الفهرس 
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Abstract
Schizophrenia is one of the most serious mental disorders. It affects approximately seven per thousand adults worldwide. Psychotic symptoms, attention deficits, and poor social skills are key features of schizophrenia and the most incapacitating aspects of functioning. It is worth noting that there are multiple therapeutic modalities and psychosocial interventions for the treatment of this disorder. Music listening is considered one of the most widely utilized forms of complementary therapy and offers a possible adjunctive intervention that may improve psychotic symptoms, social skills, and attention among patients with schizophrenia.
Recent literature indicates that psychiatric and mental health nurses can play a pivotal role in introducing a new intervention as a mean of holistic, bio psychosocial and recovery oriented models of care to patients with schizophrenia. By utilizing music listening intervention in psychiatric nursing practice, nurses are able to take a more holistic approach to caring and assessing the needs of patients who suffer from schizophrenia.
Despite the beneficial effects of applying music intervention among patients with schizophrenia, little researches are investigated to explore its effectiveness among patients with schizophrenia in Egypt. Therefore, the aim of the study was to determine the effect of music listening on psychotic symptoms, attention and social skills among patients with schizophrenia.
Research Design:
A quasi experimental design was used to conduct this study.
Setting:
The study was conducted in the psychiatric inpatient wards of EL-Maamoura Hospital for Psychiatric Medicine affiliated to the Ministry of Health and population.
Subjects:
A sample of 60 randomly selected patients with schizophrenia was included in this study. The study subjects were divided equally into two groups (study and a control group).
Tools of the study:
Data were collected using the following tools:
Tool I: A Socio-Demographic and Clinical Data Structured interview Schedule. It was developed by the researcher; it includes socio-demographic data such as age, marital status, educational level, and living situation, as well as clinical data like duration of illness, number of previous psychiatric hospitalizations, duration of current hospitalization, and medications presently taken.
Tool II: The Brief Psychiatric Rating Scale (BPRS- version 4.0):
It was developed by Ventura et al., 1993 to gather information about the possible presence and severity of various psychiatric symptoms. It comprised 24 items, each item was rated on a 7 point Likert scale ranging from 1 (not present) to 7 (extremely severe).In 2008, Kopelowicz et al. computed BPRS items to four groups including positive symptoms, negative symptoms, depression- anxiety, and agitation-mania. In addition, four symptoms including somatic concern, hostility, elevated mood and self-neglect are added to the above groups.
Tool III:-Attention questionnaire scale
Attention questionnaire scale (AQ) was developed by Paraschi (2015) to assess attention for patients with psychotic illnesses and those suffering from schizophrenia. The scale consisted of twelve items. Each item was rated on a five point Likert scale answered as strongly disagree (not have a problem = 5) to strongly agree (have a problem all the time= 1).
Tool IV:-Social skills assessment screening scale (SSASS)
The scale was developed by Bhola et al., 2016. It comprised twenty statements that was used to measure social skills deficits among inpatients with severe mental illnesses. It was divided into three primary categories; nonverbal communication (4 items), verbal communication (6 items) and social behavior (10 items). Each item has obtained a two-point rating (0 being inadequate and 1 being adequate).
Tool V:- The Nurses’ Observation Scale for Inpatient Evaluation (NOSIE)
The scale was designed by Honigfeld and Klett (1965). The scale is frequently used to assess behaviors change from baseline, pursuing the goals of treatment and has been successfully utilized for this purpose.
The NOSIE comprised 30 items which subdivided into seven domains (social competence, social interest, personal neatness, irritability, manifest psychosis, retardation, and depression). It was rated on a 5-point Likert Scale (1–5), which had a range of “never: 1” to “always: 1.”
The main results of the study:
I: Socio- demographic characteristics:
- Regarding age group, 43.3 % of the study group and 53.3 % of the control group were being in the age group of less than 30 years.
- One half (50 %) of the study group and 60% of the control group were living in urban areas.
- An equal percentage (26.7%) of both the study and control groups was highly educated, while those who had secondary educated represented 33.3 % of the study group and 30 % of the control group.
- Single patients constituted 70 % and 63.3% of the study and control group respectively.
- In relation to support, nearly three quarters of the study group (73.3%) and 80% of the control group were stated that they have no support, whilenearly one-quarter of the study group (26.7%) and only 20% of the control group were stated that they have support; of those, 62.5% and 83.3 % said they have only financial support.
II: Clinical characteristics:
- Duration of current hospitalization ranged between 1 to 3 months for 56.7% of patients in the study group and 50 % for those in the control one.
- As regard the onset of the illness, 56.7 % of the study group began to have the illness at the age of 25 years to less than 35 years compared to 63.3 % of the control group.
- More than one third of the study group and nearly one half of the control group have been admitted for three to six times (36.7% and 53.3% respectively).
- Typical antipsychotics were the most frequent prescription for the study and control groups (50 % and 53.3 % respectively),
- An equal percentage (16.7%) of both study and control group was received ECT sessions.
III: Psychotic symptoms
- Before intervention 70% of the study group had moderate level of psychiatric symptoms, while on post-intervention the level of psychiatric symptoms dropped to mild level in the same percentage of the study group. The rest (30%) of the patients still had moderate level of psychiatric symptoms. The variation was statistically significant (P= <0.001), indicating general decrease in psychiatric symptoms severity. On the other hand, the control group demonstrated moderate level of psychiatric symptoms at pre and post intervention (63.3%, 73.3%) respectively with insignificant difference (P= 0.564).
- There was no statistical significant difference in the level of psychiatric symptoms between study and control group at pre intervention phase (p=0.710). While, after implementing the intervention a statistically significant difference was found between them (p=0.001).
IV. Attention
- Regarding the total mean score of attention, the table shows that there was no statistical significant difference between study and control group before implementing the intervention ( p=0.083). In contrast, a statistical significant difference was found after implementing the intervention between the study and control group (p=<0.001).
V. Social skills
- Before intervention 56.7 % of the study group had low level of social skills, while on post-intervention the level of social skill raised to high level in all patients (100%). This variation was statistically significant (P= <0.001), indicating significant improvement of social skills as a result of the music listening intervention.
The main recommendations of the study:
- Music listening intervention should be considered as an integral part of the hospital routine for patients with schizophrenia.
- Implementation of psycho-educational programs for patients to develop patients’ awareness about the importance of regular music listening and its maintenance. Music listening should be a part of patients` activities of daily living.
- Caregivers should be taught about the importance of music listening and how to apply it for patients with schizophrenia.
- Integrating music listening intervention in the psychiatric nursing curriculum at both undergraduate and graduate levels to train psychiatric nurses in music intervention may be a fruitful future direction.
- Future comparative studies are needed to determine whether the use of different music genres or Arabic music would have the same results.
- Future studies are needed, particularly to determine the sustainability of the effect of group music listening intervention and the feasibility of its applications in the community after patients have been discharged from the hospital.
- To ensure generalizability of the results, the current music listening intervention protocol for patients with schizophrenia must be conducted on a larger sample size, including females.