Family burden during exacerbation of schizophrenia: quantification and determinants of additional costs.

BACKGROUND/AIMS: Family members of people with schizophrenia are heavily burdened. Thus, we aimed at quantifying the amount of additional efforts during the two weeks before hospitalisation of acute exacerbating psychosis compared to the time before. METHODS: By means of the semi-structured 'Interview for Measuring the Burden on the Family' we interviewed relatives of people with schizophrenia. To quantify additional burden we asked how much time a person who would take over the additional burden has to afford. Subscales of different sources of burden and total scales were correlated. RESULTS: An additional 8.9 hours per day would have to be spent in favour of the patient, which results in additional costs of Euro 3,115-Euro 4,984 (ca. pounds 2,100-3,400) for two weeks. The main sources of additional burden are quantity, quality and nature of contacts to the affected. This includes the frequency of contact to the affected, the whereabouts and symptoms of the affected, as well as the social contacts of the relatives. CONCLUSIONS: Our results clarify the quantitative aspect of care provided by relatives of people with schizophrenia. Apart from the practical and emotional help to relatives the development of a diversified network of community psychiatry services, e.g. day and night hospitals, as well as crisis accommodations should be established.

Virtual simulator as a training tool for endonasal surgery.

BACKGROUND: Virtual simulation could be an important tool for medical and surgical training as well as education. The efficacy of a simulator for endoscopic nasal procedures in a training program was evaluated. METHODS: The simulator is a medical and scientific tool for visualizing and interacting with three-dimensional volumetric data. Twenty endonasal operations with chronic rhinosinusitis were simulated by two 3rd-year residents and proctored by the senior surgeon 1 day before the actual surgery was performed with an endoscope and computer-aided surgery. A questionnaire was established. RESULTS: The surgical simulator may provide a better understanding of the morphology of the paranasal sinuses with a minor impact on performance of endoscopy by junior residents. Disadvantages identified were time consumption, absence of force feedback, and subtle handling of the joysticks. CONCLUSION: The virtual simulator allows the nonendoscopically nasal trained surgeon to understand and practice endonasal surgery using real-patient data but failed to make an impact on operating room performance. Furthermore, the simulator's effectiveness was limited by the absence of force feedback, subtle handling of the joysticks, and considerable time consumption.

Determinants of burden in caregivers of patients with exacerbating schizophrenia.

PURPOSE: Restriction in involuntary hospital admission and reduced lengths of inpatient stay increase burden on relatives of individuals with schizophrenia. This study aims at assessing the relationship between caregiver burden and behavioural disturbances of the affected, e.g. threats, nuisances, but also substance use and aggression. Two weeks before the last hospitalisation of the affected are considered as being the most burdensome period for relatives. SUBJECTS AND METHODS: Sixty-four relatives of schizophrenic patients were assessed by the semi-structured "Interview for Measuring the Burden on the Family". Subscales and total scales of burden were calculated. Predictors were identified by regression analyses. RESULTS: The most important predictor of burden is burden in the relationship between caregiver and the affected representing the changes in the relationship occurring in acute illness. Threats, nuisances, time spent with the affected, and burden due to restricted social life and leisure activities were additional predictors, but not aggression or substance abuse. Eighty-five percent of the cases could be assigned correctly. DISCUSSION AND CONCLUSIONS: To better encounter burden, relatives should learn to cope with disturbing behaviour of and altered relationship to the affected, but also with their own needs. Finally, relatives must be included in the decision whether or not an affected person should be hospitalised.