The importance of informal caregivers for persons with severe mental illness has been demonstrated. However, this role may cause a high care burden that considerably affects caregiver health. The ...Ensemble program is a five-session brief individual intervention designed to support informal caregivers. This trial aimed to assess the efficacy of the program versus SAU (support as usual) for participants with a high care burden.
A single-center randomized controlled trial including 149 participants was conducted. Caregivers in the intervention arm participated in the Ensemble program. The effects of the intervention were assessed using mixed models for repeated measures analysis of variance on improvements in informal caregivers' psychological health status, optimism levels, burden scores, and quality of life at three time points (T0 = pretest; T1 = posttest at 2 months, and T2 = follow-up at 4 months).
Analysis of the Global Psychological Index showed no significant effect at the two endpoints in favor of the Ensemble group. However, the Brief Symptom Inventory-Positive Symptom Distress Index was significantly lower at the two-month follow-up. A significant reduction in burden on the Zarit Burden Interview was observed post-intervention, along with an increase in optimism levels on the Life Orientation Test-Revised at follow-up in the Ensemble group. No significant differences were observed in quality of life. Clinical improvements in both psychological health status and burden levels were also identified.
The Ensemble program offers an inclusive approach based on a recovery perspective that significantly reduces symptom distress and burden and increases optimism among informal caregivers.
: https://clinicaltrials.gov/, NCT04020497.
•This study examined the relationship between self-stigma and depression in people with schizophrenia.•Self-stigma was strongly associated with depression over time.•Feeling discriminated against and ...having difficulties considering the positive aspects of the illness could predict and partially contribute to worsened depressive symptoms.
Harmful consequences of self-stigma in schizophrenia are well established in the literature, but its relationship with symptomatology remains unclear. Self-stigma describes the process by which some patients eventually accept, adhere to and apply to themselves the stereotypes associated with schizophrenia. This study aims to describe self-stigma experienced by people with schizophrenia in French-speaking Switzerland and to examine the relationship between self-stigma and depression. This was a longitudinal study including 80 participants. Correlation and regression analyses were used to examine the relationship between self-stigma and depression over three points of time. Correlations between Stigma Scale subdimensions and sociodemographic variables indicated that age and duration of illness were associated with the discrimination subscale. Self-stigma was strongly correlated with depression over time, whereby higher scores of self-stigma were associated with higher depression. More precisely, the more the patient felt discriminated against and the less he or she perceived the positive aspects of his or her illness, the greater the symptoms of depression. This study highlights the severity of self-stigma endorsed by people with schizophrenia in French-speaking Switzerland. The results provide new knowledge about self-stigma and its potential impact on depressive symptoms. Implementation of self-stigma assessment in clinical practice will allow distinctions to be made between the impact of self-stigma and the consequences of schizophrenia to recommend appropriate intervention.
Background: Negative symptoms are frequent in patients with schizophrenia and are associated with marked impairments in social functioning. The efficacy of drug-based treatments and psychological ...interventions on primary negative symptoms remains limited. The Positive Emotions Programme for Schizophrenia (PEPS) is designed to improve pleasure and motivation in schizophrenia patients by targeting emotion regulation and cognitive skills relevant to apathy and anhedonia. The main hypothesis of this study is that patients who attend 8 one-hour sessions of PEPS and treatment as usual (TAU) will have lower total apathy-avolition and anhedonia-asociality composite scores on the Scale for the Assessment of Negative Symptoms (SANS) than patients who attend only TAU. Methods: Eighty participants diagnosed with schizophrenia or schizoaffective disorder were randomized to receive either TAU or PEPS + TAU. The participants were assessed by independent evaluators before randomization (T0), in a post-test after 8 weeks of treatment (T1) and at a 6-month follow-up (T2). Results: The post-test results and 6-month follow-up assessments according to an intention-to-treat analysis showed that the apathy and anhedonia composite scores on the SANS indicated statistically greater clinical improvements in PEPS participants than in non-PEPS participants. In the post-test, anhedonia but not apathy was significantly improved, thus favouring the PEPS condition. These results were sustained at the 6-month follow-up. Conclusions: PEPS is an effective intervention to reduce anhedonia in schizophrenia. PEPS is a short, easy-to-use, group-based, freely available intervention that is easy to implement in a variety of environments (ClinicalTrials.gov ID: NCT02593058).
Recent literature has distinguished the negative symptoms associated with a diminished capacity to experience (apathy, anhedonia) from symptoms associated with a limited capacity for expression ...(emotional blunting, alogia). The apathy-anhedonia syndrome tends to be associated with a poorer prognosis than the symptoms related to diminished expression. The efficacy of drug-based treatments and psychological interventions for these symptoms in schizophrenia remains limited. There is a clear clinical need for new treatments.
