Efficacy of music therapy and predictors of sleep disturbance among patients with chronic schizophrenia: A prospective study.

STUDY OBJECTIVES: Patients with schizophrenia often suffer from sleep disturbance. Music therapy, as a non-invasive intervention, may have benefit on sleep problem in such population. Our study aimed to investigate the efficacy of music therapy on sleep disturbance among patients with schizophrenia. METHOD: This prospective study recruited participants with schizophrenia along with sleep disturbances in the chronic wards. Patients in the control group received standard care, and those in the intervention group received additional music therapy before sleeping at night for four weeks. The Pittsburgh Sleep Quality Index (PSQI) was used to measure the severity of sleep disturbance. The generalized estimating equation (GEE) was used to analyze measure the difference of change in PSQI scores between both groups at the baseline and four weeks later. It was also applied to find the predictors of treatment efficacy within intervention group. FINDINGS: A total of 66 (31 in control group and 35 in intervention group) participants were recruited. After adjusting with the demographic variables, the change of PSQI among intervention group was significantly more than the change among control group (Group × time; Estimate = -7.05, p < 0.001), indicating the efficacy of music therapy. In addition, irreligious patients and those with chronic medical disease predicted better efficacy. Whereas, elderly patients had compromising efficacy of music therapy. CONCLUSION: Music therapy demonstrated its merit on sleep disturbance among patients with schizophrenia. Whereas, healthcare workers should consider the variability of severity in schizophrenia during clinical practice.

Effectiveness of a Sexual Health Care Training to Enhance Psychiatric Nurses' Knowledge, Attitude, and Self-Efficacy: A Quasi-Experimental Study in Southern Taiwan.

BACKGROUND: Sexual health is a taboo issue in some societies. Limited assessments were conducted during nursing care in mental health services. It is unknown whether psychiatric nurses' competencies would be enhanced through short training courses. OBJECTIVE: The present study employed a quasi-experimental design to evaluate the effectiveness of an 8-hour sexual health care training for psychiatric nurses to improve sexual health knowledge, attitude, and self-efficacy in a teaching psychiatric hospital in southern Taiwan. METHOD: Volunteered psychiatric nurses were randomly assigned to the experimental or control group. The 8-hour training program contained sexual health knowledge and attitudes, case discussion, role play, and sexual identity or harassment issues. Each nurse received a pretest and a posttest in the 1-month period between August and September 2019. Descriptive and multivariate statistical analyses were used to evaluate the effects. RESULTS: Among the 75 psychiatric nurses, 43 were in the control group and 32 were in the experimental group. The two groups were not significantly different in the working year, gender, education, marriage, and other psychosocial variables. After the training, the overall performance of sexual health care knowledge, attitudes, and self-efficacy of the experimental group improved significantly than the controls. CONCLUSIONS: The sexual health care training program enhanced psychiatric nurses' confidence and generally improved their sexual knowledge and attitudes. It is suggested that sexual health care needs to be highlighted during in-job training to augment the well-being and life quality of psychiatric patients.

Mediating effect of empowerment on the relationship between global function and personal recovery among community-dwelling patients with schizophrenia: a cross-sectional study.

BACKGROUND: Functional degradation among community-dwelling patients with schizophrenia can negatively influence their recovery. Given the importance of patient empowerment during recovery, this study examined the mediating effect of empowerment on the relationship between global function and personal recovery among community-dwelling patients with schizophrenia. METHODS: This cross-sectional study recruited community-dwelling patients with schizophrenia from northern and central Taiwan. Questionnaires with verified reliability and validity were provided and collected on site by trained nurses. Global function, empowerment, and personal recovery were measured using the Global Assessment of Functioning (developed by the American Psychiatric Association), Empowerment Scale, and Questionnaire on the Process of Recovery, respectively. The causal steps approach proposed by Baron and Kenny and the Sobel test were utilized to verify the mediation effect. The causal steps approach tested the four following pathways (regression coefficients): global function on empowerment (Path a), global function and empowerment as predictors of personal recovery (Path b), global function on personal recovery (Path c), and global function and empowerment on personal recovery (Path c'). RESULTS: A total of 373 participants completed the survey. After controlling for factors associated with recovery, Paths a (ß = .24, p < .001), b (ß = .68, p < .001), and c (ß = .19, p < .001) were found to be significant; however, Path c' was not significant (ß = .03, p = .452). Empowerment was determined to exert "full mediation" over the effects of global function on personal recovery, and the Sobel test indicating significant mediation (Z = 3.61, p < .001). CONCLUSIONS: Empowerment fully mediates the association between global function and personal recovery. This study suggested that offering empowerment-oriented care services may be more effective than global function improvement in recovery among these patients.

[Needs, Dilemmas, and Policy Suggestions Related to Patients With Mental Health Long-Term Care].

