Are early post-discharge physician contacts associated with 30-day psychiatric re-hospitalisation? A nationwide claims data based retrospective cohort study in Austria free of immortal time bias

OBJECTIVES

Cost containment and quality of care considerations have increased research interest in the potential preventability of early re-hospitalisations. Various registry-based retrospective cohort studies on psychiatric re-hospitalisation have focused on the role of early post-discharge service contacts, but either did not consider their time-dependent nature ('immortal time bias') or evaded the issue by analysing late re-hospitalisations. The present study takes care of the immortal time bias in studying early psychiatric re-hospitalisations.

METHODS

In a retrospective cohort study using nationwide electronic claims data in Austria, 10,689 adults discharged from acute psychiatric inpatient wards were followed up for 30 days. Cox regression analyses were performed with post-discharge psychiatric and general practitioner contacts as time-dependent covariates and time to first psychiatric re-hospitalisation as outcome.

RESULTS

Post-discharge ambulatory physician contacts were significantly associated with a decreased psychiatric re-hospitalisation rate (hazard ratio 0.77 [95% CI 0.69; 0.87], p < 0.0001), with similarly strong contributions to this association by general practitioners and psychiatrists.

CONCLUSIONS

Despite avoiding the immortal time bias and controlling for several confounders, we suggest to be cautious with a causal interpretation of the identified association, since potentially relevant confounders, such as disease severity, were unavailable in our claims data base.

Depression and cognitive impairment in the elderly: a multicentre study

The present study, conducted in collaboration between the Departments of Psychiatry in Swiss Universities and the World Health Organization, had two main goals: to develop assessment methods which could subsequently be used in the Swiss centres in a standard manner; and to make arrangements for continuing collaboration between the centres in Switzerland and the acquisition of new knowledge about the distinctions between depression and cognitive impairment. For this aim, three different groups of elderly patients of either sex were selected during the period of November 1989 to July 1991 for inclusion in the study. The first two groups included the first ten patients of either sex over 60 years of age consecutively contacting the participating institutions and showing depression with or without clinically significant symptoms of cognitive impairment; the control group included patients showing no depression or clinically significant symptoms of cognitive impairment. A total of 125 patients were included in the initial evaluation, 69 of which were reassessed at a seven-month follow up (on average). Each patient was administered a number of clinician-rated or self-report instruments for the assessment of depression, cognitive impairment, disabilities, physical status and onset of disorders. The study has shown that a variety of instruments can be used for the reliable assessment of depression or cognitive impairment in the elderly; but the instruments for the assessment of depression differentiate only poorly between patients with or without cognitive impairment. Because of the importance of identifying both depressed and cognitively impaired patients among the elderly, different assessment instruments targeted at the different symptom clusters need to be administered simultaneously.

The reliability of a brief diagnostic interview, the trips, for the assessment of psychiatric disorders according to ICD-10 in primary care and non-psychiatric medical settings

Introduction

Although there are instruments for the assessment of DSM-IV mental disorders in primary care, there is no brief instrument to assess mental disorders in primary care according to the ICD-10.

Aims

The aim of the study was to assess the reliability of a new diagnostic interview, the TRIPS, designed for the assessment of anxiety-, mood-, and alcohol related disorders according to ICD-10 by non-mental health professionals.

Methods

At first, all Patients completed a screening questionnaire and were subsequently assessed by the staff of somatic departments of a Vienna General Hospital with the TRIPS. Within a week, patients were re-assessed by psychiatrists of the department of psychiatry with the Composite International Diagnostic Interview (CIDI).

Results

Finally, 290 patients could be assessed with both instruments. With the CIDI, 106 out of 290 patients (37%) got any diagnosis of a mental disorder, 74 (26%) had a mood disorder, 64 (22%) an anxiety disorder and 10 patients (3%) an alcohol-related disorder.

Sensitivity of the TRIPS was 88%, specificity was 76% and diagnostic accuracy was 80% for any disorder, and 88%, 83%, and 84% respectively for any mood disorder, 72%, 88%, and 84% for any anxiety disorder, and 60%, 98%, and 97% for alcohol related disorders.

Conclusions

The results show that the TRIPS is a useful instrument with sufficient reliability to detect anxiety disorders and mood disorders in patients with somatic disorders by health professionals without psychiatric training. Due to the low base rate the test criteria for alcohol-related disorders cannot be interpreted sufficiently.

One-year outcome of low-intensity booster sessions versus care as usual in psychosis patients after a short-term psychoeducational intervention

Objective

In this study we aimed to evaluate long-term effects of a community-based, quality of life oriented psychoeducational intervention for schizophrenia with and without booster sessions.

Method

One hundred and three outpatients with a diagnosis of schizophrenia or schizoaffective disorder completed a 9-week psychoeducational programme. At the end of the programme groups were block-randomised to either an extension programme comprising monthly booster sessions for a further nine months (booster condition) or routine clinical care with no further group meetings (non-booster condition). Outcome measures were applied before and after the seminar and at 6 and 12 months.

Results

Positive effects were observed after the short-term 9-week programme with regard to symptoms, knowledge about the illness, illness concept, control convictions and quality of life. These effects were retained over the 12-month period in both conditions. The only relevant difference between the booster and the non-booster conditions concerned external control convictions.

Conclusion

Overall this 9-week programme has shown encouraging effects still present at 12 months after baseline independent of booster or non-booster conditions. Further studies are needed to explore whether a subgroup of patients, those with impaired neurocognitive and social functioning, can benefit significantly from booster sessions.

Using national electronic health care registries for comparing the risk of psychiatric re-hospitalisation in six European countries: Opportunities and limitations

Psychiatric re-hospitalisation rates have been of longstanding interest as health care quality metric for planners and policy makers, but are criticized for not being comparable across hospitals and countries due to measurement unclarities. The objectives of the present study were to explore the interoperability of national electronic routine health care registries of six European countries (Austria, Finland, Italy, Norway, Romania, Slovenia) and, by using variables found to be comparable, to calculate and compare re-hospitalisation rates and the associated risk factors. A "Methods Toolkit" was developed for exploring the interoperability of registry data and protocol led pilot studies were carried out. Problems encountered in this process are described. Using restricted but comparable data sets, up to twofold differences in psychiatric re-hospitalisation rates were found between countries for both a 30- and 365-day follow-up period. Cumulative incidence curves revealed noteworthy additional differences. Health system characteristics are discussed as potential causes for the differences. Multi-level logistic regression analyses showed that younger age and a diagnosis of schizophrenia/mania/bipolar disorder consistently increased the probability of psychiatric re-hospitalisation across countries. It is concluded that the advantage of having large unselected study populations of national electronic health care registries needs to be balanced against the considerable efforts to examine the interoperability of databases in cross-country comparisons.