This pilot study tested the feasibility of a program to reduce anhedonia and apathy in schizophrenia and assessed its impact on 37 participants meeting the ICD-10 criteria for schizophrenia or schizoaffective disorders. Participants were pre- and post-tested using the Scale for the Assessment of Negative Symptoms (SANS) and the Calgary Depression Scale for Schizophrenia (CDSS). They took part in eight sessions of the Positive Emotions Program for Schizophrenia (PEPS)--an intervention that teaches participants skills to help overcome defeatist thinking and to increase the anticipation and maintenance of positive emotions.
Thirty-one participants completed the program; those who dropped out did not differ from completers. Participation in the program was accompanied by statistically significant reductions in the total scores for Avolition-Apathy and Anhedonia-Asociality on the SANS, with moderate effect sizes. Furthermore, there was a statistically significant reduction of depression on the CDSS, with a large effect size. Emotional blunting and alogia remain stable during the intervention.
Findings indicate that PEPS is both a feasible intervention and is associated with an apparently specific reduction of anhedonia and apathy. However, these findings are limited by the absence of control group and the fact that the rater was not blind to the treatment objectives.
PEPS is a promising intervention to improve anhedonia and apathy which need to be tested further in a controlled study.
ISRCTN registry ISRCTN74048461, registered 18 may 2015.
Le but de cette étude pilote était de tester la faisabilité et l’acceptabilité de la version française d’un programme animé par des pairs sur le dévoilement à autrui d’informations sur sa maladie ...pour des personnes atteintes de troubles psychiatriques.
Honnête, ouvert, prêt (HOP) est un programme court qui invite les participants à échanger sur la problématique du dévoilement de la maladie psychique. Trente et une personnes souffrant de troubles psychiatriques ont été recrutées dans trois institutions psychosociales pour tester ce programme.
Les résultats montrent que le programme est faisable et acceptable pour les participants. La participation aux sessions pourrait conduire à une réduction de l’auto-stigmatisation.
Le programme HOP offre une opportunité aux personnes atteintes de troubles psychiques d’échanger et de réfléchir sur le dilemme du dévoilement de la maladie psychique.
This pilot study aims to assess the feasibility and acceptability of a short program about disclosure of mental illness for people with psychiatric disorders.
The participants with a diagnosis of a severe psychiatric disorder were recruited in three psychosocial institutions in French-speaking Switzerland to attend 4 one-hour group sessions of the program Honest, Open, Proud. The sessions were led by a peer practitioner and a psychiatric nurse, using the program guide and the exercise manual shared with the participants. These documents were developed by the team of Patrick Corrigan and are available online. Session 1 invites the participants to consider the advantages and disadvantages of disclosing a mental illness. The costs and benefits are also put into perspective according to different contexts and the potential short- and long-term consequences. Session 2 presents different ways to disclose, from social avoidance to openly spreading one's experience. Session 3 allows participants to learn how to tell their own story. One month after session 3, participants attend a recall session to review their intentions to disclose or not after attending the program and if they have done so, talk about this experience. Self-stigma was measured with the Internalized Stigma of Mental Illness scale, comprising five dimensions; alienation, stereotype adherence, perceived discrimination, social withdrawal and resistance to stigmatization. Acceptability of the program for participants was measured by a 11-item self-reported questionnaire, open questions, attendance rate and drop out. Feasibility was assessed through its operational (training, accessibility, human resources), economics and legal (translation rights ethical considerations) dimensions.
The results are based on data from a sample of 31 participants, aged 43 on average (SD 11.85) with a disease duration of 12.3 years (SD 8.77). The participation rate for HOP sessions was at 93.5%. Most of participants (23/29) attended all sessions, five participants attended three sessions and two participants attended two sessions. Most of participants (84%) appreciated the facilitation by a mental health peer practitioner and having the opportunity to talk about something they could not address elsewhere (73%). For 92% of them, elements of HOP could be applied in their daily lives and all are unanimous when recommending HOP to other people with psychiatric disorders. The HOP program is designed to be facilitated by peer practitioners, yet in Switzerland, their number and integration into care settings is still limited. The program has been feasible with a peer-practitioner only, in three institutions. The program is available freely for peer-practitioners and without cost for the participants and was adapted to the cultural context and was led in four sessions. It was accepted by the ethical committee for human being research and the original authors gave the right to translate it into French. Participants ask for a longer intervention with more practical exercises. In pretest, the average self-stigmatization score for the sample was 2.10 (SD 0.40), with a theoretical maximum of 4. The sub-dimension alienation shows an average score (2.32, SD 0.58) higher than the others. sub-dimensions, and adherence to the stereotype the lowest average score (1.87, SD 0.38). In post-test, the total self-stigma score decreased by 0.16, an average of 1.94 (SD 0.41). All the means of the sub-dimension scores also decreased, most importantly for the alienation (0.267). Internalized Stigma of Mental Illness scale total score was significantly improved at post-test (t(22)=2.08, P=0.049).
This pilot study shows that the HOP program is acceptable and feasible for people with mental health disorders and achievable in psychosocial institutions. The results at the self-stigma scale show a reduction of self-stigma total score.
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