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Mlay JP, Jamieson L, Ntlantsana V, Naidu T, Bhengu BS, Paruk S, Burns JK, Chiliza B, Lessells R, Tomita A. Developing and testing unconditional cash transfer strategies among young adults with first-episode psychosis in South Africa: a study protocol for a pilot randomised control trial (PRS-FEP trial). BMJ Open 2022; 12:e067026. [PMID: 36576187 PMCID: PMC9723892 DOI: 10.1136/bmjopen-2022-067026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Access to mental health services is a challenge, especially for young people who are over-represented in the unemployment and poverty index in South Africa. Therefore, continuing care is a problem after hospital discharge for young people with first-episode psychosis (FEP) due to a lack of clinical engagement and follow-up, for which they need support, including financial, to improve their outcomes. This pilot randomised control trial (RCT) aims to assess the feasibility and acceptability of financial support, in the form of an unconditional cash transfer (UCT), among young patients with FEP to prevent relapse. METHODS AND ANALYSIS This study will use a 1:1 ratio two-arm open-label pilot RCT of 60 young participants (18-29 years) with FEP in remission, who will be recruited from specialised psychiatric facilities in KwaZulu-Natal Province, South Africa. This study will implement an UCT and assess its feasibility, acceptability and preliminary clinical outcomes (ie, medication adherence, relapse, quality of life, personal and social function). The follow-up time will be 3 months, the outcomes being measured at baseline, months 1 and 3. Descriptive and conventional content analysis will be done for quantitative and qualitative data, respectively. ETHICS AND DISSEMINATION The study obtained provisional approval from the Biomedical Research Ethics Committee at the University of KwaZulu-Natal(#BREC/00004117/2022). Also is registered on the South African National clinical trial registry (#DOH-27-092022-5894) and approved by the KwaZulu-Natal department of health (#NHRD Ref: KZ_2002209_033). The results from this investigation will be actively disseminated through peer-reviewed journal publications, conference presentations and stakeholder engagement. TRIAL REGISTRATION NUMBER DOH-27-092022-5894.
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Affiliation(s)
- Joyce Protas Mlay
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
- Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Lise Jamieson
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, University of the Witwatersrand Johannesburg Faculty of Health Sciences, Johannesburg, Gauteng, South Africa
| | - Vuyokazi Ntlantsana
- Discipline of Psychiatry, University of KwaZulu-Natal Nelson R Mandela School of Medicine, Durban, KwaZulu-Natal, South Africa
| | - Thirusha Naidu
- Discipline of Behavioural Medicine, University of KwaZulu-Natal School of Nursing and Public Health, Durban, KwaZulu-Natal, South Africa
| | - Busisiwe Siphumelele Bhengu
- Discipline of Psychiatry, University of KwaZulu-Natal Nelson R Mandela School of Medicine, Durban, KwaZulu-Natal, South Africa
| | - Saeeda Paruk
- Discipline of Psychiatry, University of KwaZulu-Natal Nelson R Mandela School of Medicine, Durban, KwaZulu-Natal, South Africa
| | - Jonathan K Burns
- Discipline of Psychiatry, University of KwaZulu-Natal Nelson R Mandela School of Medicine, Durban, KwaZulu-Natal, South Africa
- Institute of Health Research, University of Exeter, Exeter, UK
| | - Bonginkosi Chiliza
- Discipline of Psychiatry, University of KwaZulu-Natal Nelson R Mandela School of Medicine, Durban, KwaZulu-Natal, South Africa
| | - Richard Lessells
- Centre for the Aids Programme of Research in South Africa, Durban, KwaZulu-Natal, South Africa
- KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), College of Health Sciences, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Andrew Tomita
- KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), College of Health Sciences, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
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Hofer A, Baumgartner S, Edlinger M, Hummer M, Kemmler G, Rettenbacher MA, Schweigkofler H, Schwitzer J, Fleischhacker WW. Patient outcomes in schizophrenia I: correlates with sociodemographic variables, psychopathology, and side effects. Eur Psychiatry 2020; 20:386-94. [PMID: 16171653 DOI: 10.1016/j.eurpsy.2005.02.005] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2004] [Accepted: 02/02/2005] [Indexed: 10/25/2022] Open
Abstract
AbstractObjectiveThe present cross-sectional study examined the relationships of psychopathology, side effects, and sociodemographic factors with treatment outcomes in terms of patients' quality of life (QOL), functioning, and needs for care.MethodSixty outpatients with chronic schizophrenia who had been treated with either clozapine or olanzapine for at least 6 months were investigated.ResultsMost psychopathological symptoms as well as psychic side effects, weight gain, and female sex were associated with lower QOL, while cognitive symptoms correlated with better QOL. Female sex, cognitive symptoms, and parkinsonism negatively influenced occupational functioning, and negative symptoms determined a lesser likelihood of living independently. Age, education, depression/anxiety, negative symptoms, and psychic side effects were predictors of patients' needs for care.ConclusionOur results highlight the complex nature of patient outcomes in schizophrenia. They reemphasize the need of targeting effectiveness, i.e. both symptomatic improvement as well as drug safety, in such patients.
