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The association between working alliance and clinical and functional outcome in a cohort of 400 patients with first-episode psychosis: a cross-sectional study.

https://arctichealth.org/en/permalink/ahliterature261207
Source
J Clin Psychiatry. 2015 Jan;76(1):e83-90
Publication Type
Article
Date
Jan-2015
Author
Marianne Melau
Susanne Harder
Pia Jeppesen
Carsten Hjorthøj
Jens R M Jepsen
Anne Thorup
Merete Nordentoft
Source
J Clin Psychiatry. 2015 Jan;76(1):e83-90
Date
Jan-2015
Language
English
Publication Type
Article
Keywords
Adult
Case Management - standards
Cohort Studies
Cross-Sectional Studies
Denmark
Female
Humans
Male
Patient Compliance - psychology
Professional-Patient Relations
Psychotic Disorders - psychology - therapy
Randomized Controlled Trials as Topic
Schizophrenia - therapy
Schizophrenic Psychology
Young Adult
Abstract
Working alliance between patients with a first-episode psychosis and their case manager is regarded as a key element in specialized early intervention services. The impact of this patient-case manager dyad on functional and clinical outcome is unknown. We aimed to investigate if a strong working alliance was associated with fewer clinical symptoms and better social functioning.
In a cross-sectional design, patients with first-episode schizophrenia spectrum disorders (ICD-10, F20-29) were included after 18 months of treatment (N = 400). Baseline data were collected between June 2009 and December 2011. Symptoms were assessed using Scale for the Assessment of Positive Symptoms (SAPS), Scale for the Assessment of Negative Symptoms (SANS), Global Assessment of Functioning (GAF), Brief Assessment of Cognition in Schizophrenia (BACS), Working Alliance Inventory (WAI), and General Self-Efficacy (GSE). Linear regression analyses were adjusted for age, sex, cognition, and self-efficacy.
Results revealed significant associations between working alliance and fewer negative (? = -0.12; 95% CI, -0.19 to -0.04) and disorganized symptoms (? = -0.06; 95% CI, -0.11 to -0.01), and between working alliance and better social functioning (? = 1.45; 95% CI, 0.55 to 2.36). General self-efficacy mediated the effect of working alliance, explaining 14%-18% of the variance in associated outcomes. Global level of cognitive functioning, compliance, and self-efficacy influenced clinical and functional outcome more strongly than working alliance.
Better working alliance was weakly associated with fewer negative and disorganized symptoms and better social functioning. A strong working alliance may be a prerequisite for adherence to the specialized early intervention services treatment, providing the basis for positive treatment outcome.
ClinicalTrials.gov identifier: NCT00914238.
PubMed ID
25650684 View in PubMed
Less detail

The CCC2000 Birth Cohort Study of Register-Based Family History of Mental Disorders and Psychotic Experiences in Offspring.

https://arctichealth.org/en/permalink/ahliterature273409
Source
Schizophr Bull. 2015 Sep;41(5):1084-94
Publication Type
Article
Date
Sep-2015
Author
Pia Jeppesen
Janne Tidselbak Larsen
Lars Clemmensen
Anja Munkholm
Martin Kristian Rimvall
Charlotte Ulrikka Rask
Jim van Os
Liselotte Petersen
Anne Mette Skovgaard
Source
Schizophr Bull. 2015 Sep;41(5):1084-94
Date
Sep-2015
Language
English
Publication Type
Article
Keywords
Child
Delusions - epidemiology - etiology - genetics
Denmark - epidemiology
Female
Hallucinations - epidemiology - etiology - genetics
Humans
Male
Pedigree
Psychotic Disorders - epidemiology - etiology - genetics
Registries
Risk
Schizophrenia - epidemiology - etiology - genetics
Abstract
Psychotic experiences (PE) in individuals of the general population are hypothesized to mark the early expression of the pathology underlying psychosis. This notion of PE as an intermediate phenotype is based on the premise that PE share genetic liability with psychosis. We examined whether PE in childhood was predicted by a family history of mental disorder with psychosis rather than a family history of nonpsychotic mental disorder and whether this association differed by severity of PE. The study examined data on 1632 children from a general population birth cohort assessed at age 11-12 years by use of a semistructured interview covering 22 psychotic symptoms. The Danish national registers were linked to describe the complete family history of hospital-based psychiatric diagnoses. Uni- and multivariable logistic regressions were used to test whether a family history of any mental disorder with psychosis, or of nonpsychotic mental disorder, vs no diagnoses was associated with increased risk of PE in offspring (hierarchical exposure variable). The occurrence of PE in offspring was significantly associated with a history of psychosis among the first-degree relatives (adjusted relative risk [RR] = 3.29, 95% CI: 1.82-5.93). The risk increased for combined hallucinations and delusions (adjusted RR = 5.90, 95% CI: 2.64-13.16). A history of nonpsychotic mental disorders in first-degree relatives did not contribute to the risk of PE in offspring nor did any mental disorder among second-degree relatives. Our findings support the notion of PE as a vulnerability marker of transdiagnostic psychosis. The effect of psychosis in first-degree relatives may operate through shared genetic and environmental factors.
Notes
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PubMed ID
25452427 View in PubMed
Less detail

