Is group more cost effective than individual cognitive behaviour therapy? The evidence is not solid yet

This paper critically evaluates the empirical evidence of 36 studies regarding the comparative cost-effectiveness of group and individual cognitive behaviour therapy (CBT) as a whole, and also for specific mental disorders (e.g. depression, anxiety, substance abuse) or populations (e.g. children). Methods of calculating costs, as well as methods of comparing treatment outcomes were appraised and criticized. Overall, the evidence that group CBT is more cost-effective than individual CBT is mixed, with group CBT appearing to be more cost effective in treating depression and children, but less cost effective in treating drugs and alcohol dependence, anxiety and social phobias. In addition, methodological weaknesses in the studies assessed are noted. There is a need to improve cost calculation methodology, as well as more solid and a greater number of empirical cost-effectiveness studies before a firm conclusion can be reached that group CBT is more cost effective then individual CBT.

Does adolescent's exposure to parental intimate partner conflict and violence predict psychological distress and substance use in young adulthood? A longitudinal study

Little is known about the extent to which parental conflict and violence differentially impact on offspring mental health and substance use. Using data from a longitudinal birth cohort study this paper examines: whether offspring exposure to parental intimate partner violence (involving physical violence which may include conflicts and/or disagreements) or parental intimate partner conflict (conflicting interactions and disagreements only) are associated with offspring depression, anxiety and substance use in early adulthood (at age 21); and whether these associations are independent of maternal background, depression and anxiety and substance use. Data (n = 2,126 women and children) were taken from a large-scale Australian birth-cohort study, the Mater University of Queensland Study of Pregnancy (MUSP). IPC and IPV were measured at the 14-year follow-up. Offspring mental health outcomes – depression, anxiety and substance use were assessed at the 21-year follow-up using the Composite International Diagnostic Interview (CIDI). Offspring of women experiencing IPV at the 14-year follow-up were more likely to manifest anxiety, nicotine, alcohol and cannabis disorders by the 21-year follow-up. These associations remained after adjustment for maternal anxiety, depression, and other potential confounders. Unlike males who experience anxiety disorders after exposure to IPV, females experience depressive and alcohol use disorders. IPV predicts offspring increased levels of substance abuse and dependence in young adulthood. Gender differences suggest differential impact.

Cognitive Functioning in Young Adults with Depression, Anxiety Disorders, or Burnout Symptoms : Findings from a Population-based Sample

Background. Evidence of cognitive dysfunction in depressive and anxiety disorders is growing. However, the neuropsychological profile of young adults has received only little systematic investigation, although depressive and anxiety disorders are major public health problems for this age group. Available studies have typically failed to account for psychiatric comorbidity, and samples derived from population-based settings have also seldom been investigated. Burnout-related cognitive functioning has previously been investigated in only few studies, again all using clinical samples and wide age groups. Aims. Based on the information gained by conducting a comprehensive review, studies on cognitive impairment in depressive and anxiety disorders among young adults are rare. The present study examined cognitive functioning in young adults with a history of unipolar depressive or anxiety disorders in comparison to healthy peers, and associations of current burnout symptoms with cognitive functioning, in a population-based setting. The aim was also to determine whether cognitive deficits vary as a function of different disorder characteristics, such as severity, psychiatric comorbidity, age at onset, or the treatments received. Methods. Verbal and visual short-term memory, verbal long-term memory and learning, attention, psychomotor processing speed, verbal intelligence, and executive functioning were measured in a population-based sample of 21-35 year olds. Performance was compared firstly between participants with pure non-psychotic depression (n=68) and healthy peers (n=70), secondly between pure (n=69) and comorbid depression (n=57), and thirdly between participants with anxiety disorders (n=76) and healthy peers (n=71). The diagnostic procedure was based on the SCID interview. Fourthly, the associations of current burnout symptoms, measured with the Maslach Burnout Inventory General Survey, and neuropsychological test performance were investigated among working young adults (n=225). Results. Young adults with depressive or anxiety disorders, with or without psychiatric comorbidity, were not found to have major cognitive impairments when compared to healthy peers. Only mildly compromised verbal learning was found among depressed participants. Pure and comorbid depression groups did not differ in cognitive functioning, either. Among depressed participants, those who had received treatment showed more impaired verbal memory and executive functioning, and earlier onset corresponded with more impaired executive functioning. In anxiety disorders, psychotropic medication and low psychosocial functioning were associated with deficits in executive functioning, psychomotor processing speed, and visual short-term memory. Current burnout symptoms were associated with better performance in verbal working memory and verbal intelligence. However, lower examiner-rated social and occupational functioning was associated with problems in verbal attention, memory, and learning. Conclusions. Depression, anxiety disorders, or burnout symptoms may not be associated with major cognitive deficits among young adults derived from the general population. Even psychiatric comorbidity may not aggravate cognitive functioning in depressive or anxiety disorders among these young adults. However, treatment-seeking in depression was found to be associated with cognitive deficits, suggesting that these deficits relate to increased distress. Additionally, early-onset depression, found to be associated with executive dysfunction, may represent a more severe form of the disorder. In anxiety disorders, those with low symptom-related psychosocial functioning may have cognitive impairment. An association with self-reported burnout symptoms and cognitive deficits was not detected, but individuals with low social and occupational functioning may have impaired cognition.

