EFFECT OF APPLYING “ACCEPTANCE AND COMMITMENT THERAPY” ON AUDITORY HALLUCINATIONS AMONG PATIENTS WITH SCHIZOPHRENIA

Experiencing persistent auditory hallucinations may contribute to unproductive struggle and interference with valued living among patients with schizophrenia. Acceptance and commitment therapy (ACT) represents a new generation of behavior therapies that proposes active acceptance and achievement of worthwhile goals despite experiencing auditory hallucinations. Utilization of acceptance commitment therapy may assist in reducing auditory hallucinations and may increase patient's feeling of control. Aim: Determine the effect of applying acceptance and commitment therapy on auditory hallucinations among patients with schizophrenia. Setting: The study was conducted at El-Maamoura Hospital for Psychiatric Medicine in Alexandria, Egypt. Subjects: A random sample of 70 male inpatients with schizophrenia was selected and divided equally into a study and a control groups (35 patients in each group). Both groups were matched as much as possible in relation to socio- demographic and clinical data. Tools: Psychotic Symptom Rating Scales (PSYRATS-AHs) and Voices Acceptance and Action Scale (VAAS). A quasi-experimental research design was utilized in this study. Results: Significant differences were found between the study and control groups immediately post and after 3 months of ACT on baseline PSYRATS& VAAS scores. Conclusion: ACT offers a promising new treatment for auditory hallucination among patients with schizophrenia. A significant improvement in auditory hallucination was found in the study group immediately after implementing ACT and after 3 months. As well as a decrement in re hospitalization rate and improvement in drug compliance for the study group compares to control one. Recommendations: ACT should be integrated in psychiatric treatment and nursing interventions of inpatients with schizophrenia who experiencing auditory hallucination.     

Effects of biogenetic beliefs for schizophrenia on potential caregivers in China: Exploring the role of affiliate stigma

Schizophrenia affects more than eight million people in China. Stigmatization of schizophrenia may prevent family members and close others from providing social support to those with schizophrenia. This article aims to investigate the potential use of a biogenetic approach to reduce the stigma of schizophrenia using a cross‐sectional (study 1, n = 141) and an experimental design (study 2, n = 100) in China. In the first study, mediation analysis reveals that perceived affiliate stigma, the negative prejudice, and discrimination towards family members of individuals with socially stigmatized identities due to their affiliation with the person mediates the path between biogenetic beliefs and desire for social distance. This pattern is replicated in study 2 in which two 10‐min lectures were created and used to influence participants’ beliefs in biogenetic causes of schizophrenia. Findings suggest that the biogenetic approach may increase Chinese participants’ desired social distance towards their family members with schizophrenia through increasing their concerns about the negative consequences of being affiliated with the family member. Therefore, future research should investigate aspects of biogenetic anti‐stigma campaigns that do not increase participants’ perception of affiliate stigma in China.     

To what extent does severity of loneliness vary among different mental health diagnostic groups: A cross‐sectional study

Loneliness is a common and debilitating problem in individuals with mental health disorders. However, our knowledge on severity of loneliness in different mental health diagnostic groups and factors associated with loneliness is poor, thus limiting the ability to target and improve loneliness interventions. The current study investigated the association between diagnoses and loneliness and explored whether psychological and social factors were related to loneliness. This study employed a cross‐sectional design using data from a completed study which developed a measure of social inclusion. It included 192 participants from secondary, specialist mental health services with a primary diagnosis of psychotic disorders (n = 106), common mental disorders (n = 49), or personality disorders (n = 37). The study explored differences in loneliness between these broad diagnostic groups, and the relationship to loneliness of: affective symptoms, social isolation, perceived discrimination, and internalized stigma. The study adhered to the STROBE checklist for observational research. People with common mental disorders (MD = 3.94, CI = 2.15 to 5.72, P < 0.001) and people with personality disorders (MD = 4.96, CI = 2.88 to 7.05, P < 0.001) reported higher levels of loneliness compared to people with psychosis. These differences remained significant after adjustment for all psychological and social variables. Perceived discrimination and internalized stigma were also independently associated with loneliness and substantially contributed to a final explanatory model. The severity of loneliness varies between different mental health diagnostic groups. Both people with common mental disorders and personality disorders reported higher levels of loneliness than people with psychosis. Addressing perceived mental health discrimination and stigma may help to reduce loneliness.     