Cost-effectiveness of early intervention in first-episode psychosis: economic evaluation of a randomised controlled trial (the OPUS study).

https://arctichealth.org/en/permalink/ahliterature118731
Source
Br J Psychiatry. 2013 Jan;202(1):35-41
Publication Type
Article
Date
Jan-2013
Author
Lene Halling Hastrup
Christian Kronborg
Mette Bertelsen
Pia Jeppesen
Per Jorgensen
Lone Petersen
Anne Thorup
Erik Simonsen
Merete Nordentoft
Author Affiliation
Region Zealand, Psychiatric Research Unit, Roskilde, Denmark. lhhs@regionsjaelland.dk
Source
Br J Psychiatry. 2013 Jan;202(1):35-41
Date
Jan-2013
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Antipsychotic Agents - therapeutic use
Community Mental Health Services - economics - organization & administration
Cost-Benefit Analysis
Denmark
Diagnosis-Related Groups - economics
Early Medical Intervention - economics
Family Therapy - economics
Health Care Costs - statistics & numerical data
Health Services - utilization
Humans
Intention to Treat Analysis
Middle Aged
Outcome and Process Assessment (Health Care)
Patient Care Team - economics
Patient Education as Topic - economics
Psychotic Disorders - economics - therapy
Schizophrenia - economics - therapy
Single-Blind Method
Socialization
Young Adult
Abstract
Information about the cost-effectiveness of early intervention programmes for first-episode psychosis is limited.
To evaluate the cost-effectiveness of an intensive early-intervention programme (called OPUS) (trial registration NCT00157313) consisting of enriched assertive community treatment, psychoeducational family treatment and social skills training for individuals with first-episode psychosis compared with standard treatment.
An incremental cost-effectiveness analysis of a randomised controlled trial, adopting a public sector perspective was undertaken.
The mean total costs of OPUS over 5 years (€123,683, s.e. = 8970) were not significantly different from that of standard treatment (€148,751, s.e. = 13073). At 2-year follow-up the mean Global Assessment of Functioning (GAF) score in the OPUS group (55.16, s.d. = 15.15) was significantly higher than in standard treatment group (51.13, s.d. = 15.92). However, the mean GAF did not differ significantly between the groups at 5-year follow-up (55.35 (s.d. = 18.28) and 54.16 (s.d. = 18.41), respectively). Cost-effectiveness planes based on non-parametric bootstrapping showed that OPUS was less costly and more effective in 70% of the replications. For a willingness-to-pay up to €50,000 the probability that OPUS was cost-effective was more than 80%.
The incremental cost-effectiveness analysis showed that there was a high probability of OPUS being cost-effective compared with standard treatment.
PubMed ID
23174515 View in PubMed
Less detail

The effect of five years versus two years of specialised assertive intervention for first episode psychosis - OPUS II: study protocol for a randomized controlled trial.

