Requirements of caregivers of patients with schizophrenia: A qualitative study in Turkey.

Caregivers have different experiences and difficulties in the patient care process during which the role of providing care is fulfilled. Understanding the requirements of caregivers may help determine the content of the country-specific psychoeducation program needed. Caregivers of patients with schizophrenia want certain needs to be met while they provide care to these patients. This qualitative study aims to determine and analyze these needs. The researchers conducted face-to-face semi-structured interviews with 15 caregivers. Themes were Themes identified included determined as managing disease behavior, gaining independent living skills, managing social-educational problems, and psychosocial support needs of the family members. Mental health and psychiatric nurses should understand, accept, and protect the needs of caregivers. It is suggested that mental health and psychiatric nurses plan group training about the determined needs and provide support for caregiving family members.

Brief Clinical Assessment Scale for Schizophrenia (BCASS): Development, Validity, and Reliability Study.

Introduction: The instruments used for the clinical assessment of schizophrenia and other psychotic disorders are not commonly administered in routine clinical practice since their application takes a long time. This study aims to develop a short, comprehensive, and easy-to-apply scale and to examine its psychometric properties. Methods: A 14-item scale was prepared by adding two items inquiring about obsessions and memory difficulties to the items taken from Positive and Negative Syndrome Scale (PANSS) covering the diagnostic criteria for schizophrenia and schizoaffective disorder. The items were rated on a 4-point scale reflecting their effect on daily functioning as 1. not present, 2. mild problems, 3. moderate problems, 4. severe problems. The scale was administered together with other concordant scales to the patients with schizophrenia and schizoaffective disorder. The construct validity of the scale was analyzed by explanatory factor analysis, the concurrent validity was examined through correlations of the scale scores with those of comparable scales, and criterion validity was evaluated by the sensitivity to the change in psychopathology. For reliability, internal consistency coefficient and interrater reliability were assessed. Results: Data from a total of 120 patients were analyzed. The internal consistency coefficient of the scale was calculated as 0.89. Exploratory factor analysis yielded a 4-factor solution which accounted for 74.47% of the total variance of the scale scores. The first factor (psychosis) explained 43.49% of the total variance, the second factor (negative/cognitive impairment) explained 14.53%, the third factor (emotional distress) explained 11.19%, and the fourth factor (disorganization) explained 5.34% of the total variance. Significant correlations were found between the scale's total score and the PANSS (r=0.78), Clinical General Impression-Severity (CGI-S) (r=0.81), and Global Assessment of Functioning (GAF) scores (r=-0.77). Interrater reliability was strong (ICC=0.89), and the sensitivity to the change in psychopathology was significant (Cohen d=2.68). Conclusion: The scale demonstrated adequate psychometric properties in terms of reliability, validity, and dimensionality that justify its use in routine clinical practice.

Caregiver Burden in Schizophrenia and Autism Spectrum Disorders: A Comparative Study.

OBJECTIVE: There is no study comparing schizophrenia and autism spectrum disorders (ASD) in terms of caregiver burden. This study aims to compare the caregiver burden among family members of the patients with schizophrenia and ASD and investigate the predictive factors. METHODS: A cross-sectional study with the family members living with and/or providing care to their patients was carried out. A sociodemographic form, the Beck Depression Inventory, the Self-Stigma Inventory for Families, and the Zarit Caregiver Burden Scale were utilized. Regression analyses were conducted to determine the predictive factors for higher burden. RESULTS: Caregiver burden in ASD was significantly higher than in schizophrenia. Regression analysis showed that the predictors of high caregiver burden were the need for self-care (OR=3.6), self-destructive behaviors (OR=3.4), self-stigma (OR=1.1), depression (OR=1.1), and level of income (OR=1.0) for all family members. When the diagnosis was removed from the equation, the factors determining the high burden did not change. CONCLUSION: This study suggests that characteristics of the illness are stronger predictors than family members' characteristics in explaining high caregiver burden for both illnesses. Psychological, social, and economic supports should be provided for families to help alleviate their caregiving burden.

Subjective Recovery in Patients with Schizophrenia and Related Factors.

Subjective recovery is a personally perceived recovery involving other factors beyond clinical recovery. This study aims at investigating the factors related to subjective recovery in patients with schizophrenia living in Turkey. This study assessed 120 clinically stable outpatients with schizophrenia or schizoaffective disorder using the clinical and psychosocial scales. Gender, type of the diagnosis of disease, and age of the illness onset were found to be correlated with the subjective recovery. Subjective recovery was significantly correlated with CGI-S (r = - 0.25), total PANSS score (r = - 0.29), global assessment of functioning (r = 0.27), social functioning (r = 0.43), internalized stigma (r = - 0.38), self-esteem (r = 0.56), depression (r = - 0.59), and hopelessness (r = - 0.55). Hopelessness and self-esteem were found to be predictive of the subjective recovery explaining 52% of the variance. It can be argued that efforts to promote hope and self-esteem contribute to the subjective recovery.

The Effect of Psychosocial Skills Training and Metacognitive Training on Social and Cognitive Functioning in Schizophrenia.