Taking care of teenagers,taking care of me: Profiling parental caregiving burden and activity restriction in a sample of Australian parents

The current study extends the Activity Restriction Model of Depressed Affect by exploring the relationship between parental caregiving burden, activity restriction, and depressive symptoms. It investigated the mediating role of restriction in three types of activities (daily routine, personal control, and social) in the relationship between parental caregiving burden and carer depression. Respondents (n = 203, Mean_age = 45.45 years, standard deviation = 7.81, females = 84.7%) were parent carers of a young person with mental illness and based in Australia. They completed a set of measures assessing caregiving burden, participation in daily routine, personal control and social activities, and depressive symptoms. A multiple mediation analysis revealed that restriction of daily routine, personal control, and social activities indirectly mediated the relationship between parental caregiving burden and parent carers’ symptoms of depression. A latent profile analysis suggested an optimal three‐profile solution. As predicted, profile membership distinguished parent carers on depressive symptoms ranging from normal to severe levels based on participation in the specific activities. Our results suggest a typology of parent carers perceiving differential levels of caregiving burden and activity restriction. Strategies addressing these specific areas provide preventative and promotion measures to optimize carer mental health and well‐being.     

小组认知行为治疗对精神分裂症顽固性幻听的疗效观察

目的：探讨小组认知行为治疗（GCBT）在治疗精神分裂症顽固性幻听中的作用和疗效。方法：精神分裂症伴有顽固性幻听患者120例,随机分为观察组和对照组各60例,均服用抗精神病药治疗,观察组同时合并GCBT,共9个月。分别于治疗前、治疗6及9个月后采用阳性与阴性症状量表（PANSS）和听幻觉评分量表（AHRS）评定临床疗效。结果：治疗6个月后,观察组PANSS及AHRS评分均较治疗前及同期对照组治疗后明显降低（P〈0．01,0．05）;治疗9个月后,观察组AHRS评分较治疗6个月后及同期对照组明显降低（P〈0．01,0．05）,观察组PANSS评分明显低于同期对照组（P〈O．01）。结论：GCBT不仅能治疗精神分裂症的顽固性幻听,而且对改善其余精神症状、提高社会功能有较好的效果。     

经颅磁刺激治疗精神分裂症研究进展

精神分裂症是一种常见的病因尚未完全阐明的精神疾病,尽管临床治疗已取得很大进展,但某些残留症状如幻听和阴性症状等仍然影响着患者的社会功能与生活质量.重复经颅磁刺激是一种新型无创性物理治疗技术,目前已被用于精神分裂症、抑郁症、焦虑症、强迫症等精神障碍的治疗,并取得了突出的疗效,为改善精神分裂症患者的临床症状提供了一个新的治疗途径.     

Association of auditory hallucination and anxiety symptoms with depressive symptoms in patients with schizophrenia: A three-month follow-up

This study was to investigate the association of auditory hallucinations and anxiety symptoms with depressive symptoms in patients with schizophrenia for three months. The participants (N?=?189) were evaluated using Characteristics of Auditory Hallucination Questionnaire (CAHQ), Beck Anxiety Inventory (BAI), and Beck Depression Inventory-II. Forty-two participants suffered from depressive symptoms at both baseline and 3-month follow-up. Higher CAHQ and BAI at both periods predicted depressive symptoms at three-month end. Being male, increased severity of CAHQ and BAI were risk factors of depressive symptoms. Psychiatric professionals must educate patients to manage auditory hallucinations and anxiety symptoms to decrease depressive symptoms.     

Relationship between improvements of subjective well-being and depressive symptoms during acute treatment of schizophrenia with atypical antipsychotics

What is known and Objective: It has been suggested that atypical antipsychotics may exert beneficial effects on subjective well‐being as well as depressive symptoms in schizophrenia. However, the relationship between the two remains to be clarified. The authors examined the relationship between subjective well‐being and depressive symptoms across the course of acute treatment with atypical antipsychotics in patients with schizophrenia. Methods: Thirty‐five inpatients with schizophrenia were examined for subjective well‐being, psychopathology, and extrapyramidal side effects before and 8 weeks after the initiation of new treatment with atypical antipsychotics. Results and Discussion: Significant improvement was observed in subjective well‐being, psychotic symptoms, and depressive symptoms. No change was observed in the severity of extrapyramidal side effect. The subjective well‐being score had significant negative correlations with depressive symptom score both at baseline and at week 8. The mean change in subjective well‐being score was significantly correlated with that in depressive symptom score. The severity of depressive symptoms at baseline was significantly correlated with the subsequent change in subjective well‐being score and the change in depressive symptom score was the only predictor of change in subjective well‐being score. What is new and Conclusion: Depressive symptoms were significantly associated with subjective well‐being in patients with schizophrenia and may moderate the acute effects of atypical antipsychotic treatment on subjective well‐being. Further investigations are necessary to fully define the place of depressive symptoms in the conceptualization of subjective well‐being in schizophrenia and the optimal use of atypical antipsychotics.     

