Psychosocial functioning in relation to symptomatic remission: A longitudinal study of first episode schizophrenia.

OBJECTIVES: The aims of the study were: (1) to evaluate longitudinally symptomatic remission in first-episode (FE) schizophrenia, (2) to describe symptoms, social functioning and quality of life (Qol) in relation to remission status, and (3) to determine the long-term outcome of schizophrenia and its early predictors. METHODS: Sixty-four patients were assessed 1 month after a first hospitalization (T1), 12 months (T2), 4-6 years (T3), and 7-11 years (T4) after T1. The patients were allocated to three remission groups according to their remission status over the whole observation period, e.g. stable remission (SR), unstable remission (UR) and non-remission (NR). The PANSS, Social Functioning Scale and WHOQoL were used to evaluate the patients' psychosocial functioning levels, symptomatic and functional remissions and satisfying QoL. A good outcome was defined as meeting, simultaneously, the criteria of symptomatic and functional remissions and satisfying QoL at T4, while failure to meet all of these criteria was defined as a poor outcome. RESULTS: Among them, 17.2% patients were in stable remission, 57.8% in unstable remission and 25.0% were unremitted at all time points. The SR group had lower levels of psychopathological symptoms and reported better social functioning and QoL than the NR group. During the follow-up, the symptoms increased, social functioning slightly improved and QoL did not change. At T4, 53% of the sample had a poor outcome, which was independently predicted by the longer duration of untreated psychosis and a lack of satisfying QoL at T1. CONCLUSIONS: Our results demonstrate that: (1) the long-term course in schizophrenia is heterogeneous and that three illness trajectories exist, (2) social functioning and QoL are only partially connected with symptomatic remission (3), the risk of a poor outcome may potentially be reduced by appropriate interventions at an early stage of the illness.

Factors contributing to cognitive deficits in elderly residents of rural areas.

OBJECTIVE: Due to the growing aging of societies an increasingly large group of people suffers from age-related impairment of cognitive functions and thus reducing the quality of life of the elderly. The purpose of the study was to evaluate the efficiency of cognitive functions in a group of aging residents of rural areas. PATIENTS AND METHODS: The inhabitants of a rural area were recruited and assessed: cognitive function as well as intellectual and physical activity, number of years of education, presence of diseases, using stimulants, diet, sources of living, marital status and family situation Subjects were divided into two groups: persons above 65 and older, constituting the studied group and persons between 40 and 64 years of age, constituting the control group. Both groups did not significantly differ in terms of sex or years of education. RESULTS: Statistically significant differences (p < 0.05) were found in the results of the tests concerning such functions as the sight recognition memory and spatial recognition memory, spatial operating memory both on the strategy level and on the level of committed errors. An analysis of the results obtained in the group of elderly people did not indicate any major differences between men and women as regards the analyzed cognitive functions, no statistically significant differences were found in cognitive testing depending on the number of years of education. The studied persons included in the physically active group scored better in the visual memory and learning tests. CONCLUSIONS: The conducted studies elucidated the dependence of the level of cognitive functions on age, a positive impact of physical activity on some cognitive functions, however we could not find differences between the efficiency of those functions and education, sex, presence of somatic diseases and activity of persons aged > 65.

Quality of life and depression in schizophrenic patients.

PURPOSE: The aim of the study was to assess depressive symptoms, and to establish their influence on the subjective and objective quality of life (QOL) in schizophrenia patients. MATERIAL AND METHODS: Seventy four subjects: 46 male and 28 female, aged 24.7 +/- 6.7 years, were enrolled for the study. World Health Organization of Life Instrument-Bref (WHO-QOL-BREF), Social Functioning Scale (SFS) and Calgary Depression Scale for Schizophrenia (CDSS) were used. RESULTS: Severity of depressive symptoms showed moderate correlation with objective and strong correlation with subjective measures of QOL. CONCLUSIONS: Detection and appropriate treatment of depressive symptoms in schizophrenic patients may affect their functioning and perception of own health.

Burnout, stress and styles of coping among hospital nurses.

PURPOSE: The evaluation of professional burnout among hospital nurses and the analysis of correlations between burnout and a subjectively perceived stress and coping styles. MATERIAL AND METHODS: A study sample consisted of 227 nurses from general medical, neurological and psychiatric hospital wards. A set of 3 questionnaires was used, including Maslach Burnout Inventory (MBI), Coping Inventory for Stressful Situations (CISS) and Subjectively Perceived Stresss (SPS). RESULTS: Average and high level of burnout in the emotional exhaustion (EE), depersonalisation (D) and personal accomplishment (PA) was present at 71%, 39.8% and 77% of nurses respectively. A significantly higher level of burnout was noted in the subgroup of general medical nurses. The diferences involved the total MBI score and the results of the subscales EE and D (p < 0.01). A significant correlation has been found between the subjectively perceived stress and the level of burnout (r = 0.51, p < 0.01). Significant correlations has been found between MBI scores and CISS scores. Correlation between burnout and a task oriented coping was negative and correlation between burnout and emotion oriented coping was positive. CONCLUSIONS: The level of stress influences the professional burnout among nurses. There is a diversity in the level of burnout depending on the specialization at work, which is not accompanied by a similar diversity in the subjectively perceived stress. The correlation between burnout and a coping style is rather weak, but statistically significant.

Objective and subjective quality of life in schizophrenic patients after a first hospitalization.

PURPOSE: There is no single, universally accepted definition of quality of life (QOL). Both subjective and objective information is necessary to assess QOL. The aim of the study was to evaluate in cross-sectional and prospective manner objective and subjective quality of life in schizophrenic patients 1 month after hospitalization and in one year follow-up. MATERIAL AND METHODS: A study sample consisted of 86 schizophrenic subjects: 52 male and 34 female; age 25.5; +/-5.8 (range 17-47) and control group of matched 52 male and 34 female subjects were enrolled. Subjective QOL scale (WHOQOL-BREF), Social Functioning Scale (SFS) and structured questionnaire were used. Patients were evaluated 1 month (T1) and 13 months (T2) after a discharge from the hospital. RESULTS: In both T1 and T2 we found similar levels of SFS score and subjective measurement of QOL in patients, which were significantly lower than in healthy controls. CONCLUSIONS: This study showed that both objective and subjective quality of life are significantly decreased directly after hospitalization, and they are relatively stable in 1-year follow-up.

Quality of life in stroke patients.

OBJECTIVES: To describe global and domain-specific quality of life (QOL) after stroke and to identify the factors that are important for post-stroke QOL. MATERIAL AND METHODS: A hospital-based sample of 72 stroke patients was followed up for 6 months after stroke onset. QOL was assessed using the Polish version of the Quality of Life Index. Regression analysis was performed to identify the variables that best predicted QOL. RESULTS: The overall QOL of stroke patients was relatively good, although worse than that of subjects in a comparison group. The highest QOL was found in the 'Family' domain, and the lowest in the 'Health and functioning' domain. Emotional support, depression and functional disability were three separate variables explaining 38% of the variance in QOL. CONCLUSIONS: Strengthening of family support, treatment of depression and reduction of physical dependence may be the decisive factors in improving post-stroke QOL.