Quality of life and burden in parents of outpatients with schizophrenia.

BACKGROUND: Since the late 1950s, several studies have reported the burden faced by families living with a mentally ill relative. These studies have pointed out the importance of a progressive mental health service, focusing not only on the treatment of the patients, but also on the needs of the relatives. The aims of the present study were to compare the quality of life of parents of outpatients with schizophrenia with a randomly selected reference group and the relation between quality of life and burden on the parents. SUBJECTS: The sample comprised all parents (n=38) of outpatients with schizophrenia at an outpatient clinic in 2001, where the patients had contact at least once a week with both parents and staff. The parents were compared with a reference group (n=698). METHODS: The self-rating scale Quality of Life Index (QLI) was used to assess quality of life in both groups. In the case of the parents, semistructured interviews were supplemented by the data collection to assess the degree of burden with the Burden Assessment Scale (BAS). The outpatients were also interviewed to assess their global function with the Global Assessment of Functioning scale (GAF) and the Clinical Global Impression scale (CGI). RESULTS: The parents were significantly less satisfied with their overall quality of life (p<0.05). There was a correlation between lower overall quality of life and higher perceived burden r=0.58 (p<0.01). There was also a correlation between lower values on the family subscale and social subscale within the QLI and higher subjective burden r=0.54 (p<0.01) and r=0.52 (p<0.01), respectively. CONCLUSION: These results indicate that caregiving has an influence on the family situation and on the quality of life of parents. These findings suggest that the professions working with the parents must have an approach focusing not only on the care given to the ill daughter or son, but also on the parents' situation.

Needs in outpatients with schizophrenia, assessed by the patients themselves and their parents and staff.

BACKGROUND: There has been a change in psychiatric care from a hospital-oriented care system to an outpatient-centred system, which has underlined the importance of support alternatives. METHODS: The sample was drawn from outpatients with schizophrenia at an outpatient clinic in 2001. We used structured interviews when interviewing outpatients, parents and staff. The interview with the patient included the patient's needs, global function, clinical global impression and insight. Both parents and staff were interviewed about the patient's needs. RESULTS: The mean value of GAF was 56 +/- 10, CGI 4 +/- 1 and 89% of the patients had full insight into their illness. The patients rated the total score of the severity of needs at a mean of 7 +/- 4, while the parents' and staff's rating was 9 +/- 5. The needs ranking between patients and parents and patients and staff showed a correlation of rho = 0.65 (p < 0.01) and parents and staff rho =0.95 (p < 0.01). The parents rated more problems involving physical health and money than the patients. CONCLUSION: When planning mental health in the future, it is important to assess the views of the patients, the parents and the staff from a multiple perspective.

Need assessment and quality of life in outpatients with schizophrenia: a 5-year follow-up study.

The present study is a 5-year follow-up of patients with schizophrenia who were in-patients for more than 3 months in 1993. In all, 19 patients fulfilled the criteria and were interviewed 6 months after their discharge. Seventeen of them also participated in a follow-up 5 years later. Their needs were independently rated by themselves and by their key workers according to the Camberwell Assessment of Need (CAN, research version 3.0). The interview with the patients also included quality of life assessed by the Quality of Life Scale (QLS-100). The results from CAN showed a difference when using a cut-off point for higher vs. lower problem at 10 needs. Using this cut-off point, five patients at the baseline and one at the follow-up had higher problems. The need ranking with key workers showed a correlation of rho = 0.68 at the baseline and rho = 0.74 at the follow-up. QLS-100 showed that the patient's total number of unsatisfied items were significantly higher (p = 0.01) at the baseline than at the follow-up. At the follow-up, full insight into their illness was shown by most of the patients. There are several possible explanations associated with the increased quality of life, e.g. less unsatisfied items among some patients and greater autonomy at the follow-up.

Panic disorder and the Defence Mechanism Test.

The aim was to study defence categories according to the modified version of the Defence Mechanism Test (DMTm) and to see if there was a relationship between DMTm and severity of illness. The material consists of 23 patients with panic disorder according to DSM-III-R who participated in a long-term follow-up of two clinical trials. The most common defence categories were repression, denial, disavowal or denial of the threat relation or of the identity of the peripheral person. The patients with denial or polymorphous identification had more severe symptoms and the latter group also were more handicapped by their symptoms. Denial and disavowal or denial of the threat relation may be defence categories, which are not so effective in preventing the individual from experiencing anxiety. Polymorphous identification, although not so common, does not seem to be an appropriate defence among patients with panic disorder.