Anniqa Foldemo

Quality of life and burden in parents of outpatients with schizophrenia

Since the late 1950s, several studies have reported the burden faced by families living with a mentally ill relative. These studies have pointed out the importance of a progressive mental health service, focusing not only on the treatment of the patients, but also on the needs of the relatives. The aims of the present study were to compare the quality of life of parents of outpatients with schizophrenia with a randomly selected reference group and the relation between quality of life and burden on the parents. The sample comprised all parents (n=38) of outpatients with schizophrenia at an outpatient clinic in 2001, where the patients had contact at least once a week with both parents and staff. The parents were compared with a reference group (n=698). The self-rating scale Quality of Life Index (QLI) was used to assess quality of life in both groups. In the case of the parents, semistructured interviews were supplemented by the data collection to assess the degree of burden with the Burden Assessment Scale (BAS). The outpatients were also interviewed to assess their global function with the Global Assessment of Functioning scale (GAF) and the Clinical Global Impression scale (CGI). The parents were significantly less satisfied with their overall quality of life (p<0.05). There was a correlation between lower overall quality of life and higher perceived burden r=0.58 (p<0.01). There was also a correlation between lower values on the family subscale and social subscale within the QLI and higher subjective burden r=0.54 (p<0.01) and r=0.52 (p<0.01), respectively. These results indicate that caregiving has an influence on the family situation and on the quality of life of parents. These findings suggest that the professions working with the parents must have an approach focusing not only on the care given to the ill daughter or son, but also on the parents’ situation.

Needs in outpatients with schizophrenia, assessed by the patients themselves and their parents and staff.

There has been a change in psychiatric care from a hospital-oriented care system to an outpatient-centred system, which has underlined the importance of support alternatives. The sample was drawn from outpatients with schizophrenia at an outpatient clinic in 2001. We used structured interviews when interviewing outpatients, parents and staff. The interview with the patient included the patient’s needs, global function, clinical global impression and insight. Both parents and staff were interviewed about the patient’s needs. The mean value of GAF was 56 ± 10, CGI 4 ± 1 and 89% of the patients had full insight into their illness. The patients rated the total score of the severity of needs at a mean of 7 ± 4, while the parents’ and staff’s rating was 9 ± 5. The needs ranking between patients and parents and patients and staff showed a correlation of rho = 0.65 (p < 0.01) and parents and staff rho =0.95 (p < 0.01). The parents rated more problems involving physical health and money than the patients. When planning mental health in the future, it is important to assess the views of the patients, the parents and the staff from a multiple perspective.

The effects of psychological treatment in primary care in Sweden—A practice-based study

Abstract Background: Practice-based studies have found substantial effects of psychological treatment in routine care, often equivalent between treatment methods. Factors that moderate treatment outcome may be important to assess. Aim: The purpose of this study was to evaluate treatment outcome in psychological treatment in primary care, and to compare outcome between the most frequently used methods. An additional aim was to study factors that might moderate outcome differences. Method: The Clinical Outcome in Routine Evaluation (CORE) system was used to evaluate psychological treatment at Swedish primary care centers. Treatment methods were coded by the therapists after treatment. Three major treatment orientations—directive (cognitive, behavioral and CBT), reflective (psychodynamic and relational) and supportive therapy were compared. Patient and therapist variables were studied as treatment moderating factors. Results: Analyses of 733 therapies, delivered by 70 therapists, showed good results in short psychological treatments (median session number = 6). Forty-three percent of the patients were remitted, 34% recovered. For patients receiving at least five sessions, the figures were 50% and 40%. Directive therapy and reflective therapy had comparable outcome, and better than supportive treatment. Patients in supportive therapy had higher age and received fewer therapy sessions. The patients’ motivation, alliance capacity and reflective ability, as rated by the therapist after treatment, were lower for patients in supportive treatment. Conclusions: Psychological treatment in primary care obtains god results. Supportive therapy should be studied more systematically, particularly with regard to variables that may moderate treatment outcome.