Modern medicine and the one-size-fits-all approach: A clinician's comment to Alexandra Pârvan's "Mind Electric" article

As a clinician, I can easily agree with the author that a person's own reality of being healthy is independent of physical evidence or clinical categories and that this perspective should be considered to improve clinical care. However, I cannot follow the assumptions about the nature and working of modern medicine and psychiatry as typically using "black box" and one-size-fits-all treatments in daily practice. I outline several working contexts of doctors where this criticism does only marginally apply or not at all and wonder whether the author might wish, if possible at all from a philosophical viewpoint, to differentiate her concepts with regard to these different contexts. In addition, I think that ill health in the field of psychiatry might have to be dealt with differently than physical ill health.

Psychiatry's contribution to the public stereotype of schizophrenia: Historical considerations

The public stereotype of schizophrenia is characterized by craziness, a split personality, unpredictable and dangerous behaviour, and by the idea of a chronic brain disease. It is responsible for delays in help-seeking, encourages social distance and discrimination, and furthers self-stigmatization. This paper discusses the circumstances of the origins of the idea of a chronic brain disease (Emil Kraepelin, 1856-1926), of the split personality concept derived from the term "schizophrenia" (Eugen Bleuler, 1857-1939), and the craziness idea reflected in the "first rank symptoms", which are all hallucinations and delusions (Kurt Schneider, 1887-1967). It shows how Emil Kraepelin's scientific search for homogenous groups of patients with a common aetiology, symptom pattern, and prognosis materialized in the definition of "dementia praecox" as a progressing brain disease; how Eugen Bleuler's life and professional circumstances facilitated an "empathic" approach to his patients and prompted him to put in the foreground incoherence of cognitive and affective functioning, and not the course of the disease; finally, how Kurt Schneider in his didactic attempt to teach general practitioners how to reliably diagnose schizophrenia, neglected what Emil Kraepelin and Eugen Bleuler had emphasized decades earlier and devised his own criteria, consisting exclusively of hallucinations and delusions. In a strange conglomerate, the modern operational diagnostic criteria reflect all three approaches, by claiming to be Neo-Kraepelinean in terms of defining a categorical disease entity with a suggestion of chronicity, by keeping Bleuler's ambiguous term schizophrenia, and by relying heavily on Kurt Schneider's hallucinations and delusions. While interrater reliability may have improved with operational diagnostic criteria, the definition of schizophrenia is still arbitrary and has no empirical validity-but induces stigma.

Overview of post-discharge predictors for psychiatric re-hospitalisations: a systematic review of the literature

BACKGROUND

High levels of hospital readmission (rehospitalisation rates) is widely used as indicator of a poor quality of care. This is sometimes also referred to as recidivism or heavy utilization. Previous studies have examined a number of factors likely to influence readmission, although a systematic review of research on post-discharge factors and readmissions has not been conducted so far. The main objective of this review was to identify frequently reported post-discharge factors and their effects on readmission rates.

METHODS

Studies on the association between post-discharge variables and readmission after an index discharge with a main psychiatric diagnosis were searched in the bibliographic databases Ovid Medline, PsycINFO, ProQuest Health Management, OpenGrey and Google Scholar. Relevant articles published between January 1990 and June 2014 were included. A systematic approach was used to extract and organize in categories the information about post-discharge factors associated with readmission rates.

RESULTS

Of the 760 articles identified by the initial search, 80 were selected for this review which included a total number of 59 different predictors of psychiatric readmission. Subsequently these were grouped into four categories: 1) individual vulnerability factors, 2) aftercare related factors, 3) community care and service responsiveness, and 4) contextual factors and social support. Individual factors were addressed in 58 papers and were found to be significant in 37 of these, aftercare factors were significant in 30 out of the 45 papers, community care and social support factors were significant in 21 out of 31 papers addressing these while contextual factors and social support were significant in all seven papers which studied them.

CONCLUSIONS

This review represents a first attempt at providing an overview of post-discharge factors previously studied in association with readmission. Hence, by mapping out the current research in the area, it highlights the gaps in research and it provides guidance future studies in the area.

An automated tool for a uniform decentralized quality control and data analysis in multicenter studies with health care registry data

ABSTRACTObjectivesThe EU FP7 funded project CEPHOS-LINK investigates hospital re-admissions of patients with a psychiatric disorder in 6 European countries by using linked health care registry data. In addition to the problems of different healthcare, payment and data collection systems, coordinating quality control, data analysis, and statistical modeling of sensitive data with six partners is challenging. For this purpose we have designed a secure online data analysis tool to diminish the time necessary to get results and incremental adaptions of reports as well as decreasing the chance and effects of misunderstandings between national and linguistic boundaries. ApproachA comprehensive study protocol clearly defining variables to be obtained and methods to be applied has been put together. The protocol is based on a thorough investigation of the different healthcare systems and related registries. It became clear that nonetheless misconceptions occur and the incremental improvements consumed vast amounts of available resources. Therefore a system which automatically creates the required reports including all tables, graphics and statistical models including data preparation based on a defined data structure has been developed. The report system is based on the statistical environment R and the document markup language LaTeX, tightly integrated with R's package “knitr”.As this highly flexible solution is not straight forward to apply and implies various technical dependencies, a secure online platform hiding all technical details from the users has been developed. Utilizing state of the art software containers based on Linux and docker, a customized VPN solution, authentication and SSL encryption were put together. The web application itself is developed with R's “shiny” package and allows users to simply upload a dataset in the predefined format, interactively explore the contents, apply filters and generate the customizable, standardized report. Additionally, an offline version of the application is available for all major (desktop) operating systems. ResultsThe new platform advances data analysis and reporting in a situation where several partners are involved in analyzing local datasets, as is the case of the CEPHOS-LINK project. Integrating new features, graphics and research topics can be managed centrally while users can update their results and reports in nearly no time. ConclusionThe additional effort spent on developing a customized platform for quality control, data analysis and reporting has been worth the effort. Benefits include quick detection of implausible results, unifying the layout and graphics often depending on the software utilized and an established common data structure.

[Pain Symptoms as Predictors of Depressive or Anxiety Disorders in Patients with Physical Illness]

OBJECTIVE

The aim of this study was to investigate the frequency of pain symptoms reported by patients of non-psychiatric hospital departments and to explore their association with affective and anxiety disorders.