Addressing the offending-related needs of non-violent Indigenous offenders

This report examines publically-available research literature from North America, Australia and New Zealand on the effectiveness of measures that aim to reduce non-violent offending by Indigenous people. It identifies culturally safe and relevant principles for the design and implementation of measures that have been found to be promising in terms of reducing this category of offending. These principles are important for policy-makers and practitioners to understand, given that many Indigenous people come into contact with the criminal justice system in relation to non-violent offences such as public order and driving offences. The principles set out in the report include: incorporating Indigenous culture, family and community into treatment programs; combining Indigenous approaches with effective Western treatment models such as Cognitive Behavioural Therapy; and addressing the substance abuse, trauma, and historical and social context often associated with offending by Indigenous people. In addition to promoting these principles, the report provides an overview of Indigenous people’s contact with the criminal justice system in relation to non-violent crimes, as well as a discussion of specific programs that have been used with this group of offenders.

Nutritional intake of opioid replacement therapy patients in community pharmacies: A pilot study

Aim: Opioid replacement therapy (ORT) is an established therapy for a patient group that has been associated with nutrition-related comorbidities. This paper aims to assess the nutritional intake and supplementation in ORT patients, determine the extent of nutritional/dietary advice supplied to ORT patients and to briefly examine patients' perception of pharmacists' provision of nutritional advice. Methods: The nutritional intake of ORT patients receiving treatment in community pharmacies within the Australian Capital Territory was assessed via a 24-hour recall survey. Food intake data were analysed via nutrient analysis software and compared with Australian Nutrition Reference Values and the nutrient intakes of the Australian population. Patients were surveyed to determine supplement use and perceptions of nutritional advice gained by pharmacists. Results: Potential insufficient intake of various macronutrients and micronutrients was observed in both sexes. Less than 25 of patients recorded supplement use. Fifteen percent of males and 21 of females stated that they had approached a pharmacist with a nutrition-related query. All patients who received nutritional advice followed the advice. Conclusions: ORT patients dosing at community pharmacies appear to have poor nutritional intake. ORT patients appear to be receptive to pharmacist's advice. Community pharmacists can potentially increase the beneficial health outcomes in this population through the proactive supply of accurate nutritional advice.

Duckweed-based Wastewater Treatment Systems: Design Aspects and Integrated Reuse Options for Queensland Conditions

Point sources of wastewater pollution, including effluent from municipal sewage treatment plants and intensive livestock and processing industries, can contribute significantly to the degradation of receiving waters (Chambers et al. 1997; Productivity Commission 2004). This has led to increasingly stringent local wastewater discharge quotas (particularly regarding Nitrogen, Phosphorous and suspended solids), and many municipal authorities and industry managers are now faced with upgrading their existing treatment facilities in order to comply. However, with high construction, energy and maintenance expenses and increasing labour costs, traditional wastewater treatment systems are becoming an escalating financial burden for the communities and industries that operate them. This report was generated, in the first instance, for the Burdekin Shire Council to provide information on design aspects and parameters critical for developing duckweed-based wastewater treatment (DWT) in the Burdekin region. However, the information will be relevant to a range of wastewater sources throughout Queensland. This information has been collated from published literature and both overseas and local studies of pilot and full-scale DWT systems. This report also considers options to generate revenue from duckweed production (a significant feature of DWT), and provides specifications and component cost information (current at the time of publication) for a large-scale demonstration of an integrated DWT and fish production system.

