Metacognitive training: a useful complement to community-based rehabilitation for schizophrenia patients in China

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Abstract

Background

The traditional general practitioner-based model (community-based rehabilitation [CBR]) for Chinese schizophrenia patients lacks sufficient content, usefulness, and theoretical basis for rehabilitation. Based on previous research, we postulate that Metacognitive Training (MCT) is effective in the community for schizophrenic patients.

Method

A randomized controlled, assessor-blinded trial was conducted. A total of 124 schizophrenia patients were recruited from Ningbo China and were randomly assigned to an intervention or a control group. A general practitioner (GP) training plan was carried out before intervention. Intervention and control groups received two CBR follow-ups once a month, while the intervention group, received an additional eight once-a-in-week session of MCT. The Positive and Negative Syndrome Scale (PANSS), and the Psychotic Symptom Rating Scales (PSYRATS) were the primary outcome instruments, while the Quality of Life Scale (SQLS) was the secondary outcome instrument.

Results

In the post-treatment between-groups assessment, the patients in the intervention group showed significantly more reductions on PSYRATS delusions, PSYRATS total, PANSS P6, PANSS core delusions, PANSS positive, PANSS negative, PANSS general and PANSS total, and a significant improvement in SQLS psychosocial aspect.

Conclusions

The study provides preliminary evidence for the usefulness of MCT as a complementary measure for community-based rehabilitation of schizophrenia patients.

Trial registration

ISRCTN, ISRCTN17333276. Registered 09 August 2020 - Retrospectively registered.

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Most cited references 48

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The Positive and Negative Syndrome Scale (PANSS) for Schizophrenia

S R Kay, A Fiszbein, L A Opler (1987)

The variable results of positive-negative research with schizophrenics underscore the importance of well-characterized, standardized measurement techniques. We report on the development and initial standardization of the Positive and Negative Syndrome Scale (PANSS) for typological and dimensional assessment. Based on two established psychiatric rating systems, the 30-item PANSS was conceived as an operationalized, drug-sensitive instrument that provides balanced representation of positive and negative symptoms and gauges their relationship to one another and to global psychopathology. It thus constitutes four scales measuring positive and negative syndromes, their differential, and general severity of illness. Study of 101 schizophrenics found the four scales to be normally distributed and supported their reliability and stability. Positive and negative scores were inversely correlated once their common association with general psychopathology was extracted, suggesting that they represent mutually exclusive constructs. Review of five studies involving the PANSS provided evidence of its criterion-related validity with antecedent, genealogical, and concurrent measures, its predictive validity, its drug sensitivity, and its utility for both typological and dimensional assessment.

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Early appraisal of China's huge and complex health-care reforms.

Winnie Chi-Man Yip, William C Hsiao, Wen Chen … (2012)

China's 3 year, CN¥850 billion (US$125 billion) reform plan, launched in 2009, marked the first phase towards achieving comprehensive universal health coverage by 2020. The government's undertaking of systemic reform and its affirmation of its role in financing health care together with priorities for prevention, primary care, and redistribution of finance and human resources to poor regions are positive developments. Accomplishing nearly universal insurance coverage in such a short time is commendable. However, transformation of money and insurance coverage into cost-effective services is difficult when delivery of health care is hindered by waste, inefficiencies, poor quality of services, and scarcity and maldistribution of the qualified workforce. China must reform its incentive structures for providers, improve governance of public hospitals, and institute a stronger regulatory system, but these changes have been slowed by opposition from stakeholders and lack of implementation capacity. The pace of reform should be moderated to allow service providers to develop absorptive capacity. Independent, outcome-based monitoring and evaluation by a third-party are essential for mid-course correction of the plans and to make officials and providers accountable. Copyright Â© 2012 Elsevier Ltd. All rights reserved.

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Prevalence, treatment, and associated disability of mental disorders in four provinces in China during 2001-05: an epidemiological survey.

