The European Journal of Psychiatry

Use of functioning-disability and dependency for case-mix and subtyping of schizophrenia

Background and Objectives: To evaluate the utility of the constructs functioning and disability (F & D) and dependency for case-mix and subtyping of patients with schizophrenia by psychosocial, clinical, use of services and attention received from informal carers. Methods: A randomly selected total of 205 people with schizophrenia, and their careers were evaluated through PANSS, DAS-sv, Objective and Subjective Burden Scale (ECFOS-II) and use of services. Results: Two groups and Four profiles were identified according to levels of Dependency: The non-dependent group was made of two profiles: independent (I), and persons with disability in the community (DiC). The dependent group included persons with dependency in the community (DeC) and persons with dependency in hospital care (DeH). There are clinical and psychosocial differences between these profiles being the dependent the most severe. Regarding use of services, DeC use the most resources, with the exception DeH (more hospitalization resources). The DeC profile generate greater family burden in the following areas; taking medication, being accompanied to appointments, and management than the DiC, despite both groups showing a high need for support. Conclusions: Dependency is a relevant construct for case-mix and subtyping in schizophrenia, and it is related to severity both at the social and clinical level. DeC generate more family burden than the other profiles, followed by DiC (patients with schizophrenia with disability but non-dependent).

Changes in distress of psychiatric in-patients after the changeover of junior psychiatric trainees as a function of attachment style: A pilot study

Background and Objectives: Therapists, including psychiatrists, may act as attachment figures. Rotational training schemes necessitate the regular and frequent ending of therapeutic relationships. The effects on patients are rarely studied. This is a pilot prospective study to evaluate whether relative distress in adult psychiatric in-patients follows change in trainee psychiatrists; whether differences in distress are mediated by patient attachment style; and to provide data for power calculation. Methods: Twenty adult in-patients were assessed using the Mental Health Inventory 5 (MHI-5) scale before and after changeover of psychiatric trainees; attachment style was assessed prior to the changeover. Qualitative data were also collected. Results: The average MHI-5 scores improved with time (p = 0.021). Less improvement correlated with higher score on preoccupied attachment (rho = 0.41, p1-tail <0.05). A non-significantly stronger improvement was seen with secure/dismissing styles compared to preoccupied/fearful styles (p1-tail = 0.08). Based on these results, a study of at least 87 patients is likely to produce a statistically significant result. Most patients were not aware a staff change was due and would like to be informed by their clinical team. Conclusions: Relative distress following junior trainee changeover may have a link with patients' attachment styles.

Gender differences in the use of mental health services in a Barcelona area

Background and Objectives: The exploration of the use of specialised mental health services and the prevalence of mental disorders recorded by these services is important when planning and adapting the various mental health services to real users' needs. The fact of being a woman has repeatedly proved to be a predicting factor for higher service use and this could imply than such needs may vary according to gender. The objectives of our study are: to analyse the attended prevalence in both out-patient and hospital services data as per diagnoses according to gender, and to analyse the use of hospital care services with respect to diagnoses according to gender. Methods: The sample for this observational and retrospective study (n = 65,465) is comprised of everyone who visited any of the Sant Joan de Déu-SSM mental health services between 2002 and 2007. Main measures: total number of consultations, and number and length of hospitalisations. Results: Women presented higher attended prevalence. Men show a higher risk of a first hospitalisation and longer length of admissions. Among the group of admitted patients, the number of women is higher. With regard to diagnosis, gender influences the attended prevalence. Regarding hospitalisation, we find differences in patients with schizophrenia and other mood disorders. Conclusions: The main result is that women have a higher attended prevalence of mental disorders than men. In the total sample, women have a higher number of hospitalisations although men have a higher risk of a first hospitalisation and their stays prove to be longer. When taking diagnosis into account, gender differences are greater in attended prevalence than in number and length of hospitalisations.

Antipsychotics switching strategies in real life: A longitudinal study in clinical practice

Background and Objectives: Switching antipsychotics (APs) in the treatment of mental ilnesses such as schizophrenia is common practice for clinicians as well as a transitional moment associated with the possibility of adverse events and recurrence of psychoses. As in recent years, AP switching strategies have received more attention, a number of authors have recommended transitions with overlapping drug dosage regimens in time (such as tapering, cross-tapering, plateau switching) over abrupt switches. However, there is a paucity of data documenting how clinicians are switching APs in real life. Moreover, the question if recently recommended switching strategies are converted into everyday practice is still very much unanswered. The present investigation aims to study if indeed there is a preference for tapered approaches over abrupt switching. Methods: In a retrospective longitudinal descriptive study, electronic prescription data from a large clinical psychiatric setting in the Netherlands were collected for the year 2007. Timelines of medication regimens were constructed for individual patients, enabling to identify transitions between APs. As patients could have been subjected to multiple switches in a given time period, transitions were expressed as episodes. Abrupt switches were defined as switches having no overlap in time. Results: From a total of 5322 AP prescriptions involving 1465 patients, a total of 180 episodes (associated with 158 patients) were identified where APs were switched. Of these 180 episodes, 110 (61%) involved abrupt transitions. 70 episodes (39%) had overlap in time with an average taper length of 16.1 (SEM 1.6) days. Conclusions: In the majority of cases in the studied clinical setting, APs are switched abruptly.

Association of gender and schizophrenia subtype with age at disease onset in a cohort from rural Turkey

Background and Objectives: This study was designed to investigate the association of the gender and subtype diagnosis with the onset age of the disease, marriage, reproductive rates in the schizophrenic inpatients. Methods: Total of 463 patients (329 males and 134 females) hospitalized with the diagnosis of schizophrenia according to DSM-IV criteria and who were between 15-65 years of age were included in the study. We evaluated the age, gender, marital status, number of children, onset of the disease and subtype of schizophrenia. Results: Mean of onset of the disease score was higher statistically in the females (27.6 ± 4.3) than the males (23.7 ± 3.9) (p < 0.05) in our study. The paranoid subtype was the commonest, while women were more likely to be married than men, men had more children than women; and the paranoid subtype were more likely to be married than the other groups. Conclusions: Onset age of schizophrenia was four years higher in the women than in men and that the rates of the schizophrenia subtypes were consistent with those detected in the other studies demonstrates that these rates were determined by neurobiological mechanisms rather than socio-cultural factors.

Measuring public attitudes to severe mental illness in Greece: Development of a new scale

Background and Objectives: The purpose of the present study was to develop an attitudinal schedule, the Attitudes to Severe Mental Illness (ASMI) scale, which synthesizes elements from different conceptual frameworks of the field, while addressing gaps on the existing literature on stigma measurement. Methods: A national representative sample of 2039 adults from the general population was interviewed by telephone. Results: Factor analysis revealed 4 factors to underlie the data, namely "stereotyping" "optimism", "coping" and "understanding", which explained 67% of total variance. The instrument's face and predictive validity were also supported, while its internal consistency and test -retest reliability were found to be high for the overall scale and its factors. Conclusions: Consistent with these, the ASMI scale emerges as a valid and reliable tool for the assessment of attitudes towards severe mental illness, while it opens new directions for advancing scientific understanding of the topic.