1. Conclusion/Identify the gaps - Consider what we need to know next. Based on your identified articles, identify the limitations or gaps in knowledge. Consider where we can aim to create or influence new knowledge through research.

AutoSave . OFF Design PICO and PEO Literature R Part | Assignment - Saved to my Mac Q Home Insert Draw Design Layout References Mailings Review View ? Tell me Share Comments Times New... ~ 12 A" A Aa Ap REEVEVEE AaBbCcDdE AaBbCcDdE AaBbCcDc AaBbCcDdEE AaBbCcDdEe AaBbCcDdEe Paste BIUvab X x A LA. Normal No Spacing Heading 1 Heading 2 Heading 3 Heading 4 Styles Dictate Editor Pane Abstracts and references Qualitative Article Canas, F., Alptekin, K., Azorin, J. M., Dubois, V., Emsley, R., Garcia, A.G., Gorwood, P., Haddad, P. M., Naber, D., Olivares, J. M., Papageorgiou, G., & Roca, M. (2013). Improving Treatment Adherence in Your Patients with Schizophrenia: The STAY Initiative. Clinical Drug Investigation, 33(2), 97-107. https:/prx usa.lirn.net/login?url=https://www.proquest.com/scholarly-journals/improving-treatment adherence-your-patients-with/docview/1458576920/se-2?accountid=158603 Abstract Partial and non-adherence to medication is a common problem in schizophrenia, leading to an increased risk of relapse, increased likelihood of hospitalization and poorer long-term outcomes. In contrast, continuous medication in the treatment of schizophrenia is associated with positive outcomes, including improved clinical status, improved quality of life and functioning, and reduced risk of relapse and rehospitalization. Strategies aimed at improving medication adherence are therefore key for patients to achieve their treatment goals. In an attempt to address the issues of partialon-adherence to antipsychotic medication in schizophrenia, a group of psychiatrists convened to discuss and develop a set of principles aimed at helping patients adhere to their medication. These principles were then refined and developed into the STAY (the Six principles to improve Treatment Adherence in Your patients) initiative following presentation to a wider group of psychiatrists from across Europe. This manuscript summarizes these principles and explains the rationale for their selection. These principles are: (1) recognizing that most patients with schizophrenia are at risk of partialon-adherence at some time during the course of their illness; (2) the benefits of a Page 8 of 17 2780 words English (United States) Focus E + 110%AutoSave . OFF Design PICO and PEO Literature R Part | Assignment - Saved to my Mac Q Home Insert Draw Design Layout References Mailings Review View ? Tell me Share Comments Times New... ~ 12 A" A Aa Ap REEVEVEE AaBbCcDdE AaBbCcDdE AaBbCcDc AaBbCcDdEE AaBbCcDdEe AaBbCcDdEe Paste BIUvab X x ALVA~ Normal No Spacing Heading 1 Heading 2 Heading 3 Heading 4 Styles Dictate Editor Pane good therapeutic alliance for identifying potential adherence issues; (3) tailored treatment plans to meet an individual's needs, including the most suitable route of delivery of antipsychotic medication; (4) involving family/key persons in care and psychoeducation of the patient, assuming the patient agrees to this; (5) ensuring optimal effectiveness of care; and (6) ensuring continuity in the care of patients with schizophrenia. The application of these six principles should help to raise awareness of and address poor patient adherence, as well as generally improving care of patients with schizophrenia. In turn, this should lead to improved overall clinical outcomes for patients receiving long-term treatment for schizophrenia. Qualitative Article Harvey, P. D., & Keefe, R. S. E. (2001). Studies of cognitive change in patients with schizophrenia following novel antipsychotic treatment. American Journal of Psychiatry, 158(2), 176-184. https://doi.org/10.1176/appi.ajp.158.2.176 Abstract Objetive: Novel antipsychotic medications have been reported to have beneficial effects on cognitive functioning in patients with schizophrenia. However, these effects have been assessed in studies with considerable variation in methodology. A large number of investigator-initiated and industry-sponsored clinical trials are currently underway to determine the effect