Raimo K.R. Salokangas

Gender and short-term outcome in schizophrenia

227 first-contact schizophrenic patients (DSM-III) were followed-up for 2 years. The psychiatric teams responsible for the treatment of the patients conducted a detailed, standardized interview with the patients at entry and during the follow-up. Men showed a poorer premorbid heterosexual development and they also tended to be more withdrawn than women. Following the onset of the illness, men still failed to establish satisfactory heterosexual relationships, they suffered more often from negative symptoms, and they displayed poorer working capacity and functional ability than women. At the beginning of the follow-up men had a more pessimistic view of the development of their life situation over the next 2 years, a prediction which turned out to be correct. The predictions made by the psychiatric teams were very similar. In their plans for treatment the psychiatric teams recommended primarily psychotherapeutic methods for female patients--and women actually went to psychotherapy more often than men--whereas it was felt that the rehabilitation of men should concentrate on working capacity and basic social skills. The poorer psychosocial outcome of men seems to be due to their poor premorbid development--specifically heterosexual development--and negative symptoms. Together, these factors form a particularly harmful combination from the point of view of the social role of men in our society. The treatment system seems to be unable to adequately respond to the specific needs of men suffering from schizophrenia.

Physical and Mental Health Changes in Retirement Age

Effects of retirement on health were studied in a prospective follow-up study (TURVA project). The subjects were examined when they were 62 and 66 years old. At the beginning of the study more than half of the subjects were still working and the rest of them pensioned. Retirement had no clear effect on the subjects physical health. Mental health of the subjects who retired at age of old-age retirement became better than that of the subjects who retired before the study. Diminished work stress may explain positive changes in mental health during retirement process.

Need for community care among psychotic outpatients

Psychiatric teams examined a representative sample of 177 psychotic patients in community care. The patients’ need for care was assessed using a standardized method. The need for alternative, noninstitutional forms of care (i.e. day and residential services) was greater than the actual use of these services. The same was true of the need for support in social activities, for occupational therapy, training in domestic skills, counselling for relatives and psychotherapy. Unmet needs for care were commonest among patients who were young, who drank heavily, and who suffered from many psychotic symptoms and drug side effects. Outpatient care based primarily on visits to the community mental health centres did not provide adequate services for the most disabled patients. It is concluded that decrease of hospital care has brought a growing need for psychiatric day and residential services among outpatients suffering from psychotic disorders.

The need for social support among out-patients suffering from functional psychosis

From an original sample of 177 patients in community care and suffering from functional psychosis, the psychiatric teams involved in the treatment of these patients interviewed 136 patients and 103 relatives. The interviews aimed at determining the patients problems in social-role behaviour, as evaluated both by the patients themselves and by their relatives, and to measure the stress caused to the relatives. According to the patients themselves, over 60% had considerable difficulties in at least one area of social-role behaviour; the same conclusion was reached by over 50% of the relatives. The patients had a more positive view of their abilities to cope with housework, self-care, and managing money than their relatives. One-third of the relatives said they were dissatisfied with the situation, and more than 40% displayed a resigned attitude to the amount of support required by the patient. Problems in social-role behaviour were commonest in patients who were dissatisfied with their treatment, in male patients, and in patients who lived together with their spouse, and among the relatives dissatisfaction with the situation as a whole was also highest in these cases. On the basis of these findings it is stressed that the treatment of psychotic patients should be based on a broad approach involving not only the patients themselves but also their relatives.

The GBS scale in the testing of unselected psychogeriatric patients a comparison of three dementia tests

Salokangas RKR, Loikkanen T, Santala H. The GBS scaie in the testing of unselected psychogeriatric patients. A comparison of three dementia tests.A new dementia scale (the GBS scale) was tested in an unselected sample of psychogeriatric patients. The scale was easy to complete, and it proved useful in staff training. The use of the scale also improved staff motivation. The GBS scale was compared with the MMS and the SPMSO. There were no marked differences between these tests in their ability to distinguish dementia patients or in their correlations with EEG and CT results. On the other hand, the GBS was more accurate in predicting the patients functional status, particularly in the case of patients with functional disorder. A shorter, seven-item version of the GBS scale was also produced: the validity of GBS 7 was just as good as that of the original scale. The GBS scale seems to be a useful tool for the purpose of assessing the degree of dementia in psychogeriatric patients and for predicting their func...