INTRODUCTION: The aim of this study is to investigate the effects of Psychosocial Skills Training (PSST) and Metacognitive Training (MCT) programs on general psychopathology, cognitive functioning, and social functioning in patients with schizophrenia. METHODS: Twenty patients with schizophrenia who were treated at the Kocaeli University Psychiatry Department outpatient clinic between January and June 2016, accepted to participate in the study and met inclusion criteria were included in this study. Patients were randomized as two groups of 10 people. The management of each group was carried out by a trainer and a co-trainer. The Positive and Negative Symptom Scale (PANSS) and Clinical Global Impression Scale-Severity (CGI-S) to assess psychopathology, the General Assessment of Functioning (GAF) and the Quality of Life Scale in Schizophrenia (QoLS) to assess social functioning, the Cognitive Assessment Interview (CAI) to assess cognitive functioning were used by the clinicians blinding to groups in the first two weeks before and after the intervention. After the training, first and last test scale scores were compared. RESULTS: All patients who participated in the study completed the study (male: 13, female: 7). There was no significant difference in age, gender, marital status, years of education, duration of illness, the age of onset, and the number of hospitalizations in comparison of individual and clinical characteristics of the groups (p>0.05). When the scores were compared of the groups before and after the intervention, there was a significant difference concerning psychopathology, social and cognitive functioning in both groups (p<0.05). There were no significant differences between the groups in terms of effect size. CONCLUSION: The study showed that both programs aiming to improve psychopathology and functioning in the treatment of schizophrenia have positive results. Improvement in cognitive functioning should also be tested by neurocognitive tests in the large-scale studies with control groups.

Rates and correlates of employment in patients with schizophrenia: A multicenter study in Turkey.

BACKGROUND: There is not enough information regarding the participation in the working life of the patients with schizophrenia in Turkey. AIMS: The aim of this study was to examine the occupational experiences of patients with schizophrenia before and after the illness and to investigate the factors that predict work participation. METHODS: The data on occupational life of the patients with schizophrenia, which were treated as outpatients in six different centers, were examined. The rates of participation in working life before and after the disease were evaluated. Patients with and without occupational life history after the disease were compared in terms of demographic characteristics. Factors predicting participation in work life after the disease were analyzed by logistic regression analysis. RESULTS: Out of the 587 patients evaluated in the study, 73% were males, 73% were single, the mean age was 42, mean level of education was 9 years and the average duration of illness was 18 years. The duration of the employment before the disease was higher than that after the disease regarding expected working time. The rate of employment was 11% currently, 14% in the last year, 62% after the disease and 83% for the lifetime. While the factors that predicted to be in working life after the illness were male gender (odds ratio (OR) = 2.9), diagnosis of schizoaffective disorder (OR = 2.6), high level of education (OR = 1.2) and employment history before the onset of the illness (OR = 1.0), only the shorter duration of illness (OR = 1.1) predicted the current working status when the gender variable was excluded. CONCLUSION: Rate of employment of patients with schizophrenia living in Turkey was low as in other countries. Good premorbid functioning seems to determine participation in occupational life after the illness.

Case Management for Individuals with Severe Mental Illness: Outcomes of a 24-Month Practice. / Ciddi Ruhsal Hastaligi Olan Bireylerde Olgu Yöneticiligi: 24 Aylik Uygulama Sonuçlari.

OBJECTIVE: The aim of this study is to conduct a case management model on a group of individuals with severe mental illness (SMI) and to evaluate the outcomes during a 24-month follow up. METHOD: A total of 34 patients diagnosed with schizophrenia or schizoaffective disorder with at least one exacerbation over the last year, poor treatment compliance, who were unemployed and unable to live independently and who gave consent to participate were included to the study. Case management was conducted by a medical professional in the house, schizophrenia association, hospital, and workplace of the patients by interviewing the patients, family members, and the employers of the patients, at intervals arranged according to the need of each patient. Patients were assessed at baseline stage, the sixth, 12th and the 24th month regarding functionality, clinical condition, treatment compliance and family burden. RESULTS: The study was completed in 24 months with 30 patients with a mean age was 36, mean education level of 11 years, and a mean illness duration of 13 years. The majority consisted of unmarried males living with their parents. During the follow up, every patient participated in the recommended rehabilitation programs with, improvement in treatment adherence and functionality. A significant decrement was detected in the number of hospitalizations when compared to the history before the start of the study. Family burden decreased. Ten patients got employed and 3 patients left work. CONCLUSION: It can be concluded that case management hypothesized to be beneficial for people with SMI with positive outcomes on clinical recovery, improved social and vocational functionality and reduced incidences of hospital stay should be included as a routine psychosocial rehabilitation service.

Respectful care of human dignity: how is it perceived by patients and nurses?

OBJECTIVE: Dignified care protects the patient's rights and provides appropriate ethical care while improving the quality of nursing care. In this context, the opinions of nurses and patients who receive nursing care about dignified care are important. The aim of this study was to explore the opinions and experiences of Turkish patients and nurses about respectful care of human dignity. METHODS: This descriptive cross-sectional study was conducted in Turkey. Participants were inpatients at cardiology, neurology and neurosurgery clinics and nurses working in these clinics. The data for the study were collected from face-to-face interviews using questionnaires. The percentages of characteristics and preferences of the participants were calculated, and the results were analysed using statistical tests. RESULTS: A total of 150 patients and 78 nurses participated in the study. The patients stated that the protection of their rights was the most important factor for dignified nursing care. The nurses stated that being careful to not expose the patients' body and being respectful of the patients' privacy were important in dignified nursing care. The age of the patient, duration of the disease, number of hospitalisations and length of time the nurses had been working at the clinic caused significant changes in the factors considered important in dignified care. CONCLUSIONS: Our findings provide a perspective on dignified care in the Turkish healthcare setting. There were some differences between patients and nurses in the factors considered important for dignified care. The discussion with patients and nurses related to care and practices that protect or detract from human dignity can provide insights to ethics.