Effect of Community-Based Social Skills Training and Tai-Chi Exercise on Outcomes in Patients with Chronic Schizophrenia: A Randomized, One-Year Study

Abstract

Background: Antipsychotic drugs are limited in their ability to improve negative symptoms, quality of life, and medication adherence in patients with schizophrenia. The addition of nonpharmacological interventions like social skills training has a positive effect on medication adherence and decreases rehospitalization rates but is limited in improving patients' symptoms, aggressive behaviors, and quality of life. Aerobic exercise, especially Tai-chi, can potentially reduce psychopathological and negative symptoms, decrease aggressive behaviors, and improve quality of life. It is an ideal rehabilitation intervention for patients with schizophrenia. However, no study has investigated the effects of social skills training plus Tai-chi on outcomes among outpatients with schizophrenia. This study analyzes the effect of antipsychotics combined with community-based integrated interventions on outcomes of schizophrenia. Methods: In this study, a 24-session social skills training plus Tai-chi was used in community settings among patients with schizophrenia. A total of 244 patients were randomly assigned to medication treatment alone (MTA group) or community-based integrated intervention (CBII group), which accepted social skills training plus Tai-chi in addition to medication treatment. Generalized linear mixed models were used to evaluate the intervention effect (group effect), intervention effect over time (time effect), and interaction effect (group × time effect). t tests were used to evaluate between-group differences on clinical variables. Multiple linear regression analysis was used to analyze the differences between the intervention at 12 months and baseline for the Positive and Negative Syndrome Scale (PANSS) negative symptoms and quality of life-social domain. Results: Compared with the MTA group, the CBII group had lower scores on PANSS (F = 17.312, p < 0.001) and negative symptoms (F = 44.909, p < 0.001), a lower risk for aggressive behavior (F = 12.382, p < 0.001), and a greater improvement in adherence to medication (F = 12.391, p < 0.001) after 1 year of intervention. The changes in PANSS total scores, negative scores, and social domain of the World Health Organization Quality of Life Scale-Brief version (WHOQOL-BREF) from baseline to 12 months were significant between the two groups (PANSS total score: t = 4.839, p < 0.001; negative symptoms: t = 8.250, p < 0.001, and quality of life-social domain: t = -2.171, p = 0.031). Multiple linear regression analysis also showed that the intervention was significantly effective for changes from baseline to 12 months on PANSS total score (B = 0.804, p < 0.001), negative score (B = 0.709, p < 0.001), and social domain of quality of life (B = -0.673, p = 0.044). Conclusions: This study suggested that the community-based integrated intervention such as social skills training plus Tai-chi should be part of a rehabilitation effort for patients with schizophrenia in order to improve clinical symptoms, quality of life, and medication adherence.

To explore the efficacy of community rehabilitation for facilitating daily function among patients with mental illness

“…Previous studies demonstrated that community rehabilitation services could improve symptoms and quality of life for patients with schizophrenia. Another study also assumed that community rehabilitation could effectively reduce the disability of patients with schizophrenia . In the current study, the DLF was higher among patients receiving community rehabilitation.…”

“…Currently, in many countries, community healthcare is the preferred model for providing long‐term care to patients with mental illness . The efficacy of community‐based psychiatric care in improving psychiatric treatment, including medication adherence and improved clinical symptoms has been documented, especially for frequent users of community‐based care and first episode patients . Community rehabilitation programs have been shown to alleviate functional degeneration, reduce hospitalization rates, and help patients achieve a better quality of life …”

Effects of Mind–Body Exercises on Schizophrenia: A Systematic Review With Meta-Analysis

“…Sixty-five full-text articles were screened, and 52 records were excluded with reasons (two included nonschizophrenia patients, two did not use MBEs in the experimental group, 17 did not remain unaltered lifestyle or engage in active control condition like psychotherapy in the control group, 26 without relevant outcomes, two non-controlled experiments, two reviews and one non-original publication). Finally, 13 studies with 1,159 patients were included in this systematic review and meta-analysis (22)(23)(24)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45).…”

“…A sensitivity analysis was performed to determine consistency of the effects of MBEs on positive symptoms. By checking both the visually asymmetrical Funnel Plot (Figure 3) and the Egger's Regression Test (Egger's regression intercept = 2.70, p = 0.17), two studies were removed (SMD = 0.34) (24,42). After their removal, the funnel plot of the remaining studies showed a symmetrical Funnel plot (Egger's regression intercept = 1.43, p = 0.56).…”

Scoping review protocol on non-pharmacological interventions for interpersonal and self-directed violence in adults with severe mental illness

“…A systematic review was conducted related to non-pharmacological interventions on interpersonal violence in people with severe mental illness; 42 however, it did not include all diagnoses of severe mental illness, the search was limited in terms of language and databases and the search period was until June 2015, and hence, it does not consider more recently published studies such as those of Kang et al , Inchausti et al , Kingston et al . 35 37 43 Additionally, an umbrella review was performed of interventions in general and forensic psychiatry on violence prevention. 44 Nonetheless, this review is not focussed on severe mental illness and intervention studies included non-randomised as well as randomised controlled designs.…”