METHODS

Patients of non-psychiatric hospital departments (n = 290) reported pain symptoms by filling in a self-rating questionnaire. Psychiatric examinations were performed by psychiatrists using a structured diagnostic interview. The sum-scores of self-reported pain symptoms were tested for their screening accuracy for anxiety and depression.

RESULTS

Patients suffering from affective or anxiety disorders reported significantly more often three or more pain symptoms (63 % vs. 28 %). Using a cut-off value of ≥ 3 of self-reported pain symptoms yielded a sensitivity of 63.1 % and a specificity of 71.7 %.

CONCLUSIONS

These findings highlight the relevance of a higher number of pain symptoms as a possible indicator for affective and anxiety disorders. The use of pain symptoms as pre-screening for depression and anxiety might be a useful tool, but needs further research before it can be recommended.

[Counselling customers with psychotropic vs. cardiovascular prescriptions: a survey among Austrian community pharmacists]

BACKGROUND

Prescriptions for psychotropic drugs in general and their share of all prescriptions have substantially risen over the last decades. Thus, also counselling by pharmacists becomes more important in this area. This study focuses on how community pharmacists see their own role when counselling persons with prescriptions for psychotropic medication and how this differs from counselling persons with other types of prescriptions.

METHODS

Based on the Toronto Community Pharmacists' Questionnaire an online questionnaire was developed with the assistance of the Austrian Pharmacists Association. This instrument elicits pharmacists' attitudes toward and professional interactions with users of psychotropic drugs on the one hand and of cardiovascular medication on the other. After a pilot study the questionnaire - which was to be filled in anonymously - was put on a web portal for six months and Austrian community pharmacists were invited to answer it.

RESULTS

125 pharmacists completed the questionnaire. Overall it was reported, that new customers with psychotropic prescriptions were less often counselled than those with prescriptions for cardiovascular medication. The main reasons for this difference seem to be the lack of privacy in public pharmacies, the fear of stigmatising customers with psychotropic medication and a perceived lack of training concerning the treatment of mental disorders. In addition to improving such training, it was suggested that seminars and workshops for communication skills should be organised.

CONCLUSION

The reduced frequency in counselling new customers with psychotropic medication is related to a lack of privacy in public pharmacies, fear of stigmatising customers and a perceived need for improving the training on the treatment of mental disorders.

Die Untersuchung von Körperflüssigkeiten mit geringer Proteinkonzentration mittels einer Kombination von Mikro-Disk- Elektrophorese und Elektroimmundiffusion /Investigations of Body Fluids with Low Protein Content by the Combination of Micro-Disc-Electrophoresis and Electroimmunodiffusion

Fluids of the human body with low protein content, i.e. aqueous humour, tears, cerebrospinal fluid, and urine were analyzed by a combination of micro-disc-electrophoresis and electroimmuno-diffusion. By this method both qualitative and quantitative statements about the proteins of these fluids can be established.

Mental health care for irregular migrants in Europe: barriers and how they are overcome

BACKGROUND

Irregular migrants (IMs) are exposed to a wide range of risk factors for developing mental health problems. However, little is known about whether and how they receive mental health care across European countries. The aims of this study were (1) to identify barriers to mental health care for IMs, and (2) to explore ways by which these barriers are overcome in practice.

METHODS

Data from semi-structured interviews with 25 experts in the field of mental health care for IMs in the capital cities of 14 European countries were analysed using thematic analysis.

RESULTS

Experts reported a range of barriers to mental health care for IMs. These include the absence of legal entitlements to health care in some countries or a lack of awareness of such entitlements, administrative obstacles, a shortage of culturally sensitive care, the complexity of the social needs of IMs, and their fear of being reported and deported. These barriers can be partly overcome by networks of committed professionals and supportive services. NGOs have become important initial points of contact for IMs, providing mental health care themselves or referring IMs to other suitable services. However, these services are often confronted with the ethical dilemma of either acting according to the legislation and institutional rules or providing care for humanitarian reasons, which involves the risk of acting illegally and providing care without authorisation.

CONCLUSIONS

Even in countries where access to health care is legally possible for IMs, various other barriers remain. Some of these are common to all migrants, whilst others are specific for IMs. Attempts at improving mental health care for IMs should consider barriers beyond legal entitlement, including communicating information about entitlement to mental health care professionals and patients, providing culturally sensitive care and ensuring sufficient resources.

Pain and depression in general hospital patients

Background

Symptoms of physical pain can indicate a current depressive episode. The study aimed to assess pain symptoms among physically ill general hospital patients and to explore if pain symptoms are more prevalent among physically ill patients with a depressive episode than among those without a depressive episode.

Methods

Pain symptoms were assessed by a modified version of the Patient Questionnaire (Spitzer et al1). Diagnosis of a current depressive episode was made by psychiatrists with the Composite International Diagnostic Interview (CIDI; ICD-10 version2).

Results

Of the 290 patients included in the study 247 (85.2%) indicated at least one pain symptom. About a fifth of the patients suffered from a current depressive episode. Physically ill patients with depression suffered significantly more often from pain and reported significantly more often three or more symptoms of pain than those without depression.

Headaches, stomach pain and chest pain were significant independent predictor variables for depression in a multiple logistic regression analysis controlled for age, gender and primary somatic diagnosis.

Conclusion

Patients in general hospital who suffer from pain symptoms should be checked physically and psychologically in order to detect a comorbid depressive episode.

1Spitzer RL, Williams JB, Kroenke K, Linzer M, deGruy FV 3rd, Hahn SR, Brody D, Johnson JG. Utility of a new procedure for diagnosing mental disorders in primary care. The PRIME-MD 1000 study. JAMA 1994;272:1749-56.

2Wittchen, H.U., Pfister, H., 1997. DIA-X-Interviews. Manual für Screening-Verfahren und Interview; PC-Programm zur Durchführung des Interviews (Längs- und Querschnittuntersuchung); Auswertungsprogramm. Frankfurt, Swets & Zeitlinger.

ICD-10 or DSM-IV? Anhedonia, fatigue and depressed mood as screening symptoms for diagnosing a current depressive episode in physically ill patients in general hospital

OBJECTIVE

To explore the usefulness of "anhedonia", "fatigue" and "depressed mood" as screening symptoms for predicting a depressive episode in physically ill patients.

