Ratings of social functioning in outpatients with schizophrenia: Patient self-report versus caregiver assessment

Patients with schizophrenia often have deficits in day-to-day functioning that are central to their disability. The ability of patients to rate their own social functioning, however, has not been established. In this study we examined the concordance between the ratings on the Social Functioning Scale of 58 outpatients with schizophrenia and their caregivers. We found a high level of overall concordance between the self and informant ratings. Items measuring the frequency of behaviors were among those with the highest concordance, while ratings of ability or social skill showed lower correlations. On only nine of 73 items did patients rate themselves significantly higher than did caregivers. There was no difference in concordance between family and nonfamily caregivers. These findings indicate that outpatients with schizophrenia can provide self-report ratings that are consistent with the ratings of their caregivers.     

Problem and Pathological Gambling in Schizophrenia: Exploring Links with Substance Use and Impulsivity

High rates of both problem and pathological gambling (PPG) and substance-use disorders (SUDs) have been reported in schizophrenia, and yet PPG frequently goes undetected in clinical practice and unexamined in research. Here, we aimed to examine the relationship between PPG and SUDs in a large sample of patients across several factors related to both gambling and substance use, including poly-substance use. Additionally, delay discounting is a form of impulsivity known to positively associate with both PPG and SUDs and thought to underlie mechanisms of addiction in both contexts. We aimed to investigate the relationship between PPG and delay discounting in schizophrenia. 337 individuals with schizophrenia completed structured face-to-face interviews regarding gambling behaviors, substance use, and delay discounting. PPG in schizophrenia was associated with substance use, in particular with poly-substance use, and with delay discounting among males. Factors related to substance use were strongly linked with gambling in this sample, but not always with PPG more than recreational gambling. Our findings overall support the notions that multiple forms of gambling in schizophrenia are clinically relevant, that gambling may share common substrates with substance use, and that delay discounting represents a potential mechanism of this association in males.     

Now take a deep breath: inhaled loxapine for the treatment of acute agitation

Acute agitation in patients with schizophrenia or bipolar disorder is an important clinical management problem. Liquid concentrates, orally disintegrating tablets, and/or intramuscular formulations of several second-generation atypical antipsychotic drugs are available for treating acute agitation. Loxapine is an older first-generation antipsychotic drug that is approved for the treatment of schizophrenia. Staccato(?) loxapine is an investigational device system using a loxapine-coated heat source to administer loxapine by inhalation. Three multicenter, randomized, double-blind, placebo-controlled efficacy and safety studies of Staccato loxapine have been conducted in patients with acute agitation associated with schizophrenia or bipolar disorder. These studies found that inhaled loxapine was rapidly effective and generally well tolerated, although there are potential concerns about adverse pulmonary effects.     

The nurse's role in neuroleptic medications.

1. A questionnaire study of schizophrenia sufferers' (N = 132) views on medication, contrary to expectations, revealed generally favorable attitudes. Clients seemed to understand the fine balance between costs and benefits better than many health-care professionals imagine. 2. Because nurses spend more time communicating with clients than physicians, they are ideally placed to find out how patients perceive neuroleptic therapy, and to provide information, advice, and counseling support. 3. There is a strong case for asserting that mental health nurses should extend their role in monitoring the effects of medication on their clients.     

Mindfulness: an intervention for anxiety in schizophrenia

Despite evidence that individuals with schizophrenia spectrum disorders experience significant and persistent symptoms of anxiety, there are few reports of the use of empirically supported treatments for anxiety in this population. This article describes how we have tried to adapt mindfulness interventions to help individuals with schizophrenia who experience significant anxiety symptoms. Although mindfulness has been widely used to help individuals without psychosis, to our knowledge, this is the first study adapting it to help those with schizophrenia manage worry and stress. We provide an overview of the intervention and use an individual example to describe how our treatment development group responded. We also explore directions for future research of mindfulness interventions for schizophrenia.     

Schizophrenia in older adults

Although the number of people older than 55 with schizophrenia is expected to double during the next 20 years, the research data on older adults with schizophrenia are limited. This appears to be because until the middle of the 20th century, it was assumed that mental illness in older adults was a part of the aging process and because older adults are often excluded from research investigations. Nursing research is needed to explore how people with schizophrenia learn to manage their problems as they age, as well as how those who are first diagnosed with schizophrenia in later life adapt to their illness. Mental health nurses need to be cautious in assigning premature labels to older adults with mental illness that may lead to unsubstantiated assumptions about levels of disability. Instead, nurses should realize individual potential regarding undiscovered strengths and should attempt to create interventions that recognize and foster personal development for older adults with schizophrenia.     

