Assuntos
Psiquiatria Comunitária/organização & administração , Prontuários Médicos/normas , Pessoas com Deficiência Mental , Inquéritos e Questionários/normas , Assertividade , Terapia Cognitivo-Comportamental , Psiquiatria Comunitária/economia , Psiquiatria Comunitária/métodos , Psiquiatria Comunitária/tendências , Intervenção em Crise , Humanos , Hungria , Pessoas com Deficiência Mental/psicologia , Pessoas com Deficiência Mental/reabilitação , Medição de Risco , Fatores de Risco , Estresse PsicológicoRESUMO
OBJECTIVE: This random-controlled study evaluated benefits derived from continued integrated biomedical and psychosocial treatment for recent-onset schizophrenia. METHOD: Fifty cases of schizophrenia of less than 2 years duration were allocated randomly to integrated or standard treatment (ST) for 2 years. ST comprised optimal pharmacotherapy and case management, while IT also included cognitive-behavioural family treatment, that incorporated skills training, cognitive-behavioural strategies for residual psychotic and non-psychotic problems and home-based crisis management. Psychopathology, functioning, hospitalisation and suicidal behaviours were assessed two monthly and a composite index, reflecting overall clinical outcome was derived. RESULTS: IC proved superior to ST in reducing negative symptoms, minor psychotic episodes and in stabilising positive symptoms, but did not reduce hospital admissions or major psychotic recurrences. The composite index showed that significantly more IC patients (53%) had excellent 2-year outcomes than ST (25%). CONCLUSION: Evidence-based treatment achieves greater clinical benefits than pharmacotherapy and case management alone for recent-onset schizophrenia.
Assuntos
Antipsicóticos/uso terapêutico , Terapia Cognitivo-Comportamental/métodos , Continuidade da Assistência ao Paciente/estatística & dados numéricos , Tratamento Farmacológico/métodos , Esquizofrenia/terapia , Adolescente , Adulto , Terapia Combinada , Intervenção em Crise , Prestação Integrada de Cuidados de Saúde , Feminino , Humanos , Masculino , Recidiva , Esquizofrenia/tratamento farmacológico , Fatores de Tempo , Resultado do TratamentoRESUMO
OBJECTIVE: To develop a reliable standardized assessment of psychiatric symptoms for use in clinical practice. METHOD: A 50-item interview, the Current Psychiatric State 50 (CPS-50), was used to assess 237 patients with a range of psychiatric diagnoses. Ratings were made by interviewers after a 2-day training. Comparisons of inter-rater reliability on each item and on eight clinical subscales were made across four international centres and between psychiatrists and non-psychiatrists. A principal components analysis was used to validate these clinical scales. RESULTS: Acceptable inter-rater reliability (intra-class coefficient > 0.80) was found for 46 of the 50 items, and for all eight subscales. There was no difference between centres or between psychiatrists and non-psychiatrists. The principal components analysis factors were similar to the clinical scales. CONCLUSION: The CPS-50 is a reliable standardized assessment of current mental status that can be used in clinical practice by all mental health professionals after brief training.
Assuntos
Comparação Transcultural , Entrevista Psicológica , Transtornos Mentais/diagnóstico , Determinação da Personalidade/estatística & dados numéricos , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/psicologia , Manual Diagnóstico e Estatístico de Transtornos Mentais , Humanos , Capacitação em Serviço , Classificação Internacional de Doenças , Variações Dependentes do Observador , Escalas de Graduação Psiquiátrica/estatística & dados numéricos , Psicometria/estatística & dados numéricos , Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/psicologia , Reprodutibilidade dos Testes , Estatística como AssuntoRESUMO
OBJECTIVE: To evaluate the efficacy of two community-based programs that combined antipsychotic medication, family interventions and social skills training. METHOD: A randomized controlled trial with 2 years follow-up. The study included 84 patients with schizophrenic disorders, continuously managed in terms of care and treatment, and regularly assessed. Analysis was by intention-to-treat. RESULTS: Between-program comparisons showed significantly improved social function and consumer satisfaction in favour of the program 'Integrated Care' (IC) at the 2-year follow-up. The main clinically important differences between the two treatment programs studied were the procedures for shared decision making and patient empowerment in IC. CONCLUSION: The implementation of IC in clinical practice can improve social recovery and increase consumer satisfaction for patients with schizophrenic disorders. We identified specific procedures that might be added to improve the effectiveness of any program for severely mental ill people.
Assuntos
Antipsicóticos/uso terapêutico , Prestação Integrada de Cuidados de Saúde , Terapia Familiar , Participação do Paciente , Esquizofrenia/terapia , Comportamento Social , Adulto , Terapia Comportamental , Terapia Combinada , Serviços Comunitários de Saúde Mental , Tomada de Decisões , Feminino , Humanos , Masculino , Satisfação do Paciente , Relações Médico-Paciente , Resultado do TratamentoRESUMO
OBJECTIVE: Depressive symptoms in schizophrenia are associated with a substantial morbidity and mortality burden. The 'International Survey of Depression in Schizophrenia' was designed to evaluate current awareness and clinical approaches in this area. METHOD: A 48-item questionnaire was distributed to approximately 80 000 consultant psychiatrists world-wide. Responses were analysed using descriptive statistics. RESULTS: Respondents demonstrated considerable awareness of the prevalence and consequences of depression in schizophrenia. Although there was widespread adjunctive use of antidepressants, one-third of respondents indicated that they rarely or never prescribe these agents in combination with antipsychotic medication. There were considerable variations in opinions about the best approach to the treatment of depressive symptoms associated with schizophrenia. CONCLUSION: The considerable clinical burden of depressive symptomatology in schizophrenia was acknowledged by the majority of respondents to this survey. There was, however, little agreement on the best management strategy.