OBJECTIVE: To investigate the connection between overweight and first-episode schizophrenia spectrum as well as non-schizophrenia spectrum psychiatric disorders in adolescent male and female drug-naïve psychiatric inpatients, whose illness was early onset. METHOD: Three hundred twenty-three adolescents with no past or present psychiatric medication, 12-17 years of age, admitted to the psychiatric inpatient care (Oulu University Hospital, Northern Finland) between April 2001 and March 2006. DSM-IV diagnoses were based on the "Schedule for Affective Disorder and Schizophrenia for School-Age Children Present and Lifetime" (K-SADS-PL). An adolescent was defined as overweight if his or her BMI was greater than or equal to the 85th percentile. RESULTS: Overweight values were highest in drug-naïve adolescent boys with first-episode schizophrenia spectrum (RR: 2.5, 95%CI: 1.08-4.29) and non-schizophrenia spectrum (RR: 2.80, 95%CI: 2.20-3.45) disorders. The RR in girls with non-schizophrenia spectrum disorders was 1.73 (95%CI: 1.31-2.23), but in those with first-episode schizophrenia spectrum disorders RR did not differ from general population. CONCLUSIONS: In our study sample of first-episode schizophrenia spectrum drug-naïve adolescents, overweight was shown to be prevalent in all diagnostic groups other than first-episode schizophrenia spectrum psychotic girls. To the best of our knowledge, this is the first study in which overweight was analyzed and verified among drug-naïve adolescent boys, suffering from first-episode schizophrenia spectrum disorder. To what extent our results are applicable to other regions and study groups, remains to be seen.
A clinical follow-up study (mean follow-up period 16.8 +/- 6.4 years) of 278 patients with juvenile-onset endogenous episodic psychosis (Endogenous Psychosis Episodic Type, EPET -- ICD-10 F20.03, F20.23, F25) with first episodes in 1984-1995 was performed. The period of the most intense occurrence of repeated episodes occurred during the first five years from the initial episode (almost all repeat episodes in the patients occurred during this period). At the time of the follow-up study, "good" outcomes were seen in 18.7% of patients, "relatively good" in 33.8%, "relatively poor" in 30.2%, and "poor" in 17.2%. Analysis of correlations between disease course and outcome and types of manifest episode and a number of clinical-pathogenetic parameters yielded several statistically significant criteria for clinical and social prognosis. Nosological evaluation at the time of the follow-up study showed that 76.2% of patients had schizophrenia (episodic progressive in 61.1%, recurrent in 15.1%) and 28.3% had schizoaffective psychosis. Comparison of the data with results from previous analogous studies led to the conclusion that the contemporary pathomorphosis of EPET is more favorable, with trends to improvements in disease course and outcome, decreases in progression, and significant reductions in cases of transition to a chronic course.
Bispebjerg Hospital, Department of Psychiatry, and Copenhagen University Faculty of Health Science, Bispebjerg Bakke 23, DK-2400 Copenhagen NV, Denmark. mbe_76@yahoo.dk
There is an ongoing debate as to whether psychosis is a progressively deteriorating illness or one of progressive amelioration. This paper aims at investigating the rate of recovery and institutionalization and predicting a continuous illness course in a descriptive prospective study of a sub-sample of the OPUS trial of 265 first-episode psychotic patients after five years. Recovery, defined as no psychotic or negative symptoms, living independently, GAF (f)>59, working or studying, was reached for 18% after five years, whereas 13% were institutionalized either at hospital or supported housing after five years. Male gender (OR 1.9, 95% CI 1.06 to 3.23), premorbid social functioning (OR 1.2, 95% CI 1.01 to 1.33), psychotic symptoms (OR 1.3, 95% CI 1.07 to 1.66), and negative symptoms (OR 1.3, 95% CI 1.01 to 1.67) were found to predict a continuous illness course at five-year follow-up. Rates of recovery and institutionalization contradict the assumption that the illness deteriorates progressively, since no changes in the rates are seen from two to five years.
A clinical follow-up study (mean duration of the follow-up 16,8+/-6,4 years) of 278 patients with juvenile endogenous psychosis, episodic type (EPET, ICD-10 items F20.03, F20.23, F25), with the first episode in 1984-1995, demonstrated that the first five years was the period of most intensive manifestation of episodes (this period covered about a half of all recurrent episodes). At the time of follow-up, a favorable outcome was observed in 18,7% patients, a "relatively favorable" - in 33,8%, a "relatively poor" in 17,2%. An analysis of correlations of the course and outcome with the variant of the manifesting episode and some clinical and pathogenetic parameters allowed to single out a number of statistically significant criteria of clinical and social prognosis. The nosologic assessment at the time of follow-up showed that 76,2% of patients had schizophrenia (episodic-progressive - 61,1%, recurrent - 15,1%) and 23,8% - schizoaffective psychosis. A comparison of the present results with the results of the earlier study, allows to make a conclusion on the current pathomorphosis of EPET with the increase of favorable tendencies in the disease course and outcome, reduction of the progression rate and substantial decrease of cases of the transition to chronic stage.
The aim of this study was to describe the prognosis and risk factors for the first readmission after postpartum psychosis.
Linking the Danish Medical Birth Register and the Danish Psychiatric Central Register from 1 January 1973 to 31 December 1993 revealed 1173 women diagnosed with a psychosis within 91 days of delivery. The relative risk (RR) of readmission was estimated using Cox proportional hazard regression models.