Early-Onset Schizophrenia: A Literature Review of Empirically Based Interventions

Children presenting with early-onset schizophrenia are now diagnosed utilizing the same criteria as adults with schizophrenia. A review of the literature indicates that there is a dearth of intervention studies specific to the treatment of children diagnosed with early-onset schizophrenia, though this form of schizophrenia is considered to be more severe and chronic. Pharmacological studies specific to children are reviewed as are social skills training and family behavioral therapy studies conducted on the adult schizophrenia population which may hold potential for treating children diagnosed with early-onset schizophrenia. Recommendations for practice and research are presented.     

An education intervention for families of people with schizophrenia in China: development and evaluation

In China, nurses and physicians are the main care providers for people with schizophrenia. This care is provided primarily in institutions because community services are in their infancy, and families carry the burden of care. In the absence of published nursing research in the area, this article reports the rigorous development and evaluation of a culturally sensitive patient/family intervention, which was implemented in a large psychiatric hospital in Beijing, China. A random sample of 15 nurses responded to an open-ended questionnaire to explore what they believed people with schizophrenia and their family members should learn. A convenience sample of 51 family members who lived with a person with schizophrenia were also interviewed to explore what they understood and needed to know about schizophrenia. Common learning needs were integrated with the literature and presented as the Comprehensive Patient/Family Education Guide, which was implemented with an experimental group of 42 family members, while a control group of 45 received the usual hospital treatment. The effect of the intervention was evaluated by interviewing a random sample of 19 of the family members. The results revealed some useful information for the future planning and implementation of such programs, and although focused on a Chinese sample, do offer insights for nurses around the world.     

Refractory schizophrenia: what works pharmacologically?

1. Many patients with refractory schizophrenia remain undertreated and are at great risk for serious consequences of their illness, up to and including suicide. 2. Clozaril is the only antipsychotic medication proven to be effective in treating refractory schizophrenia. It is particularly effective in reducing violence associated with assaults and suicide. 3. Nurses can be very instrumental in working with resistant systems, treating clinicians, and patients by recommending Clozaril therapy for refractory schizophrenia.     

Schizophrenia and genomics: linking research to practice

New knowledge about genetics and genomics is emerging at a rapid pace. This article discusses how this emerging knowledge related to schizophrenia affects the nursing care of patients with the disorder. Newly defined competencies related to genetics are also addressed. The relevance of this knowledge and the application of the competencies are demonstrated in an individual example.     

Intervention options: Participation in work activities for people with schizophrenia

Vocational rehabilitation is a method by which people with disabilities are able to learn skills and receive supports that are necessary to take part in work activities. Vocational rehabilitation interventions can be used in a wide variety of settings with many different populations of people with disabilities, including those with schizophrenia. However, there is little available research to help guide clinicians to identify which vocational rehabilitation intervention methods may be the most effective for their clients. OBJECTIVES: The purpose of this paper is to identify what is the best practice for obtaining and maintaining participation in work activities for people with schizophrenia. STUDY DESIGN: This paper reviewed sixteen previously conducted studies (seven specific solely to schizophrenia) to identify which vocational rehabilitation method is the best practice to aid those with schizophrenia to obtain and maintain participation in work activities. RESULTS: The reviewed literature suggests that there are a variety of vocational rehabilitation intervention methods that may be effective treatment interventions. The effective interventions were those programs that had a client-centered approach and enabled the client to play an active role in his/her vocational rehabilitation. CONCLUSION: With this study review, clinicians will be able to examine a variety of successful client-centered vocational rehabilitation methods that may aid in helping their clients with schizophrenia to obtain and maintain participation in work activities.     

Are clinician's ever biased in their judgments of the capacity of older adult's to make medical decisions?

Capacity assessment is a growing area of practice in geriatrics. In this pilot study we illustrate the potential relationship between clinician variables and capacity ratings. Twelve older adults with mild dementia or schizophrenia were rated by six clinicians from diverse disciplinary backgrounds. Capacity ratings were associated with clinician values regarding patient involvement in medical decisions, clinician-patient mismatches on such values, and emotional reactions to patients. Expanding our understanding of the impact of clinician variables on capacity ratings may enhance the reliability and validity of capacity assessments and help to promote autonomy when appropriate.     

The treatment of posttraumatic stress disorder in an extended care psychiatric rehabilitation program

This research study intended to determine which patient diagnostic group benefited most from an extended care psychiatric rehabilitation program (Program). Archival data were used to assess the completion rates among those subjected to one or more of the Program's treatment modalities. A correlational design was used to determine whether demographic or diagnostic variables were related to program completion. The results indicate that patients with a diagnosis of posttraumatic stress disorder or bipolar disorder are the most likely diagnostic groups to benefit from participation in an extended care psychiatric rehabilitation program. Those patients with a diagnosis of schizophrenia or substance abuse may not be appropriate for this type of treatment program, and in this study, were the least likely to benefit.     

