Triple chronotherapy (sleep deprivation for 36 h, followed by 4 days of advancing the time of sleep and daily morning bright-light therapy for 6 months) has demonstrated benefits for the rapid treatment of depressive symptoms in four small controlled trials of in-patients.

To test the feasibility of recruitment and delivery of triple chronotherapy for out-patients with depression (ISRCTN17706836; NCT03405493).

In a single-blind trial, 82 participants were randomised to triple chronotherapy or a control intervention. The primary outcome was the number of participants recruited per month and adherence to the protocol. Secondary outcomes included the 6-item Hamilton Rating Scale for Depression (HRSD-6) at 1 week. Timings of observer ratings were baseline and 1, 2, 4, 8 and 26 weeks after randomisation.

The triple chronotherapy group stayed awake for the planned 36 h and 89.9% adhered to the plan of phase advance of their sleep over the following 4 days. We achieved our recruitment target (60 participants completed the trial within 13 months). There were no reported adverse side-effects. We found a significant difference between the groups by intention-to-treat analysis for the HRSD-6 at weeks 1, 8 and 26. There was a large effect size of Cohen's d = 0.8 on HRSD-6 score at week 1, increasing to d = 1.30 at week 26. A response (≥50% reduction in symptoms) was achieved by 33.3% in the triple chronotherapy group and 16.2% in the control group. This stayed relatively steady until week 26 (35.9 v. 13.9%).

Triple chronotherapy produced a significant and rapid benefit after 1 week in out-patients with depression that was sustained at 26 weeks. Cost-effectiveness trials with a larger clinical sample are required.

This qualitative study aimed to identify the service and support needs of people with a recent history of traumatic brain injury (TBI) living in the community.

A postal survey was sent to 662 people 6–18 months after hospital admission for a mild-to-severe TBI. The survey included an open-ended item (‘wish-basket’) for collecting ideas about important unmet needs.

Responses from 53 individuals were coded and processed using thematic analysis. Five themes (n = 39) were identified, three of which were related to personal needs. These personal wishes were about being symptom-free, independent and emotionally supported by, and connected to, loved ones. The remaining themes were about the wished-for changes to the health system and society, such as wishing for health care continuity (as opposed to being abandoned), and for greater understanding and support by society.

There is scope to improve the services and support for people living with TBI in the community. This includes reconsidering the way that discharge occurs, addressing the personal needs that remain when living in the community and promoting greater social awareness of TBI to counteract disadvantage.

To investigate the experiences of significant others when their loved one with a severe acquired brain injury (ABI) is being discharged from an ABI-specific rehabilitation unit.

Significant others of loved ones with an ABI participated in interviews close to their loved ones being discharged from inpatient ABI rehabilitation.

Semi-structured interviews were conducted, and thematic analysis applied. Additionally, the drawing method was also used which involved participants drawing what it was like for them as their loved one was going home. Image analysis was then combined with the interview data.

Eight significant others participated in interviews on discharge and completed a drawing describing their experience. Five themes were identified (Change, Mixed feelings, Support of family and friends, Journey and Staff interactions).

The experience of having a loved one with a severe ABI in rehabilitation is an emotional event. Compassionate communication, consistency of information and thorough discharge planning practices were cornerstones to enhancing the experience of significant others, empowering them to undertake their new role.

Building upon the findings of an earlier study that explored the experience and impact of narrative storytelling following acquired brain injury (ABI), this study sought to examine the engagement of storytelling facilitators with storytellers.

Transcripts of in-depth interviews conducted with six storytelling facilitators were analysed drawing upon content analysis. The analysis included a process of mapping previously analysed data (D’Cruz et al., 2020b) to a humanising values framework (Galvin & Todres, 2013; Todres et al., 2009).

The findings of this study provide insights into how facilitators engaged in humanising practice within the context of a storytelling advocacy programme. The facilitator participants ranged in years of facilitation experience from 1 to 11 years, with a mix of professional backgrounds, including health care (3), journalism (1) and community development (2). Analysed facilitator data mapped to each of the eight dimensions of the framework (insiderness, agency, uniqueness, togetherness, sense-making, personal journey, sense of place and embodiment), with a breadth of codes represented in each dimension, revealing the depth of humanisation.