https://arctichealth.org/en/permalink/ahliterature136300
Source
Trials. 2011;12:72
Publication Type
Article
Date
2011
Author
Marianne Melau
Pia Jeppesen
Anne Thorup
Mette Bertelsen
Lone Petersen
Christian Gluud
Gertrud Krarup
Merete Nordentoft
Author Affiliation
Psychiatric Centre Copenhagen, Copenhagen University, Faculty of Health Sciences, Copenhagen, Denmark. marianne.melau@regionh.dk
Source
Trials. 2011;12:72
Date
2011
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Antipsychotic Agents - therapeutic use
Cognitive Therapy
Community Mental Health Services
Crisis Intervention
Denmark
Family Therapy
Humans
Psychiatric Status Rating Scales
Psychotherapy, Group
Psychotic Disorders - diagnosis - psychology - therapy
Research Design
Social Behavior
Time Factors
Treatment Outcome
Young Adult
Abstract
The Danish OPUS I trial randomized 547 patients with first-episode psychosis to a two-year early-specialised assertive treatment programme (OPUS) versus standard treatment. The two years OPUS treatment had significant positive effects on psychotic and negative symptoms, secondary substance abuse, treatment adherence, lower dosage of antipsychotic medication, and a higher treatment satisfaction. However, three years after end of the OPUS treatment, the positive clinical effects were not sustained, except that OPUS-treated patients were significantly less likely to be institutionalised compared with standard-treated patients. The major objective of the OPUS II trial is to evaluate the effects of five years of OPUS treatment versus two years of OPUS treatment.
The OPUS II trial is designed as a randomized, open label, parallel group trial with blinded outcome assessment. Based on our sample size estimation, 400 patients treated in OPUS for two years will be randomized to further three years of OPUS treatment versus standard treatment. The specialized assertive OPUS treatment consists of three core elements: assertive community treatment, psycho-educational family treatment, and social skills training.
It has been hypothesized that there is a critical period from onset up to five years, which represents a window of opportunity where a long-term course can be influenced. Extending the specialized assertive OPUS treatment up to five years may allow the beneficial effects to continue beyond the high-risk period, through consolidation of improved social and functional outcome.
Clinical Trial.gov NCT00914238.
Notes
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PubMed ID
21392377 View in PubMed
Less detail

From research to practice: how OPUS treatment was accepted and implemented throughout Denmark.

https://arctichealth.org/en/permalink/ahliterature268608
Source
Early Interv Psychiatry. 2015 Apr;9(2):156-62
Publication Type
Article
Date
Apr-2015
Author
Merete Nordentoft
Marianne Melau
Tina Iversen
Lone Petersen
Pia Jeppesen
Anne Thorup
Mette Bertelsen
Carsten Rygaard Hjorthøj
Lene Halling Hastrup
Per Jørgensen
Source
Early Interv Psychiatry. 2015 Apr;9(2):156-62
Date
Apr-2015
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Combined Modality Therapy
Community Mental Health Services
Denmark
Early Medical Intervention - methods
Family Therapy
Female
Humans
Male
Middle Aged
Patient satisfaction
Program Development
Psychotic Disorders - therapy
Young Adult
Abstract
The early phases of psychosis have been hypothesized to constitute a critical period, a window of opportunity. At the same time, the early phases of psychosis are associated with increased risk of unwanted outcome, such as suicidal behaviour and social isolation. This was the background for the emergence of early intervention services, and in Denmark, the OPUS trial was initiated as part of that process.
Modified assertive community treatment, together with family involvement and social skills training, constituted the core elements in the original programme. A total of 547 patients with first-episode psychosis were included in the trial.
To summarize briefly the results of the OPUS trial: the OPUS treatment was superior to standard treatment in reducing psychotic and negative symptoms and substance abuse, in increasing user satisfaction and adherence to treatment, and in reducing use of bed days and days in supported housing. Moreover, relatives included in the OPUS treatment were less strained and had a higher level of knowledge about schizophrenia and higher user satisfaction.
The OPUS treatment was implemented throughout Denmark. Training courses were developed and manuals and books were published. Regional health authorities had access to national grants for implementing early intervention services; as a result, OPUS teams were disseminated throughout the country. The content of the treatment is now further developed, and new elements are being tried out - such as individual placement and support, lifestyle changes, cognitive remediation, specialized treatment for substance abuse and different kinds of user involvement.
PubMed ID
24304658 View in PubMed
Less detail

Health Anxiety in Preadolescence--Associated Health Problems, Healthcare Expenditure, and Continuity in Childhood.