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Affiliation(s)
- Alex Hofer
- Department of Biological Psychiatry, Innsbruck Medical University, Anichstrasse 35, A-6020 Innsbruck, Austria.
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Li Y, Hou CL, Ma XR, Zhong BL, Zang Y, Jia FJ, Lin YQ, Lai KYC, Chiu HFK, Ungvari GS, Hall BJ, Cai MY, Ng CH, Xiang YT. Quality of life in Chinese patients with schizophrenia treated in primary care. Psychiatry Res 2017; 254:80-84. [PMID: 28456026 DOI: 10.1016/j.psychres.2017.04.049] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 02/26/2017] [Accepted: 04/23/2017] [Indexed: 11/17/2022]
Abstract
In China, maintenance treatment for clinically stable patients with schizophrenia is usually provided by primary care physicians. This study examined the quality of life (QOL) in patients with schizophrenia treated in primary care and explored the demographic and clinical characteristics associated with QOL. Altogether, 612 patients with schizophrenia treated in 22 randomly selected primary care services in China formed the study sample. QOL, psychotic and depressive symptoms, extra-pyramidal symptoms and insight were assessed using standardized instruments. Data analyses were conducted with the one sample t-test and multiple linear regression analyses. Compared with the normative data for the Chinese general population, significantly lower scores in physical and mental QOL domains were found in the patient group. Older age, being unemployed, major medical conditions, no smoking, more severe depressive and negative symptoms, more frequent insomnia, and suicidality were independently associated with poor physical QOL. Male gender, more severe depressive and anxiety symptoms, more frequent insomnia, and suicidality were independently associated with poor mental QOL. Patients with schizophrenia treated in primary care had lower level of QOL in comparison with general population. Effective measures need to be implemented to improve their QOL.
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Affiliation(s)
- Yan Li
- The National Clinical Research Center for Mental Disorders, China & Mood Disorders Center, Beijing Anding Hospital, Capital Medical University, Beijing, China; Department of Psychiatry, the Chinese University of Hong Kong, Hong Kong SAR, China
| | - Cai-Lan Hou
- Guangdong Mental Health Center, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangdong Province, China
| | - Xin-Rong Ma
- Ningxia Mental Health Center, Ningxia Ning-An Hospital, Ningxia Province, China
| | - Bao-Liang Zhong
- The Affiliated Mental Health Center, Tongji Medical College of Huazhong University of Science & Technology, Wuhan, China
| | - Yu Zang
- Shenzhen Key Laboratory for Psychological Healthcare & Shenzhen Institute of Mental Health, Shenzhen Kangning Hospital & Shenzhen Mental Health Center, Shenzhen, China
| | - Fu-Jun Jia
- Guangdong Mental Health Center, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangdong Province, China.
| | - Yong-Qiang Lin
- Guangdong Mental Health Center, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangdong Province, China
| | - Kelly Y C Lai
- Department of Psychiatry, the Chinese University of Hong Kong, Hong Kong SAR, China
| | - Helen F K Chiu
- Department of Psychiatry, the Chinese University of Hong Kong, Hong Kong SAR, China
| | - Gabor S Ungvari
- The University of Notre Dame Australia/Marian Centre, Perth, Australia; School of Psychiatry & Clinical Neurosciences, University of Western Australia, Perth, Australia
| | - Brian J Hall
- Global and Community Mental Health Research Group, Department of Psychology, University of Macau, Macao SAR, China; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mei-Ying Cai
- Guangzhou Yuexiu Center for Disease Control and Prevention, Guangdong Province, China
| | - Chee H Ng
- Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia.
| | - Yu-Tao Xiang
- Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macao SAR, China
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Neogi R, Chakrabarti S, Grover S. Health-care needs of remitted patients with bipolar disorder: A comparison with schizophrenia. World J Psychiatry 2016; 6:431-441. [PMID: 28078207 PMCID: PMC5183995 DOI: 10.5498/wjp.v6.i4.431] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 09/18/2016] [Accepted: 10/18/2016] [Indexed: 02/05/2023] Open
Abstract
AIM To investigate health-care needs and their correlates among patients with remitted bipolar disorder (BD) compared to patients with remitted schizophrenia.