This study extends our understanding of approaches to engagement with adults living with ABI, demonstrating the humanising potential of storytelling. Furthermore, the findings help us to think about what it means to be human, guiding us to find ways to better partner with and support adults living with brain injury.

Irregular hospital discharge is highly prevalent among people admitted to hospital for mental health reasons. No study has examined the relationship between irregular discharge, post-discharge mortality and treatment setting (i.e. mortality after patients are discharged from acute in-patient or residential mental health settings).

To understand the relationship between irregular discharge and mortality among patients discharged from acute in-patient and residential settings.

A retrospective study was conducted in members of the US veteran population discharged from acute in-patient or residential settings of the US Department of Veterans Affairs between 2003 and 2018. Multivariate Cox proportional hazards were used to evaluate associations between irregular discharge and suicide, external-cause (as defined by ICD-10 Codes: V01-Y98) and all-cause mortality in the first 30-, 90- and 180-days post-discharge.

There were over 1.5 million mental health discharges between 2003 and 2018. Patients with an irregular discharge were at increased risk for suicide, external-cause and all-cause mortality in the first 180 days after discharge. In the first 30 days after discharge, patients with irregular discharge had more than three times greater suicide risk than patients with regular discharge (adjusted hazard ratio (HR) = 3.41, 95% CI 2.21–5.25). Suicide risk was higher among patients with irregular discharge in the first 30 days after acute in-patient discharge (adjusted HR = 1.55, 95% CI 1.11–2.16). In both settings, the mortality risk associated with irregular discharge attenuated but remained elevated within 90 and 180 days.

Irregular discharge after an acute in-patient or residential stay poses a large risk for mortality soon after discharge. Clinicians must identify effective interventions to mitigate harms associated with irregular discharge in these settings.

The aim of this study was to investigate the long-term outcome of quality of life (QOL) in the lower-limb amputees 10 years after the 2008 Sichuan earthquake.

In the cross-sectional study, 66 lower-limb amputees were recruited. The prosthetics-related QOL was assessed using the Prosthetic Evaluation Questionnaire (PEQ) in terms of the scales of utility, appearance, sounds, residual limb health, perceived response, frustration, social burden, ambulation, and well-being. The score of each PEQ subscale was calculated and compared among the cohorts with different demographic characteristics.

The PEQ scores showed that the scales of sounds, residual limb health, and frustration were still low in the lower-limb amputees 10 years after the 2008 Sichuan earthquake. The comparison of PEQ scales among cohorts with different demographic characteristics indicated that the potential demographic risk factors, namely, age, marital status, educational level, living independence, and comorbidity, were associated with prosthesis-related QOL.

The prosthesis-related QOL of the lower-limb amputees 10 years after the 2008 Sichuan earthquake has been partly documented in this study. The potential demographic risk factors associated with QOL of amputees were also identified. These findings could enhance the understanding of prosthesis-related QOL of lower-limb amputees sustained in an earthquake and facilitate the optimization of post-disaster rehabilitation strategies.

HSE ‘Vision for Change, 2006’ placed emphasis on person-centred, recovery-oriented, community-integrated treatment. The high support residential hostel in Tuam ‘Toghermore House’ is not integrated into the community and was scheduled to be closed as a residence in the last quarter of 2019. The individuals whom accessed support from Toghermore House were offered residential places in community settings in the urban area of Tuam with support plans according to individual assessed needs.

To assess the quality of life of individuals accessing the Rehabilitation & Recovery Service and who are residing in supported and independent accommodation in Tuam.

Cross sectional study. Scales used were Manchester Short Assessment of Quality of Life Scale (MANSA) including both objective and subjective components and the INSPIRE scale which gathered information about the support and relationship each individual has with their assigned keyworker. SPSS 24 was used for data analysis.

27/32 responses. Mean age: 52 years, males: 78% and schizophrenia: most common primary diagnosis (52%), mean duration of illness: 28 years 3 months. 74% of individuals were satisfied with their life, 78% with their health and 56% with mental health. Only three individuals were employed and were happy with work and finances. 81.5% service users reported to have a good quality of life but only 59% felt in control of their lives.