Menopause and schizophrenia

We have come a long way from our understanding of the menopause as it was described in the 11th century by Trotula of Salerno, a female gynaecologist who said 'there are older women who give forth blood matter especially as menopause approaches them'. Yet very little is known about the impact menopause has on the mental health of women especially severe and enduring illnesses like schizophrenia. A lot of research has shown that estrogen acts as a protective factor due to its antidopaminergic properties, thus providing an explanation for the increase in risk of a new psychotic disorder during the menopause. This has further led to the hypothesis of hormone replacement therapy providing benefits in the management of these disorders in menopausal women. This review article highlights the importance of a clear understanding of this phase of life in patients suffering from or who present with a risk of developing schizophrenia.     

Long-acting injectable risperidone: an emerging tool in schizophrenia treatment

Long-term treatment of patients with schizophrenia remains challenging. Functional and cognitive declines associated with schizophrenia compromise patients' ability to adhere to therapy. While medications can improve outcomes, partial adherence limits effectiveness and is associated with relapse and rehospitalization. Partial adherence has been shown to be high with both oral conventional and oral atypical antipsychotic agents. While long-acting conventional antipsychotic agents provide ensured medication delivery and reduce relapse rates, they carry a substantial risk of movement disorders. A new long-acting formulation of the atypical agent risperidone has shown improved efficacy with decreased risk of adverse events. Its use, along with psychosocial approaches focused on adherence, may help, if initiated during inpatient treatment, by promoting adherence immediately postdischarge and improving long-term treatment outcomes.     

Clozapine: a new drug for schizophrenia

Clozapine, a new drug for schizophrenia, was recently released for use. We have described the drug and nursing care involved for patients who are on acute inpatient unit for a trial of the drug. From our early observations, clozapine appears to be a promising drug for patients who have not responded to standard neuroleptics.     

Correlates of caregiving burden in schizophrenia:A cross-sectional,comparative analysis from India

Schizophrenia is a global mental health issue that has serious implications not only for the person with the diagnosis, but for caregivers as well. In Asian societies, the family tends to be the “natural” caregiver in such situations and the caregiving function is usually shouldered by parents or the spouse. Asian communities tend to be more closely knit, and it would be expected that more social support would be available to those facing distressing circumstances such as managing the demands of a person with mental illness. This study seeks to explore the perceived burden in family caregivers of persons diagnosed with schizophrenia, the coping strategies that come into play, as well as the extent of social support available to them. Standardized instruments were administered to collect data at a teaching cum treatment facility in south India. A quantitative methodology was used to analyze cross-sectional data from 75 primary caregivers of people with a diagnosis of schizophrenia and a reference group of caregivers of patients with general medical ailments. Results indicate higher levels of burden, low social support, and poor coping in the caregivers of people with schizophrenia than the reference group. Implications for intervention with caregivers are also discussed in this article.     

Diagnosis and therapy of male gamblers in a university psychiatric hospital

From 1980 to mid-1990 fifty-one gamblers were evaluated and treated at the psychiatric university hospital of Homburg/Saar in Germany. All were men with a mean age of 33.7 years. Gambling had lasted 5.2 years on average. Most patients were motivated to undergo therapy by members of their family. The majority of them had been in psychotherapeutic treatment before. Thirty-six of the 51 patients had committed punishable acts including fraud and embezzlement and, in 7 cases, robbery. The sample could be divided into three clinical subgroups. The first group consisted of patients with severe psychiatric diseases such as schizophrenia, manic-depressive illness or organic brain disorder. Patients of the second group suffered from serious personality disorders. Those of the third group showed deep-rooted problems in their current relationships.This article is an extension of the special issue on Gambling in Europe edited by Iver Hand, M.D.     

Decreased psychopathology & family burden. Associated with clozapine treatment of patients with refractory schizophrenia

1. Intensive multimodal treatment produces measurable gains in community functioning of people with schizophrenia and reduces family burden. 2. Families that were more involved with patients were more satisfied. 3. Money directed at intensive management and rehabilitation decreases hospitalization and increases community functioning of people with schizophrenia.     

Teaching hospitalized patients with serious, persistent mental illness.

1. Although patient teaching is an important nursing function, minimal research was found related to education of patients with schizophrenia. Teaching psychiatric patients about illness, treatment, and rehabilitation has not received the same attention in psychiatric nursing as it has in other nursing specialties. 2. Eighty percent of the patients who participated in patient education classes would recommend the program to others. Treatment teams reported that some patients asked more questions about their treatment and became more active in ward groups following the classes. 3. The use of nurses as patient educators facilitates professional nursing practice and effectively ensures that patients' general physical health and psychiatric education needs are systematically addressed.