METHOD

290 patients filled in a modified version of the Patient Questionnaire and were subsequently assessed by psychiatrists with the Composite International Diagnostic Interview (CIDI; ICD-10 version).

RESULTS

63 patients suffered from a current depressive episode according to the CIDI. If at least two of the three symptoms were used for screening positively (ICD-10 algorithm), the sensitivity was 93.2% and the specificity 72.7%, while the simpler algorithm of DSM-IV - requiring depressed mood or anhedonia to be present - yielded a slightly higher sensitivity (95.2%) and a slightly lower specificity (66.5%). One in five patients with a depressive episode did not report "depressed mood".

LIMITATION

It remains unclear how relevant the three core symptoms of depression are for the diagnosis of an ICD-10 depression in people who are not physically ill.

CONCLUSION

The fact that both diagnostic algorithms yielded comparable results suggests that the more parsimonious DSM-IV algorithm is preferable and "fatigue" could be left out as a screening symptom. Since "depressed mood" was absent in a substantial proportion of patients, special attention has to be paid to "anhedonia". Medical students and non-psychiatric clinicians should be especially trained to ask for anhedonia, so that cases of depression will not be overlooked.

Are psychiatrists an endangered species? Observations on internal and external challenges to the profession

Based on recently voiced concerns about a crisis in psychiatry, six challenges to our profession are identified and discussed. As we approach the revisions of ICD-10 and DSM-IV, the validity of psychiatry's diagnostic definitions and classification systems is increasingly questioned also from inside psychiatry. In addition, confidence in the results of therapeutic intervention studies is waning. A further challenge is the existence of de facto subgroups with opposing ideologies, a situation which is responsible for an unclear role profile of the psychiatrist. Challenges from outside include mounting patient and carer criticism, intrusion of other professions into psychiatry's traditional field of competence, and psychiatry's low status within medicine and in society in general. Studies suggest that the decline of the recruitment into psychiatry, as it is observed in many countries, might be related to problems arising from these challenges. It is unclear whether psychiatry will survive as a unitary medical discipline or whether those segments which are more rewarding, both financially and in status, will break away, leaving the unattractive tasks to carry out by what remains of psychiatry. The demise of the generalist and the rise of the specialist in modern society may contribute to this development. Attempts are underway by professional bodies to define the profile of a "general psychiatrist". Such discussions should be complemented by an analysis of the incentives which contribute to the centrifugal tendencies in psychiatry.

Patients' perspectives on what works in psychoeducational groups for schizophrenia: a qualitative study

BACKGROUND

Psychoeducational groups are a common component of interventions in schizophrenia.

AIMS

To explore patients' views about wanted and unwanted effects of group psychoeducation.

METHOD

Subjective feedback of 103 participants of a psychoeducational intervention as well as data from two specific focus groups-one with "enthusiastic" and one with "critical" participants-were analyzed by means of qualitative content analysis.

RESULTS

Participants emphasized the importance of information received and of exchanging information with others suffering from the same disorder. Positive effects on coping, activation and social interaction were reported. Perceived overemphasis on illness related information produced defensive reactions, whereas the integration of quality of life topics was appreciated. A pleasant group atmosphere and clinical stability were suggested as important determinants of success.

CONCLUSIONS

Qualitative analyzses of participants' views help to understand the potentials of a psychoeducational intervention in schizophrenia.

Patterns of social distance towards people suffering from schizophrenia in Austria: a comparison between the general public, relatives and mental health staff

OBJECTIVE

The aims of this study were to identify the different aspects of the attitudes towards people suffering from schizophrenia and to find factors influencing these attitudes -- especially the willingness to contact people suffering from schizophrenia -- as well as to obtain information on how to reduce stigma and discrimination.

METHOD

We conducted a study to investigate these attitudes in Austria. A representative sample of the general public, different professional groups working in the field and relatives of mentally ill people were interviewed. The public, relatives and people working in the mental health field were asked a number of the same questions, to allow for comparisons between groups.

RESULTS

We found great differences in key dimensions of the attitude towards people suffering from schizophrenia between groups: these included different causal attributions to schizophrenia, different attitudes concerning the perceived success of the treatment of schizophrenia, different fears concerning perceived dangerousness and a different willingness to interact voluntarily with schizophrenia patients.

CONCLUSION

The factors influencing the distance towards people suffering from schizophrenia differ between groups. Our findings should help to optimize campaigns fighting against stigma and discrimination.

Die Kosten von "Gehirnerkrankungen" in Österreich im Jahr 2004

OBJECTIVES

The costs of twelve selected neurological, neuro-surgical and psychiatric disorders in Austria in the year 2004 will be presented. The present paper is part of the "Cost of Disorders of the Brain in Europe" study.

METHODS

The data for the present calculations are based on systematic reviews of epidemiological and health-economic studies. For all European countries identical methods were applied. All economic data were transformed to Euros for Austria in the year 2004 ("Purchasing Power Parity adjusted").

RESULTS

The highest costs per case per disorder were caused by brain tumors (49,800 Euro) and multiple sclerosis (30,500 Euro). One-year-prevalence estimates (Austrian population 8.1 million) were highest for anxiety disorders (848,000 cases), followed by migraine (537,000 cases) and affective disorders (479,000 cases). The total costs (i.e. for all cases of a specific disorder in Austria) were highest for affective disorders and addiction (alcohol and illegal drugs). The total cost of all included disorders (addiction, affective disorders, anxiety disorders, brain tumours, dementia, epilepsy, migraine, multiple sclerosis, Parkinson's disease, psychotic disorders, stroke and brain trauma) was estimated at 8.8 billion Euros for Austria in the year 2004. Direct health care cost amounted to Euros 3.2 billion (37% of total cost), direct non-medical cost totalled Euros 1.5 billion (17%), and indirect cost Euros 4.1 billion (47%).

DISCUSSION

Even when considering that such estimates based on international studies have methodological limitations, the total cost of the twelve included disorders is considerable. The total cost of these twelve disorders constitutes 4% of the gross national product of Austria. Taken together, these disorders cost each Austrian citizen Euros 1 090 per year.

Learning by doing: a novel approach to improving general practitioners' diagnostic skills for common mental disorders

INTRODUCTION

Two strategies have been proposed to increase the rather low recognition rate of common mental disorders in primary care: (1) the use of screening instruments and (2) extensive psychiatric training for general practitioners. We have chosen a "middle-of-the-road" approach to teach general practitioners by means of a time-saving psychiatric training programme how to make their own psychiatric diagnoses. This pilot study aimed at assessing the acceptance of this programme, its impact on general practitioners' knowledge of 12 ICD-10 disorders - depressive, anxiety and alcohol-related disorders - and the short-term persistence of the knowledge acquired.

