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The World Health Organization Short Disability Assessment Schedule: a validation study in patients with schizophrenia

PURPOSE The World Health Organization Short Disability Assessment Schedule (DAS-s) is used for patients with schizophrenia, although no validation is available. This manuscript addresses this issue by dealing with its psychometric properties in a clinical sample of patients with schizophrenia. METHODS Two hundred forty-one patients from 10 Adult Mental Health Care Centers meeting the following inclusion criteria were included: (1) International Classification of Diseases, 10th Revision, diagnosis of schizophrenia; (2) Global Assessment of Functioning scores 50 or less; (3) illness duration of more than 2 years; and (4) clinical stability at assessment time. Patients were evaluated at baseline and at 1-year follow-up regarding disability, sociodemographic and clinical variables, psychosocial measures, and use of mental health services. RESULTS The factor analysis revealed a single factor that explained 60.57% of the variance. Internal consistency values were appropriate for the DAS-s total (0.78 at baseline and 0.78 at 1-year follow-up). Correlations between DAS-s scores and those of global functioning, psychiatric symptoms, social support, and quality of life ranged between small and moderate (range, 0.13-0.39). There were significant differences between groups of patients with schizophrenia in the DAS-s. Patients who were unemployed, with lower global functioning, with cognitive impairment, and lacking social support scored significantly lower in DAS-s scores. After 1-year follow-up, there was a nonsignificant decrease in DAS-s scores; and patients improved significantly in overall functioning and psychiatric symptoms. DISCUSSION This study shows that the DAS-s has good reliability and validity and suggests that it is suitable for the assessment of disability in patients with schizophrenia.

Ten year outcomes of participants in the REACT (Randomised Evaluation of Assertive Community Treatment in North London) study

BackgroundA previous randomised controlled trial that investigated Assertive Community Treatment (ACT) in the UK (the REACT Study) found no clinical advantage over usual care delivered by Community Mental Health Teams (CMHTs) at 18 and 36 month follow-ups. No studies have investigated long term clinical and social outcomes for patients receiving ACT.MethodWe investigated inpatient service use, social outcomes, service contact and adverse events for the 251 REACT study participants 10 years after randomisation through case note review. Data were analysed using regression models adjusted for original treatment group allocation and changes in treatment group.ResultsWe found no statistically significant differences in outcomes by original treatment group over the 10 years. Those whose care remained with ACT, or transferred to ACT or forensic services, had more inpatient days over the 10 years (coefficient 223, 95% CI 83 to 363, p = 0.002) than those whose care remained with the CMHTs or were discharged to primary care. Being subject to a Community Treatment Order was associated with a greater chance of being under ACT at 10 year follow-up (OR 6.39, 95% CI 2.98 to 13.70, p <0.001).ConclusionsThe ACT teams in this study showed no clinical advantage over usual care provided by CMHTs at 10 year follow-up. We also found that the ACT teams accrued patients from the original study sample who had more complex needs than those who remained with or transferred to the CMHTs or primary care during this period. Further well conducted trials are needed to identify the most cost-effective approaches to supporting successful community living and optimum long term outcomes for this group.

Depicting current case management models

Summary Case management (CM) is one of the principal components of service delivery in mental health services. Over time, it has evolved into new models, and various meta-analytic studies have been carried out to establish its effects. Those studies have yielded non-homogeneous results, which might be related in part to the progress of case management models. Therefore, there is a need to understand the relationship between CM models and CM effects. This paper deals with this issue by reviewing and updating the literature regarding case management models and effects in order to help understand its current role and suggest how CM could be reorganized. Findings Assertive community treatment and any other case management model seem to have fused and turned into two models that differ mainly with regard to the intensity of care provided to patients. The results of the meta-analyses on the efficacy/effectiveness of case management are not homogeneous across all studies, which seems to be related to the case management model used and the strictness of the methodology followed. When the model of case management used is congruent with clinical practice, the results favor case management over standard care and show that intensive and non-intensive case management may be provided depending on the previous use of hospital resources. Application The argument suggests that case management models could be reconfigured by offering an intensive form of care based on patients’ needs.

Considering Variables for the Assignment of Patients with Schizophrenia to a Case Management Programme

The elements and intensity of case management (CM) practices should be established according to patients’ needs. Therefore, greater understanding of patients’ needs in such community-based programmes is essential. This paper addresses this issue by characterizing two groups of patients receiving CM or a standard treatment programme (STP) and identifying the characteristics of patients receiving CM services. We recruited 241 patients with schizophrenia from 10 Adult Mental Health Centres in Barcelona (Catalonia, Spain). We analyzed the profile of new patients included in a clinical, non-intensive CM program against that of patients in a STP. CM patients, compared with STP patients, have a lower educational level and quality of life; greater use of health care services, and higher levels of psychiatric symptoms, disability and unmet needs. Community psychiatric visits, social services, education, physical health and needs were significantly associated with CM services. This study may help in identifying patients’ needs and strengthening the CM programme.

Physical Health and Schizophrenia in Clinical Practice Guidelines and Consensus Statements

Research about the epidemiology of physical health problems in schizophrenia, as well as the development of consensus statements and recommendations to deal with it, has increased in recent years. The objective of this study is to identify, review and compare the clinical practice guidelines and consensus statements on physical health problems in people with schizophrenia that have developed over the last five years. We conducted a computerized search in PubMed of the literature regarding the management of schizophrenia. We identified 8 clinical practice guidelines or expert consensus statements, including recommendations for monitoring the physical health of people with schizophrenia. We extracted descriptive information from each article and established the level of consensus between them regarding the physical health parameters that they recommend monitoring. Most of the studies identified were conducted by multidisciplinary groups from European countries between 2010 and 2012. Their recommendations were agreed upon and evidence based and all of them concurred in that the study population is especially vulnerable to physical illness. Although there was a high degree of agreement on most of the physical health parameters that they recommend monitoring, their degree of agreement regarding regular check-ups, including blood tests and renal, hepatic and thyroid function tests, was low. This lack of agreement may be related to the specificity of their approach. There is a need to include all components of physical health as a key part of the management of schizophrenia, which requires comprehensive guidelines and systematic and evidence-based assessments and interventions, but also changes in care professionals’ attitudes, stigma and the organization of health care services.

Measuring stages of recovery from psychosis

BACKGROUND Mental health consumers invite us to abandon the pathology model, which is tied to pessimism, and instead to embrace a model of personal recovery that goes beyond being free from symptoms, and involves self-management of the illness. The Stages of Recovery Instrument (STORI) is a measure developed from the perspective of consumers according to a conceptual five-stage model of recovery. AIMS The main aim of this work was to study the psychometric properties of the STORI, but we also set out to compare the stages of recovery in our sample with the five-stage model in the sample with which the scale was developed. METHODS Our sample consisted of 95 people diagnosed with schizophrenia-spectrum psychoses, with a mean age of 34.74 (SD=9.25). RESULTS The STORI scores showed adequate psychometric properties in this sample. Cluster analysis indicated that the three-cluster model fitted the data better than the five-cluster model. Internal consistency of the STORI scores ranged between .83 and .87. STORI stages were associated with Recovery Styles Questionnaire scores. DISCUSSION The results provide empirical validation of the STORI in other countries. Empirical evidence revealed that the stages of recovery found in our own and other clinical samples differ from those found in the samples with which the scale was developed.