Majority of individuals reported having a good quality of life and being satisfied with their overall health and current living arrangements. Meaningful occupation and subjective supportive therapeutic relationships are predictors of enhanced quality of life.

No significant relationships.

Psychosocial rehabilitation is a challenge in a society with demands unsuitable for those with severe mental illness (SMI). The Mental Health Department of Matosinhos Local Health Unity (MHD-MLHU) has developed a solidarity project aiming to evaluate and elaborate individualized rehabilitative responses with people with SMI, including people from the community motivated for solidarity initiatives.

To describe a psychosocial rehabilitation project focused on community integration of people with SMI, considering needs and resources of the population, and to present the individualized rehabilitation plans carried out for people with SMI.

In January 2019, we began the home evaluation of people with SMI monitored in the MHD-MLHU. To develop solidary based play-occupational groups, we interviewed people from the community and from the common mental pathology outpatient clinic willing to participate.

We present the description and evaluation of the psychosocial responses developed by the project. These responses include recreational-occupational groups, tailored to interests of each person with SMI, and using the community support group built for the purpose. These responses promote face-to-face activities, and enhance the destigmatization of SMI. The constraints resulting from the COVID-19 pandemic led to the creation of digital responses aimed at people with SMI and the community in general.

This experience has revealed the great potential of rehabilitating the community context of people with SMI, rather than just contemplating pre-existing structured responses. The pandemic created specific challenges but made the initiative even more relevant for SMI people and for promoting the mental health of the general population.

The need to implement a program of autonomy in the handling of oral medication has been observed at the time of discharge from the hospital.

- That the patient is able to know his medication, differentiating between active ingredient and commercial brand. - That the patient is able to interpret the guideline in the electronic prescription. - That the patient is able to prepare his weekly medication autonomously.

- The doctor in charge indicates the Program in those patients susceptible to benefit of the same and after consensus with the multidisciplinary team. He validates and prints the electronic prescription well in advance. Preferably the patient himself (alone or accompanied by family members or Educators) get their medication and a weekly “polydosis” at a pharmacy office bringing him with him to the Unit. - Occupational Therapy helps the patient interpret the electronic prescription guideline and place the weekly medication in the “polydosis” and works with the patient in forecasting execution tasks of medication needs for outpatient follow-up.

The program is well accepted by patients. None of the patients included so far have had an early relapse.

The program has helped patients interpret the medical indications given mnesical and executive difficulties of patients with severe mental disorder.

No significant relationships.

Neurocognitive dysfunction is associated with important socio-professional consequences and diminished quality of life. In the Neurocognitive Remediation Clinic of the Centre Hospitalier Universitaire Brugmann (Brussels, Belgium), patients suffering from neurocognitive dysfunctions related to common mental disorders (e.g. psychotic, mood, adjustment disorders) are considered for Neurocognitive Remediation Therapy (NCRT), combining personalized computerized cognitive training and strategy training, with group sessions of physical rehabilitation and cognitive behavior therapy.

This cross-sectional study aims to assess the efficacy of a 12 week (1day/week) NCRT program organized within the day clinic.

Patients who completed the NCRT between March 2018 and June 2019 were eligible to participate. Efficacy was assessed using the cognitive failure questionnaire (CFQ) and a 17-item questionnaire assessing daily functioning. Current scores on the CFQ were compared to the scores before and after NCRT. Additionally NCF was retrospectively assessed through the neuropsychological test results before and after NCRT.

Of the eligible 38 patients, 27 consented to participate (18 women/9 men); median age was 52 years, range (29-61); median time since stop NCRT was 7 months, range (4-17). Twenty patients (80%) reported improvement in daily function. Subjective neurocognitive function improved significantly immediately after NCRT (t=2.681, df=23, p=0.013) and remained stable at time of assessment (t=2.775, df=24, p=0.011). After NCRT at least 1 neuropsychological subtest normalized in 25 patients (96.15%). Divided attention, long-term visual memory and planning improved in respectively 80%, 75% and 75% of the patients.

