Individual placement and support (IPS) has a considerable body of evidence for its effectiveness in helping people with mental disorder to obtain and maintain competitive jobs in the labour market. IPS closely follows 8 main principles (such as it aims to get people into competitive employment, it is open to all those who want to work, it tries to find jobs consistent with people’s preferences, it works quickly, it brings employment specialists into clinical teams, it provides time unlimited, individualised support, benefits counselling is included). However, little data in young adults are currently available, especially in Europe.

Aim of this study was to evaluate the beneficial effect of IPS in Italian young adults with severe mental illness, examining the main competitive employment outcomes and drop out rates during a 3-year follow-up period.

54 participants were recruited from patients receiving psychiatric treatment in adult Community Mental Health Centers of an Italian Department of Mental Health. Together with drop out rates, we examined job acquisition, job duration (total number of days worked), total hours per week worked and job tenure (weeks worked on the longest-held competitive job).

A crude competitive employment rate of 40.7% and a crude drop out rate of 22.2% over the 3-year follow-up period were found. However, 66% of 42 clients who remained in the program over 3 years gained competitive employment at some time during the 3-year period.

This research shows the feasibility of an IPS intervention model in the public mental health care system in Italy, especially for a young adult target population.

No significant relationships.

Cognitive deficits are considered a key feature of schizophrenia due to their substantial influence on the psychosocial outcome of subjects affected by this disorder. Several studies showed that moderate to severe cognitive impairments, including dysfunctions of social cognition, are already present during the early phases of the illness, in subjects with first-episode psychosis (FEPs). Psychosocial interventions, such as social skill training (SST), could therefore be implemented already upon occurrence of the first episode of psychosis to improve the overall functional outcome of schizophrenia, which represents to date an unmet need in the care of these patients.

The study aims to evaluate the use of SST to enhance social skills and real-life functioning in FEPs.

The sample included 7 FEPs (age between 15 and 40). The SST intervention included 30 sessions lasting 2 hours and delivered twice a week. Psychopathology, neurocognition, real life functioning, functional capacity and social cognition were assessed at baseline ad after training. Paired samples t-tests were performed to evaluate the effects of the intervention. All subjects were treated with second generation antipsychotics.

Significant improvements were observed in negative symptoms, social cognition, problem solving skills, as well as in global functioning (all p<0.05). Within real-life functioning, the improvement was greater for the domain of interpersonal relationships.

These preliminary findings suggest that SST might complement pharmacological treatment in FEPs to improve functional outcome in these subjects. Further studies with a higher sample size and a longer follow-up are required in order to confirm the present results.

Anorexia is a disorder associated with severe disturbances in eating behaviors and related thoughts and emotions (distorted weight perception, body dissatisfaction). Multidimensional integrative treatment approaches are needed to act both on intrapersonal (e.g. nutritional and psychological) and interpersonal (e.g. behavioral and affective) processes.

Aim of this pilot project was to develop a 3-months horse-assisted intervention based on Equestrian Vaulting (EV) and tests its suitability and acceptability in patients with anorexia nervosa. Preliminary observations were carried out to assess the effectiveness of this program on body image, interpersonal relationships and communication and in managing anxiety.

Seven patients in charge of public service specialized in eating disorder participated in the study. EV activities were performed in an Equestrian Centre included horse grooming, gym exercises and horseback sessions.Clinical and psychological tests (SF 36, IPAQ, EDI3, STAI, SCL90) were administered at baseline and at the end of the program.

Increases in body fat and decreases in lean muscle mass were observed. These were accompained by an improvement in participants’ anxiety and relational skills and in the specific disease related symptoms.

Results indicate the potential of EV to help patients with eating disorder regaining awareness of themselves and their body, a critical element for their future reintegration in the contexts of everyday life and society. Although this is a pilot, the protocol developed represents an initial step to promote the application of EV in persons with eating disorders, informing feasibility in the design of larger controlled studies and suggesting critical variables to be targeted.

In Taiwan, residents of mental health halfway houses (MHHH) receive psychiatric rehabilitation services, aiming for independent living and community integration. Research is yet to investigate how MHHH may effectively assist residents’ discharge in this cultural context.

To examine the processes of assessment, preparation, assistance, and appraisal of discharge from MHHH staff’s perspectives.