Huumeriippuvuudesta toipuminen Nimettömien Narkomaanien toveriseurassa

The subjects of this study are Narcotics Anonymous (NA), a non-profit, peer-support-based fellowship, its recovery programme, and the former drug addicts who consider themselves members of the fellowship. The study data consist of episodic interviews (n=24) and questionnaires (n=212). In the collection of questionnaire data, survey research methods had to be applied judiciously. This study analyses NA members background and their substance abuse and treatment history, as well as factors that have contributed to or hindered their bonding with NA. A recovery model is presented that stems from NA s written and oral tradition, and which has been conceptualised into NA s recovery theory. At its simplest, NA s recovery theory can be described in two sentences: 1) There are drug dependent addicts who have an addiction disease. 2) Through an NA way of life, recovery is possible. In this study, addiction and addiction disease are described through recovery stories shared at NA. It also describes how the way of life offered by NA supports recovery from drug addiction, the way of life which recovering addicts have adopted, and how they have done so. The study also presents results that, based on the study data, emerge from participation in the NA programme, and describes how the NA recovery theory works in practice, i.e. how NA members utilise the tools provided by the fellowship and how the lives of recovering addicts change during their membership. Furthermore, this study also discusses criticism of NA. According to the study, NA affects the lives of recovering drug addicts in a number of ways. People of different ages and with a variety of personal, treatment and drug abuse histories seem to benefit from membership of NA. Viewed from the outside, NA may appear as strictly normative, but in practice each member can adapt the programme in a way that suits him/her best. Indeed, flexibility is one of the strengths of NA, but without more extensive knowledge of the fellowship, it is possible that the norms reflected in NA texts or the fanaticism of individual NA members may drive some people away. Due to the increasing number of NA members, the association is also able to provide more alternatives. This study confirms the view that peer support is important, as well as the fact that an official treatment system is required in parallel with peer support activities. NA can never fully replace professional support, neither should it be left with sole responsibility for recovering addicts. Keywords: Narcotics Anonymous, peer support, recovery study, recovery, substance addiction, drug treatment, drugs, explorative research

Cognitive Functioning in Alcohol and Other Substance Use Disorders in Young Adulthood : A Genetic Epidemiological Study