Is suicide assessment harmful to participants? Findings from a randomized controlled trial

There is considerable debate on whether suicide assessment carries an iatrogenic risk for participants/patients. A double‐blind randomized controlled trial (registration: R000022314) tested the emotional impact of suicide assessment on participants (n = 259) randomly assigned to experimental (n = 122) or control conditions (n = 137). The experimental condition included the Suicidal Affect‐Behavior‐Cognition Scale and intensive death‐related questions, the control condition a quality of life scale. Both included measures of depression, social support and loneliness. Affective states were assessed immediately before and after testing, and research biases minimized. Post‐test debriefing interviews collected qualitative reactions. Experimental participants ranged from nonsuicidal to highly suicidal. Between‐groups ANCOVAs and repeated measures ANOVAs showed no differences by study condition, and no pre‐post‐test affect changes for either condition or suicidal participants (P > 0.10), supporting the null hypothesis of no iatrogenic effects. However, depressive participants in both conditions showed significant decreases in positive affect (P < 0.05). Smallest real difference (SRD) scores approximated clinically meaningful differences and showed 20% of participants had a significant positive survey reaction, 24% a negative reaction, with the rest neutral. Linear regressions revealed depressive symptoms and perceived family support, but not suicidality or other factors, predicted negative affect changes, which was supported by qualitative findings. Social desirability bias was also found in qualitative survey responses. No evidence of iatrogenic effects of suicide assessment were found. Recommendations are made to counter possible negative assessment effects on depressive participants/patients, and nurses and other caregivers are encouraged to talk to patients about suicidal symptoms.     

Predictors of depressive symptoms and physical health in caregivers of individuals with schizophrenia

This cross‐sectional study examined relationships among factors influencing caregiver burden, depressive symptoms, and physical health in family caregivers of individuals with schizophrenia. Two hundred family caregivers of individuals with schizophrenia completed standardized questionnaires related to depressive symptoms, physical health, perceptions of burden, coping, and social support. The results revealed that 19.5% of family caregivers of individuals with schizophrenia experienced significant depressive symptoms and 65.5% perceived themselves in poor physical health. Burden, self‐controlling coping strategies, and physical health status were all independently predictive of depressive symptoms. Two emotion‐focused coping strategies (self‐controlling and escape‐avoidance) were independently predictive of caregiver burden. Only burden predicted physical health status. The findings suggest that health professionals who provide community care for those with schizophrenia need to consider the “unit of care” as the family rather than the individual. The health status of family caregivers should be routinely assessed. Individualized interventions to reduce family burden could include community‐based health professionals as well as trained community volunteers, opportunities for social interaction, and improving self‐care for all family members.     

Exploring the Mechanism of the Clinical Encounter on Depressive Symptoms in Young Adults: A Path Analysis

Elucidating mechanisms of how high quality clinical encounters with providers may alleviate depressive symptoms in young adults are critical to reduce psychological morbidity and disability. Guided by Street's Model of Health Communication (SMHC), this study explores the predictive relationships of the clinical encounter, which includes communication functions (patient-provider communication and patient self-appraisal of communication skills with provider) and proximal outcomes (patient activation; PA) to improve health outcomes (depressive symptoms) in young adults. This study of young adults (n = 60) employed path analysis to examine the overall model fit and direct and indirect effects of each variable on depressive symptoms. The final SMHC had excellent model fit (X² = 2.26, p =.32, TLI =.99, CFI = 1.00, RMSEA =.05). Patient-provider communication and self-appraised communication skills with providers had indirect effects on depressive symptoms and a direct effect on PA; PA had a direct effect on depressive symptoms (R² =.30, p <.01). Findings elucidate potential novel targets, amenable to behavioral intervention, to improve depressive symptoms within the clinical encounter, and provide a foundation for hypothesis-driven model testing among young adults with depressive symptoms.     