An increased risk of readmission was found for women with a diagnosis of schizophrenia (RR = 2.4, 95% CI = 1.9-3.1) and for women with a history of previous psychiatric admission (RR = 1.8, 95% CI = 1.5-2.1) compared to first-admitted women with other functional psychoses. Unmarried women also showed an increased risk of readmission, and only preterm delivery was associated with a reduced risk of readmission.
Preterm delivery predicts the best prognosis after postpartum psychosis. The majority of readmissions were related to the psychopathology of the patient and to lack of social support.
The Client Assessment of Strengths Interests and Goals (CASIG), a measure that assesses the treatment outcomes of individuals with serious and persistent mental illness, has previously shown adequate psychometric properties with an American sample. Since it assesses quite specific skills and needs, it is necessary to assess its cultural relevance and psychometric characteristics before using it in a different country. Hence, the purposes of this study were to (1) adapt CASIG to the culture of a Canadian setting and translate its items and directions into French, (2) determine the psychometric characteristics of the adapted English and French versions of CASIG, and (3) identify its latent constructs via an exploratory factor analysis. The CASIG self-report (CASIG-SR) measure was administered to 224 consumers living in the community, and the CASIG informant (CASIG-I) measure to 31 clinicians answering for 172 consumers. The participating consumers also completed the Behavior and Symptom Identification Scale-32 (BASIS-32), the Short Form Health Survey-36 (SF-36), and the Camberwell Assessment of Needs (CAN). The informants also completed the clinician version of the CAN. The CASIG-SR and the CASIG-I had adequate internal consistency, test-retest, and interrater reliabilities. Correlations of the consumers' and informants' results with the BASIS-32, SF-36, and CAN provided evidence of convergent and discriminant validity, as did contrasts between higher and lower functioning community consumers. The factor analysis also supports the construct validity of the assessment. The results confirm the psychometric adequacy of the adapted and translated CASIG in Canada.
Differences between 24 female and 35 male clients were assessed at entry into an intensive case management program serving homeless shelter residents and again nine months later. Both men and women were socially isolated, with small social networks and severe deficits in social functioning. Histories of homelessness were similar for both genders, and there were no gender differences in psychopathology at baseline or follow-up. At entry into the program women had higher levels of social skills, larger and more supportive networks, and better housing conditions than men, but these differences disappeared after the subjects spent nine months in the program. Inadequate living conditions may have contributed to the more negative initial picture for men. Although there were more similarities than differences between the men and women in this sample, more research on gender differences is needed to design and evaluate programs for homeless mentally ill persons.
OBJECTIVE: To examine gender differences in prediction of long-term outcome in first episode psychosis (FEP). METHOD: Eighty-one male and 72 female FEP patients were compared regarding the sensitivity and specificity of the Predictive Rating Scale (PRS). The contributions of pre-admission clinical and socio-demographic characteristics to a poor 5-year outcome were analysed for males and females separately. Gender differences in the relations between predictors and outcome were examined using the equality of correlation comparing correlation coefficients. RESULTS: The sensitivity of the PRS was significantly better for males than for females. The following items: 'the highest Global Assessment of Functioning (GAF) the year before first admission
A recently reported outbreak of HIV among injection drug users in Vancouver determined that, in early 1997, 23% of this population was HIV-positive, and that HIV-negative injection drug users were becoming positive at the rate of 18.6% per year, the highest rate reported in North America. One significant factor behind the outbreak is the high prevalence of injection cocaine use among drug addicts in Vancouver. Cocaine, because it has a short "high," creates a need for more frequent injections and therefore increases the likelihood of needle sharing and HIV transmission. The mentally ill in Vancouver are particularly at risk for HIV infection because of their vulnerability to substance misuse and because large numbers of them reside in the main drug-using neighborhood. The provincial and federal governments have made $4,700,000 available to respond to this public health emergency, to be spent on the expansion of community services, including a number of needle-exchange sites. Accessing these and other health care services continues to be a challenge for injection drug users who also suffer from serious mental illnesses; for these persons an assertive case management model may be the most effective way of maintaining continuity of care.
To describe the profile of the intensive use of mental health services over a 4-year period in a population of 1.1 million people.
Data obtained from computerized hospital separation records and physician reimbursement claims were combined to form patient-based histories of mental health care utilization. Users of mental health services in a 24-month period were hierarchically classified as having a psychotic disorder (ICD-9-CM 295-299) or a nonpsychotic disorder (ICD-9-CM 300-301, 306-309, 311). Intensive use was defined as 12 or more contact months or a minimum of 2 episodes of therapy in the 24-month period. The cohort of intensive users were followed over the subsequent 24-month interval to describe the persistence of intensive use.
In the initial observation periods, intensive users constituted 27.4% of individuals in treatment for psychotic disorder and 4.4% of persons in treatment for nonpsychotic disorder. These 2 groups, which represent 7.4% of all users of mental health care, were responsible for 53% of physician services, 72.7% of contacts with psychiatrists, and 64.4% of acute psychiatric bed days in the initial period. In the follow-up period, intensive use status was replicated by 44.6% of the cohort.
The diagnostic and therapeutic characteristics of intensive users of mental health services are heterogeneous. There is substantial persistence of intensive mental health service use over time.