In Taiwan, The increase in life expectancy in Taiwan has increased the incidents of age-related problems among patients with mental illness. Therefore, the needs related to long-term care in mental health are significantly important. These needs include: (1) reducing stigmatization; (2) reducing the physical and economic burden of caregivers; (3) constructing a comprehensive, long-term care service system; and (4) developing assessment tools suitable to the long-term care of patients with mental illness. Moreover, six dilemmas in meeting long-term care needs were identified. These dilemmas include: (1) lack of a model of continuous care and of a platform for integrating hospital and community resources; (2) poor / inadequate service quality provided by certain community rehabilitation institutions; (3) the needs of patient/family centered care; (4) the persistence of stigma and misunderstanding; (5) the heavy burdens borne by family members providing long-term care; and (6) the disconnect between subsequent needs and the disability assessment system. Policy suggestions provided in this article include: (1) establish an inclusive platform for mental health long-term care information and resource integration; (2) construct long-term care centers for patients with mental health conditions; (3) train adequate manpower to provide long-term care services to these patients; and (4) promote community inclusiveness for these patients. In order to enter the era of long-term mental health care, government policy should target long-term care programs to meet the needs of patients with mental health conditions. These programs should include seamlessly integrating services into the long-term mental health care system and the care resources of community mental health, developing suitable assessment tools, establishing a multidisciplinary team of long-term care professionals to provide mental health care.

Factors influencing patient-perceived quality of care in psychiatric hospitals in Taiwan.

Patient-perceived quality of inpatient/outpatient psychiatric care remains under-researched. A cross-sectional survey with purposive sampling comprising 567 inpatients and 549 outpatients was conducted among eight psychiatric care facilities in Taiwan to examine the factors influencing patient-perceived care quality. Inpatients and outpatients perceived moderate quality of care, where "Encounter" was reported as the highest dimension. Inpatients perceived "Secure environment" as the lowest; outpatients rated "Discharge/Referring" as the lowest. Hospital region and customer loyalty were significantly associated with patient-perceived care quality. Other significant factors were also identified: inpatient employment, perceived mental health and treatment effects, understanding diagnosis, previous treatment, and visited by appointment.

Factors related to the improvement in quality of life for depressed inpatients treated with fluoxetine.

BACKGROUND: The aim of this study was to explore the relationships between depressive symptoms and health-related quality of life (HRQOL) measurements for inpatients with major depressive disorder (MDD) before and after 6-week fluoxetine treatment, and to elucidate the factors related to the HRQOL changes. METHODS: A total of 131 inpatients with MDD were enrolled to receive 20 mg of fluoxetine for 6 weeks. Symptom severity and adverse events were assessed at weeks 0, 1, 2, 3, 4, and 6 using the 17-item Hamilton Depression Rating Scale (HAMD-17) and UKU Side Effect Rating Scale, respectively. HRQOL was measured using the Short Form 36 (SF-36), including 8 subscales, physical component summary (PCS) and mental component summary (MCS), at baseline and week 6. Spearman's coefficient, Cohen's d, and multiple linear regression model were used for statistical analysis. RESULTS: One hundred and six patients completing all measures at weeks 0 and 6 entered the analysis. HAMD-17 negatively correlated with SF-36 at baseline and week 6. The HAMD-17 had a larger effect size than SF-36. MCS, rather than PCS, showed statistically significant improvement. After using multiple linear regression analysis, age at onset, HAMD-17 score change, and number of adverse events reported during the trial period were related to MCS change after adjusting for confounding variables. CONCLUSIONS: Fluoxetine treatment was associated with an improvement in depressive symptomology and HRQOL. Depressive symptoms had a greater extent of change than HRQOL. Clinicians must consider the negative effects of adverse events caused by antidepressants on the improvement of HRQOL. TRIAL REGISTRATION: http://clinicaltrials.gov , NCT01075529 , retrospectively registered 24/2/2010.

[Care of Individuals With Bipolar Disorders].

Bipolar disorder (BD) is a severe mental illness that is characterized by chronicity, pervasive instability, and relatively high rates of recurrence and suicide. Current evidence supports that adverse circles among hereditary and genetic factors, neuroinflamation, and social rhythm constitute a crucial etiology. Pharmacological treatment is the first priority for BD patients during the acute stage. Pharmacological and psychosocial treatments should be combined during the maintenance stage in order to help patients self-manage medication, effectively control mood swings, enhance disease self-management and social functions, decrease the risks of relapse and re-hospitalization, and stabilize overall health. The present article firstly introduces the characteristics and etiological assumptions related to BD, the related evidence-based care models and their effects, and the early development of an evidence-based care model, the BalancingMySwing group, for BD patients in Taiwan. This article provides updated information to clinicians who are involved in caring for this population. Moreover, the existing data related to biological and psychosocial factors for BD in Taiwan is insufficient and developing individual-tailored psychosocial intervention is urgently needed. The authors hope that this article will elicit greater concern for this issue from policy decision-makers and healthcare providers.