Alcohol and other substance use disorders (SUDs) result in great costs and suffering for individuals and families and constitute a notable public health burden. A multitude of factors, ranging from biological to societal, are associated with elevated risk of SUDs, but at the level of individuals, one of the best predictors is a family history of SUDs. Genetically informative twin and family studies have consistently indicated this familial risk to be mainly genetic. In addition, behavioral and temperamental factors such as early initiation of substance use and aggressiveness are associated with the development of SUDs. These familial, behavioral and temperamental risk factors often co-occur, but their relative importance is not well known. People with SUDs have also been found to differ from healthy controls in various domains of cognitive functioning, with poorer verbal ability being among the most consistent findings. However, representative population-based samples have rarely been used in neuropsychological studies of SUDs. In addition, both SUDs and cognitive abilities are influenced by genetic factors, but whether the co-variation of these traits might be partly explained by overlapping genetic influences has not been studied. Problematic substance use also often co-occurs with low educational level, but it is not known whether these outcomes share part of their underlying genetic influences. In addition, educational level may moderate the genetic etiology of alcohol problems, but gene-environment interactions between these phenomena have also not been widely studied. The incidence of SUDs peaks in young adulthood rendering epidemiological studies in this age group informative. This thesis investigated cognitive functioning and other correlates of SUDs in young adulthood in two representative population-based samples of young Finnish adults, one of which consisted of monozygotic and dizygotic twin pairs enabling genetically informative analyses. Using data from the population-based Mental Health in Early Adulthood in Finland (MEAF) study (n=605), the lifetime prevalence of DSM-IV any substance dependence or abuse among persons aged 21—35 years was found to be approximately 14%, with a majority of the diagnoses being alcohol use disorders. Several correlates representing the domains of behavioral and affective factors, parental factors, early initiation of substance use, and educational factors were individually associated with SUDs. The associations between behavioral and affective factors (attention or behavior problems at school, aggression, anxiousness) and SUDs were found to be largely independent of factors from other domains, whereas daily smoking and low education were still associated with SUDs after adjustment for behavioral and affective factors. Using a wide array of neuropsychological tests in the MEAF sample and in a subsample (n=602) of the population-based FinnTwin16 (FT16) study, consistent evidence of poorer verbal cognitive ability related to SUDs was found. In addition, participants with SUDs performed worse than those without disorders in a task assessing psychomotor processing speed in the MEAF sample, whereas no evidence of more specific cognitive deficits was found in either sample. Biometrical structural equation models of the twin data suggested that both alcohol problems and verbal ability had moderate heritabilities (0.54—0.72), and that their covariation could be explained by correlated genetic influences (genetic correlations -0.20 to -0.31). The relationship between educational level and alcohol problems, studied in the full epidemiological FT16 sample (n=4,858), was found to reflect both genetic correlation and gene-environment interaction. The co-occurrence of low education and alcohol problems was influenced by overlapping genetic factors. In addition, higher educational level was associated with increased relative importance of genetic influences on alcohol problems, whereas environmental influences played a more important role in young adults with lower education. In conclusion, SUDs, especially alcohol abuse and dependence, are common among young Finnish adults. Behavioral and affective factors are robustly related to SUDs independently of many other factors, and compared to healthy peers, young adults who have had SUDs during their life exhibit significantly poorer verbal cognitive ability, and possibly less efficient psychomotor processing. Genetic differences between individuals explain a notable proportion of individual differences in risk of alcohol dependence, verbal ability, and educational level, and the co-occurrence of alcohol problems with poorer verbal cognition and low education is influenced by shared genetic backgrounds. Finally, various environmental factors related to educational level in young adulthood moderate the relative importance of genetic factors influencing the risk of alcohol problems, possibly reflecting differences in social control mechanisms related to educational level.

Cognitive functioning and its heritability in bipolar I disorder

Bipolar I disorder is a severe psychiatric disorder characterized by episodic mood alterations that can be manic, depressive or mixed. Bipolar disorder seems to be highly genetic, but the etiology of this complex disorder has remained elusive. In recent years, studies have found that euthymic patients with bipolar disorder may have impairments particularly in executive functioning, verbal learning and memory. These impairments may be present also among some of the relatives of these patients, who may be vulnerable to the disorder. Using neuropsychological variables as endophenotypes, i.e. intermediate phenotypes between genes and the phenotypes, has been suggested to aid search for the etiological background of the disorder, but evidence is sparse on whether these variables fulfill the criteria for endophenotypes. The present thesis is part of the Genetic Epidemiology and Molecular Genetics of Severe Mental Disorders in Finland project. The specific aim was to investigate whether neuropsychological test variables would indicate genetic liability to the disorder and could therefore be regarded as endophenotypes. Thus, cognitive functions and their heritability were studied in bipolar I disorder patients and in their unaffected first-degree relatives from a population-based sample of families, comparing them to a population-based control group. In order to add homogeneity to the subgroups of bipolar disorder patients and their relatives, cognitive functions and their heritability were further studied in a group of families affected by bipolar I disorder only (bipolar families) and another group of families affected by both bipolar I disorder and schizophrenia or schizoaffective disorders (mixed families). Finally, the effect of processing speed on other cognitive functions was investigated. The study showed that especially executive functioning and processing speed fulfilled the endophenotype criteria. Impairments in these functions were found in bipolar patients and in their relatives irrespective of other severe psychopathology in the family. These functions were highly heritable in these families. Study also showed that generalized impairment in verbal memory may associate more with bipolar disorder than to vulnerability to other psychotic disorders, and be more related to fully developed disease; impairments in verbal learning and memory were found only in patients, and they were not found to be highly heritable. Finally, the most potential endophenotype, i.e. processing speed, seemed to contribute to a range of other cognitive dysfunctions seen in bipolar disorder patients. Processing speed, in particular, has also been shown to be a valid endophenotype in subsequent association analyses in psychiatric genetics in Finland and internationally. Information concerning cognitive impairments and their association with the psychosocial consequences of bipolar disorder is important in planning treatment. It is also important to understand and acknowledge that patients may have cognitive impairments that affect their everyday life. Psychosocial interventions and neuropsychological rehabilitation may supplement other conventional treatments for bipolar patients.

