A Comparative study of nurses as case manager and telephone follow-up on clinical outcomes of patients with severe mental illness

Background: Providing community-based mental health services is crucial and is an agreed plan between the Iranian Mental Health Office and the Regional Committee for the Eastern Mediterranean (affiliated with WHO). The aim of this study was to determine the effectiveness of home-visit clinical case-management services on the hospitalization rate and other clinical outcomes in patients with severe mental illness. Methods: A total of 182 patients were randomly allocated into three groups, namely, home-visit (n=60), telephone follow-up (n=61) and as-usual care (n=61) groups. Trained nurses as clinical case-managers provided home-visit services and the telephone follow-up tasks. Hospitalization rate as a measure of recurrence, as well as burden, knowledge, general health condition of caregivers with positive/negative symptoms, satisfaction, quality of life, and social skills of the consumers were assessed as the main and secondary outcomes, respectively. Results: Most clinical variables were improved in both intervention groups compared with the control group. During the one year follow-up, the rate of rehospitalization for the telephone follow-up and as-usual groups were respectively 1.5 and 2.5 times higher than the home-visit group. Conclusion: Trained clinical case-managers are capable of providing continuous care services to patients with severe mental illness. The telephone follow-up services could also have beneficiary outcome for the consumers, their caregivers, and the health system network. © 2016, Shiraz University of Medical Sciences. All rights reserved

Attitudes and burden in relatives of patients with schizophrenia in a middle income country

BACKGROUND: Most studies of family attitudes and burden have been conducted in developed countries. Thus it is important to test the generalizability of this research in other contexts where social conditions and extended family involvement may be different. The aim of this study was to assess the relationship between the attitudes of caregivers and the burden they experience in such a context, namely Arica, a town located in the northernmost region of Chile, close to the border with Peru and Bolivia. METHODS: We assessed attitudes towards schizophrenia (including affective, cognitive and behavioural components) and burden (including subjective distress, rejection and competence) in 41 main caregivers of patients with schizophrenia, all of whom were users of Public Mental Health Services in Arica. RESULTS: Attitude measures differed significantly according to socio-demographic variables, with parents (mainly mothers) exhibiting a more negative attitude towards the environment than the rest of the family (t = 4.04; p = 0.000).This was also the case for caregivers with a low educational level (t = 3.27; p < 0.003), for the oldest caregivers (r = 0.546; p = 0.000) and for those who had spent more time with the patient (r = 0.377; p = 0.015). Although attitudes had significant association with burden, their explanatory power was modest (R2 = .104, F = 4,55; p = .039). CONCLUSIONS: Similar to finding developed countries, the current study revealed a positive and significant relationship between the attitudes of caregivers and their burden. These findings emphasize the need to support the families of patients with schizophrenia in this social context

Family and carer participation in mental health care: perspectives of consumers and carers in hospital and home care settings

It is widely accepted that family and carer participation in adult mental health care is desirable. However, rarely is service development informed by representative opinions of both carers and service users. This study took place in the context of a larger project to introduce and evaluate practice standards relating to family participation. The aim of this paper is to explore the perceptions of service users and carers to carer participation in adult mental health services. One hundred and twenty-nine service users and 86 family members recruited via hospital and community settings completed a survey which addressed obstacles to family participation, perceived benefits of participation and areas for improvement. Many service users and family were entirely satisfied with existing levels of family participation. Different needs for information, support and the nature of participation in mental health care are highlighted in acute hospital and community settings. Across settings, the provision of support and accessing services were identified as the most useful aspects of family participation. Meaningful carer and family participation in mental health care should proceed from respectful connection with carers and be informed by need which will vary depending on setting and circumstances

Ethnographic analysis of expressed emotions in Pakistani families of patients with schizophrenia

Family expressed emotions (EE) have been found to be closely linked with the course of the disorder in patients with schizophrenia. Despite substantial cross-cultural differences in rates and impact of EE, a qualitative understanding of the construct is missing in relevant literature. This work was undertaken in Pakistan to understand the indigenous expression of emotional overinvolvement, criticism, and hostility as the primary components of the construct. We transcribed and conducted content analysis on the audio-recorded Camberwell Family Interviews of sixty-four caregivers to search the statements indicating these three elements. The frequency of statements showing overinvolved behavior surpasses all other accounts indicating criticism or hostility. Although many emotionally overinvolved behaviors are culturally relevant, some behaviors of the relatives, particularly of mothers, are above and beyond the cultural expectations. Outcome studies are warranted to determine whether extreme sacrificing and devoted behavior is pathological or a part of the culture. Criticism is mostly directed to socially objectionable behavior followed by personality traits of the patients. The higher frequency of hostility may be explained by specific socio-cultural factors. This ethnographic analysis shows that expressed emotions is not a culture specific construct. However, cultural distinctive patterns of emotional overinvolvement and critical attitude may exist across cultures

Effect of a psycho-educational intervention for family members on caregiver burdens and psychiatric symptoms in patients with schizophrenia in Shiraz, Iran

<p>Abstract</p> <p>Background</p> <p>This study explored the effectiveness of family psycho-education in reducing patients’ symptoms and on family caregiver burden.</p> <p>Methods</p> <p>Seventy Iranian outpatients with a diagnosis of schizophrenia disorder and their caregivers were randomly allocated to the experimental (n = 35) or control groups (n = 35). Patients in the experimental group received antipsychotic drug treatment and a psycho-educational program was arranged for their caregivers. The psycho-educational program consisted of ten 90-min sessions held during five weeks (two session in each week). Each caregiver attended 10 sessions (in five weeks) At baseline, immediately after intervention, and one month later. Validated tools were used to assess patients’ clinical status and caregiver burden.</p> <p>Results</p> <p>Compared with the control group, the case group showed significantly reduced symptom severity and caregiver burden both immediately after intervention and one month later.</p> <p>Conclusions</p> <p>These results suggest that even need based short-term psycho-educational intervention for family members of Iranian patients with schizophrenic disorder may improve the outcomes of patients and their families.</p> <p>Trial registration</p> <p>IRCT Number:138809122812 N1`</p