METHODS Outpatients with BD (n = 150) and schizophrenia (n = 75) meeting clearly defined remission criteria were included in the study along with their relatives. Diagnostic ascertainment was carried out using the Mini International Neuropsychiatric Interview. Demographic and clinical details were recorded using structured formats. Residual symptoms were assessed using standardized scales. Health-care needs were assessed on two separate scales. The principal instrument employed to assess health-care needs was the Camberwell Assessment of Need-Research version (CAN-R). To further evaluate health-care needs we felt that an additional instrument, which was more relevant for Indian patients and treatment-settings and designed to cover those areas of needs not specifically covered by the CAN-R was required. This instrument with a structure and scoring pattern similar to the CAN-R was used for additional evaluation of needs. Patients’ level of functioning was assessed using the Global Assessment of Functioning Scale and their quality of life (QOL) using the World Health Organization Quality Of Life-BREF version in Hindi.
RESULTS An average of 6-7 needs was reported by patients with BD as well as their relatives. Commonly reported needs were in the areas of economic and welfare needs, informational needs, social needs and the need for treatment. According to the CAN-R, both patients and relatives reported that more than 60% of the total needs were being met. However, over 90% of the needs covered by the additional evaluation were unmet according to patients and relatives. Needs in the areas of economic and welfare-benefits, information, company, daytime activities and physical health-care were largely unmet according to patients and relatives. Total, met and unmet needs were significantly higher for schizophrenia, but the most common types of needs were quite similar to BD. Relatives reported more needs than patients with certain differences in the types of needs reported. Level of patients’ functioning was the principal correlate of greater total and unmet needs in both groups. Significant associations were also obtained with residual symptoms and QOL.
CONCLUSION The presence of unmet needs in remitted patients with BD was an additional marker of the enduring psychosocial impairment characteristic of the remitted phase of BD.
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Grover S, Avasthi A, Shah S, Lakdawala B, Chakraborty K, Nebhinani N, Kallivayalil RA, Dalal PK, Sinha V, Khairkar P, Mukerjee DG, Thara R, Behere P, Chauhan N, Thirunavukarasu M, Malhotra S. Indian Psychiatric Society multicentric study on assessment of health-care needs of patients with severe mental illnesses as perceived by their family caregivers and health-care providers. Indian J Psychiatry 2015; 57:181-9. [PMID: 26124525 PMCID: PMC4462788 DOI: 10.4103/0019-5545.158185] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
AIM To study the health-care needs of the patients with severe mental disorders as perceived by their family caregivers and the treating psychiatrists. MATERIALS AND METHODS Caregivers of patients with severe mental disorders and their treating psychiatrists were assessed using Camberwell Assessment of Need-Research Version (CAN-R) scale and indigenously designed Supplementary Assessment of Needs Scale (SNAS). RESULTS The study included 1494 patients recruited from 15 centers. The mean needs as per the CAN-R, perceived by the caregivers were 7.8 and treating psychiatrists were 8.1. About one-third of needs were unmet. On SNAS, both caregivers and treating psychiatrists reported a mean of 7.9 needs, of which more than half were unmet as per the caregivers. As per the treating psychiatrists, 45.5% of the needs as assessed on SNAS were unmet. There was a high level of correlation between needs perceived by the patients, caregivers and the treating psychiatrists. On CAN-R, main domains of needs as reported by the caregivers were those of money, relief of psychological distress, information about the illness and treatment, welfare benefits, transport, company and food. As per the treating psychiatrists, the most common total needs identified were those of relief of psychological distress, welfare benefits, information about the illness and treatment, money, transport, company self-care and physical health. The most common domains of needs as assessed on SNAS as per the caregivers were those of free treatment, medical reimbursement, psychoeducation, financial help, social support, insurance, more time from the clinicians and travel concession. The treating psychiatrists identified dealing with caregiver's stress as the most common need. CONCLUSIONS According to the family caregivers and treating psychiatrists, about one-third of the needs of the patients as assessed using CAN-R and about half of the needs as assessed using SNAS are unmet.
