Hospital readmissions in the group of users on the Flexible Assertive Community Treatment – experiences from RECOVER E Montenegro samples

Introduction

As a part of Horizon 2020 program, RECOVER-E project activities were initiated in Montenegro in 2018. The initial step involved a thorough situation analysis of the setting and circumstances of treatment of users with severe mental health illnesses, followed by the establishment of the community mental health team (CMHT) within the Special Psychiatric Hospital Kotor. The CMHT became responsible for the treatment of a group of clients with severe mental health illnesses, based on the principles of „Flexible Assertive Community Treatment (FACT – A Dutch model).

Objectives

The main objective of this research was to establish whether there were substantial differences regarding the hospital readmissions in the group of patients treated by the CMHT, compared to usual mental health care in Montenegro.

Methods

Within the RECOVER-E project, a sample of 202 patients, users of mental health services, were recruited in Montenegro. Patients were randomized into two similar-sized groups - intervention group, whose treatment was managed by the multidisciplinary CMHT, and control group where treatment as usual was continued. To estimate and follow-up the frequency of hospital readmissions, medical documentation was used.

Results

Patients in the intervention group had less hospital days during the 18 months follow-up period. However, the differences between two groups regarding number of readmissions, and total length of hospital days were not statistically significant measured by independent T test.

Conclusions

This study showed that CMHT care could reduce the total length of hospital days during the treatment of psychotic disorders even dough during the COVID 19 pandemic and lock down measures

Disclosure

No significant relationships.

Perceived Support for Recovery and Level of Functioning Among People With Severe Mental Illness in Central and Eastern Europe: An Observational Study

Background: Many people with severe mental illness experience limitations in personal and social functioning. Care delivered in a person's community that addresses needs and preferences and focuses on clinical and personal recovery can contribute to addressing the adverse impacts of severe mental illness. In Central and Eastern Europe, mental health care systems are transitioning from institutional-based care toward community-based care. The aim of this study is to document the level of functioning and perceived support for recovery in a large population of service users with severe mental illness in Central and Eastern Europe, and to explore associations between perceived support for recovery and the degree of functional limitations. Methods: The implementation of community mental health teams was conducted in five mental health centers in five countries in Central and Eastern Europe. The present study is based on trial data at baseline among service users across the five centers. Baseline data included sociodemographic, the World Health Organization Disability Assessment Schedule (WHODAS 2.0) for functional limitations, and the Recovery Support (INSPIRE) tool for perceived staff support toward recovery. We hypothesized that service users reporting higher levels of perceived support for their recovery would indicate lower levels of functional limitation. Results: Across all centers, the greatest functional limitations were related to participation in society (43.8%), followed by daily life activities (33.3%), and in education or work (35.6%). Service users (N = 931) indicated that they were satisfied overall with the support received from their mental health care provider for their social recovery (72.5%) and that they valued their relationship with their providers (80.3%). Service users who perceived the support they received from their provider as valuable (b = -0.10, p = 0.001) and who reported to have a meaningful relationship with them (b = -0.13, p = 0.003) had a lower degree of functional limitation. Conclusion: As hypothesized, the higher the degree of perceived mental health support from providers, the lower the score in functional limitations. The introduction of the community-based care services that increase contact with service users and consider needs and which incorporate recovery-oriented principles, may improve clinical recovery and functional outcomes of service users with severe mental illness.

The Influences of Antipsychotics Therapy at Cognitive Impairments in Schizophrenia Spectrum Disorders

Significant degree of cognitive impairment represents one of the basic cornerstones among clinical manifestations of the schizophrenia spectrum disorders and accordingly to some authors it is present in up to 75% patients with these syndromes. The aim of this study was to examine degree of cognitive impairment, firstly among patients on first generation antipsychotics therapy (FGA) compared to the patients on second generation antipsychotics therapy (SGA), and secondly to compare both groups of patients with healthy controls.

Material and methods

Prospective, parallel research was conducted, in which the sample of patients and employees of Specialized Psychiatric Hospital Kotor was tested with Montreal Cognition Scale (MoCA). There were 66 participants in the samples and they were divided on four subgroups: (1) patients with FGA; (2) patients with SGA; (3) patients with combined FGA and SGA; (4) Healthy controls.

Results

All groups of patients had statistically significantly lower mean MoCA scores in the comparison with healthy controls. The fact that among 83.7% of patients was diagnosed significant degree of cognitive decline (MoCA score bellow 26) strongly speaks in favour of high sensitivity of MoCA test in detection of cognitive impairment among patients with schizophrenia spectrum psychotic disorders. In addition, the group of patients with FGA also had statistically significantly lower mean MoCA score compared to patients with SGA.

Discussion

The mechanisms of explanation of these results can be additionally enlightened with further studies on larger samples of patients, which would investigate the correlation between extrapyramidal symptomatology, anticholinergic therapy and cognitive deficit.

Disclosure of interest

The authors have not supplied their declaration of competing interest.