Continuation rates of oral hormonal contraceptives in a cohort of first-time users: a population-based registry study, Sweden 2005–2010

Objective To investigate if continuation rates in first-time users of oral hormonal contraceptives differed between different formulations and to measure if the rates were related to the prescribing categories, that is, physicians and midwives. Design A longitudinal national population-based registry study. Setting The Swedish prescribed drug register. Participants All women born between 1977 and 1994 defined as first-time users of hormonal contraceptives from 2007 to 2009 (n=226 211). Main outcome measures A tendency to switch the type of hormonal contraceptive within 6 months use and repeated dispensation identical to the first were estimated as percentages and relative risks (RRs). Physicians’ and midwives’ prescription patterns concerning the womens continuation rates of oral hormonal contraceptive type. Results In Sweden, there were 782 375 women born between 1977 and 1994 at the time of the study. Of these, 226 211 women were identified as first-time users of hormonal contraceptives. Ethinylestradiol+levonorgestrel, desogestrel-only and ethinylestradiol+drospirenone were the hormonal contraceptives most commonly dispensed to first-time users at rates of 43.3%, 24.4% and 11.1%, respectively. The overall rate of switching contraceptive types in the first 6 months was 11.3%, which was highest for desogestrel-only (14.3%) and lowest for ethinylestradiol+drospirenone (6.6%). The switching rate for all three products was highest in the 16-year to 19-year age group. Having a repeated dispensation identical to the initial dispensation was highest for users of ethinylestradiol either combined with levonorgestrel or drospirenone, 81.4% and 81.2%, respectively, whereas this rate for the initial desogestrel-only users was 71.5%. The RR of switching of contraceptive type within the first 6 months was 1.35 (95% CI 1.32 to 1.39) for desogestrel-only and 0.63 (0.59 to 0.66) for ethinylestradiol+drospirenone compared with ethinylestradiol+levonorgestrel as the reference category. There were no differences in the womens continuation rates depending on the prescriber categories. Conclusions Desogestrel-only users conferred the highest switcher rate to another hormonal contraceptive within a 6-month period. Users of ethinylestradiol+levonorgestrel were more prone to switch to another product within 6 months than women using ethinylestradiol+drospirenone. These findings may be of clinical importance when tailoring hormonal contraceptives on an individual basis.

Preventing the Development of Metabolic Syndrome in People with Psychotic Disorders—Difficult, but Possible: Experiences of Staff Working in Psychosis Outpatient Care in Sweden

The aim of this study was to explore mental health staffs’ experiences of assisting people with psychotic disorders to implement lifestyle changes in an effort to prevent metabolic syndrome. Qualitative interviews were conducted with 12 health care professionals working in psychosis outpatient care in Sweden. Data were analysed using a qualitative content analysis. The results illustrate that implementation of lifestyle changes among people with psychotic disorders was experienced as difficult, but possible. The greatest obstacles experienced in this work were difficulties due to the reduction of cognitive functions associated with the disease. Guidelines available to staff in order to help them identify and prevent physical health problems in the group were not always followed and the content was not always relevant. Staff further described feelings of uncertainty about having to motivate people to take anti-psychotic medication while simultaneously being aware of the risks of metabolic deviations. Nursing interventions focusing on organising daily routines before conducting a more active prevention of metabolic syndrome, including information and practical support, were experienced as necessary. The importance of healthy eating and physical activity needs to be communicated in such a way that it is adjusted to the persons cognitive ability, and should be repeated over time, both verbally and in writing. Such efforts, in combination with empathic and seriously committed community-based social support, were experienced as having the best effect over time. Permanent lifestyle changes were experienced as having to be carried out on the patients terms and in his or her home environment.

Health-related quality of life and metabolic risk in patients with psychosis.

UNLABELLED Improved Health-related quality of life (HRQoL) is an alternative treatment goal for individuals with psychosis, who have up to two times greater prevalence of type 2 diabetes, hypertension and obesity than the general population. AIM to compare HRQoL in patients with psychosis, especially schizophrenia, with a reference sample and explore the relationship between HRQoL and metabolic risk factors in these patients. METHODS a prospective cohort study was carried out in specialized psychiatric outpatient departments in Sweden. The patients were invited consecutively. A prospective population-based study of public health in the south-east of Sweden served as reference group. Patients were assessed with psychiatric questionnaires that included Global Assessment of Functioning (GAF). Health-related quality of life was assessed using the questionnaire EQ5D, both for patients and the population, and several other health status outcomes were used. RESULTS At 73%, schizophrenia and schizoaffective disorder were the most common diagnoses in the patient group. The results in patients (n=903) and population (n=7238) showed significant differences in lower EQ5D among patients. According to the definition by the International Diabetes Federation (IDF), elevated blood pressure was the only metabolic risk associated with lower HRQoL in patients. Raised LDL-cholesterol levels were also significantly related to lower HRQoL. CONCLUSION patients suffering from psychosis had significantly lower HRQoL regarding all components in EQ5D, except for the pain/discomfort component. Almost half of the patient group met the criteria for metabolic syndrome. According to the IDF criteria, elevated blood pressure was the only metabolic risk factor that had an impact on HRQoL.

