Prevalence of alcohol use disorders in schizophrenia – a systematic review and meta‐analysis

Objective: Our aim was to present recent studies of alcohol use disorders (AUDs) in patients with schizophrenia, estimate overall prevalence and characteristics affecting the prevalence of AUDs. Method: We conducted a search using three literature databases and a manual search on articles published in 1996–2008. Meta‐regression was used to study how prevalence is affected by different study characteristics. Articles that reported diagnoses according to DSM or ICD diagnostic systems were included. Results: Altogether 60 studies met our criteria. The median of current AUD prevalence was 9.4% (inter‐quartile range, IQR 4.6–19.0, 18 studies) and median of lifetime AUD prevalence 20.6% (IQR 12.0–34.5, 47 studies). In studies using DSM‐III‐R median prevalence was higher than that in studies using DSM‐IV, ICD‐9 or ICD‐10 (32/17/11/6%). Conclusion: Approximately every fifth patient with schizophrenia had lifetime AUD diagnosis. When contrasted with the most recent review, there might be a descending trend in AUD prevalence in patients with schizophrenia.     

Fidelity to a motivational interviewing intervention for those with post-stroke aphasia: a small-scale feasibility study

Objective: Depression after stroke is common, and talk-based psychological therapies can be a useful intervention. While a third of stroke survivors will experience communication difficulties impeding participation in talk-based therapies, little guidance exists to guide delivery for those with aphasia. We need to understand how to adapt talk-based therapies in the presence of aphasia. This study aimed to explore the feasibility of motivational interviewing (MI) in people with post-stroke aphasia.

Methods: In a small-scale feasibility study, consecutive patients admitted to an acute stroke ward were screened for eligibility. People with moderate to severe aphasia were eligible. Those consenting received an intervention consisting of up to eight MI sessions delivered twice per week over four weeks. Sessions were modified using aids and adaptations for aphasia. Session quality was measured using the Motivational Interviewing Skills Code (MISC) to assess MI fidelity.

Results: Three consenting patients identified early post-stroke took part; one male and two females ages ranging between 40s and 80s. Participants attended between five and eight MI sessions over four weeks. Aids and adaptations included visual cues, rating scales, and modified reflections incorporating verbal and non-verbal behaviors. Sessions were tailored to individual participant need. Threshold MISC ratings could be achieved for all participants however, ratings were reduced when aids and adaptations were not used.

Discussion: This small-scale feasibility study suggests that it is feasible to adapt MI for people with moderate to severe post-stroke aphasia. These findings merit further exploration of adapted MI as an intervention for this patient group.     

Pedometer walking plus motivational interviewing program for Thai schizophrenic patients with obesity or overweight: a 12-week, randomized, controlled trial

Aim: The aim of this study was to design and examine a program called the ‘pedometer walking plus motivational interviewing (PWMI) program’ in schizophrenic patients who are obese or overweight. Methods: This was a 12‐week, randomized, parallel, open‐label, controlled trial in mildly ill schizophrenic patients with a body mass index (BMI) of 23.0 kg/m² or more. Each participant in the intervention or control group was given a leaflet entitled ‘What is a healthy lifestyle?’ The 1‐week, PWMI program consisted of five 1‐h sessions of individual motivational interviewing, group education, goal‐setting, and practising of pedometer walking. The pedometers were given to the intervention group only. Weight, height, BMI and waist circumference were assessed at baseline, week 4, week 8, and week 12. The primary outcome of this trial was the changed bodyweight at week 4, week 8, and week 12. Results: Of 64 participants, 32 each were randomly allocated to intervention and control groups. All participants completed the study. Only the means of changed bodyweight at week 12 were significantly different between groups (P = 0.03). At this week, the bodyweight of the intervention group decreased significantly more than that of the control group with a mean difference of 2.21 kg (95% confidence interval of 4.12–0.29). Conclusion: Increased physical activity by pedometer walking plus individual motivational interviewing may be an effective program for the reduction of bodyweight and BMI in Thai schizophrenic patients who are obese or overweight. Its efficacy may be comparable to other cognitive/behavioral programs. Further studies in larger sample sizes are warranted.     

Adapting a blended motivational interviewing and problem-solving intervention to address risky substance use amongst South Africans

Abstract

The purpose of this study was to examine the acceptability and initial substance use outcomes of a blended motivational interviewing (MI) and problem-solving therapy (PST) intervention, delivered by peer counsellors. Twenty people who scored at risk for substance use according to the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) received a five session blended MI-PST intervention and were assessed at baseline and at three months. An open-ended semi-structured interview, designed to identify possible factors that may hinder or promote the acceptability of the intervention was also conducted. Fifteen participants completed the intervention and the three-month follow-up. According to ASSIST scores, participants significantly reduced their substance use (p > 0.001) at the three-month follow-up. Randomized controlled trials are needed to evaluate the effect of this intervention more rigorously.     

Using motivational interviewing with children and adolescents: a cognitive and neurodevelopmental perspective

Motivational interviewing (MI) is an effective method of promoting change in adults, but its efficacy with children and adolescents is in the early stages of evaluation. The brevity of the intervention, documented effectiveness in adult populations and emphasis on motivating behavioural change have encouraged some researchers to test MI in educational settings. However, the number and quality of studies of MI with children and adolescents are limited, and it remains unclear whether MI is developmentally appropriate for children. This conceptual paper reviews cognitive and neurodevelopmental evidence of children's and adolescents' cognitive and social–emotional readiness for mental tasks thought to drive behavioural change in MI. Owing to the social context of MI, we place this research in a developmental framework using the social information processing network model of Nelson, Leibenluft, McClure, and Pine (2005). Based on these findings, we recommend continued testing of MI with students in middle and high schools but caution against using MI with elementary school students.     

Comparisons of insight in schizophrenia,bipolar I disorder,and depressive disorders with and without comorbid alcohol use disorder

Aims: To compare the level of insight among six groups of patients with psychiatric disorders, including those with schizophrenia (SZ), bipolar I disorder (BP), or depressive disorders (DD) who had or did not have comorbid alcohol use disorder (AUD). Methods: A total of 285 outpatients meeting the aforementioned criteria were recruited into the study. The Schedule of Assessment of Insight–Expanded version (SAI‐E) was used to measure subjects' insight. Analysis of covariance (ancova ) was used to compare the levels of insight among the six groups of subjects. Results: Regardless of whether patients had comorbid AUD or not, patients with DD had higher levels of insight than did patients with SZ. Comorbid AUD had independent effects on the differences in the level of insight between patients with DD and BP and between patients with BP and SZ. No statistically significant difference in insight was found between patients with the same psychiatric diagnosis with and without comorbid AUD. Conclusions: In addition to psychotic features and clinical states, comorbid AUD should be taken into consideration when comparing the level of insight among patients with different psychiatric diagnoses.