The effects of psychoeducational family intervention on coping strategies of relatives of patients with bipolar i disorder: Results from a controlled, real-world, multicentric study

Background: Psychoeducational family intervention (PFI) has been proven to be effective in improving the levels of family burden and patients\u2019 personal functioning in schizophrenia and bipolar disorders (BDs). Less is known about the impact of PFI on relatives\u2019 coping strategies in BD. Methods: A multicenter, controlled, outpatient trial funded by the Italian Ministry of Health and coordinated by the Department of Psychiatry of the University of Campania \u201cLuigi Vanvitelli\u201d has been conducted in patients with bipolar I disorder (BD-I) and their key relatives consecutively recruited in 11 randomly selected Italian community mental health centers. We aim to test the hypothesis that PFI improves problem-oriented coping strategies in relatives of BD-I patients compared to the Treatment As Usual (TAU) group. Results: The final sample was constituted of 123 patients and 139 relatives. At baseline assessment (T0), the vast majority of relatives already adopted problem-oriented coping strategies more frequently than the emotion-focused ones. At the end of the intervention, relatives receiving PFI reported a higher endorsement of adaptive coping strategies, such as \u201cmaintenance of social interests\u201d (odds ratio [OR]=0.309, CI=0.04\u20130.57; p=0.023), \u201cpositive communication with the patient\u201d (OR=0.295, CI=0.13\u20130.46; p=0.001), and \u201csearching for information\u201d (OR=0.443, CI=0.12\u20130.76; p=0.007), compared to TAU relatives, after controlling for several confounders. As regards the emotion-focused coping strategies, relatives receiving the experimental intervention less frequently reported to adopt \u201cresignation\u201d (OR=-0.380, CI=-0.68 to -0.08; p=0.014) and \u201ccoercion\u201d (OR=-0.268, CI=-0.46 to -0.08; p=0.006) strategies, compared to TAU relatives. Conclusion: PFI is effective in improving the adaptive coping strategies of relatives of BD-I patients, but further studies are needed for evaluating the long-term benefits of this intervention

Improving physical health of patients with severe mental disorders. a critical review of lifestyle psychosocial interventions

People with severe mental disorders have a mortality rate that is more than two times higher than the general population, with at least a decade of potential years of life lost. People with mental disorders have a significantly higher risk of obesity, hyperglycemia and metabolic syndrome, which are related to modifiable risk factors, such as heavy smoking, poor physical activities, and inappropriate unhealthy diet, which can be improved through lifestyle changes. Areas covered: Lifestyle behaviours are amenable to change through the adoption of specific psychosocial interventions, and several approaches have been promoted. In the present review, the authors aim to: 1) critically analyze studies involving multimodal lifestyle interventions; 2) discuss the way forward to integrate these interventions in clinical routine care. Expert commentary: The psychoeducational approaches developed for the improvement of healthy lifestyle behaviours differ for several aspects: 1) the format (individual vs. group); 2) the setting (outpatient vs. inpatient vs. home-based); 3) the professional characteristics of the staff running the intervention (psychiatrists or nurses or dietitians or psychologists); 4) the active ingredients of the intervention (education only or inclusion of motivational interview or of problem solving); 5) the duration of treatment (ranging from 3 months to 2 years)

Responding to experienced and anticipated discrimination (READ): anti -stigma training for medical students towards patients with mental illness - study protocol for an international multisite non-randomised controlled study

BackgroundStigma and discrimination are a significant public health concern and cause great distress to people with mental illness. Healthcare professionals have been identified as one source of this discrimination. In this article we describe the protocol of an international, multisite controlled study, evaluating the effectiveness of READ, an anti-stigma training for medical students towards patients with mental illness. READ aims to improve students' ability to minimise perceived discriminatory behaviours and increase opportunities for patients, therefore developing the ability of future doctors to address and challenge mental illness related discrimination. READ includes components that medical education research has shown to be effective at improving attitudes, beliefs and understanding.Methods/designREAD training was developed using evidence based components associated with changes in stigma related outcomes. The study will take place in multiple international medical schools across high, middle and low income countries forming part of the INDIGO group network, with 25 sites in total. Students will be invited to participate via email from the lead researcher at each site during their psychiatry placement, and will be allocated to an intervention or a control arm according to their local teaching group at each site. READ training will be delivered solely to the intervention arm. Standardised measures will be used to assess students' knowledge, attitudes and skills regarding discrimination in both the intervention and control groups, at baseline and at follow up immediately after the intervention. Statistical analyses of individual-level data will be conducted using random effects models accounting for clustering within sites to investigate changes in mean or percentages of each outcome, at baseline and immediately after the intervention.DiscussionThis is the first international study across high, middle and low income countries, which will evaluate the effectiveness of training for medical students to respond effectively to patients' experiences and anticipation of discrimination. The results will promote implementation of manualised training that will help future doctors to reduce the impact of mental illness related discrimination on their patients. Limitations of the study are also discussed

Anti-stigma training and positive changes in mental illness stigma outcomes in medical students in ten countries: a mediation analysis on pathways via empathy development and anxiety reduction

Purpose: Studies of mental illness stigma reduction interventions have been criticised for failing to evaluate behavioural outcomes and mechanisms of action. This project evaluates training for medical students entitled 'Responding to Experienced and Anticipated Discrimination' (READ), developed to focus on skills in addition to attitudes and knowledge. We aimed to (i) evaluate the effectiveness of READ with respect to knowledge, attitudes, and clinical communication skills in responding to mental illness-related discrimination, and (ii) investigate whether its potential effectiveness was mediated via empathy or/and intergroup anxiety. Methods: This is an international multisite non-randomised pre- vs post-controlled study. Eligible medical students were currently undertaking their rotational training in psychiatry. Thirteen sites across ten countries (n = 570) were included in the final analysis. Results: READ was associated with positive changes in knowledge (mean difference 1.35; 95% CI 0.87 to 1.82), attitudes (mean difference - 2.50; 95% CI - 3.54 to - 1.46), skills (odds ratio 2.98; 95% CI 1.90 to 4.67), and simulated patient perceived empathy (mean difference 3.05; 95% CI 1.90 to 4.21). The associations of READ with knowledge, attitudes, and communication skills but not with simulated patient perceived empathy were partly mediated through student reported empathy and intergroup anxiety. Conclusion: This is the first study to identify mediating effects of reduced intergroup anxiety and increased empathy in an evaluation of anti-stigma training that includes behavioural measures in the form of communication skills and perceived empathy. It shows the importance of both mediators for all of knowledge, skills, and attitudes, and hence of targeting both in future interventions