Michael R Phillips, Jingxuan Zhang, Qichang Shi … (2009)

In China and other middle-income countries, neuropsychiatric conditions are the most important cause of ill health in men and women, but efforts to scale up mental health services have been hampered by the absence of high-quality, country-specific data for the prevalence, treatment, and associated disability of different types of mental disorders. We therefore estimated these variables from a series of epidemiological studies that were done in four provinces in China. We used multistage stratified random sampling methods to identify 96 urban and 267 rural primary sampling sites in four provinces of China; the sampling frame of 113 million individuals aged 18 years or older included 12% of the adult population in China. 63 004 individuals, identified with simple random selection methods at the sampling sites, were screened with an expanded version of the General Health Questionnaire and 16,577 were administered a Chinese version of the Structured Clinical Interview for Diagnostic and Statistical Manual (DSM)-IV axis I disorders by a psychiatrist. The adjusted 1-month prevalence of any mental disorder was 17.5% (95% CI 16.6-18.5). The prevalence of mood disorders was 6.1% (5.7-6.6), anxiety disorders was 5.6% (5.0-6.3), substance abuse disorders was 5.9% (5.3-6.5), and psychotic disorders was 1.0% (0.8-1.1). Mood disorders and anxiety disorders were more prevalent in women than in men, and in individuals 40 years and older than in those younger than 40 years. Alcohol use disorders were 48 times more prevalent in men than in women. Rural residents were more likely to have depressive disorders and alcohol dependence than were urban residents. Among individuals with a diagnosable mental illness, 24% were moderately or severely disabled by their illness, 8% had ever sought professional help, and 5% had ever seen a mental health professional. Substantial differences between our results and prevalence, disability, and treatment rate estimates used in the analysis of global burden of disease for China draw attention to the need for low-income and middle-income countries to do detailed, country-specific situation analyses before they scale up mental health services. China Medical Board of New York, WHO, and Shandong Provincial Bureau of Health.

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Author and article information

Contributors

Qi Chen:

ORCID: http://orcid.org/0000-0001-7186-8593

47229942@qq.com

Yueyun Sang: sangyueyun@sina.cn

Journal

Journal ID (nlm-ta): BMC Psychiatry

Journal ID (iso-abbrev): BMC Psychiatry

Title: BMC Psychiatry

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-244X

Publication date (Electronic): 13 January 2021

Publication date PMC-release: 13 January 2021

Publication date Collection: 2021

Volume: 21

Electronic Location Identifier: 38

Affiliations

[1 ]Department of Chronic Disease and Mental Health, YinZhou Center for Disease Control and Prevention, Ningbo, China

[2 ]GRID grid.452715.0, ISNI 0000 0004 1782 599X, Ningbo Mental Health Center, , Ningbo Kangning Hospital, ; Ningbo, China

[3 ]Department of Community Health, Hengxi Community Health Center, Ningbo, China

[4 ]Department of Community Health, Maoshan Community Health Center, Ningbo, China

[5 ]Department of Community Health, Shounan Community Health Center, Ningbo, China

[6 ]GRID grid.194645.b, ISNI 0000000121742757, LKS Faculty of Medicine, , The University of Hong Kong, ; Hong Kong, China

Author information

Qi Chen http://orcid.org/0000-0001-7186-8593

Article

Publisher ID: 3039

DOI: 10.1186/s12888-021-03039-y

PMC ID: 7805146

PubMed ID: 33441093

SO-VID: 8e25e7c0-8084-430c-8adb-7fad460ebe7b

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 11 August 2020

Date accepted : 4 January 2021

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100007928, Ningbo Municipal Bureau of Science and Technology;

Award ID: 2016C05

Award Recipient : Qi Chen

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ScienceOpen disciplines: Clinical Psychology & Psychiatry

Keywords: schizophrenia,metacognition,general practitioner,community rehabilitation

Data availability:

ScienceOpen disciplines: Clinical Psychology & Psychiatry

Keywords: schizophrenia, metacognition, general practitioner, community rehabilitation

Metacognitive training: a useful complement to community-based rehabilitation for schizophrenia patients in China

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Measurement of Glucocorticoid Receptor Signaling in Major Depression

Most cited references 48

The Positive and Negative Syndrome Scale (PANSS) for Schizophrenia

Early appraisal of China's huge and complex health-care reforms.

Prevalence, treatment, and associated disability of mental disorders in four provinces in China during 2001-05: an epidemiological survey.

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