https://arctichealth.org/en/permalink/ahliterature279474
Source
J Abnorm Child Psychol. 2016 May;44(4):823-32
Publication Type
Article
Date
May-2016
Author
Charlotte Ulrikka Rask
Anja Munkholm
Lars Clemmensen
Martin K Rimvall
Eva Ørnbøl
Pia Jeppesen
Anne Mette Skovgaard
Source
J Abnorm Child Psychol. 2016 May;44(4):823-32
Date
May-2016
Language
English
Publication Type
Article
Keywords
Anxiety - economics - epidemiology
Attitude to Health
Child
Child, Preschool
Denmark - epidemiology
Female
Follow-Up Studies
Health Expenditures - statistics & numerical data
Health status
Humans
Hypochondriasis - economics - epidemiology
Male
Abstract
Epidemiological data on the distribution, persistence, and clinical correlates of health anxiety (HA) in childhood are scarce. We investigated continuity of HA symptoms and associated health problems and medical costs in primary health services in a general population birth cohort. HA symptoms were assessed in 1886 Danish 11-12 year old children (48 % boys) from the Copenhagen Child Cohort using the Childhood Illness Attitude Scales (CIAS) together with information on socio-demographics and the child's somatic and mental status and healthcare expenditure. Non-parametric statistics and regression analysis were used to compare groups with low (n?=?184), intermediate (n?=?1539), and high (n?=?161) HA symptom scores. The association between HA symptoms assessed at age 5-7 years and HA symptoms at ages 11-12 years was examined by Stuart-Maxwell test. HA symptoms were significantly associated with emotional disorders and unspecific somatic complaints, but not with chronic physical conditions. In regression analyses controlling for gender and physical comorbidity, healthcare expenditure peaked in children with the highest HA symptom score, that is these children used on average approximately 150 Euro more than children with the lowest score during the 2-year period preceding inclusion. HA symptoms at age 5-7 years were significantly associated with HA symptoms at age 11-12 years. We conclude that HA symptoms, including hypochondriacal fears and beliefs, were non-trivial in preadolescents; they showed continuity from early childhood and association with emotional disorders, unspecific somatic complaints, and increased healthcare expenditure. Further research in the clinical significance of childhood HA is required.
PubMed ID
26311618 View in PubMed
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Hospital contact for mental disorders in survivors of childhood cancer and their siblings in Denmark: a population-based cohort study.

https://arctichealth.org/en/permalink/ahliterature107972
Source
Lancet Oncol. 2013 Sep;14(10):971-80
Publication Type
Article
Date
Sep-2013
Author
Lasse Wegener Lund
Jeanette F Winther
Susanne O Dalton
Luise Cederkvist
Pia Jeppesen
Isabelle Deltour
Marie Hargreave
Susanne K Kjær
Allan Jensen
Catherine Rechnitzer
Klaus K Andersen
Kjeld Schmiegelow
Christoffer Johansen
Author Affiliation
Survivorship, Danish Cancer Society Research Centre, Copenhagen, Denmark. wegener@cancer.dk
Source
Lancet Oncol. 2013 Sep;14(10):971-80
Date
Sep-2013
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Child
Child, Preschool
Cohort Studies
Denmark
Female
Humans
Infant
Infant, Newborn
Male
Mental Disorders - epidemiology - etiology
Neoplasms - mortality - psychology
Proportional Hazards Models
Registries
Risk
Siblings - psychology
Survivors - psychology
Abstract
Survivors of childhood cancer are known to be at risk for long-term physical and mental effects. However, little is known about how cancers can affect mental health in the siblings of these patients. We aimed to assess the long-term risks of mental disorders in survivors of childhood cancer and their siblings.
Hospital contact for mental disorders was assessed in a population-based cohort of 7085 Danish children treated for cancer by contemporary protocols between 1975 and 2010 and in their 13?105 siblings by use of data from the Danish Psychiatric Central Research Registry. Hazard ratios (HRs) for first hospital contact were calculated using a Cox proportional hazards model. We compared these sibling and survivor cohorts with two population-based cohorts who were not childhood cancer survivors or siblings of survivors.
Survivors of childhood cancer were at increased risk of hospital contact for mental disorders, with HRs of 1·50 (95% CI 1·32-1·69) for males and 1·26 (1·10-1·44) for females. Children younger than 10 years at diagnosis had the highest risk, and increased risks were seen in survivors of CNS tumours, haematological malignancies, and solid tumours. Survivors had higher risk of neurodevelopmental, emotional, and behavioural disorders than population-based comparisons and siblings, and male survivors had higher risk for unipolar depression. Overall, siblings had no excess risk for mental disorders. However, our data suggest that siblings who were young at the time of cancer diagnosis of the survivor were at increased risk for mental disorders, whereas those older than 15 years at diagnosis were at a lower risk than the general population.
Childhood cancer survivors should be followed up for mental late effects, especially those diagnosed in young age. Further, clinicians should also be aware that siblings who were young at the time of cancer diagnosis might be at increased risk for mental health disorders.
PubMed ID
23954078 View in PubMed
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Predictors of recovery from psychosis Analyses of clinical and social factors associated with recovery among patients with first-episode psychosis after 5 years.