METHODS

The training programme consisted of two 3-hour sessions four weeks apart. An educational instrument, a short interview named TRIPS (Training for Interactive Psychiatric Screening), a shortened and adapted form of PRIME-MD, was used to train single-handed general practitioners in Vienna, Austria. TRIPS had to be used by the participants in daily practice in between sessions. Five weeks after the second training session a follow-up evaluation was held to assess the persistence of the knowledge acquired. The perceived usefulness of TRIPS was assessed by a short questionnaire. Knowledge was assessed by a separate 15-item questionnaire.

RESULTS

Of the 31 participating general practitioners 26 attended all three sessions. There was a significant increase in the mean number of correctly answered questions between baseline (5.5 of 15) and session two (9.8; p<0.0001), and a further increase between the second and the follow-up session (11.3; p<0.05). Also, general practitioners rated TRIPS as a practical and useful tool for family practice and stated that its use met with patients' approval.

CONCLUSION

The format chosen was successful in its intended educational endpoints. According to participants TRIPS is appropriate for the family practice situation and is accepted by patients.

Cognitive and emotion recognition deficits in obsessive-compulsive disorder

Previous investigations have demonstrated impaired recognition of facial affect and cognitive dysfunction in several psychiatric disorders. The specificity of these deficits is still debated. The aim of this study was to investigate the deficits in emotion recognition and cognition in obsessive-compulsive disorder (OCD). Forty patients with OCD (DSM-IV, 16 women, 34.7+/-10.4 years) and 40 healthy volunteers (16 women, 34.7+/-8.7 years) were compared. All participants underwent a computerized neuropsychological test battery (Gur, R.C., Erwin, R.J., Gur, R.E., Zwil, A.S., Heimberg, C., Kraemer, H.C., 1992. Facial emotion discrimination II. Behavioral findings in depression. Psychiatry Research 42, 241-251; Gur, R.C., Ragland, J.D., Moberg, P.J., Turner, T.H., Bilker, W.B., Kohler, C., Siegel, S.J., Gur, R.E., 2001. Computerized neurocognitive scanning: I. Methodology and validation in healthy people. Neuropsychopharmacology 25, 766-776). A German version of the Penn Facial Emotion Acuity Test, the Facial Emotion Intensity Differentiation, including happy, sad and neutral faces, and the Facial Memory Test were administered. Executive functions were assessed by a computerized version of the Wisconsin Card Sorting Test and attention was evaluated using the Continuous Performance Test. OCD patients performed more poorly than healthy controls in facial memory tests (especially delayed), as well as in attention and executive functions. The only significant difference between the groups in emotion processing was poorer recognition of sad female faces in patients, who misperceived neutral faces as sad. The results point to memory and executive deficits in addition to a "negative" bias in emotion recognition in OCD patients.

[Bipolar disorder and manic-depressive disorder on the Internet]

OBJECTIVE

The internet is an important source of information and exchange for patients and can exert considerable influence on their health-related behaviours and decisions. This makes the quality of information on the internet an important factor. The present study analyzes the quality of German-language internet information on "bipolar disorder" and "manic-depressive disorder".

METHODS

Two separate searches were conducted with the terms "bipolar disorder" and "manic-depressive disorder", using the Google search engine set to produce only German hits. The quality of the first hundred resulting sites was assessed according to a range of criteria considering form and content.

RESULTS

Comprehensive information on the nature of the illness (such as symptoms and diagnosis) was provided more frequently by sites resulting from the search term "manic-depressive disorder". The term "bipolar disorder" produced more results offering information on evidence-based therapeutic strategies.

DISCUSSION

It is necessary to improve the available internet information on the term "bipolar disorder", and to establish the term as firmly as its predecessor, the term "manic-depressive disorder".

Quality of life in mental disorders: challenges for research and clinical practice

The term quality of life (Qol) has become a rallying cry for all those who strive to integrate patients' subjective experience of their life during illness into clinical care. With its intuitive appeal, Qol seems to be understood by everyone involved in managing health and disease. However, when examining the ever increasing research literature, it becomes clear that many methodological questions still beset this field, since neither a commonly accepted definition nor a gold standard for measuring Qol exist. On the contrary, one is irritated by the myriad of different instruments and it remains questionable how valid and comparable research results obtained with different instruments are. It is argued that, especially when attempting to measure Qol in mental disorders: a) in addition to "subjective", also "objective" (i.e., external) assessment is needed; b) the inclusion of psychopathological symptoms in Qol instruments has to be controlled for; c) in addition to well-being and satisfaction, also functioning and environmental assets have to be assessed; d) different life areas have to be considered separately, and e) changes over time have to be taken into account. A concluding section in the paper reflects on the still largely missing transfer of research results into clinical care.

Schizophrenie und Psychose im Internet

OBJECTIVE

The internet is an increasingly important source of information for patients concerning their illness. This has to be borne in mind concerning its growing influence on communications between patients and clinicians. The aim of this study is to assess the quality of German-language information on schizophrenia on the internet.

METHOD

Two searches of the terms schizophrenia and psychosis were conducted, using the Google search engine set to produce only German hits. The quality of the first hundred resulting sites was assessed according to a range of criteria, including diagnosis and therapy, links and interactive offers.

RESULTS

Evidence-based medical information was provided by more than half of the sites resulting from the search term schizophrenia and by less than one third of psychosis hits. Information and discussion on the relationship between drugs and psychosis appeared almost exclusively under the term psychosis.

CONCLUSIONS

It is suggested that mental health care professionals can use knowledge on what sort of information their patients are confronted with on the internet in order to assist them in profiting from this source of information.

„Wissen - genießen - besser leben” - Ein Seminar für Psychoseerfahrene zur Verbesserung der Lebensqualität und Verringerung der Verletzlichkeit

As a result of a recent paradigm change in medicine the improvement of quality of life has become a central goal of treatment next to reducing symptoms. In order to address this demand we designed a new psychoeducational program for outpatients, which -- in contrast to traditional psychoeducation -- attaches as much importance to quality of life topics as it does to illness related topics. The seminar was developed especially in view of the score resources available today. First results of the evaluation are presented.