of various novel antipsychotics on cognitive deficits in patients with schizophrenia. The ability to discriminate between high- and low-quality studies will be required to understand the true implications of these studies and their relevance to clinical practice. Page 8 of 17 2780 words English (United States) Focus E + 110%AutoSave . OFF Design PICO and PEO Literature R Part | Assignment - Saved to my Mac Q Home Insert Draw Design Layout References Mailings Review View ? Tell me Share Comments Times New... ~ 12 A" A Aa Po AaBbCcDdE AaBbCcDdE AaBbCcDc AaBbCcDdEE AaBbCcDdEe AaBbCcDdEe Paste BIUvab X x A LA Normal No Spacing Heading 1 Heading 2 Heading 3 Heading 4 Styles Dictate Editor Pane Methods: This article addresses several aspects of research on cognitive enhancement in schizophrenia, emphasizing how the assessment of cognitive function in clinical trials requires certain standards of study design to lead to interpretable results. Results: Novel antipsychotic medications appear to have preliminary promise for the enhancement of cognitive functioning. However, the methodology for assessing the treatment of cognitive deficits is still being developed. Conclusions: Researchers and clinicians alike need to approach publications in this area with a watchful eye toward methodological weaknesses that limit the interpretability of findings. Quantitative Article/ International reference: Lutgens, D., Gariepy, G., & Malla, A. (2017). Psychological and psychosocial interventions for negative symptoms in psychosis: Systematic review andmeta-analysis. British Journal of Psychiatry, 210(5), 324-332. doi:10.1192/bjp.bp.116.197103 Abstract Background: Negative symptoms observed in patients with psychotic disorders undermine quality of life and functioning. Antipsychotic medications have a limited impact. Psychological and psychosocial interventions, with medication, are recommended. However, evidence for the effectiveness of specific non-biological interventions warrants detailed examination. Aims: To conduct a meta-analytic and systematic review of the literature on the effectiveness of non-biological treatments for negative symptoms in psychotic disorders. Method: We searched for randomized controlled studies of psychological and psychosocial interventions in psychotic disorders that reported outcome on negative symptoms. Standardized Page 8 of 17 2780 words English (United States) Focus E + 110%AutoSave . OFF Design PICO and PEO Literature R Part | Assignment - Saved to my Mac Q Home Insert Draw Design Layout References Mailings Review View ? Tell me Share Comments Times New... ~ 12 A" A Aa Ao REEVEVEE AaBbCcDdE AaBbCcDdE AaBbCcDc AaBbCcDdEE AaBbCcDdEe AaBbCcDdEe Paste BI Uvab X x A LA Normal No Spacing Heading 1 Heading 2 Heading 3 Heading 4 Styles Dictate Editor Pane Scholarly Design mean differences (SMDs) in values of negative symptoms at the end of treatment were calculated across study domains as the main outcome measure. Results: A total of 95 studies met our criteria and 72 had complete quantitative data. Compared with treatment as usual cognitive-behavioral therapy (pooled SMD 70.34, 95% CI - 0.55 to -0.12), skills-based training (pooled SMD -0.44, 95% CI -0.77 to -0.10), exercise (pooled SMD -0.36, 95% CI-0.71 to -0.01), and music treatments (pooled SMD -0.58, 95% CI -0.82 to - 0.33) provide significant benefit. Integrated treatment models are effective for early psychosis (SMD -0.38, 95% CI -0.53 to -0.22) as long as the patients remain in treatment. Overall quality of evidence was moderate with a high level of heterogeneity. Conclusions: Specific psychological and psychosocial interventions have utility in ameliorating negative symptoms in psychosis and should be included in the treatment of negative symptoms. However, more effective treatments for negative symptoms need to be developed. Quantitative Article Morrison, A. P., Pyle, M., Maughan, D., Johns, L., Freeman, D., Broome, M. R., Husain, N., Fowler, D., Hudson, J., MacLennan, G., Norrie, J., Shiers. D., Hollis, C., James, A., & MAPS group (2020). Antipsychotic medication versus psychological intervention versus a combination of both in adolescents with first-episode psychosis (MAPS): a