https://arctichealth.org/en/permalink/ahliterature139496
Source
Schizophr Res. 2011 Feb;125(2-3):257-66
Publication Type
Article
Date
Feb-2011
Author
Nikolai Albert
Mette Bertelsen
Anne Thorup
Lone Petersen
Pia Jeppesen
Phoung Le Quack
Gertrud Krarup
Per Jørgensen
Merete Nordentoft
Author Affiliation
Psychiatric Center Copenhagen, Copenhagen University, Faculty of Health Sciences, Copenhagen, Denmark.
Source
Schizophr Res. 2011 Feb;125(2-3):257-66
Date
Feb-2011
Language
English
Publication Type
Article
Keywords
Adult
Cohort Studies
Combined Modality Therapy
Community Mental Health Services
Denmark
Family Therapy
Female
Follow-Up Studies
Humans
Male
Multivariate Analysis
Patient Education as Topic
Prognosis
Psychiatric Status Rating Scales
Psychotic Disorders - diagnosis - psychology - rehabilitation
Rehabilitation, Vocational
Schizophrenia - diagnosis - rehabilitation
Schizophrenic Psychology
Sex Factors
Social Adjustment
Social Behavior
Young Adult
Abstract
This paper aims to investigate the predictors of good outcome after first-episode non-affective psychosis and the clinical and social trajectories of those that recover.
A cohort of 255 patients with first-episode non-affective psychosis was interviewed 5 years after first diagnosis and treatment. Recovery was defined as working or studying, having a GAF-function score of 60 or above, having remission of negative and psychotic symptoms, and not living in a supported housing facility or being hospitalized during the last 2 years before the five-year follow-up interview.
A total of 40 (15.7%) were found to be recovered, and 76 (29.8%) had a job or were studying after 5 years. Of those working, as many as 20 still had psychotic symptoms. Also notable is that out of the 40 recovered, less than half were recovered after 2 years. Recovery after 5 years was predicted by female sex (OR 2.4, 95% CI 1.0-5.8), higher age (OR 0.91, 95% CI 0.83-0.99), pre-morbid social adaptation (OR 0.72, 95% CI 0.56-0.93), growing up with both parents (OR 2.6, 95% CI 1.0-6.8) and low level of negative symptoms (OR 0.51, 95% CI 0.33 to 0.77) at baseline.
Our findings suggest that a stable social life with normal social functioning has a predictive value for good outcome. These measures might be influenced by negative symptoms, but in the multivariate analysis with negative symptoms included they have an independent effect. Also our findings suggest that, after first-episode psychosis, some patients can still experience psychotic symptoms, but have a job and a fairly stable life.
PubMed ID
21056926 View in PubMed
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Psychotic experiences co-occur with sleep problems, negative affect and mental disorders in preadolescence.