Precarious Pregnancies : Alcohol, drugs and the regulation of risks

Since the 1970s alcohol and drug use by pregnant women has become a target of political, professional and personal concern. The present study focuses on prenatal substance use and the regulation of risks by examining different kinds of societal responses to prenatal alcohol and drug use. The study analyses face-to-face encounters between professionals and service users at a specialised maternity clinic for pregnant women with substance abuse problems, medical and political discourses on the compulsory treatment of pregnant women as a means of FAS prevention and official recommendations on alcohol intake during pregnancy. Moreover, the study addresses the women s perspective by asking how women who have used illicit drugs during pregnancy perceive and rank the dangers linked to drug use. The study consists of five empirical sub-studies and a summary article. Sub-study I was written in collaboration with Dorte Hecksher and Sub-study IV with Riikka Perälä. Theoretically the study builds on the one hand, on the socio-cultural approach to the selection and perception of risks and on the other on governmentality studies which focus on the use of power in contemporary Western societies. The study is based on an ethnographic approach and makes use of the principles of multi-sited ethnography. The empirical sub-studies are based on three different types of qualitative data: ethnographic field notes from a maternity clinic from a period of 7 months, documentary material (medical journals, political documents, health education materials, government reports) and 3) interviews from maternity clinics with clients and members of staff. The study demonstrates that the logic of the regulation of prenatal alcohol use in Finland is characterised by the rise of the foetus , a process in which the urgency of protecting the foetus has gradually gained a more prominent role in the discourses on alcohol-related foetal damage. An increasing unwillingness to accept any kinds of risks when foetal health is at stake is manifested in the public debate on the compulsory treatment of pregnant women with alcohol problems and in the health authorities decision to advise pregnant women to refrain from alcohol use during pregnancy (Sub-studies I and II). Secondly, the study suggests that maternity care professionals have an ambivalent role in their mundane encounters with their pregnant clients: on the one hand professionals focus on the well-being of the foetus, but on the other, they need to take into account the women s needs and agency. The professionals daily encounters with their clients are thus characterised by hybridisation: the simultaneous use of technologies of domination and technologies of agency (Sub-studies III and IV). Finally, the study draws attention to the women s understanding of the risks of illicit drug during pregnancy, and shows that the women s understanding of risk differs from the bio-medical view. The study suggests that when drug-using pregnant women seek professional help they can feel that their moral worth is threatened by professionals negative attitudes which can make service-use challenging.

吗啡奖赏效应及其敏化与空间学习能力的关系

Rewarding experience after drug use is one of the mechanisms of substance abuse. Previous evidence indicated that rewarding experience was closely related to learning processes. Neuroscience studies have already established multiple-mode learning model. Reference memory system and habit memory are associated with hippocampus and dorsa striatum respectively, which are also involved in the rewarding effect of morphine. However, the relationship between spatial/habit learning and morphine reward property is still unclear. After drug use, with sensitization to rewarding effect, spatial learning is also changed. To study the mechanism of increment of spatial learning would provide new perspective about reward learning. Based on the individual difference between spatial learning and reward learning, the experiments studied relationship between the two leaning abilities and tested the function of dorsal hippocampus and dorsal striatum in morphine-induced CPP. The results were summarized below： 1 In a single－rule learning water maze task, subjects better in spatial learning also excelled in rewarding learning. In a multi-rule learning task, morphine administration was more rewarding to subjects of use place strategy. 2 Treatment potentiating the rewarding effect of morphine also increased place-rule learning, with no significant improvement in habit learning. 3 Intracranial injections into CA1 of hippocampus or dorsal striatum of M1 antagonist, Pirenzepine, could block the establishment of morphine CPP after three days morphine treatment. In contrast, the antagonist of D1 receptor SCH23390 had no blocking effect. Both Pirenzepine and SCH23390 blocked the locomotor-stimulating effect of morphine. In summary, spatial learning stimulated the behavioral expression of morphine’s rewarding effect, in which CA1 of hippocampus was critically involved. On the other side, a pretreatment schedule of morphine, while increased the rewarding effect, improved place-rule learning, indicating that spatial learning might be one chain of sensitization to drug rewards effects

Estádios de motivação para o tratamento na dependência alcoólica – percursos individuais e género

Dissertação de Mestrado apresentada à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Mestre em Psicologia Clínica e da Saúde.