Semi-structured in-depth interviews were conducted with 11 halfway house staff members. Verbatim transcripts were analyzed with dimensional analysis procedures of the grounded theory methodology.

Successful discharge is a personalized process with integrated approaches addressing three essential factors: (a) regular community involvement, (b) the residents’ capacity to work, and (c) the family’s acceptance and support. Staff supported individual residents’ community involvement by attending to residents’ personal interests, resource availability, financial concerns, and transportation. Moreover, staff provided rehabilitation trainings to develop work capacity. However, residents’ motivation and functioning as well as job opportunities might affect their employment. Finally, in Taiwan, residents were rarely discharged without their family members’ consent because residents tended to co-reside with their family after discharge or rely on family support while living separately. Staff worked to engage families, which was influenced by family relationship quality, past traumatic events, financial concerns, capacity to assist the resident, and/or the resident’s ability to assist with family affairs.

To achieve successful discharges, MHHH staff need to assist each resident by developing an integrated plan to enhance conditions of the aforementioned factors, including strategies for different familial situations to garner family support in this cultural context.

Social cognition and skill deficits have been largely documented in subjects with schizophrenia (SCZs), and have a strong influence on the functional outcome of these subjects. Different behavioural interventions have been developed to target and improve social skills in SCZs. For instance, the Social Skills Training (SST) focuses on improving communication skills and assertiveness to facilitate disease management, independent living and real-life functioning of SCZs. SST seems also to have an impact on negative symptoms and social cognition.

The study aims to evaluate the effectiveness of SST in improving social cognition and negative symptoms in SCZs.

The sample included 8 chronic SCZs (age between 18 and 60), who completed 6 months of SST. The intervention consisted of two weekly group sessions of 2 hours each. We assessed psychopathology, neurocognition, real-life functioning, functional capacity and social cognition at baseline and after training. Paired samples t-tests were performed to evaluate the differences of the variables considered after completing the treatment.

Significant improvements in negative symptoms (p<.05), social cognition (p<.05), functional capacity (p<.001), activities of daily living (p<.001) and interpersonal relationships (p<.011) were found.

The present findings suggest that SST might ameliorate social cognition and negative symptoms which are generally not influenced by antipsychotic treatment. The integration of pharmacological and SST interventions might have an impact on major determinants of poor real-life functioning in SCZs.

Stigma resistance (SR) is defined as one's ability to deflect or challenge stigmatizing beliefs. SR is positively associated with patient's outcomes in serious mental illness (SMI). SR appears as a promising target for psychiatric rehabilitation as it might facilitate personal recovery.

The objectives of the present study are: (i) to assess the frequency of SR in a multicentric non-selected psychiatric rehabilitation SMI sample; (ii) to investigate the correlates of high SR

A total of 693 outpatients with SMI were recruited from the French National Centers of Reference for Psychiatric Rehabilitation cohort (REHABase). Evaluation included standardized scales for clinical severity, quality of life, satisfaction with life, wellbeing, and personal recovery and a large cognitive battery. SR was measured using internalized stigma of mental illness – SR subscale.

Elevated SR was associated with a preserved executive functioning, a lower insight into illness and all recovery-related outcomes in the univariate analyses. In the multivariate analysis adjusted by age, gender and self-stigma, elevated SR was best predicted by the later stages of personal recovery [rebuilding; p = 0.004, OR = 2.89 (1.36–4.88); growth; p = 0.005, OR = 2.79 (1.30–4.43)). No moderating effects of age and education were found.

The present study has indicated the importance of addressing SR in patients enrolled in psychiatric rehabilitation. Recovery-oriented psychoeducation, metacognitive therapies and family interventions might improve SR and protect against insight-related depression. The effectiveness of psychiatric rehabilitation on SR and the potential mediating effects of changes in SR on treatment outcomes should be further investigated in longitudinal studies.

Self-stigma is a major issue in serious mental illness (SMI) and is negatively associated with patient outcomes. Most studies have been conducted in schizophrenia (SZ). Less is known about self-stigma in other SMI and autism spectrum disorder (ASD). The objectives of this study are: (i) to assess the frequency of self-stigma in a multicentric nonselected psychiatric rehabilitation SMI and ASD sample; and (ii) to investigate the correlates of elevated self-stigma in different SMI conditions and in ASD.