https://arctichealth.org/en/permalink/ahliterature269346
Source
J Child Psychol Psychiatry. 2015 May;56(5):558-65
Publication Type
Article
Date
May-2015
Author
Pia Jeppesen
Lars Clemmensen
Anja Munkholm
Martin K Rimvall
Charlotte U Rask
Torben Jørgensen
Janne T Larsen
Liselotte Petersen
Jim van Os
Anne M Skovgaard
Source
J Child Psychol Psychiatry. 2015 May;56(5):558-65
Date
May-2015
Language
English
Publication Type
Article
Keywords
Affective Symptoms - epidemiology
Child
Comorbidity
Delusions - epidemiology
Denmark - epidemiology
Female
Follow-Up Studies
Hallucinations - epidemiology
Humans
Male
Mental Disorders - epidemiology
Psychotic Disorders - epidemiology
Sleep Wake Disorders - epidemiology
Abstract
Knowledge on the significance of childhood psychotic symptoms and experiences (PE) is still limited. This study aimed to investigate the prevalence and clinical significance of PE in preadolescent children from the general population by use of in-depth psychopathological interviews and comprehensive diagnostic assessments.
We investigated 1,632 children from the general population-based Copenhagen Child Cohort 2000. PE were measured by semistructured interviews using the K-SADS-PL-items on psychotic and affective symptoms, each symptom scored as not present versus likely or definitely present. The Development and Well-Being Assessment (DAWBA) was used independently to diagnose DSM-IV-mental disorders. Puberty development and sleep disturbance were self-reported. The associations between PE (any lifetime hallucination and/or delusion) and various mental problems and disorders were examined by multivariable binomial regression analyses, adjusting for gender and onset of puberty.
The weighted life time prevalence of PE at age 11-12 years was 10.9% (CI 9.1-12.7). The majority of children with PE (n = 172) either had a diagnosable DSM-IV-mental disorder (31.4%) or self-reported mental health difficulties in absence of a diagnosis (31.4%). The risk of delusions increased with onset of puberty. The risk of PE increased with emotional and neurodevelopmental disorders, subthreshold depressive symptoms, sleep problems and lack of sleep, regardless of whether PE were expressed as hallucinations and/or delusions. The highest correlations were seen for emotional and multiple disorders.
Psychotic experiences are particularly prevalent in the context of affective dysregulation and sleep disturbance, increase with onset of puberty and represent a trans-diagnostic marker of psychopathology.
PubMed ID
25156482 View in PubMed
Less detail

The quality of life among first-episode psychotic patients in the OPUS trial.

https://arctichealth.org/en/permalink/ahliterature98768
Source
Schizophr Res. 2010 Jan;116(1):27-34
Publication Type
Article
Date
Jan-2010
Author
Anne Thorup
Lone Petersen
Pia Jeppesen
Merete Nordentoft
Author Affiliation
Bispebjerg Hospital, Psychiatric Department, Denmark. atv@dadlnet.dk
Source
Schizophr Res. 2010 Jan;116(1):27-34
Date
Jan-2010
Language
English
Publication Type
Article
Keywords
Adult
Assertiveness
Behavior Therapy - methods
Community Mental Health Services
Denmark
Female
Humans
Longitudinal Studies
Male
Psychiatric Status Rating Scales
Psychotic Disorders - psychology - rehabilitation
Quality of Life
Retrospective Studies
Treatment Outcome
Young Adult
Abstract
BACKGROUND: From an 'objective' perspective, treatment of first-episode psychosis has improved in many ways with the development of specialised early and intensive team-based treatment like e.g. the 'OPUS' treatment. However, the patients' perspective is also important and was investigated in the 'OPUS' study by analysing data concerning quality of life. AIM: We aimed to investigate the 'quality of life from patients' perspective' among a cohort of young adults with a first-episode psychosis at the time of treatment initiation and after two years. Especially, we were interested in analysing if there were any significant effects on the subjective quality of life of receiving an intensive psychosocial assertive community treatment called 'OPUS' compared to standard treatment (ST). METHOD: This study is part of the Danish 'OPUS' trial, a randomised controlled trial (RCT) comparing 'treatment as usual' (standard treatment, ST) with 'OPUS' treatment. The Lancashire Quality of Life Profile (LQoLP), which is a combined objective and subjective instrument, was administered at baseline and after two years of treatment, N=280. RESULTS: The intensive 'OPUS' treatment did not affect the quality of life measured by Lancashire QoLP in a significantly different way from the standard treatment (ST). There were no significant differences in quality of life between the ST group and the OPUS group concerning the 9 life domains. Quality of life correlated with psychopathology (both psychotic and negative symptoms) to a minor extent and more strongly with the affective balance and level of self-esteem.
PubMed ID
19897341 View in PubMed
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