Our innovative integrative program improves neuropsychological performances and sustainably ameliorate subjective neurocognitive and daily function.

No significant relationships.

Acute traumatic injuries in children are diverse: skeletal trauma, traumatic brain injury (TBI), spinal injury (SCI), amputations, combined trauma and others. Severe injuries lead to severe disability and desadaptation of the child. It is known that children tolerate hard the awareness and acceptance of their new state.

To study emotional disorders after traumatic injuries in children at early stages of rehabilitation.

159 children up to 18 y.o.: 80 (TBI), 60 (SCI), 19 (amputation, skeletal injury, electro-trauma). Methods: psychopathological, psychological; scales, questionnaires.

In children after severe and moderately severe TBI, depression was detected in 43% as a consequence of injury and recovery of mental activity. In children with SCI, depression was detected in 48% as a reaction to stressful situation. In children with amputation, severe skeletal injury, electro-trauma depression was in 60%, both as a consequence of organic recovery of mental activity and as a reaction to psycho-traumatic situation. In the acute period, children had comprehensive interdisciplinary rehabilitation. Neuropsychiatrist recommended neuropharmacotherapy with antidepressants from the group of serotonin reuptake inhibitors (sertraline), GABA preparations. For psychological support, gestalt correction techniques were used.

After acute trauma, depression in children occupies a significant place in clinical picture. Genesis of depressive disorders can be caused both by organic damage to brain structures and by reaction to psychotraumatic situation. In order to improve rehabilitation effectiveness, to make patient’s returning to usual living environment easier as well as to improve the quality of life, interdisciplinary approach is needed since early stages of rehabilitation and after.

Horticultural therapy is used as alternative treatment option in rehabilitation programs for patients suffering from chronic mental disorders. In Greece, the Psychiatric Hospital of Thessaloniki was the first that organized a organized Rehabilitation Program approved by the Greek Ministry of Health, the “Green Unit - Monada Prasinou”.

The purpose of this study was to investigate the effect of horticultural intervention on the functionality of patients employed in the Green Unit of the Psychiatric Hospital of Thessaloniki.

The Mini-ICF-APP Social Functioning Scale was used to evaluate the functionality of the patients. Horticulture therapy included actual gardening and other agricultural activities. The sample consisted of two groups, 22 inpatient of the Green Unit and 22 patients of outpatient units as a control group. The majority of the patients suffered from Schizophrenia spectrum disorders. Both patients’ groups were evaluated over 12 months (May 2018- May 2019).

At baseline evaluation, the patients of the Green Unit patients presented higher scores only in the mobility and endurance subscale. A year later there was a statistically significant difference in all thirteen subscales. Shortly, the patients were rated as more consistent, organizational, social, flexible, responsible, more confident and enterprising, more adaptable and more able to take care of themselves.

The results suggest that horticulture as a therapeutic method had beneficial effects in all dimensions of patient functionality confirming the hypothesis that such programs should be a priority in the effort of psychosocial reintegration of patients suffering from chronic mental disorders.

Сognitive deficit significantly affects the quality of life of patients. Aims of research was detection of cognitive impairments of varying degrees in epilepsy, and as well as studying the results of complex treatment in conditions of University clinic, physical and psychological rehabilitation, cognitive training and VNS included.

We studied the features of clinical and psychopathological manifestations of cognitive impairments in patients suffering from epilepsy.

The study was attended by 100 patients (35 men and 65 women) who were inpatient care. The following psychodiagnostic techniques were used: the Toronto Cognitive Assessment TorCA, the test of 10 words of Luria, the MOCA test, the Münsterberg test, the quality of life scale, the Hamilton scale of depression and anxiety.

MCI was observed in 88 % patients, dementia in 12 % (50 % - mild dementia, in 24 % - moderate dementia and in 16% - severe dementia). We used non-pharmacological rehabilitation methods for correction of cognitive impairment in epileptic patients with MCI and mild dementia during 3 mounth.. Improving of cognitive function was observed in 48 % patients, stable level of cognitive function - in 36 %, progressing of cognitive imparment - in 16 % patiens with epilepsy.

