small city and promoting maintenance, rehabilitation and returning to community of chronic psychotic patients. METHODS: We performed this model from May 1997 to December 1998 for about 20 months. The subjects were composed of 33 psychotic patients. PANSS (Positve and Negative Sydrom Scale), QLS (Quality of Life Scale), LSSS (Life Satisfaction Self-Rating Scale) were administered twice before starting and after 6 months of participation in this program. RESULTS: 1) This model helped the maintenance and rehabilitation of chronic psychotic patients, reducing symptoms and increasing quality of life; 2) This model was useful in integrating multi-disciplinary personnel and therapeutic methods as a whole with a psychiatrist intervening the least; 3) This model enabled a psychiatrist as a consultant to manage and control all Community Mental Health Service with him participating weekly; 4) It is possible for this model to be easily applied to Community Mental Health Service in a small city. CONCLUSION: model will be likely to be applied effectively and efficiently to the Community Mental Health Service in a small city for maintenance, rehabilitation and returning to community of chronic psychotic patients.