Two Approaches to the Management of Long-Term Psychiatric Outpatients in the Community

Slavinsky, Ann T.; Krauss, Judith B.

doi:10.1097/00006199-198209000-00007

Cited by 22 publications

(1 citation statement)

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“…But not all diagnostic categories are equally affected (Angermeyer, 2002;Oliveira, Esteves, & Carvalho, 2015;Stuart & Arboleda-Flórez, 2001). Among various diagnostic categories, schizophrenia is known as one of the most severe and most stigmatized psychiatric illnesses (Angermeyer & Dietrich, 2006;Crisp, Gelder, Goddard, & Meltzer, 2005;Slavinsky & Krauss, 1982;Wood, Byrne, Varese, & Morrison, 2016). Attributing danger and unpredictability to people with schizophrenia (85%) is much more common than in people, for example, diagnosed with depression or anxiety (71%); (Angermeyer & Dietrich, 2006).…”

Section: Introductionmentioning

confidence: 99%

Disclosing the diagnosis of schizophrenia: A pilot study of the ‘Coming Out Proud’ intervention

Setti

Loch

Modelli

et al. 2019

Int J Soc Psychiatry

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Background: Schizophrenia is one of the most stigmatized psychiatric disorders, and disclosing it is often a source of stress to individuals with the disorder. The Coming Out Proud (COP) group intervention is designed to reduce the stigma’s negative impact and help participants decide if they want to disclose their disorder. Aims: To assess the effect of the COP intervention in individuals with the diagnosis of schizophrenia. Methods: A pilot study of 3 2-hour group lessons (6–12 participants) per week. Individuals were selected from three specialized outpatient services in São Paulo, Brazil; 46 people were willing to participate, 11 dropped out during the intervention and 4 were excluded due to low intelligence quotient (IQ), resulting in a final sample of 31 participants. Outcomes were assessed before ( T0/baseline) and after ( T1/directly) after the COP intervention, and at 3-week follow-up ( T2/3 weeks after T1). We applied eight scales, of which four scales are analyzed in this article (Coming Out with Mental Illness Scale (COMIS), Cognitive Appraisal of Stigma as a Stressor (CogApp), Self-Stigma of Mental Illness Scale-Short Form (SSMIS) and Perceived Devaluation-Discrimination Questionnaire (PDDQ)). Results: People who completed the COP intervention showed a significant increase in the decision to disclose their diagnosis (22.5% in T0 vs 67.7% in T2). As to the perception of stigma as a stressor, mean values significantly increased after the intervention ( T0 = 3.83, standard deviation ( SD) = .92 vs T2 = 4.44, SD = 1.05; p = .006). Two results had marginal significance: self-stigma was reduced ( T0 = 3.10, SD = 1.70 vs T2 = 2.73, SD = 1.87; p = .063), while perceived discrimination increased ( T0 = 2.68, SD = .55 vs T2 = 2.93, SD = .75; p = .063). Conclusion: This study suggests that the COP group intervention facilitated participants’ disclosure decisions, and the increasing awareness of stigma as a stressor in life may have facilitated their decision to eventually disclose their disorder. The results raise questions that require further analysis, taking sociocultural factors into account, as stigma is experienced differently across cultures.

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Section: Introductionmentioning

confidence: 99%

Disclosing the diagnosis of schizophrenia: A pilot study of the ‘Coming Out Proud’ intervention

Setti

Loch

Modelli

et al. 2019

Int J Soc Psychiatry

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Community mental health teams (CMHTs) for people with severe mental illnesses and disordered personality

Tyrer¹,

Coid²,

Simmonds³

et al. 1998

Cochrane Database of Systematic Reviews

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Community mental health teams (CMHTs) for people with severe mental illnesses and disordered personality

Malone

Marriott

Newton‐Howes

et al. 2007

Cochrane Database of Systematic Reviews

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Background Closure of asylums and institutions for the mentally ill, coupled with government policies focusing on reducing the number of hospital beds for people with severe mental illness in favour of providing care in a variety of non-hospital settings, underpins the rationale behind care in the community. A major thrust towards community care has been the development of community mental health teams (CMHT). Objectives To evaluate the effects of community mental health team (CMHT) treatment for anyone with serious mental illness compared with standard non-team management. Search methods We searched The Cochrane Schizophrenia Group Trials Register (March 2006). We manually searched the Journal of Personality Disorders, and contacted colleagues at ENMESH, ISSPD and in forensic psychiatry. Selection criteria We included all randomised controlled trials of CMHT management versus non-team standard care. Data collection and analysis We extracted data independently. For dichotomous data we calculated relative risks (RR) and their 95% confidence intervals (CI) on an intention-to-treat basis, based on a fixed effects model. We calculated numbers needed to treat/harm (NNT/NNH) where appropriate. For continuous data, we calculated weighted mean differences (WMD) again based on a fixed effects model. Main results CMHT management did not reveal any statistically significant difference in death by suicide and in suspicious circumstances (n=587, 3 RCTs, RR 0.49 CI 0.1 to 2.2) although overall, fewer deaths occurred in the CMHT group. We found no significant differences in the number of people leaving the studies early (n=253, 2 RCTs, RR 1.10 CI 0.7 to 1.8). Significantly fewer people in the CMHT group were not satisfied with services compared with those receiving standard care (n=87, RR 0.37 CI 0.2 to 0.8, NNT 4 CI 3 to 11). Also, hospital admission rates were significantly lower in the CMHT group (n=587, 3 RCTs, RR 0.81 CI 0.7 to 1.0, NNT 17 CI 10 to 104) compared with standard care. Admittance to accident and emergency services, contact with primary care, and contact with social services did not reveal any statistical difference between comparison groups. Authors’ conclusions Community mental health team management is not inferior to non-team standard care in any important respects and is superior in promoting greater acceptance of treatment. It may also be superior in reducing hospital admission and avoiding death by suicide. The evidence for CMHT based care is insubstantial considering the massive impact the drive toward community care has on patients, carers, clinicians and the community at large.

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Two Approaches to the Management of Long-Term Psychiatric Outpatients in the Community

Cited by 22 publications

References 0 publications

Disclosing the diagnosis of schizophrenia: A pilot study of the ‘Coming Out Proud’ intervention

Disclosing the diagnosis of schizophrenia: A pilot study of the ‘Coming Out Proud’ intervention

Community mental health teams (CMHTs) for people with severe mental illnesses and disordered personality

Community mental health teams (CMHTs) for people with severe mental illnesses and disordered personality

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