Estimation of Efficiency of the Integrative Motivational Training Program (IPMT) for Patients with Schizophrenia, Undergoing Treatment in a Psychiatric Hospital, and for those living in Residential Institutions for Psychiatric Patients (PRI)

Abstract

Rationale. For effective reforming the system of mental health, the system of residential institutions for psychiatric patients (PRI) in the Russian Federation, the development and validation of efficiency of scientifically based methods of socializing psychiatric patients through the activation and development of their psychological resources and social competencies are of particular significance. Among the residents of PRI 46,9% have schizophrenia. Study Objective. Verification of efficiency of the original integrative motivational training program (IPMT) in two samples of patients with schizophrenia: those on inpatient treatment and those living in PRI. Materials and methods. In total, 11 training groups were carried out for the patients with schizophrenia, undergoing treatment in Psychiatric Clinical Hospital No. 4 n.a. Gannushkin (PCH) (total 45 persons, average age 44, 32 women and 13 men with different duration of the disease), and 7 training groups were conducted for the patients in PRI (total 35 persons, average age 50, 17 women and 18 men with duration of the disease over 5 years). The efficiency of the training was estimated using self-assessment instruments that the patients completed before and after the training: “Self-efficacy Diagnostics”, “Coping Strategy Indicator”, “Compliance”, “Social Avoidance and Distress Scale” (SADS), “Feedback Questionnaire”. Results. The proposed program motivational training is based on principles close to those of the recovery-oriented cognitive therapy (CT-R), cultural and historical psychology and reflection-activity approach, and contributes to positive changes in the motivational sphere of patients with schizophrenia. In the sample of patients from PCH, the indicators of social anxiety have statistically significantly reduced and there has been an increase in indicators of self-efficacy and compliance. At the level close to statistical significance, the frequency of using a problem-solving strategy has increased, the indicators of their avoidance strategy have decreased, and the indicators of a seeking social support strategy have not changed. In the sample of patients from the PRI, on the contrary, the frequency of using a constructive seeking social support strategy has statistically significantly increased. At the same time, the overall indicator of their social anxiety has reduced, and the overall indicator of their self-efficacy has increased at the level close to statistical significance. The absence of statistically significant dynamics in the variables of compliance and using a problem-solving strategy, as well as in using a destructive avoidance strategy indicates that these deficits are the most persistent and require an additional targeted work. The training participants from both samples have subjectively highly evaluated the results of the training and the changes that they have experienced. Output. There has been a preliminary conclusion made about the efficiency of IPMT for delivering on the target of increasing the resources for socializing patients with schizophrenia, both in PCH and PRI. The main differences in two samples are related to the fact that in the PRI group, in contrast to the PCH group, the indicator of a seeking social support strategy has increased, and use of dysfunctional strategies and compliance problems are more stable. The prospects for this research work consist in expanding the samples and analyzing the influence of such factors gender, age, duration of the disease and duration of stay in the residential facility.