Bo Ivarsson

Durability of the Efficacy of Integrated Care in Schizophrenia: A Five-Year Randomized Controlled Study

OBJECTIVE The aim of the study was to evaluate the durability of efficacy of the Integrated Care (IC) program in a Swedish context. The IC program is a person-centered flexible assertive community treatment approach delivered through a novel mechanism: a resource group clinical microsystem for each patient. METHODS All patients with schizophrenia in a Gothenburg urban-sector catchment area were randomly assigned to either the IC or the Rational Rehabilitation (RR) programs. Sixty-six patients were interviewed and assessed by independent interviewers before treatment, after treatment (24 months), and at follow-up (five years). Analysis was by intention to treat. RESULTS At the five-year follow-up, significant improvements were noted in social functioning and consumer satisfaction in the IC group (N=35) compared with the RR group (N=31). No patients were lost to services in either program. CONCLUSIONS The major finding was the durability of efficacy of the IC program.

Self-reported consumer satisfaction in mental health services: Validation of a self-rating version of the UKU-Consumer Satisfaction Rating Scale

The UKU-Consumer Satisfaction Rating Scale (UKU-ConSat) for the evaluation of consumer satisfaction in mental health services was constructed for assessments by independent professional interviewers. In the present study, a patient self-reported version of the scale is validated against the original version. The Spearmans rank correlation between single items, subscores and the total of the original scale and the self-assessment version was found to be good. Another main finding was an acceptable unidimensionality of the self-rating version of the UKU-Consumer Satisfaction rating scale, evaluated by a Mokken analysis. Furthermore, the internal consistency by Cronbachs alpha was found to be satisfactory. The results show that the patient self-rating version is psychometrically sound and therefore suitable for use in ordinary clinical practice. Being a part of a concept for continuous quality control and development in mental health services, the self-rating version of the UKU-ConSat promotes an open collaborative dialogue between professionals and users. A further advantage is that it saves professional time.

The self-assessment Global Quality of Life scale: Reliability and construct validity

Abstract Objective. The aim was to establish psychometric properties of the Global Quality of Life Scale (GQL) for people with severe mental illness. Methods. GQL is a stand-alone visual analogue scale included in “The Quality Star”, a minimal platform for clinical follow-up and efficiency documentation of mental health services in eight dimensions widely used in Sweden. Validating instruments included MANSA, Inventory of Problem and Solutions, Consumer Satisfaction Rating Scale, Perceived Global Distress, health screening using UKU-Side Effect Rating Scale, GAF, and Perceived Global Burden (for next of kin). Test–retest reliability of the GQL was examined between ratings at quarterly intervals during 1 year. Results. There were three main results: test–retest reliability at quarterly intervals was very satisfactory, concurrent validity with the initial item of life satisfaction scale of MANSA, “Life as a whole”, was demonstrated and finally content validity was clarified by associations with a number of validating measures from several contexts in three studies. Conclusion. GQL have acceptable psychometric properties and is valid for serious mental ill persons. Its use as easy-to-use instrument for screening of perceived global quality of life was supported.

6 – Cognitive-Behavioral Strategies for the Treatment of Schizophrenic Disorders

Publisher Summary Social care and support rather than active treatment and restoration of mental and social functioning have become the focus of most of the service developments in the past few decades. Although the precise causes of schizophrenic disorders remain unclear, several factors that increase the risk of the characteristic psychotic episodes have been elucidated. Psychotic episodes appear to result from a disturbance of brain chemistry that is triggered by stress. Thus, any strategies that lead to a reduction in stress, or improved ability to cope with stresses, can improve the course of the disorder. The vulnerability/stress model provides a clear rationale for a comprehensive assessment that includes medical and mental health background; pattern of symptoms and diagnosis; comprehensive medical screening; family history; social factors—current stresses in social support system and major life stressors, including problems of housing, finances, and basic support—social and coping skills; side effects and stresses associated with medication and psychosocial treatment currently provided, including the benefits and stresses associated with hospital admissions. The Optimal Treatment Project (OTP) is a field trial of the benefits and costs of applying optimal biomedical and psychosocial strategies for schizophrenic and other nonaffective psychotic disorders.