High-quality community care costs less than usual treatment and inpatient care and seems to be effective to improve clinical and social outcomes; for these reasons, policymakers should consider, in their future mental health reforms, allocating more resources to community-based care.
Study of the relationship between mental disorder and violent behavior is critical both from a public health perspective and for the proper planning and development of mental health services.However, the complex contribution of clinical, historical and environmental risk factors for violence in persons with schizophrenia remains unclear. The aim of the study was to identify clinical and social risk factors for violence in patients with schizophrenia and schizophrenia spectrum disorders (SSD) using a case-control design. Cases were defined as patients with SSD who had committed at least one act of offence in the past (94 patients wereenrolled from forensic psychiatricward). Controls were genderand age matched patients with SSD who had never committed violent acts (106 patients from general psychiatric services).A standard set of instruments was used to assess patients exposure to a variety of risk factors. Data were collected through patient interviews and medical records.Study results showed, that increased risk of violence was associated with severity of positive psychotic symptoms, diagnosis of delusional disorder, irregular or no contacts with mental health services. Significant risk factors for serious violent acts were associated with comorbid alcohol misuse, impulsivity,persecutory delusions,decreased emotional responseand unsatisfactory living environment. Study confirmed that the interaction of social andclinicalfactorswith treatment related factors played an important role as determinants of violence. These factors should be the focus of treatment and management of patients with SSD to prevent violent behavior.
International research, which focuses on frequent users of the psychiatric services and on the psychosocial factors that are associated with frequent rehospitalization, emphasize that the problem of revolving door patient still stands and is severe. Research concerning the above mentioned issue has not been conducted in Georgia, therefore, this study aimed to explore the revolving door patients and psychosocial factors that contribute to their relapse and frequent readmission to acute psychiatric unit. Study was conducted at psychiatric department of Ghudushauri National Medical Center. Qualitative and quantitative analysis based on medical files of 34 adult patients with psychotic disorders, rehospitalized in acute psychiatric unit 60 days after their last discharge in 2012–2014 years, was conducted. Results of the study are in line with international research findings concerning the psychosocial factors that contribute to frequent rehospitalization of patients with psychotic disorders, such as: unemployment (97%), lack of support system (76,5%), non-compliance with treatment (91.2%), emotional reactivity to stressful life events, etc. However, according to the study, family atmosphere turned out to be the central problem which influences the index of conflict and expressed aggression in the family, has impact on the size of patient's support system, on substance abuse, on patient's relapse and on their emergency rehospitalization. According to the results of the study, family atmosphere is one of the most active and multifaceted factors that contribute to patient's relapse and frequent rehospitalization in Georgia. Therefore, implementing and developing interventions discussed in the research paper that will target this factor is essential.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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