METHOD

Psychiatrists in the community are encouraged to refer patients suffering from schizophrenia or schizoaffective disorders to this psychoeducational program as an additional component to regular treatment. The program is carried out in 9 group sessions at weekly intervals with 6-8 group members. At the beginning and at the end of the seminar different objective and subjective outcomes were assessed and predictors for seminar success were identified.

RESULTS

98 participants could be included in data analysis. After completing the program the seminar participants had significantly more knowledge about the illness, a significantly better quality of life and significantly more competence and control. Furthermore there were changes in the illness concept: prejudices about medication decreased, confidence in medication increased, and beliefs about susceptibility to illness and to relapse increased.

CONCLUSIONS

First experiences with a psychoeducational seminar for persons with psychosis, putting equal stress on disease related and quality of life topics are encouraging, but require further confirmation through a randomised controlled trial.

Pharmacophilia and pharmacophobia: determinants of patients' attitudes towards antipsychotic medication

OBJECTIVE

To identify factors that influence attitudes towards psychopharmacological treatment in patients suffering from schizophrenia and schizoaffective psychoses.

METHODS

Ninety-two participants in an outpatient psychoeducational program, classed as "pharmacophobic" or "pharmacophilic" according to the Drug Attitude Inventory scale, were compared with regard to sociodemographic variables, clinical characteristics, subjective deficit syndrome, illness concepts, knowledge, locus of control, and quality of life.

RESULTS

The 59 pharmacophilic and the 33 pharmacophobic patients did not differ significantly with regard to most sociodemographic variables, symptoms, or classic personality traits such as locus of control, self-concept, and quality of life. The only differences concerned hospitalization history ( P < 0.05) and statements on the actual, subjective experience of desired and undesired effects of medication ( P < 0.01).

CONCLUSIONS

The impact of subjective experiences with drug treatment on attitudes towards medication and compliance needs to be a main focus of interventions targeting attitudes towards pharmacological treatment.

Effects of socio-demographic variables on health-related quality of life determined by the quality of life index--German version

STUDY OBJECTIVE

The purpose of this study was to determine subjective health-related quality of life (HRQoL) in a sample of the Austrian population over 14 years of age in order to evaluate the effect of socio-demographic variables on HRQoL.

DESIGN/SETTING

HRQoL was determined by means of the quality of life index-German version (QLI-Ge). The influence of socio-demographic variables on HRQoL was assessed by statistical analysis using the Kruskal-Wallis test and an analysis of variance.

PARTICIPANTS

A random-quota procedure was used to get balanced representation from regions and demographic groups of the Austrian population. The sample consisted of 1049 participants, 493 men and 556 women.

MAIN RESULTS

Age was found to influence the QLI-Ge total score (index score) and most individual items, with increasing age resulting in a decrease in HRQoL. Differences between the sexes were observed in three dimensions: males scored higher in 'physical well-being', 'psychological well-being' and 'occupational functioning'. Marital status impacted most items with married persons showing better values than divorced persons or singles. Profession had only a minor effect on HRQoL, the level of education showed no influence at all.

CONCLUSIONS

The socio-demographic variables age, sex and objective living conditions had a major influence on subjectively rated HRQoL, whereas profession and education were found to play a minor role in this context. It is recommended that in the interpretation of studies assessing HRQoL the above-mentioned objective factors be considered. This will be of particular importance when determining the effect of a pharmacotherapy on HRQoL in patients.

P300 event-related potentials and cognitive function in social phobia

The aim of the study was to investigate abnormalities of event-related potentials (ERPs) in social phobia patients indicating deficits in speed and amount of perceptual and cognitive resources as well as relationships between ERPs and cognitive functioning. ERPs were recorded from 19 EEG leads in a two-tone oddball paradigm in medication-free patients with DSM-IV social phobia (n=25) and in age- and sex-matched healthy controls (HC). Neuropsychological test performance was administered. Compared with the HC group, patients with social phobia showed reductions in N1 at temporal leads, N2 and P300 amplitudes, predominantly centroparietally, and longer P300 latencies. The observed P300 latency prolongation was associated with reduced Non-Verbal Learning Test (NVLT) but not the Wisconsin Card Sorting Test (WCST) scores. The reduction in N1 amplitude indicates an impairment in perceptual processing. The reduced P300 amplitudes may reflect reduced cognitive resources for the evaluation of relevant information. The increased P300 latency, indicating longer stimulus evaluation time, was correlated to deficits in learning processes as measured by the Non-Verbal Learning Test but not to executive function as measured by the Wisconsin Card Sorting Test. It may therefore be concluded that social phobia patients show deficits in cognitive information processing as reflected by ERPs.

Facial recognition deficits and cognition in schizophrenia

Previous investigations have found impaired recognition of facial affect and cognition in schizophrenia. We compared patients with schizophrenia and healthy control volunteers on computerized tasks of emotion recognition, to determine whether emotion processing deficits were correlated with neurocognitive performance. A Computerized Neuropsychological Test Battery (CNP) was administered to 40 patients (25 male, 15 female, mean age+/-S.D. 30.4+/-8.1) with schizophrenia (DSM-IV, 15 first episode and 25 chronically ill patients) treated with atypical neuroleptics and 43 healthy volunteers. A German version of the PENN Facial Discrimination, Differentiation and Memory Test, including happy, sad and neutral faces was used. Additionally, all patients were tested with a standard neuropsychological battery and rated for positive and negative symptoms. Patients with schizophrenia performed worse than control subjects on all emotion recognition tasks (p<0.01). We found higher error rates for discrimination of emotion in happy (p<0.02) and happy female faces (p<0.01), for differentiation of sad versus happy faces (p<0.001) and for facial memory (p<0.04). Poorer performance in emotion discrimination and facial memory correlated with severity of negative symptoms, abstraction-flexibility (p<0.001), verbal memory (p<0.01) and language processing (p<0.001). The study did not reveal a specific deficit for emotion recognition in schizophrenia. These findings lend support to the notion that difficulties in emotion recognition are associated in schizophrenia with key cognitive deficits.

Personality disorder and social anxiety predict delayed response in drug and behavioral treatment of panic disorder

BACKGROUND

The aim of this study was to analyze the impact of pretreatment characteristics and personality disorders on the onset of response in the treatment of panic disorder.

METHODS

The data of 73 out-patients with panic disorder who had completed at least 6 weeks of a randomized trial of 24 weeks of either paroxetine only or paroxetine combined with cognitive group-therapy were analyzed in a Cox proportional hazards model.

RESULTS

The likelihood of having responded to treatment (defined by a CGI rating of improvement) was more than twice as high for patients without a personality disorder or social phobia than for Patients with a personality disorder or social phobia.