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Affiliation(s)
- Sandeep Grover
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajit Avasthi
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sandip Shah
- Department of Psychiatry, SBKS MI and RC, Sumandeep Vidyapeeth, Pipaira, Vadodara, Gujarat, India
| | - Bhavesh Lakdawala
- Department of Psychiatry, B. J. Medical College and Civil Hospital, Ahmedabad, Gujarat, India
| | - Kaustav Chakraborty
- Department of Psychiatry, College of Medicine and J.N.M. Hospital, Kalyani, India
| | | | - Roy A Kallivayalil
- Department of Psychiatry, Pushpagiri Institute of Medical Sciences, Tiruvalla, Kerala, India
| | - Pranob K Dalal
- Department of Psychiatry, KGMU, Lucknow, Uttar Pradesh, India
| | - Vishal Sinha
- Department of Psychiatry, S. N. Medical College, Agra, Uttar Pradesh, India
| | - Praveen Khairkar
- Department of Psychiatry, Mahatma Gandhi Institute of Medical Sciences, Sevagram, India
| | - Divya G Mukerjee
- Department of Psychiatry, R. G. Kar Medical College, Kolkata, West Bengal, India
| | - R Thara
- Schizophrenia Research Foundation (SCARF), Chennai, India
| | - Prakash Behere
- Department of Psychiatry, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India
| | | | - M Thirunavukarasu
- Department of Psychiatry, SRM Medical College Hospital and Research Centre, Chennai, Tamil Nadu, India
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Grover S, Avasthi A, Shah S, Lakdawala B, Chakraborty K, Nebhinani N, Kallivayalil RA, Dalal PK, Sinha V, Khairkar P, Mukerjee DG, Thara R, Behere P, Chauhan N, Thirunavukarasu M, Malhotra S. Indian Psychiatric Society multicentric study on assessment of health-care needs of patients with severe mental illnesses. Indian J Psychiatry 2015; 57:43-50. [PMID: 25657456 PMCID: PMC4314916 DOI: 10.4103/0019-5545.148520] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
AIM To assess the health-care needs of the patients with severe mental disorders. MATERIALS AND METHODS Patients with the diagnosis of a severe mental disorder (schizophrenia and related psychotic disorders, bipolar disorder, recurrent depressive disorder, major depressive disorder and obsessive compulsive disorder) were assessed using Camberwell Assessment of Need-Research version (CAN-R) Scale and indigenously designed Supplementary Needs Assessment Scale (SNAS). RESULTS The study included 1494 patients recruited from 15 centers. The most common diagnostic group was that of affective disorders (55.3%), followed by psychotic disorders (37.6%). The mean number of total needs as perceived by the patients was 7.6 on the CAN-R. About two-third of the needs as assessed on CAN-R were met, and one-third were unmet. On CAN-R, main domains of needs as reported by patients were those of money, welfare benefits, transport, information about the illness and treatment, relief of psychological distress, company, household skills and intimate relationships. On SNAS, the mean number of total needs as perceived by the patients was 7.6 of which 4.1 were met needs. The most common domains of needs as assessed on SNAS were those of financial help, medical reimbursement, psychoeducation, free treatment, certification of mental illness, flexible work/job timings, addressing the caregiver stress and legal aid. CONCLUSION About two-third of the needs, of the patients with severe mental disorders are met as assessed using CAN-R. However, higher percentages of unmet needs are identified on SNAS. In view of the commonly reported needs, a change in the orientation of services offered to people with mental disorders is very much called for. At the government level, desired policies must be formulated to support the patients with mental disorders.