Early Improvement Predicts Treatment Outcomes for Patients With Acute Mania: A Naturalistic Study in Taiwan.

BACKGROUND: Bipolar disorder is a serious mental disorder. This study investigated whether early improvement at week 1 or 2 could predict treatment outcomes at week 4 in clinical populations with acute mania. METHODS: We conducted a naturalistic study, recruiting inpatients with bipolar mania for acute treatment. Symptom severity was assessed using the Young Mania Rating Scale (YMRS) at weeks 0, 1, 2, 3, and 4. Early improvement was defined as a reduction in the YMRS score of at least 20% or 25%, assessed at weeks 1 and 2. Response was defined as a reduction of 50% or more in the YMRS score, and remission was defined as an end-point YMRS score of 12 or less. Receiver operating characteristic curves were used to determine whether week 1 or week 2 had better discriminative capacity. Sensitivity, specificity, and predictive values were calculated for the different definitions of early improvement. RESULTS: Of the 350 patients, 32.9% (n = 115) and 16.6% (n = 58) of the subjects were classified as responders and remitters at week 4, respectively. Early improvement at week 2 showed better discriminative capacity, with areas under the receiver operating characteristic curve greater than 0.8. It had high sensitivity and high negative predictive value for 2 cutoffs in predicting response and remission. CONCLUSIONS: Relatively lower response and remission rates were observed. Response and remission could be predicted by early improvement at week 2, whereas patients without early improvement were unlikely to reach response and remission at week 4.

Comparison of physician-rating and self-rating scales for patients with major depressive disorder.

Physician-rating scales remain the standard in antidepressant clinical trials. The current study aimed to examine the discrepancies between physician-rating scales and self-rating scales for symptoms and functioning, before and after treatment, in newly hospitalized patients. A total of 131 acutely ill inpatients with major depressive disorder were enrolled to receive 20 mg of fluoxetine daily for 6 weeks. Symptom severity and functioning were assessed at baseline and again at week 6. Symptom severity was rated using the 17-item Hamilton Depression Rating Scale (HDRS-17) and the Zung Self-rating Depression Scale (ZDS). Functioning was measured by the Global Assessment of Functioning (GAF) and the Work and Social Adjustment Scale (WSAS). Pearson correlation coefficients (r) between HDRS-17 and ZDS and between GAF and WSAS were calculated at week 0 and week 6. Sensitivity to change was measured using effect sizes. One-hundred twelve patients completed the 6-week trial. After 6 weeks of treatment, correlations between HDRS-17 and ZDS or correlations between GAF and WSAS became larger from baseline to end point. All correlations were statistically significant (P < 0.001). Effect sizes measured by physician-rating scales (ie, HDRS-17 and GAF) were larger than by self-rating scales (ie, ZDS and WSAS). Correlations between baseline physician-rating scale scores and self-rating scale scores improved after 6 weeks of treatment. Physician-rating scales had larger effect sizes than self-rating scales. Physician-rating scales were more sensitive in detecting symptom or functional changes than self-rating scales.

Acupressure improves sleep quality of psychogeriatric inpatients.

BACKGROUND: Acupressure, a noninvasive form of acupuncture, may be used as a low-cost and noninvasive means of improving sleep quality. Although it has been evaluated to improve self-reported sleep quality, it has not been assessed with regard to effectiveness in improving perceived and objective measures of sleep quality outcomes. OBJECTIVES: The aim of this study was to investigate the effectiveness of acupressure in improving sleep quality of psychogeriatric inpatients. METHODS: Using a convenience sample, 60 psychogeriatric inpatients with affective disorders from southern Taiwan were recruited. They were assigned randomly to an experimental or control group. Although both groups received standard medical care, those in the experimental group received 9-minute acupressure treatment daily for 4 consecutive weeks. Acupressure was applied to three acupoints: shenmen, yangchuan, and neiguan. Outcomes were measured using the Pittsburgh Sleep Quality Index and actigraphy. Data were collected at baseline and after 4 weeks of intervention. RESULTS: Participants in the experimental group improved significantly in subjective sleep quality as measured by the Pittsburgh Sleep Quality Index and in objective sleep quality as measured by actigraphy (p < .001 for all) after 4 weeks of intervention. Although the control participants also had some improvement in sleep quality, those in the experimental group had significantly greater improvements (p < .05) in all domains of subjective and objective sleep quality than the control group. DISCUSSION: Acupressure may be an effective means of improving sleep quality of psychogeriatric inpatients.