Schizophrenic patients: physical health and access to somatic care.

This study concerns the state of physical health and the availability of somatic care for 3,470 adult patients diagnosed as schizophrenic according to the research criteria established by the International Classification of Diseases (ICD-10 F20) and treated in public institutions. These institutions volunteered to participate in the study, whereas the patients were selected at random. Data concerning demographic characteristics, physical health, and access to somatic care are compared to that of a public health survey of a sample of the French population. The present study allows the estimation of ratios for a large number of diseases and of some risk factors among the target group. Heavy smokers and overweight individuals are more numerous among schizophrenics. Pathologies such as epilepsy, diabetes and AIDS infection are overrepresented. Patients' access to somatic care is more prevalent than that of the general population overall, similar to that of the less qualified workers or unemployed group. In this study, gender does not appear to allow prediction of care use for schizophrenics in contrast to the general population.

No season-of-birth effect in schizophrenic patients from a tropical island in the Southern Hemisphere.

The distribution of birth rates was examined in 668 schizophrenic patients born in Réunion, a tropical French island in the Southern Hemisphere, and compared with that in the general local population. We failed to observe a significant season-of-birth effect, either in the total sample of schizophrenic patients or in subgroups categorized by gender, age, or family history of schizophrenia. Seasonal factors do not appear to affect the yearly distribution of births among schizophrenic patients on Réunion Island. It is nevertheless possible that environmental factors which are seasonal in countries with more contrasting climates have a continuous effect, throughout the whole year, in subtropical areas. Conversely, these findings provide some evidence against the hypothesis that there is an age-incidence artifact in seasonal studies from countries in the Northern Hemisphere.

[Quality of life in children with chronic disease. Review of the literature and conceptual aspects]. / La qualité de vie chez l'enfant atteint de maladie chronique. Revue de la littérature et aspects conceptuels.

Most studies of the literature concerning the quality of life of children with chronic illness have been conducted in the somatic field, using objective criteria. However the concept of quality of life has evolved: while the first studies took into consideration the effects of somatic diseases on children or on their families, the recent studies tend to focus on the coping strategies developed by the families. The authors emphasize two main points concerning the evaluation and the concept of quality of life: 1) the measures of the quality of life should be "dynamic", i.e. they should deal with the developmental changes of the child; 2) due to the difficulty to clearly define the concept and to the variability of the available informations, a "convergence" notion should be preferably used: i.e. information should be collected from several sources (professionals, families and children) and should concern most domains of the child's life: school, health, games, relational life.

[Childhood difficulties: representations by the family and caregivers; value of interviews]. / Les difficultés de l'enfant: représentations de la famille et des soignants; intérêt d'une enquête.

This investigation was conducted in 7 consultation centers in child psychiatry of the Lyon region (France). The aim was to evaluate the influence of the care professional's response to the demands of the consulting party, on the evolution of the child. The investigation is based on what is said about the difficulties of the child, as manifested in the way care professionals, parents and children perceive them. Relevant instruments and a reliable methodology are used in assessing these various parameters. Results indicate that what happens in the first interview might be more important than the effective type of intervention in determining the evolution of the subsequent intervention.

[Study of the uni-dimensionality of the Yesavage-Brinck geriatric depression scale. Comparison between classical methods and Rasch's model]. / Etude sur l'unidimensionnalité de l'échelle de dépression gériatrique de Yesavage et Brink. Comparaison entre méthodes classiques et modèle de Rasch.

The authors present a contribution to the french validation of the self-rating questionnaire of the depression in the elderly proposed by Yesavage and Brink (1982), the Geriatric Depression Scale (30 items). This study focusses on the assessment of the homogeneity and of the unidimensionality of this scale. 99 aged women living in old-people homes or attending a geriatric somatic day-hospital, not known to be psychiatrically ill, filled the GDS and were interviewed by either a psychiatrist or by a clinical psychologist. This interview yielded 44 cases of Major Depressive Disorder or of Dysthymia (DSM III). Firstly, we have applied the classical correlational methods of assessment of scale Reliability and Construct Validity: Cronbach's coefficient alpha and item-total correlations (homogeneity) and Principal Component Analysis (PCA) without rotation. Then, we have performed a Rasch Model Analysis: this method which belongs to the general frame of Latent Trait Theory relies on a probabilistic model of subject's response to individual questions. In the Rasch model, the response probability of a given subject to a given item is a logistic function of the difference between the item location parameter and the subject location parameter along a single continuous latent dimension. Our results have shown that the Cronbach's alpha was very high (.902) and that the item-total correlations were quite satisfactory (mean .470), thus giving a strong impression of homogeneity (similar to unidimensionality for many authors).(ABSTRACT TRUNCATED AT 250 WORDS)

[Outcome of care in a pediatric psychiatry outpatient clinic: "photography" of seven consultation centers]. / Le parcours des consultants en pédopsychiatrie: "photographie" de sept centres de consultation.