Reactions to caregiving of frail, older persons predict depression

Reactions to caregiving and depression affect a carer's ability to continue in their caring role. This paper examines the relationship between reactions to caregiving and depression in carers of frail, older people and is a cross‐sectional study of carers of community‐living people (≥70 years), identified as frail, who completed a postal questionnaire. Reactions to caregiving were evaluated using the Caregiver Reaction Assessment. Anxiety and depression symptoms were measured using the Hospital Anxiety and Depression Scale. Borderline depressive symptoms were reported in 15% of carers, and 10% had abnormal depressive symptoms. Anxiety symptoms in the carers were slightly higher at 24% and 12%, respectively. Multiple regression indicated that the impact on carers' daily schedules (β = 1.419, P = 0.001; β = 1.162, P = 0.025) and their health (β = 1.509, P = 0.007; β = 1.850, P = 0.006) as a result of caregiving explained 49% of the variance in carers' depressive symptoms (P < 0.001) and 42% of the variance in their anxiety symptoms (P < 0.001). Specific reactions to caregiving are important predictors of depressive and anxiety symptoms in carers of frail, older people. Regular carer support services and targeted health‐care initiatives could alleviate or lessen negative reactions associated with caregiving, such as depression.     

Perceived severity of Visual Snow Syndrome is associated with visual allodynia

Objective

To investigate whether sensory sensitivity is associated with the perceived severity of Visual Snow Syndrome (VSS) symptoms.

Background

Visual Snow (VS) is a perceptual anomaly which manifests as flashing pinpricks of light throughout the visual field. VSS has an estimated population prevalence of 2.2% and is thought to be at least moderately debilitating for all who experience it. However, some people who meet the criteria for VSS have no awareness of it. This may be because they have lower sensory sensitivity, allowing them to ignore their visual phenomena.

Method

Our study used a cross-sectional design. We recruited two distinct samples of people with VSS: a sample of people with confirmed VSS; and a sample of people who met the criteria for the condition but had no prior knowledge of it (latent VSS). The latter group was recruited and screened for symptoms via an online crowd-sourcing platform. In total, 100 participants with VSS (49 with confirmed VSS, 51 with latent VSS) completed the Visual Snow Handicap Index and three measures of sensory hypersensitivity.

Results

The 100 participants (52 female, 47 male, 1 non-binary) had a mean age of 35.1 years (SD = 12.2). Leiden Visual Sensitivity Scale scores were associated with both the perceived severity of VSS, β = 0.35, p = 0.003, and the number of VSS symptoms endorsed, β = 0.45, p < 0.001. On average, participants with VSS experienced elevated sensory hypersensitivity across all measures. Furthermore, longer duration of VSS was associated with lower perceived severity, F(1, 98) = 11.37, p = 0.001, R² = 0.103.

Conclusions

Our results suggest that sensory hypersensitivity may be prevalent in people with VSS and indicate that visual allodynia is associated with increased severity of VSS. Additionally, our findings indicate that inclusion of cases of latent VSS in future research may be important for researchers to develop a more complete understanding of the perceptual experiences of people with VSS.     

An Examination of Integrated Cognitive-Interpersonal Vulnerability to Depression: The Role of Rumination,Perceived Social Support,and Interpersonal Stress Generation

This research examined an integration of cognitive and interpersonal theories of depression by investigating the prospective contribution of depressive rumination to perceptions of social support, the generation of interpersonal stress, and depressive symptoms. It was hypothesized that depressive ruminators would generate stress in their relationships, and that social support discontent would account for this association. Further, depressive rumination and dependent interpersonal stress were examined as joint and unique predictors of depressive symptoms over time. Participants included 122 undergraduate students (M age = 19.78 years, SD = 3.54) who completed assessments of depressive rumination, perceptions of social support, life stress, and depressive symptoms across three waves, each spaced 9 months apart. Results revealed that social support discontent accounted for the prospective association between depressive rumination and dependent interpersonal stress, and that both depressive rumination and dependent interpersonal stress contributed to elevations in depressive symptoms over time. These findings highlight the complex interplay between cognitive and interpersonal processes that confer vulnerability to depression, and have implications for the development of integrated depression-focused intervention endeavors.     