A total of 738 SMI or ASD outpatients were recruited from the French National Centers of Reference for Psychiatric Rehabilitation cohort (REHABase). Evaluations included sociodemographic data, illness characteristics, and standardized scales for clinical severity, quality of life, satisfaction with life, wellbeing, personal recovery, a large cognitive battery, and daily functioning assessment.

31.2% of the total sample had elevated self-stigma. The highest prevalence (43.8%) was found in borderline personality disorder and the lowest (22.2%) in ASD. In the multivariate analysis, elevated self-stigma was best predicted by early stages of personal recovery (moratorium, p = 0.001, OR = 4.0 [1.78–8.98]; awareness, p = 0.011, OR = 2.87 [1.28–6.44]), history of suicide attempt (p = 0.001, OR = 2.27 [1.37–3.76]), insight (p = 0.002, OR = 1.22 [1.08–1.38]), wellbeing (p = 0.037, OR = 0.77 [0.60–0.98]), and satisfaction with interpersonal relationships (p < 0.001, OR = 0.85 [0.78–0.93]).

The present study has confirmed the importance of addressing self-stigma in SMI and ASD patients enrolled in psychiatric rehabilitation. The effectiveness of psychiatric rehabilitation on self-stigma and the potential mediating effects of changes in self-stigma on treatment outcomes should be further investigated.

Psychiatric rehabilitation (PR) can improve functioning in people with severe mental illness (SMI), but outcomes are still suboptimal. Cognitive impairments have severe implications for functioning and might reduce the effects of PR. It has been demonstrated that performance in cognitive tests can be improved by cognitive remediation (CR). However, there is no consistent evidence that CR as a stand-alone intervention leads to improvements in real-life functioning. The present study investigated whether a combination of PR and CR enhances the effect of a stand-alone PR or CR intervention on separate domains of functioning.

A meta-analysis of randomized controlled trials of PR combined with CR in people with SMI was conducted, reporting on functioning outcomes. A multivariate meta-regression analysis was carried out to evaluate moderator effects.

The meta-analysis included 23 studies with 1819 patients. Enhancing PR with CR had significant beneficial effects on vocational outcomes (e.g. employment rate: SMD = 0.41), and social skills (SMD = 0.24). No significant effects were found on relationships and outcomes of community functioning. Effects on vocational outcomes were moderated by years of education, intensity of the intervention, type of CR approach and integration of treatment goals for PR and CR. Type of PR was no significant moderator.

Augmenting PR by adding cognitive training can improve vocational and social functioning in patients with SMI more than a stand-alone PR intervention. First indications exist that a synergetic mechanism also works the other way around, with beneficial effects of the combined intervention compared with a stand-alone CR intervention.

Objective – To discuss the difficulties encountered in providing rehabilitation to multi-problematic clients, and possible remedies. Method – The principles of psychiatric rehabilitation are outlined in the frame of the bio-psycho-social model and in the light of long-term follow-up studies. The limits of professional services and the importance of natural networks for successful rehabilitation and social adjustment are highlighted. Results – Worker cooperatives and consumer self-help associations seem to successfully complement health and social services in meeting the complex needs of this population. Conclusions – The integration of formal and informal networks of care is a major challenge and a relatively neglected, but important area of interest in contemporary psychiatric rehabilitation.

Declaration of Interest: no conflict of interests.

The Telemedicine Spacebridge, a satellite-mediated, audio-video-fax link between four United States and two Armenian and Russian medical centers, permitted remote American consultants to assist Armenian and Russian physicians in the management of medical problems following the December 1988 earthquake in Armenia and the June 1989 gas explosion near Ufa.

During 12 weeks of operations, 247 Armenian and Russian and 175 American medical professionals participated in 34 half-day clinical conferences. A total of 209 patients were discussed, requiring expertise in 20 specialty areas.

Telemedicine consultations resulted in altered diagnoses for 54, new diagnostic studies for 70, altered diagnostic processes for 47 and modified treatment plans for 47 of 185 Armenian patients presented. Simultaneous participation of several US medical centers was judged beneficial; quality of data transmission was judged excellent.

These results suggest that interactive consultation by remote specialists can provide valuable assistance to on-site physicians and favorably influence clinical decisions in the aftermath of major disasters.