A survey was carried out on 7 pedopsychiatric outpatient centres in the area of Lyon in order to evaluate the general outcome of care in consulting children and their families. Five public centres (centres médico-psychologiques) and 2 non-profit making private centres (centre médico-psychopédagogiques and centre d'action médico-sociale précoce) were part of the survey which included 706 children and adolescents. The survey showed that many children stop attending these centres; although, the numbers were significantly higher in the public centres compared with the non-profit making private centres. The authors suggest that differences in status and management between the two types of centres, leading to different conditions of functioning, on a practical as well as on a symbolic level, may be responsible, at least in part, for the different outcome in care between the 2 types of centres.

[Mortality survey of treated mentally ill patients. Methodological reflections]. / Enquête de mortalité des malades mentaux en soins. Réflexions méthodologiques.

All the studies performed in many industrialized countries have shown that the mortality-rates of mentally-ill patients are higher than expected, despite of a recent trend indicating a diminishing difference by comparison with control-groups (review in Corten et al). In France, the works by Casadebaig and Quemada focused on the mortality-rates of psychiatric in-patients from 1968 to 1982 cannot unfortunately be performed nowadays because of an administrative change in the nation-wide death-registration. This is the main reason for the purpose of a longitudinal study on this topic for the next years in our country. The chief goals are concerned with public health and with analytical epidemiology: defining the Standardized Mortality Ratios (SMR) globally and by cause of death for the most typical clinical groups. Methodology and feasibility. The main methodological issues have to be examined first before implementation. Theoretically, one should wait that a multicentric longitudinal survey could be representative of the whole population of french mentally in and out-patients. Actually, this study will be more likely performed with collaborative centers agreeing for data-collection; and secondly, it will be necessary to control that these collaborative centers do not differ significantly from the other public psychiatry-departments for the main variables that may influence the mortality-rates. The definition of cases and their identification will be done according to the International Classification of Disorders (ICD) considering its ninth and tenth revision. This research also needs to include a large number of patients because of statistical constraints.(ABSTRACT TRUNCATED AT 250 WORDS)

[Mortality of mentally ill patients. Review of the literature]. / Mortalité des malades mentaux. Revue de la littérature.

UNLABELLED: Overmortality among psychiatric patients has been a regular observation from the XIXth century to nowadays. If the rates of mortality have decreased in these last fifty years, they still remain higher than in the general population Standardized Mortality Ratio (SMR) (two or three times greater than normal). The authors reviewed 53 recent articles from european, north american, japanese and israelian researches on this question. Most of them proceed from crossings between psychiatric case register and death-register, and concern inpatients only (Brook, Giel, Saugstad, Mortensen, Herman, Haugland, Rorsman, Sturt, Winokur, Zilber). Some take into account outpatients as well (Eastwood, Koranyi, Martin, Ribourdouille). SMR are calculated and comparisons are made between different groups by sex, age, diagnosis and cause of death. Those are usually divided into 2 categories: natural deaths somatic diseases) and unnatural deaths (suicides-accidents). MAIN RESULTS: Among the patients, mortality rates are higher for men than women, but SMR are higher for women. The highest mortality relative risk is observed between 20 and 40 years of age. Except for three authors, unnatural deaths are not sufficient to explain overmortality. SMR for suicides and accidental deaths are decreasing with age; the relative risk is more important for outpatients, men, some specific diagnoses (affective disorders, acute schizophrenia) and during the first two years of the course of the illness. Suicide rates have been increasing among patients these last twenty years. Natural death is more frequent among patients with organic brain syndromes but is also in excess for the other patients. Cardiovascular diseases represent the first cause of mortality but infections (pneumonia-influenza) and metabolic diseases are over-represented.(ABSTRACT TRUNCATED AT 250 WORDS)

[Social context of the access to care in public psychiatry. An intersector study in the Rhône department]. / Le contexte social de l'accès aux soins en psychiatrie publique. Etude intersectorielle du Rhône.

We studied the social status of psychiatric patients (N = 1085) in care for the first time in the public psychiatric department in an area surrounding Lyon. The survey shows some demographic and social factors characterizing this population. We examined also how clinicians take life-events into account during this first access. The findings are discussed by comparison with other works seen in the literature.

[Life events and breast cancer. Initial results of a comparative study dealing with 100 cases and their control]. / Evènements de la vie et cancer du sein. Premiers résultats d'une étude comparative portant sur 100 cas et leurs témoins.

The authors present the first results of a case-control study relative to the importance of life events in the 5 years which precede the clinical apparition of breast cancer. This study has examined a group of 100 women of french origin, aged from 45 to 65 years and carriers of a breast cancer which had been diagnosed less than a year ago, as well as their controls matched according to age. If the total number of events is similar in the two groups, there appears a negative peak of social desirability events in the two years preceding the diagnosis of cancer. The quantification of event impact by the subjects shows a greater vulnerability in women with cancer.