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Affiliation(s)
- Sandeep Grover
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajit Avasthi
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sandip Shah
- Department of Psychiatry, SBKS MI and RC, Sumandeep Vidyapeeth, Pipaira, Vadodara, Gujarat, India
| | - Bhavesh Lakdawala
- Department of Psychiatry, B.J. Medical College and Civil Hospital, Ahmedabad, Gujarat, India
| | - Kaustav Chakraborty
- Department of Psychiatry, College of Medicine and J.N.M. Hospital, Kalyani, India
| | | | | | - Pranob K Dalal
- Department of Psychiatry, KGMU, Lucknow, Uttar Pradesh, India
| | - Vishal Sinha
- Department of Psychiatry, S. N. Medical College, Agra, Uttar Pradesh, India
| | - Praveen Khairkar
- Department of Psychiatry, Mahatma Gandhi Institute of Medical Sciences, Sevagram, India
| | - Divya G Mukerjee
- Department of Psychiatry, R. G. Kar Medical College, Kolkata, West Bengal, India
| | - R Thara
- Schizophrenia Research Foundation (SCARF), Chennai, India
| | - Prakash Behere
- Department of Psychiatry, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India
| | | | - M Thirunavukarasu
- Department of Psychiatry, SRM Medical College Hospital and Research Centre, Chennai, Tamil Nadu, India
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Zahid MA, Ohaeri JU. Clinical and psychosocial factors associated with needs for care: an Arab experience with a sample of treated community-dwelling persons with schizophrenia. Soc Psychiatry Psychiatr Epidemiol 2013; 48:313-23. [PMID: 22547168 DOI: 10.1007/s00127-012-0514-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Accepted: 04/17/2012] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To (1) highlight the profile of the needs for care among a sample of persons with schizophrenia, using the Camberwell Assessment of Needs (CAN-EU), in comparison with the international data; (2) assess the association of patients' needs with socio-demographics, clinical characteristics and objective quality of life (QOL); and (3) compare the perceptions of patients with those of the staff. METHOD Consecutive outpatients in stable condition were interviewed with the CAN-EU and measures of QOL and psychopathology. RESULTS There were 130 patients (68.5% men, mean age 36.8). The highest frequency of unmet needs was for money (29.2%). About a fifth of the subjects expressed unmet needs for six other items, including accommodation. The mean total needs was 8.67(7.1), the total met needs was 5.29 and total unmet needs was 3.38. The dimension with the highest frequency (40%) of unmet needs (functioning) is constituted by items that are related to family care at home. Staff identified significantly more needs than patients. Higher levels of needs were significantly associated with severity of psychopathology and negative affect, and not participating in outdoor activities. The mean number of needs was similar to reports from developing countries and higher than those from European countries. The met/unmet need ratio was similar to European data. CONCLUSION Despite free health services and family support, a number of our treated community-dwelling persons with schizophrenia had problems meeting basic and health-care needs. The findings call for a consideration of techniques for enhancing the capability of families to cope with the care of patients.
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Affiliation(s)
- Muhammad A Zahid
- Department of Psychiatry, Faculty of Medicine, Health Sciences Centre, Kuwait University, P. O. Box 24923, 13110 Safat, Kuwait.
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Ouzir M, Azorin JM, Adida M, Boussaoud D, Battas O. Insight in schizophrenia: from conceptualization to neuroscience. Psychiatry Clin Neurosci 2012; 66:167-79. [PMID: 22443240 DOI: 10.1111/j.1440-1819.2012.02325.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Lack of insight into illness is a prevalent and distinguishing feature of schizophrenia, which has a complex history and has been given a variety of definitions. Currently, insight is measured and treated as a multidimensional phenomenon, because it is believed to result from psychological, neuropsychological and organic factors. Thus, schizophrenia patients may display dramatic disorders including demoralization, depression and a higher risk of suicide, all of which are directly or indirectly related to a lack of insight into their illness, and make the treatment difficult. To improve the treatment of people with schizophrenia, it is thus crucial to advance research on insight into their illness. Insight is studied in a variety of ways. Studies may focus on the relationship between insight and psychopathology, may view behavioral outcomes or look discretely at the cognitive dysfunction versus anatomy level of insight. All have merit but they are dispersed across a wide body of literature and rarely are the findings integrated and synthesized in a meaningful way. The aim of this study was to synthesize findings across the large body of literature dealing with insight, to highlight its multidimensional nature, measurement, neuropsychology and social impact in schizophrenia. The extensive literature on the cognitive consequences of lack of insight and the contribution of neuroimaging techniques to elucidating neurological etiology of insight deficits, is also reviewed.
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Affiliation(s)
- Mounir Ouzir
- Laboratory of Clinical Neuroscience and Mental Health, Faculty of Medicine and Pharmacy, Casablanca, Morocco.