Positive psychotherapy for depression and self‐efficacy in undergraduate nursing students: A randomized,controlled trial

Nursing students across the globe experience depressive symptoms, and many interventions have been used to alleviate their depression. However, few interventions focus on students' personal strengths and advantages. The aim of the present study was to explore the effects of an 8‐week group positive psychotherapy (PPT) programme on depression and self‐efficacy in full‐time undergraduate nursing students. A randomized, controlled trial was conducted for 76 nursing students (34 in the experimental group, 42 in the control group). The Beck Depression Inventory‐II and the General Self‐Efficacy Scale were used to collect data prior to, immediately after PPT, 3 months', and 6 months' post‐PPT. Repeated‐measures analysis of variance indicated that the intervention significantly alleviated depression and improved self‐efficacy (each P < 0.05); the effect of time and time–group interaction was also significant (each P < 0.05). The findings suggest that PPT could significantly relieve depressive symptoms and improve self‐efficacy. We recommend that PPT is effective in alleviating depression and improving self‐efficacy in undergraduate nursing students. Academic mental health nurses should appreciate the value of PPT and consider incorporating it in psychological support methods in order to facilitate nursing students' mental health.     

氯氮平舒必利治疗精神分裂症持久性知觉障碍的疗效观察

为探讨精神分裂症经氯氮平治疗后存在的持久性、复发性幻听,再联用舒必利的效应,对48例在初期单用氯氮平治疗,但残存幻听,遂再联用舒必利,分别为时6～8周。结果:35例幻听消失(72.9％),其余诸例在程度上也有所减轻。提示:两药联用对缓解精神分裂症的幻听有显著效应,宜作进一步研究。     

The effect of reminiscence therapy on quality of life,attitudes to ageing,and depressive symptoms in institutionalized elderly adults with cognitive impairment: A quasi‐experimental study

The aim of this study was to analyse the effect of group narrative reminiscence therapy on cognition, quality of life, attitudes towards ageing, and depressive symptoms in a group of older adults with cognitive impairment in institutional care. A quasi‐experimental pretest/post‐test control group design was employed. Interventions involving reminiscence therapy with a narrative approach were included in the care plan and implemented in groups of between five and ten respondents once a week for 8 weeks (total 59 participants). The members of the control group (n = 57) received standard care. A study questionnaire was designed to measure demographic characteristics, quality of life (WOHQOL‐BREF, WHOQOL‐OLD), depressive symptoms (GDS), cognition (MMSE), and attitudes towards ageing (AAQ). Reminiscence therapy positively affected older adults’ quality of life (mostly the areas of mental health and social participation), and also their attitudes to ageing and old age. It reduced symptoms of depression, but had no discernible effect on cognitive function. Reminiscence therapy can positively affect selected aspects of quality of life, attitudes towards old age, and symptoms of depression in the elderly in long‐term healthcare facilities. Group reminiscence therapy can be used as a nursing intervention.     

Mediation analysis of health‐related quality of life among people living with HIV infection in China

The effects of stigma, social support, and depressive symptoms on health‐related quality of life are well documented in the literature, but how these psychological factors interact with each other, and the combined effects when taken together on the health‐related quality of life for people living with HIV, remain unclear. This cross‐sectional study investigated 114 people living with HIV who were taking antiretroviral medication using the HIV/AIDS‐related Stigma Scale (Chinese version), the Social Support Rating Scale, the Center for Epidemiological Studies Depression Scale, and the Medical Outcomes Study–HIV health survey. Multiple linear regression analyses were used to examine the mediation effect of the psychosocial factors on health‐related quality of life. Results showed that stigma and social support did not have direct effects, but indirect effects on health‐related quality of life through a full mediation effect of depressive symptoms. The results indicate that interventions targeting depression might be the most effective approach to improving health‐related quality of life among people living with HIV who are taking antiretroviral medication in China.     

Social Support as a Mediator of Physical Disability and Depressive Symptoms in Chinese Elderly

The relationship between physical disability and depressive symptoms has been associated with social support. Different aspects of social support may play distinct roles in health-related quality of life. The aim of this study was to examine the mediation of social support in the relationship between physical disability and depressive symptoms among old people in Mainland China. Subjective support and utilization of support mediated the relationship between ADL and depressive symptoms, with the indirect effect of subjective support and utilization of support at 0.038 and 0.030 respectively (the total effect was 0.180). Subjective support was negatively associated with depressive symptoms in independent elderly people, utilization of support was negatively associated with depressive symptoms in partially dependent elderly people, and utilization of support had a greater association with geriatric depressive symptoms than subjective support in severely dependent elderly people. Social support mechanism and positive psychological intervention should be established and introduced in accordance with the physical disability of the elderly people, to protect them from depressive symptoms.