Differences in prescription rates and odds ratios of antidepressant drugs in relation to individual hormonal contraceptives: A nationwide population-based study with age-specific analyses.

ABSTRACT Objectives To examine, among young women, the association of individual hormonal contraceptives, within two broad groupings, with antidepressant therapy. Methods In a nationwide register-based study, we examined the prescription rates of antidepressant drugs in relation to individual combined hormonal and progestin-only contraceptives among Swedish women aged 16–31 years (N = 917,993). Drug data were obtained from the Swedish Prescribed Drug Register for the period 1 July 2005–30 June 2008. Data on the total population of women aged 16–31 in 2008 were obtained from the Total Population Register of Statistics Sweden. The proportion of women using both hormonal contraception and antidepressants, and odds ratios (ORs) for antidepressant use for hormonal contraceptive users versus non-users, were calculated, the latter by logistic regression, for each formulation. Results The highest antidepressant OR in all age groups, particularly in the 16–19 years age group, related to medroxyprogesterone-only, followed by etonogestrel-only, levonorgestrel-only and ethinylestradiol/norelgestromin formulations. Oral contraceptives containing ethinylestradiol combined with lynestrenol or drospirenone had considerably higher ORs than other pills. ORs significantly lower than 1 were observed when ethinylestradiol was combined with norethisterone, levonorgestrel or desogestrel. Conclusion The association between use of hormonal contraceptives and antidepressant drugs varies considerably within both the combined hormonal contraceptive and the progestin-only groups.

Use of hormonal contraceptives in relation to antidepressant therapy: A nationwide population-based study

Objectives The relation between the use of different hormonal contraceptives and antidepressant therapy was investigated. Methods In a nationwide cross-sectional study among all women in Sweden aged 16–31, drug expenditure data on hormonal contraceptives and antidepressants were obtained from the Swedish Prescribed Drug Register. Odds ratios (ORs) for antidepressant use were calculated by logistic regression for progestin-only users versus non-users as well as for combined hormonal contraceptive (CHC) users versus non-users. Results In the study population (N = 917,993), 58.9% were hormonal contraceptive users, and 8.5% were antidepressant users. The age-pattern for antidepressant ORs differed between the two types of users of contraceptives; progestin-only users had significant ORs above 1 in all age groups whereas among CHC users the OR was above 1 solely in those aged 16–19. The largest difference between types of users was seen in the age group 16–19 in which women resorting to a progestin-only contraceptive had a 67% (95% confidence interval: 57– 78%) higher antidepressant use than women treated with a CHC. Conclusion Progestin-only contraceptive users resorted to antidepressants more than users of CHCs. This phenomenon is particularly pronounced among teenagers. Therefore, special attention should be given to young womens mental history when prescribing hormonal contraceptives and vice versa: the contraceptive history should be taken into account when prescribing antidepressants.

Prerequisites for a healthy lifestyle-experiences of persons with psychosis.

The purpose of this study is to explore prerequisites for a healthy lifestyle as described by individuals diagnosed with psychosis. Forty participants who had performed a lifestyle intervention focusing on physical activities and lifestyle education were interviewed. Conventional content analysis was used. The results are described in two categories: (1) Individual Prerequisites and (2) Being a Part of Society. The individuals said that they got stuck in a state of planning without taking action. It was pointless to make a bigger effort because the psychotic disorder could, at any time, worsen the prerequisites. They also said that they wanted to live like everybody else and therefore tried to adopt a normal lifestyle. Future interventions or professional support by mental health nurses and other health care givers should target the transition from planning to action to achieve a healthy lifestyle, and should help the individual to taking part in society.

An Intervention with Physical Activity and Lifestyle Counseling Improves Health-Related Quality of Life and Shows Small Improvements in Metabolic Risks in Persons with Psychosis

This research studied the effects of a lifestyle intervention on health-related quality of life (HRQoL) and metabolic risk factors in persons with psychosis, using a longitudinal intervention design with a matched reference sample. In participants in the intervention group, scores on the EQ-VAS, which measured HRQoL, improved from 57.6 to 63.3 (SD = 17.8) (p = 0.05), and HDL cholesterol concentration increased from 1.03 to 1.11 (0.19) mmol/l. (p = 0.02). There was no significant change in body weight among participants. The results of this study indicate that a lifestyle intervention based on group meetings improves HRQoL in patients with psychosis and provides small improvements in metabolic risk factors.