multicenter, three-arm, randomized controlled pilot and feasibility study. The lancet. Psychiatry, 7(9), 788-800. https://doi.org/10.1016/$2215-0366(20)30248-0 Page 8 of 17 2780 words English (United States) Focus E + 110%AutoSave . OFF Design PICO and PEO Literature R Part | Assignment - Saved to my Mac Q Home Insert Draw Design Layout References Mailings Review View ? Tell me Share Comments Times New... ~ 12 A" A Aa Ao EVENEVENT AaBbCcDdE AaBbCcDdE AaBbCcDc AaBbCcDdEE AaBbCcDdEe AaBbCcDdEe Paste BIUvab X x A LA Normal No Spacing Heading 1 Heading 2 Heading 3 Heading 4 Styles Dictate Editor Pane Abstract Background: Evidence for the effectiveness of treatments in early-onset psychosis is sparse. Current guidance for the treatment of early-onset psychosis is mostly extrapolated from trials in adult populations. The UK National Institute for Health and Care Excellence has recommended evaluation of the clinical effectiveness and cost-effectiveness of antipsychotic drugs versus psychological intervention (cognitive behavioral therapy [CBT] and family intervention) versus the combination of these treatments for early-onset psychosis. The aim of this study was to establish the feasibility of a randomized controlled trial of antipsychotic monotherapy, psychological intervention monotherapy, and antipsychotics plus psychological intervention in adolescents with first-episode psychosis. Methods: We did a multicenter pilot and feasibility trial according to a randomized, single- blind, three-arm, controlled design. We recruited participants from seven UK National Health Service Trust sites. Participants were aged 14-18 years; help-seeking; had presented with first- episode psychosis in the past year; were under the care of a psychiatrist; were showing current psychotic symptoms; and met ICD-10 criteria for schizophrenia, schizoaffective disorder, or delusional disorder, or met the entry criteria for an early intervention for psychosis service. Participants were assigned (1:1:1) to antipsychotics, psychological intervention (CBT with optional family intervention), or antipsychotics plus psychological intervention. Randomization was via a web-based randomization system, with permuted blocks of random size, stratified by center and family contact. CBT incorporated up to 26 sessions over 6 months plus up to four booster sessions, and family intervention incorporated up to six sessions over 6 months. Choice and dose of antipsychotic were at the discretion of the treating consultant psychiatrist. Page 8 of 17 2780 words English (United States) Focus E + 110%AutoSave . OFF Design PICO and PEO Literature R Part | Assignment - Saved to my Mac Q Home Insert Draw Design Layout References Mailings Review View ? Tell me Share Comments Times New... ~ 12 A A Aa Ao BE EVEVEE AaBbCcDdE AaBbCcDdE AaBbCcDc AaBbCcDdEE AaBbCcDdEe AaBbCcDdEe Paste BIUvab X x A LA . Normal No Spacing Heading 1 Heading 2 Heading 3 Heading 4 Styles Dictate Editor Pane Scholarly Design Participants were followed up for a maximum of 12 months. The primary outcome was feasibility (ie, data on trial referral and recruitment, session attendance or medication adherence, retention, and treatment acceptability) and the proposed primary efficacy outcome was total score on the Positive and Negative Syndrome Scale (PANSS) at 6 months. Primary outcomes were analysed by intention to treat. Safety outcomes were reported according to as-treated status, for all patients who had received at least one session of CBT or family intervention, or at least one dose of antipsychotics. The study was prospectively registered with ISRCTN, ISRCTN80567433. Findings: Of 101 patients referred to the study, 61 patients (mean age 16-3 years [SD 1-3]) were recruited from April 10, 2017, to Oct 31, 2018, 18 of whom were randomly assigned to psychological intervention, 22 to antipsychotics, and 21 to antipsychotics plus psychological intervention. The trial recruitment rate was 68% of our target sample size of 90 participants. The study had a low referral to recruitment ratio (around 2:1), a high rate of retention (51 [84%] participants retained at the 6-month primary endpoint), a high rate of adherence to psychological intervention (defined as six or more sessions of CBT; in 32 [82%] of 39 participants in the monotherapy and combined groups), and a moderate rate of adherence to antipsychotic medication (defined as at least 6 consecutive weeks of exposure to antipsychotics; in 28 [65%] of 43 participants in the monotherapy and combined groups). Mean scores for PANSS total at the 6- month primary endpoint were 68-6 (SD 17-3) for antipsychotic monotherapy (6-2 points lower than at randomization), 59-8 (13-7) for psychological intervention (13-1 points lower than at randomization), and 62.0 (15-9) for antipsychotics plus psychological intervention (13.9 points lower than at randomization). A good clinical response at 6 months (defined as 250% improvement in PANSS total score) was achieved in four (22%) of 18 patients receiving Page 8 of 17 2780 words English (United States) Focus E 1 1070AutoSave . OFF Design PICO and PEO Literature R Part | Assignment - Saved to my Mac Q Home Insert Draw Design Layout References Mailings Review View ? Tell me Share Comments Times New... ~ 12 A" A Aa Po REEVEVEE AaBbCcDdE AaBbCcDdE AaBbCcDc AaBbCcDdEE AaBbCcDdEe AaBbCcDdEe Paste BI Uvab X x ALVA~ Normal No Spacing Heading 1 Heading 2 Heading 3 Heading 4 Styles Dictate Editor Pane antipsychotic monotherapy, five (31%) of 16 receiving psychological intervention, and five (29%) of 17 receiving antipsychotics plus psychological intervention. In as-treated groups, serious adverse events occurred in eight [35%] of 23 patients in the combined group, two [13%] of 15 in the antipsychotics group, four [24%] of 17 in the psychological intervention group, and four [80%] of five who did not receive any treatment. No serious adverse events were considered_ to be related to participation in the trial. Interpretation: This trial is the first to show that a head-to-head clinical trial comparing psychological intervention, antipsychotics, and their combination is safe in young people with first-episode psychosis. However, the feasibility of a larger trial is unclear because of site- specific recruitment challenges, and amendments to trial design would be needed for an adequately powered clinical and cost-effectiveness trial that provides robust evidence. Funding: National Institute for Health Research. Quantitative Article / American Journal of Occupational Therapy (AJOT) Tan, B.-L., Zhen Lim, M. W., Xic, H., Li, Z., & Lee, J. (2020). Defining occupational competence and occupational identity in the context of recovery in Schizophrenia. American Journal of Occupational Therapy, 74(4). https://doi.org/10.5014/ajot.2020.034843 Abstract Importance: The Occupational Self-Assessment (OSA) measures two constructs from the Model of Human Occupation: occupational competence and occupational identity. In the field of mental health, the recovery movement has sparked discussions about what constitutes personal, Page 8 of 17 2780 words English (United States) Focus EAutoSave . OFF Design PICO and PEO Literature R Part | Assignment - Saved to my Mac Q Home Insert Draw Design Layout References Mailings Review View ? Tell me Share Comments Times New... ~ 12 A" A Aa Po AaBbCcDdE AaBbCcDdE AaBbCcDc AaBbCcDdEE AaBbCcDdEe AaBbCcDdEe Paste BI Uvab X x A LA Normal No Spacing Heading 1 Heading 2 Heading 3 Heading 4 Styles Dictate Editor Pane clinical, and functional recovery. However, how occupation-based terminologies are related to the recovery framework is unclear. Objective: To elucidate how domains of recovery and psychological constructs are related to the OSA's constructs of occupational competence and occupational identity in order to inform occupational therapy practice in the recovery arena. Design: Cross-sectional study. Setting: Outpatient mental health unit. Participants: Sixty-six community-dwelling adults with schizophrenia recruited through convenience sampling. Outcomes and Measures: Participants completed the OSA and clinical, functional, and personal recovery assessments. They also completed five scales that measured psychological constructs of recovery such as hope, resilience, empowerment, internalized stigma, and subjective well-being. Participants also identified up to four OSA items that were priorities for