CONCLUSIONS

We suggest that patients with these characteristics do benefit from prolonged treatment, and they may profit from an additional treatment focused on social anxiety.

The long-term course of panic disorder--an 11 year follow-up

BACKGROUND

The purpose of this study was to assess the naturalistic long-term course of panic disorder over a period of 11 years.

METHOD

Thirty DSM-III-R panic disorder patients, who had suffered from panic disorder for 6 years on average and who had taken part in an 8-week multicenter drug trial, were included in the intent-to-follow-up group to be reinterviewed 11 years after the end of the trial. At baseline and at follow-up the same instruments were used to assess frequency of panic attacks, level of phobic avoidance, and disabilities. Treatments received during the follow-up period and attempted suicides were assessed with a structured interview. Periods of well-being during the follow-up period were elicited retrospectively with a specifically designed longitudinal chart.

RESULTS

Twenty-four patients could actually be reinterviewed after 11.3 years. While at baseline all patients had suffered from panic attacks and had been severely disabled on a number of measures, 66.7% had no panic attack during the year before follow-up. During the month before follow-up 87.5% had no panic attack, and 54% showed no or only mild phobic avoidance. In the areas of work and family life 90% showed no or only mild disabilities, whereas in the area of social life this percentage was lower (67%). Thirty-three percent of the patients were completely remitted according to a composite remission criterion.

CONCLUSIONS

Panic disorder is not a uniformly chronic and progressing disorder. Over a period of 11 years there is a good chance of recovery from panic attacks and disabilities, and full remission is also possible.

Quality of life in nonorganic and organic sleep disorders: II. Correlation with objective and subjective quality of sleep and awakening

OBJECTIVE

The purpose of this study of 100 patients suffering from sleep-disorders was to determine correlations between their subjective health-related quality of life (HRQoL) and objective variables in sleep initiation and maintenance, sleep architecture, objective quality of awakening, psychophysiological parameters and subjective quality of sleep and awakening.

METHODS

Objective measurements were obtained from overnight diagnostic polysomnography. Subjective HRQoL was determined from the Quality of Life Index (QLI, Mezzich and Cohen) completed prior to the adaptation night. Other measurements included subjective and objective quality of sleep and awakening (psychometry) the evening before and morning after polysomnographic investigations.

RESULTS

63% of the patients were suffering from nonorganic and 37% from organic sleep disorders (SDs). Within the first group, nonorganic insomnia predominated; within the second, sleep apnea. Subjective HRQoL correlated well with subjective sleep and awakening quality, especially in nonorganic SDs. There were only a few correlations of objective measurements with subjective HRQoL: in the total group of SD patients HRQoL correlated with sleep stage S2, and in nonorganic SDs with attention scores and psychophysiological measurements (mainly the pulse rate in the evening and morning).

CONCLUSION

Our findings suggest only a weak relationship between objective sleep variables and subjective HRQoL in both organic and nonorganic SDs. However, we found various significant correlations of HRQoL with subjective measurements of sleep, especially in nonorganic SDs.

Quality of life in nonorganic and organic sleep disorders: I. Comparison with normative data

Subjective health-related quality of life (HRQoL) was investigated in 100 patients with disturbed sleep (39 women aged 52 +/- 13 years and 61 men aged 53 +/- 10 years) referred to the sleep laboratory and compared with HRQoL in 100 normal healthy adults. Measurements included the Quality of Life Index (QLI) (Mezzich and Cohen), and objective (polysomnographic) and subjective (psychometric) quality of sleep and awakening. Statistical analysis (Mann-Whitney U-test) showed HRQoL to be significantly reduced in sleep disorders (SDs), with a more pronounced reduction in nonorganic than in organic SDs. Patients with nonorganic hypersomnia were more disturbed than those with nonorganic insomnia. Within organic SDs, patients with apnea were more disturbed than those with obstructive snoring. Out of ten elementary HRQoL components, seven were disturbed in SDs: physical well-being, psychological well-being, self-care and independent functioning, occupational functioning, interpersonal functioning, personal fulfillment, and overall quality of life. No differences between patients and normal healthy subjects where found in the components social support, community and services support or spiritual fulfillment. Patients suffering from nonorganic SDs had significantly worse scores in physical and psychological well-being and overall quality of life than those with organic SDs. Patients with both SDs and additional diagnoses of affective disorders had more profoundly reduced HRQoL than those with anxiety disorders. Follow-up of 51 patients (31 with nonorganic SDs and 20 with organic SDs) one year after sleep laboratory investigation and subsequent treatment found significantly improved HRQoL compared with pre-treatment. Moreover, patients diagnosed and treated in the sleep laboratory showed lower re-hospitalization rats.

[Days in psychiatric hospitals: who consumes most of them? A five-year record linkage study of "Heavy Users" in an Austrian province]

OBJECTIVE

To find out whether the use of hospital days in all psychiatric inpatient services in the province of Lower Austria is equally distributed among patients or whether subgroups with different intensity of hospital day use can be identified, and if so, how these subgroups can be characterized.

METHODS

Data collected for administrative purposes for all three inpatient services of Lower Austria were analyzed for the years 1996 to 2000. Record Linkage allowed to identify patients who had used several of these hospitals within the respective study periods. Cumulative hospital days per patient were calculated for each of the years studied and the distribution of these cumulative hospital days was analyzed.

RESULTS

Of the 202 996 hospital days accrued in the year 1996, 44.5 % were consumed by patients who continuously stayed in hospital during the whole year ("static" population). In 2000 this percentage had dropped to 16.3 %; also the total number of hospital days had decreased by one third to 141 738. Of those patients, who had at least once been admitted and/or discharged during a specific year ("dynamic population"), a stable proportion of around 17.0 % were responsible for 50.0 % of all hospital days. These patients were more frequently of female sex, significantly younger, had more often repeated admissions and suffered more frequently from schizophrenia than the rest of the group.

CONCLUSIONS

The astonishing finding that, despite substantial change in the system of psychiatric care over five years, the percentage of patients with high values for cumulative hospital days remains constant, warrants further analyses. In such analyses not only patient and illness characteristics should be studied (which is suggested by the terms "heavy users" and "high utilizers"), but also factors such as the social context of the patient, the existence or non-existence of community psychiatric services and their functioning, as well as existing or non-existing financial incentives for single services.