Systematic Review of Supported Housing Literature 1993 – 2008

Supported housing for individuals with severe mental illness strives to provide the services necessary to place and keep individuals in independent housing that is integrated into the community and in which the consumer has choice and control over his or her services and supports. Supported housing can be contrasted to an earlier model called the “linear residential approach” in which individuals are moved from the most restrictive settings (e.g., inpatient settings) through a series of more independent settings (e.g., group homes, supervised apartments) and then finally to independent housing. This approach has been criticized as punishing the client due to frequent moves, and as being less likely to result in independent housing. In the supported housing model (Anthony & Blanch, 1988) consumers have choice and control over their living environment, their treatment, and supports (e.g., case management, mental health and substance abuse services). Supports are flexible and faded in and out depending on needs. Results of this systematic review of supported housing suggest that there are several well-controlled studies of supported housing and several studies conducted with less rigorous designs. Overall, our synthesis suggests that supported housing can improve the living situation of individuals who are psychiatrically disabled, homeless and with substance abuse problems. Results show that supported housing can help people stay in apartments or homes up to about 80% of the time over an extended period. These results are contrary to concerns expressed by proponents of the linear residential model and housing models that espoused more restrictive environments. Results also show that housing subsidies or vouchers are helpful in getting and keeping individuals housed. Housing services appear to be cost effective and to reduce the costs of other social and clinical services. In order to be most effective, intensive case management services (rather than traditional case management) are needed and will generally lead to better housing outcomes. Having access to affordable housing and having a service system that is well-integrated is also important. Providing a person with supported housing reduces the likelihood that they will be re-hospitalized, although supported housing does not always lead to reduced psychiatric symptoms. Supported housing can improve clients’ quality of life and satisfaction with their living situation. Providing supported housing options that are of decent quality is important in order to keep people housed and satisfied with their housing. In addition, rapid entry into housing, with the provision of choices is critical. Program and clinical supports may be able to mitigate the social isolation that has sometimes been associated with supported housing.

Identifying novel molecular mechanisms of ghrelin receptor signalling underlying neural control of food intake: interaction with stress and impulsivity

The gut-hormone, ghrelin, activates the centrally expressed growth hormone secretagogue 1a (GHS-R1a) receptor, or ghrelin receptor. The ghrelin receptor is a G-protein coupled receptor (GPCR) expressed in several brain regions, including the arcuate nucleus (Arc), lateral hypothalamus (LH), ventral tegmental area (VTA), nucleus accumbens (NAcc) and amygdala. Activation of the GHS-R1a mediates a multitude of biological activities, including release of growth hormone and food intake. The ghrelin signalling system also plays a key role in the hedonic aspects of food intake and activates the dopaminergic mesolimbic circuit involved in reward signalling. Recently, ghrelin has been shown to be involved in mediating a stress response and to mediate stress-induced food reward behaviour via its interaction with the HPA-axis at the level of the anterior pituitary. Here, we focus on the role of the GHS-R1a receptor in reward behaviour, including the motivation to eat, its anxiogenic effects, and its role in impulsive behaviour. We investigate the functional selectivity and pharmacology of GHS-R1a receptor ligands as well as crosstalk of the GHS-R1a receptor with the serotonin 2C (5-HT2C) receptor, which represent another major target in the regulation of eating behaviour, stress-sensitivity and impulse control disorders. We demonstrate, to our knowledge for the first time, the direct impact of GHS-R1a signalling on impulsive responding in a 2-choice serial reaction time task (2CSRTT) and show a role for the 5-HT2C receptor in modulating amphetamine-associated impulsive action. Finally, we investigate differential gene expression patterns in the mesocorticolimbic pathway, specifically in the NAcc and PFC, between innate low- and high-impulsive rats. Together, these findings are poised to have important implications in the development of novel treatment strategies to combat eating disorders, including obesity and binge eating disorders as well as impulse control disorders, including, substance abuse and addiction, attention deficit hyperactivity disorder (ADHD) and mood disorders.