change. Tests of association and multiple regression analyses were conducted to identify predictors of occupational competence and occupational identity. Results: Personal recovery predicted occupational competence, whereas depressive symptoms and hope predicted occupational identity. Functional and clinical recovery did not predict occupational competence. The top three OSA priorities for change were performance items: "managing my finances," "concentrating on my tasks," and "taking care of myself." Page 8 of 17 2780 words English (United States) Focus E TIV 70AutoSave . OFF Design PICO and PEO Literature R Part | Assignment - Saved to my Mac Q Home Insert Draw Design Layout References Mailings Review View ? Tell me Share Comments Times New... ~ 12 A" A Aa Po REEVEVEE AaBbCcDdE AaBbCcDdE AaBbCcDc AaBbCcDdEE AaBbCcDdEe AaBbCcDdEe Paste BIUvab X x ALVA~ Normal No Spacing Heading 1 Heading 2 Heading 3 Heading 4 Styles Dictate Editor Pane Conclusions and Relevance: Occupational therapy interventions should not be limited to functional improvement. Instead, they should account for clients' affective states and seek to instill recovery-oriented psychological states such as hope and efficacy. What This Article Adds: Occupational competence is achieved by enhancing personal states of self-efficacy in fulfilling valued occupations rather than through functional improvement. The top three occupations prioritized for change were performance tasks that were observable by service users and immediate caregivers. Empowering clients to partake in these everyday performance tasks such as finance management, concentrating on tasks, and self-care may pave the way to enhancing occupational competence and identity. Keywords: clients, depressive disorders, schizophrenia, positive and negative syndrome scale, empowerment, self-care, self-efficacy, recovery of function, social stigma Qualitative Article Ventriglio, A., Ricci, F., Magnifico, G., Chumakov, E., Torales, J., Watson, C., Castaldelli-Maia. J. M., Petito, A., & Bellomo, A. (2020). Psychosocial interventions in schizophrenia: Focus on guidelines. The International journal of social psychiatry, 66(8), 735-747. https://doi.org/10.1177/0020764020934827 Abstract Background: Schizophrenia is a lifelong condition with acute exacerbations and varying degrees of functional disability. Acute and long-term treatments are based on antipsychotic drugs, even if some domains of personal and social functioning are not addressed by MEES-FER psychopharmacotherapy. In fact, psychosocial interventions show a positive impact on patient's Page 8 of 17 2780 words English (United States) Focus EAutoSave . OFF Design PICO and PEO Literature R Part | Assignment - Saved to my Mac Q Home Insert Draw Design Layout References Mailings Review View ? Tell me Share Comments Times New... ~ 12 A" A Aa Po E EEVEE AaBbCcDdE AaBbCcDdE AaBbCcDc AaBbCcDdEE AaBbCcDdEe AaBbCcDdEe BI Uvab X x ALVA~ Normal No Spacing Heading 1 Heading 2 Heading 3 Heading 4 Styles Dictate Editor Paste Pane functioning and clinical outcome. In addition, psychosocial interventions are significantly associated with a lower number of relapses and hospitalizations in schizophrenia. Methods: An analytical review of the International Guidelines on Psychosocial Interventions in Schizophrenia has been performed; we included the National Institute for Health and Care Excellence (NICE) guidelines, the Scottish Intercollegiate Guidelines Network (SIGN) guidelines, the Royal Australian, and New Zealand College of Psychiatrists (RANZCP) guidelines, the Schizophrenia Patient Outcomes Research Team (PORT) guidelines and the American Psychiatric Association (APA) guidelines. Results: The international guidelines recommend psychosocial interventions as supportive treatments alongside pharmaceutical or psychotherapeutic ones. Conclusion: More research studies need to be conducted and included in the updated version of the international guidelines to confirm the effectiveness of psychosocial interventions in the long-term outcome of schizophrenia. Keywords: Guidelines; psychosocial interventions; recovery; schizophrenia; social functioning. 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