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Kulhara P, Avasthi A, Grover S, Sharan P, Sharma P, Malhotra S, Gill S. Needs of Indian schizophrenia patients: an exploratory study from India. Soc Psychiatry Psychiatr Epidemiol 2010; 45:809-18. [PMID: 19707701 DOI: 10.1007/s00127-009-0126-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2009] [Accepted: 08/12/2009] [Indexed: 12/30/2022]
Abstract
BACKGROUND Although there are many studies from the West, no study has evaluated the needs of schizophrenia patients in Indian setting. METHODOLOGY 100 consecutive patients of schizophrenia were assessed on Camberwell Assessment of Needs questionnaire. Same questionnaire was also administered to the caregiver to assess their perception about the needs of the patients. RESULTS Patients and their caregivers reported 8.12 and 7.13 needs, respectively, more than two-third of which were unmet. The most commonly reported needs by both patients and their caregivers were need for welfare benefits. Besides the welfare benefits, the four most common areas in which patients had needs and required help were-psychotic symptoms, psychological distress, information about the condition and money, whereas four most commonly reported area of needs reported by the caregivers were psychological distress, money, company and intimate relationships. Help provided by the government or non-governmental organizations was negligible. CONCLUSIONS Most of needs of schizophrenia patients are unmet.
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Affiliation(s)
- Parmanand Kulhara
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.
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Affiliation(s)
- Ajit Avasthi
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Grinshpoon A, Ponizovsky AM. The relationships between need profiles, clinical symptoms, functioning and the well-being of inpatients with severe mental disorders. J Eval Clin Pract 2008; 14:218-25. [PMID: 18093104 DOI: 10.1111/j.1365-2753.2007.00836.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND This study aimed to examine the subjective needs and their relationship with clinical symptoms, functioning and well-being of hospitalized patients with severe mental disorders. METHODS Using the Camberwell Assessment of Need, we surveyed 52 consecutive voluntarily readmitted inpatients aged 18-65 years fulfilling the ICD-10 criteria for schizophrenia and schizoaffective disorders. Current levels of clinical symptoms, functioning and well-being were assessed using the Positive and Negative Syndrome Scale, Global Life Functioning inventory and the General Health Questionnaire, respectively. Spearman's correlation coefficients and t-test comparisons were performed to examine the relationships between the parameters of interest. RESULTS The basic needs of inpatients in food and accommodation were met in a greater extent than social needs ('sexual expression' and 'intimate relationships') and informational needs ('information on condition and treatment'). Patients' unmet needs were associated with current symptomatology severity rather than with the course of disorder. CONCLUSION In any course of illness, services must help patients in solution of their problem (met their needs) immediately after clinical improvement or alleviation of psychiatric symptoms.
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Schwartz-Stav O, Apter A, Zalsman G. Depression, suicidal behavior and insight in adolescents with schizophrenia. Eur Child Adolesc Psychiatry 2006; 15:352-9. [PMID: 16604378 DOI: 10.1007/s00787-006-0541-8] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/02/2006] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To investigate the interrelationships between depressive symptoms of adolescent schizophrenia, post-psychotic depression (PPD), negative signs, suicidal behavior and insights into the disease. METHODS Three groups of 16 adolescent inpatients were assessed with regard to: Schizophrenia alone, schizophrenia with PPD and major depressive disorder (MDD). The following measures were used: DSM IV diagnostic criteria, the Calgary Depression Scale for Schizophrenia (CDSS), the PANSS (Positive and Negative Signs of Schizophrenia Scale), (BDI) Beck Depression Inventory, (CCL) Cognitive Check List, (HS) Hopelessness Scale, (SRS) Suicide Risk Scale, (CSPS) Child Suicide Potential Scale and the (SAUMD) Scale to Assess Unawareness of Mental Disorder. RESULTS Compared with MDD adolescents, PPD adolescents showed few somatic and behavioral symptoms of depression but had equally severe cognitive and affective depressive symptomatology. Suicide risk scores and actual suicidal behavior was prominent in PPD adolescents. A positive and significant correlation was found between PPD symptoms, suicide risk and awareness of disease (insight). Negative symptoms of schizophrenia could be distinguished from PPD symptoms and there was a negative correlation between blunted affect and PPD scores. CONCLUSIONS PPD can be diagnosed in adolescent schizophrenia. The symptom pattern is different from MDD, therefore, there may be cause to modify DSM IV provisional criteria for this condition. Adolescents with schizophrenia who have insight into their illness are at higher risk for suicidal behavior and the development of PPD.