Cuidar da pessoa com esquizofrenia em processo de reabilitação psicossocial

Este ensino clínico permitiu-nos prestar cuidados de enfermagem especializados a 16 homens com esquizofrenia em processo de reabilitação psicossocial. Na sua maioria são: adultos, solteiros, da região sul de Portugal, com uma média de 9 anos de escolaridade, com história de consumo de substâncias (álcool, tabaco, haxixe, cocaína, heroína e anfetaminas), institucionalizados na Casa de Saúde do Telhal (CST) há mais de 11 anos. Todos apresentam diagnósticos de enfermagem das várias dimensões do adoecer, com exceção da dimensão comportamental excitatória, sendo os de maior prevalência: “Conhecimento sobre Processo de doença/Cuidados na doença/Tratamento, Não Demonstrado”; Cognição, Comprometida”; “Processo Social, Alterado”; “Autoestima, Diminuída”. Foram desenvolvidos 4 programas de intervenção: consulta de enfermagem de saúde mental e psiquiatria (CESMP); atelier de estimulação cognitiva (AEC); programa de desenvolvimento de competência intrapessoais, interpessoais e profissionais (PDCIIP); programa de psicoeducação (SABER+). A satisfação global com os programas foi superior a 7 (numa escala de 1 a 10) e os resultados que foram percebidos pela maioria dos reabilitandos situaram-se acima das suas expectativas iniciais. De uma forma geral, todos registaram ganhos: no desempenho cognitivo (em particular os que beneficiaram do AEC); na adaptação psicossocial – nomeadamente ao nível do insight; os reabilitandos que beneficiaram do programa SABER+ melhoraram ainda os comportamentos demonstrados de aceitação do estado de saúde; no bem-estar psicológico – nomeadamente ao nível da autoestima (sobretudo os que beneficiaram da CESMP e/ou do PDCIIP), dos afetos positivos e dos comportamentos de motivação; nos vários domínios da qualidade de vida (QdV) medidos pelo WHOQOL-Bref em particular o domínio ambiental; todos elevaram o seu nível de conhecimentos nos 3 eixos em que que se estruturou o programa de psicoeducação (processo da doença, cuidados na doença, tratamento da doença); na adesão à medicação, sobretudo os que integraram o programa de psicoeducação, contudo todos tendem a necessitar de ajuda parcial para conseguir demonstrar conhecimento no cumprimento do esquema terapêutico e estão envolvidos em treinos supervisionados de preparação e autoadministração; ABSTRACT: This clinical training allowed us to provide skilled nursing care to 16 men with schizophrenia in a psychosocial rehabilitation setting. Most of these individuals are: adults, singles, from the southern region of Portugal, with an average of 9 years of schooling, with a history of substance abuse (alcohol, tobacco, cannabis, cocaine, heroin and amphetamines), institutionalized in Casa de Saúde do Telhal (CST) for over 11 years. We find nursing diagnoses from all of the disease dimensions with the exception of excitatory behavioral dimension, being the most prevalent: "knowledge about disease process / care / treatment, not stated"; cognition, impaired", "social process, impaired”, “self-esteem, decreased". We developed 4 intervention programs: psychiatry and mental health nursing consultation (CESMP); atelier of cognitive stimulation (AEC); intrapersonal, interpersonal and professional competences training (PDCIIP); psychoeducation (SABER+). The overall satisfaction with the programs was above 7 (on a scale of 1 to 10) and the results noticed by most patients were above their initial expectations. All registered nursing results were: in cognitive performance (particularly those who benefited from the AEC); in psychosocial adaptation - especially in terms of insight; patients who benefited from the SABER+ program demonstrated improved further acceptance of their health condition, psychological well-being, particularly in terms of self-esteem (especially those who benefited from the CESMP and/or the PDCIIP), positive affects and motivation; in the different domains of quality of life (QoL) measured by WHOQOL-Bref in particular the environmental domain; every patients raised their level of knowledge in the 3 axes in which the psychoeducational program (SABER+) was structured (disease process, care and treatment); in medication adherence, especially those who benefited of the psychoeducational program, however all the patients tend to need partial help to demonstrate knowledge in meeting the therapeutic regimen and are involved in supervised training programs for preparation and self administration.