The results of the conducted research indicate the need for further study of the features of cognitive disorders in pharmacologically treatment resistant epilepsy and implementation of training aimed at improving cognitive function and preventing the progression of cognitive impairment in complex treatment of those patients.

Horticultural therapy is a professional practice that is increasingly used in a lot of mental health rehabilitation programs. This therapy was introduced in the Comunitary Rehabilitation Service of INAD, considering its beneficial results in patients with severe mental disorder in combination with the usual rehabilitation program.

We would like to study the benefits of this therapy compared to the usual in our patients.

This is an explanatory study for the purpose of establishing the association between the application of a Therapeutic Horticulture Program and the Clinical Symptomatology of Schizophrenia. A research with an experimental design Pre and Post-Test was carried out, by applying a Horticulture Program and evaluating with PANSS after 6 months its effects on the Clinical Symptomatology. The participants of the experimental group were selectively chosen. The only selection criteria were to attend the orchard at least once a week and be diagnosed with a schizophrenic disorder. The control group was chosen according to the number of members that made up the other group, with the criterion that they did not perform any outdoor activities and also had a diagnosis of schizophrenia.

The comparison of the Pre and Post-Test measures in the case of the experimental group reports the presence of statistically significant differences in the scale of positive symptomatology composite scale and general scale.

This psychopathological improvement of those participants open a door to possible applications of this therapy as a psychosocial treatment.

There is a high degree of comorbidity between serious mental illness (SMI) and substance use disorders (SUD) and cardiovascular disorders. Other life-style related disorders are also common in patients with SMI and SUD. Consequently, comorbidity with somatic diseases contributes to a dramatic reduction in life-expectancy for these patient groups. Physical training has been shown to have positive effects also for mental health, but there has been little systematic use of physical training as part of the treatment for patients suffering from SMI and SUD in Norwegian health care.

To present a new project on physical training for patients suffering from SMI and SUD.

We briefly describe a project in a major Norwegian hospital, where physical exercise will be offered as part of the treatment for patients suffering from SMI and SUD.

The Division for Substance Use and Mental Health now offers an exercise room for inpatients at the main clinic in Tromsø, Norway. The exercise room contains various equipment including treadmills and equipment for strength training. This facility has recently been made available and is currently being used by a selection of patients. A study of user experiences is forthcoming and a systematic study of effects of physical exercise for patients suffering from SMI and SUD is being planned.

Physical exercise has been shown to have positive effects also on mental health. In one major Norwegian hospital, facilities are now offered for inpatients suffering from SMI or SUD. The effects of physical exercise on patients with SMI and SUD will be examined.

No significant relationships.

Psychiatric rehabilitation promotes recovery in individuals with mental disabilities. Its mission is to engage patients and families or caregivers in a collaborative treatment process. The vision of recovery is more likely to become a reality when patients and families are actively involved in treatment. Numerous factors have converged during the past decades to facilitate development and refinement of evidence-based approaches for strengthening families coping with mental disorders.

To review current knowledge on the importance of involving families in psychiatric treatment and rehabilitation, addressing effectiveness of family interventions, role of family coping skills in neutralizing stress and vulnerability, and family burden of mental illness.

Non-systematic review of literature through search on PubMed/MEDLINE database for publications up to 2020. Textbooks were consulted.

Given the unpredictability of major mental disorders, families assume responsibility for extensive monitoring and supervision of a severely and chronically mentally ill relative. Clinical, social, family and economic benefits are achieved by adding psychosocial family interventions to a comprehensive array of services required by patients. Family interventions are not stand-alone modalities: they are coordinated with pharmacotherapy, illness management, crisis intervention, clinical case management, skills training and supportive services. Family interventions show benefits, such as fewer psychotic/affective episodes of exacerbation or relapse by the patient, reduced hospitalizations and improved family morale and less emotional burden.

The new and effective family interventions do not stigmatize families as being ‘sick’ or in need of therapy to ‘straighten them out’. Family interventions are viewed as conferring added therapeutic protection to the patient and relatives.

No significant relationships.