Rolf W. Gråwe

Non-adherence to antipsychotic medication, relapse and rehospitalisation in recent-onset schizophrenia

BackgroundThe aims of this study were to describe outcome with respect to persistent psychotic symptoms, relapse of positive symptoms, hospital admissions, and application of treatment by coercion among patients with recent onset schizophrenia being adherent and non-adherent to anti-psychotic medication.Materials and methodsThe study included 50 patients with recent onset schizophrenia, schizoaffective or schizophreniform disorders. The patients were clinically stable at study entry and had less than 2 years duration of psychotic symptoms. Good adherence to antipsychotic medication was defined as less than one month without medication. Outcomes for poor and good adherence were compared over a 24-month follow-up period.ResultsThe Odds Ratio (OR) of having a psychotic relapse was 10.27 and the OR of being admitted to hospital was 4.00 among non-adherent patients. Use of depot-antipsychotics were associated with relapses (OR = 6.44).ConclusionNon-adherence was associated with relapse, hospital admission and having persistent psychotic symptoms. Interventions to increase adherence are needed.Trial registrationCurrent Controlled Trials NCT00184509. Key words: Adherence, schizophrenia, antipsychotic medication, admittances, relapse.

Gambling behavior and gambling problems in Norway 2007.

In Norway, legalized gambling is pervasive, easily accessible and socially accepted, particularly the participation in national lotteries. We conducted a stratified probability sample study during January-March 2007 (age group 16-74 years, N = 3,482, response rate 36.1%) to assess gambling behavior and prevalence of problematic gambling by the NORC Diagnostic Screen (NODS). Overall, 67.9% of the study population had been engaged in past-year gambling and 0.7% were past-year problematic gamblers (NODS score 3+). Male gender, low educational level, single marital status, and being born in a non-Western country were variables positively associated with problematic gambling. Past-year problematic gamblers indicated the slot machine (34.6%) and Internet gambling (26.9%) as the most important games, while most non-problematic gamblers pointed out the lotteries (62.3%) as the most important game. The prevalence of self-reported sleeping disorders, depression and other psychological impairments was significantly higher among problematic gamblers. Gambling problems affect peoples lives in multiple ways.

Early Intervention for Schizophrenic Disorders: Implementing Optimal Treatment Strategies in Clinical Services

Integrated pharmacological and psychosocial interventions with adults who show early signs and symptoms of schizophrenic disorders may lower the incidence and prevalence of major episodes of acute disturbance. These programs combine early detection of psychotic symptoms by general practitioners with close collaboration with mental health professionals who are trained to conduct comprehensive psychiatric assessments and to apply without delay those medication and psychosocial strategies that have proven effective in reducing the prevalence of psychotic symptoms and associated disability in randomized, controlled studies. Long-term monitoring of early signs of recurrence of these subthreshold psychotic episodes, with further intervention aimed at reducing biological vulnerability and managing the detrimental effects of excessive stress, appears essential to maintain these benefits. A large-scale international study, the Optimal Treatment Project (OTP), aims to apply these effective treatment strategies to all incident cases of psychosis throughout a 5-year period, with repeated assessments of clinical, social, and economic benefits. Preliminary 2-year results from a Norwegian center reveal, in spite of the small number of patients and low statistical power, that this kind of optimalized treatment approach has an effect on rehospitalization rates, and that 40 percent of the recent-onset cases have a very good outcome.

Identifying co-occurring substance use disorders in community mental health centres. Tailored approaches are needed

Background: Increasing evidence shows that substance use disorders (SUD) and psychiatric illness co-occur, and that this co-morbidity renders treatment more difficult and results in greater use of health services. Thus, clinical routines to identify SUD amongst patients in mental healthcare should have high priority in order to provide optimal treatment. Aim: In this study, we examine whether common and well-known substance use measures are appropriate in detecting SUD in Community Mental Health Centres (CMHCs). Material and methods: The present study used a subset of data from an evaluation of the National Plan for Mental Health. Clinicians at eight CMHCs registered socio-demographic and treatment information about their patients during a 4-week period in 2007. This included diagnostic measures, the Alcohol and Drug Use Scales and the substance use item of the Health of the Nation Outcome Scales. Prevalence rates from the different substance use measures and the observed agreement between them were calculated. The prevalence rates were compared with other estimates of substance use prevalence. Results: All the different measures gave low prevalence rates of SUD, and the inter-measure agreement was poor. A combination of the measures gave prevalence rates closer to what is expected from previous epidemiological studies. Conclusion: The CMHCs participating in this study lack sufficient diagnostic routines and specific instruments to identify SUD. Clinical research that relies on methods used in this study will need combined approaches to provide reliable findings. Both clinical practice and research would benefit from valid, reliable screening methods and diagnostic procedures.

The Better Life Program: Effects of group skills training for persons with severe mental illness and substance use disorders

Objectives: Despite the widespread use of group interventions for treating dual disorders, few standardized programs have been empirically validated. This study evaluated a manualized group skills training intervention for clients with dual disorders, the Better Life Program, in order to determine its feasibility and changes in substance abuse and mental health outcomes. Method: Patients with dual disorders at nine centres in Norway participated in a pilot study using a within-subjects pre- and post test design. The program required an average of 37 sessions to complete and was provided as a supplement to standard mental health care. The aim of the program is to reduce substance misuse through providing information, motivational enhancement, skills training to develop rewarding relationships, relapse prevention, and establishing healthy leisure activities. Results: Among the 82 patients who began treatment, 63 (83%) completed it. Treatment completers showed significant reductions in substance misuse and improvement in global functioning, but did not change in general symptom distress. Conclusions: This pilot study supports the feasibility of the Better Life Program, and suggests that it may improve substance misuse and mental health outcomes. Further research is warranted to evaluate the effects of this program using controlled research designs. Conflicts of interest: None.

Group therapy in community mental health centres

Background: Developing accessible community mental health centres (CMHCs) with high quality of care, has been a major health strategy in Norway. There is, however, scarce knowledge about the kinds of therapy which are practiced at the CMHCs. Aims: We wanted to study the extent of use of group therapy in CMHCs, types of group therapy, and characteristics of patients who receive such therapy. We also wanted to explore if the use of group therapy seemed to be according to trends suggested by the research literature. Material and Methods: A cross-sectional study of all patients (N=3041) receiving consultations at eight selected CMHCs during 4 weeks in 2005. The catchment areas of these CMHCs represented about 10% of the national population. Demographic, clinical, and treatment information was recorded. Results: 15.1% received group therapy, and of these, 40.2% received analytic group therapy, 14.6% cognitive therapy, and 45.2% received ‘other types’ of group therapy. Group patients were older, had less psychopathology, and were more often treated in day-care or in-patient units. One half also received additional individual sessions (combined therapy). Patients in combined therapy had more severe psychiatric problems than those receiving group sessions alone, and patients in analytic groups had less psychopathology than patients receiving ‘other types’ of group therapy. Analytic groups were most common in day-care services. Conclusion: Analytic group therapies have a more central position in everyday clinical work than cognitive group therapy. There are few evidence based guidelines for selecting group therapy methods and more research is needed to decide both what kind of group therapy should be offered to different patient categories, and what kind of group therapy approaches the community mental health centres should be able to offer, within and across the different units.