The needs of people with schizophrenia are great, and having extensive knowledge of this patient group is crucial for providing the right support. The aim of this study was to investigate, over 4 years, the importance of repeated assessments by patients with schizophrenia and by professionals. Data were collected from evidence-based assessment scales, interviews, and visual self-assessment scales. The data processing used descriptive statistics, correlation and regression analyses. The results showed that the relationships between several of the patients' self-rating assessments were stronger at the 4-year follow-up than at baseline. In parallel, the concordance rate between patient assessments and case manager assessments increased. The conclusions drawn are that through repeated assessments the patients' ability to assess their own situation improved over time and that case managers became better at understanding their patients' situation. This, in turn, provides a safer basis for assessments and further treatment interventions, which may lead to more patients achieving remission, which can lead to less risk for hospitalization and too early death.
The knowledge about factors contributing to remission among individuals with schizophrenia is still missing. Studies show that the number of individuals' reaching remission is varying among psychiatric outpatient care centres. Therefore, the purpose was to investigate case managers (CM) perception of care interventions promoting remission. Semi-structured interviews were conducted with CM (n = 12) and data were analysed with qualitative content analysis. The results show that CM needs to possess competence, master assessment structure and process. These key-points appear to be of crucial importance for a successful promotion of remission among individuals with schizophrenia.
BackgroundPatients with schizophrenia have about 20 years shorter lifetime expectancy compared to healthy population. The cause of this excess in mortality is due to both unnatural and natural causes. While the lifetime prevalence of death due to suicide among patients with schizophrenia is estimated to be 4.9%, Cardiovascular (CV) disease contributes to as much as 50% of the excess mortality in patients with schizophrenia.This study focuses on whether hypertension, diabetes, hyperlipidemia and tobacco could be related to the reduced lifetime expectancy in patients with schizophrenia spectrum disorder.MethodsFrom the Clinical Long-term Investigation of Psychosis in Sweden (CLIPS) study, 79 patients now deceased were analyzed at baseline. Data regarding occurrence of hypertension, diabetes, hyperlipidemia, tobacco but also data on the type of antipsychotic treatment were collected. Two patients, one with zero risk factors and one with 5 risk factors were omitted from the study. We created four categories based on the number of risk factors. 31 patients with one risk factor, 24 patients with two risk factors, 12 patients with three risk factors and 4 patients with four risk factors.ResultsThe mean age for death was 61 years and the age varied between 35–83 years old. 18 percent were treated with typical antipsychotics and 61 percent with atypical antipsychotics. 18 percent had both atypical and typical antipsychotic treatment. 17 percent had treatment for diabetes, 27 percent had treatment for hypertonia, 8 percent had treatment for hyperlipidemia and 43 percent were using tobacco. The data collected pictures the occurrence of the different risk factors on average 6 years before their death. We compared the age of death for the four different risk factor groups with a Kruskal-Wallis Test and could not find any significant difference between them.DiscussionCompared to the general population in Sweden there is an increased risk for diabetes in patients with schizophrenia, however the prevalence of hypertonia is the same, 27 percent for 18 years old and elder, in the general population. Daily tobacco use was rather high among patients with schizophrenia. Compared to general population, women and man with 10 percent respective 8 percent higher. Even if both diabetes and tobacco use has a high prevalence in patients with schizophrenia, it may not be enough to explain the reduced lifetime expectancy in patients with schizophrenia This study indicates that metabolic syndrome and the risk factors it contains need to be further studied in order to find its association to early death in patients with schizophrenia.
BackgroundPeople with schizophrenia demonstrate deficits in insight and the ability to self-evaluate their functioning. Research about patients’ ability to recognize their psychotic symptoms is well established, but recent findings show that there are still unexplored fields regarding how patients perceive their level of functioning A previous study showed that patients who overestimate their functioning, also consistently get high scores in interview-based assessment regarding real-world functional performance. The possible consequences of patients’ ability to correctly estimate their function need to be further investigated. The aim of the present study was to examine how the perception of one’s own capacity relate to symptoms in patients with schizophrenia spectrum disorders.MethodsData collection took place within the ongoing project Clinical Long-term Investigation of Psychosis in Sweden (CLIPS), which examines psychiatric outpatients. In this study, 222 patients with schizophrenia participated. They were divided into four groups based on their results on the UPSA-B and their self-perceived function; two groups with ordinary function (accurate estimators and under -estimators) and two groups with low function (accurate estimators and over-estimators). The groups were compared regarding psychiatric symptoms, examined using the Positive and Negative Syndrome Scale (PANSS). Non-parametric statistics were used to analyze differences in their symptoms.ResultsThere were statistically significant differences in the total score of PANSS across the four groups of function. The following analyses showed significant differences in the negative and general domain. Results from the post hoc examination revealed identical patterns in these two symptom domains. The group with Low function accurate estimators have significantly more severe symptoms compared to the other three groups.DiscussionThe result in the present study showed that patients with low function who overestimate their function have less or the same level of symptoms as patients in the two groups with ordinary functioning. In further studies it is important to investigate if this actually is a result of lower symptom level or if it is due to the impaired insight. This is important since the result in the present study mirror previous results where patients who overestimate a low function also, by clinicians, will be perceived as patients with a higher capacity and less difficulties.
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