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Affiliation(s)
- Osnat Schwartz-Stav
- Feinberg Child Study Centre, Schneider's Children's Medical Centre of Israel, 14 Kaplan St., Petah Tikva, 49202, Israel
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Ochoa S, Haro JM, Usall J, Autonell J, Vicens E, Asensio F. Needs and its relation to symptom dimensions in a sample of outpatients with schizophrenia. Schizophr Res 2005; 75:129-34. [PMID: 15820331 DOI: 10.1016/j.schres.2004.06.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2004] [Revised: 06/02/2004] [Accepted: 06/02/2004] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To analyse the association between symptom dimensions in schizophrenia and number and type of met and unmet needs. METHOD A sample of 231 outpatients randomly selected from a register that included all patients treated in 5 mental health care centres (MHCC) was evaluated. Assessment instruments included the Camberwell Assessment of Needs (CAN) questionnaire and the PANSS. RESULTS Number of needs are related to overall severity of psychopathology. Patients with more symptoms have more total needs (p < 0.001) and unmet needs (p < 0.001). A multiple lineal regression model showed that the disorganized and excited dimensions of the PANSS are the most important components for explaining the variance of number of needs. Type of needs is related to subtypes of schizophrenia, specially with disorganized and excited symptoms. CONCLUSION Psychosocial needs are related to schizophrenia subtypes. Patients with more needs are those with more disorganized and excitatory symptoms.
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Affiliation(s)
- S Ochoa
- Research and Development Unit, Sant Joan de Déu-SSM, C/ Dr. Pujades, 42, 08830 Sant Boi de Llobregat, Barcelona, Spain.
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14
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Kallert TW, Leisse M, Winiecki P. Suicidality of chronic schizophrenic patients in long-term community care. CRISIS 2004; 25:54-64. [PMID: 15387211 DOI: 10.1027/0227-5910.25.2.54] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
In the provision of mental health care for chronic schizophrenic patients, the specific problems and requirements of long-term community care of suicidal behavior is an area of research not yet fully explored. This study focuses on a 4 1/2-year prospective assessment of normative and subjective needs for care related to this specific area for a cohort living in the Dresden region (Germany). One significant result of this study shows the constant high level of needs for care in the area of suicidal behavior imposed on community services by 30-40% of this diagnostic group. Furthermore, the study identified a special high-risk subgroup for suicides as well as specific needs for care. This subgroup is characterized by clinical reasons for the index hospitalization (suicidal risk or attempt) as well as by psychopathological features (suicidal thoughts and higher levels of anxiety/depression) 1 month after release from index hospitalization. Four items of care were rated as potentially effective for addressing suicidality in the community setting: clinical assessment, increased supervision or systematic recording of (suicidal) behavior, medication, and a sheltered environment. Because these care measures are provided, the percentage of unmet normative needs for the area of suicidal behavior was rather low. Due to limitations of the instrument used for assessment of normative needs, the Needs for Care Assessment (NFCAS), the care measures most frequently provided do not define a quality standard of community care for this problem. A subjective needs assessment differing from the normative approach has to be integrated in establishing guidelines for effective community care.
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Affiliation(s)
- Thomas W Kallert
- Department of Psychiatry and Psychotherapy, University Hospital, Dresden Univ. of Technology, Germany.
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15
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Schröder A, Ahlström G. Psychiatric care staff's and care associates' perceptions of the concept of quality of care: a qualitative study. Scand J Caring Sci 2004; 18:204-12. [PMID: 15147484 DOI: 10.1111/j.1471-6712.2004.00271.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Quality of care is a multidimensional concept and has been given different meanings in the literature. The aim in the present study was to describe how the psychiatric care staff and care associates perceived the concept of quality of care in the case of psychiatric care. Ten staff and 10 associates were interviewed. Qualitative method with a phenomenographic approach was used for the analysis. Four descriptive categories emerged: The patient's dignity is respected, The patient's participation in the care, The patient's recovery, and The patient's care environment plays an important role. Quality of care was perceived as a positive concept and as being of great importance for the patient's health and conditions of living. The results were of importance with regard to the forthcoming development of an instrument to measure the quality of psychiatric care.
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Affiliation(s)
- Agneta Schröder
- Psychiatric Research Centre, Primary Care, Psychiatry and Rehabilitation, Orebro County Council, Orebro, Sweden.
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