Incentives in financing mental health care in Austria

BACKGROUND

In Austria, financing health care -and even more so mental health care- is characterized by a mix of federal and provincial responsibilities, lack of uniformity in service provision and service providers, and diverse funding arrangements. The division between financing structures for health care and social care makes the situation even more complex. This state of affairs results in various, partly counterproductive and sometimes paradoxical financial incentives and disincentives for the providers, recipients and financiers of mental health services. In several provinces of Austria, recent reform plans in mental health care have focused strongly on establishing community-based and patient-oriented mental health care. One of the main challenges in implementing this new policy is the re-allocation of resources.

AIMS OF THE STUDY

The authors hypothesize that the existing structure of mental health care financing, with its incentives and disincentives, constitutes an obstacle to patient-oriented community-based mental health care. Analyzing the characteristics of the overall mental health care financing system in one Austrian province, Lower Austria, will provide a better understanding of actor-relationships and inherent incentives and highlight implications for the process of deinstitutionalization.

METHOD

The authors used an analytical framework based on the principal-agent theory, empirical evidence, and information on financial, organizational and legal structures to identify the characteristics of actor-relationships and the position of single actors within the system.

RESULTS

The article shows how incentives are linked to existing constellations of actors involved in mental health care financing and identifies significant power relations. As a consequence, incentives and disincentives within the financing system result in hospital- centered and supply-oriented mental health care in Lower Austria.

DISCUSSION

The current system of financing mental health care provides an obstacle to the provision of patient-oriented and community-based mental care. This is due to existing constellations and power relations among the actors where, most importantly, patients are the weakest party in the patient-payer-provider triangle. Balancing power relations will be a significant prerequisite for alternative financing systems. IMPLICATIONS FOR HEALTH POLICIES AND FURTHER RESEARCH: If a community and needs-based mental health care system is to be established in Austria, the financing structures have to be changed accordingly. Applying a principal-agent framework is useful for identifying key aspects in mental health care financing in relation to the provision of services. Further research is needed to help develop alternative financing mechanisms that support community-based and patient-oriented mental health care systems.

[The course of illness and problems of schizophrenic women and men from the relatives' perspective]

OBJECTIVES

Members of HPE, an Austrian self-help organization for the relatives of mentally ill people, were questioned about their opinion with regard to the situation of families with a mentally ill member.

METHODS

A questionnaire was sent to the addresses of members of this self-help organisation. 182 respondents reported to care for 132 male and 50 female sufferers diagnosed as having a psychosis from the schizophrenic spectrum replied.

RESULTS

Relatives, who care for male sufferers reported greater distress than those caring for females. Depression and exhaustion are reported significantly more frequently in caregivers of males. Other burdens, for example financial burdens, to assist the sufferer in the household, renunciation of holidays, and the problem of neglect also have a tendency to be more common among those caring for men. These gender differences cannot be accounted for by differences in the course of illness. Our study showed no evidence of gender differences in this regard. Contrary to our expectations women in our study are less compliant with medication and psychosocial treatment.

CONCLUSIONS

Despite a better compliance with treatment strategies among men, relatives of males generally experience a greater burden. Our results indicate a greater need for the development of independence strategies for male sufferers and a requirement that professionals support sufferers and carers in this direction.

The influence of age on the female/male ratio of treated incidence rates in depression

BACKGROUND

Poor data exist on the influence of psychosocial variables on the female/male ratio of depression because of the small number of cases and the resulting limited numbers of variables available for investigation. For this investigation a large number of first admitted depressed patients (N = 2599) was available which offered the unique opportunity to calculate age specific sex ratios for different marital and employment status categories.

METHODS

Age and sex specific population based depression rates were calculated for first ever admissions for single year intervals. Moving averages with interpolated corrections for marginal values in the age distribution were employed.

RESULTS

For the total group the female/male ratio of depression showed an inverted U-shape over the life-cycle. This pattern was influenced by the group of married persons, which showed a sex-ratio of 3:1 between the age of 30-50, but ratios of around 1:1 at younger and older ages. For not married persons the female/male ratio was already around 2:1 at the age of 18 and rose to 2.5:1 in mid-life and declined to 1 at around 55. The almost parallel decline of depression rates in employed men and women resulted in a female/male ratio of about 2:1 from age 18 to age 50 and became 1 after the age of 60. The female/male ratio among the not employed was about 1, in mid-life it became negative.

CONCLUSIONS

Our analyses show that the gender-gap in first admitted depressed patients is age dependent and that psychosocial factors modify the sex ratio.

Sleeping habits in the Austrian population

OBJECTIVES

To gain reliable data on sleeping habits and sleep disturbances of the Austrian population.

BACKGROUND

Exact data on sleeping habits are of interest in relation to assessment of sleep disturbance-related illnesses and general social processes.

METHODS

A prospective, cross-sectional study was performed with recruitment of a representative sample of 1049 Austrians (aged 15-82 years), according to the Federal Statistics population characteristics. Interviews were conducted in the households of the participants by specially trained interviewers of an institute for empirical research.

RESULTS

Men consider their quality of sleep to be significantly better than women (P=0.00234), and younger persons consider their quality of sleep to be significantly better than older persons (P=0.00001). In comparison, women and people over the age of 50 report worse subjective sleep quality, worse sleep efficiency, more difficulty in falling asleep and sleep maintenance, more apneic events, more pathologic limb movements, more daytime dysfunction, and more intake of sleeping medication. Other sociodemographic factors influence sleep reports to a lesser extent.

CONCLUSIONS

Subjectively disturbed sleep (prevalence in the total population 24.9%), excessive hypnotic drug intake (prevalence 13.0%), and daytime dysfunction (prevalence 17.4%) are a widespread problem, especially in women and older people. With increasing life expectancy in Western societies, the prevalence of sleep disturbances will increase.

Schizophrenia and quality of life

OBJECTIVE

The purpose of this paper is to examine critically results of quality-of-life research in schizophrenic patients living in the community.

METHOD

Based on the relevant literature results of specific studies are discussed in the light of the methodological problems of assessing quality of life in these people.

RESULTS

Subjectively assessed quality of life was found to be higher in the less educated and in female patients, and when a sense of control is experienced. If negative or extrapyramidal symptoms are experienced and stigmatization is perceived, subjective quality of life is reported as being poorer. These results are discussed in view of the additional needs and fewer resources of this population, their stigma-dilemma and their occasional difficulties in adequately assessing quality of life.

CONCLUSION

It is argued that subjective and quantitative measures of quality of life in schizophrenic patients should be supplemented by external assessment and qualitative methods.