Dead and forgotten--postmortem time before discovery as indicator of social isolation and inadequate mental healthcare in schizophrenia.

The psychiatric care of patients with schizophrenia has changed dramatically following the "deinstitutionalization" of mental health care in many Western countries. In a study of forensic autopsies in the Swedish city of Malmö between 1952 and 2005, we found an increase over time in the number of patients with schizophrenia whose bodies were not discovered until late after death, which correlated closely with the decrease in the number of hospital beds in the psychiatric services used by this group of patients. This indicates a strong increase in the social isolation and unavailability of adequate mental health care for patients with schizophrenia.

Symptoms profile and quality of life in rural and urban patients with chronic psychoses.

The symptoms profile (modified Positive and Negative Syndrome Scale, PANSS) and the quality of life (Lancashire Quality of Life Profile, LQLP, and the Quality of Life Scale 100, QLS-100) were compared between two groups of patients with chronic psychoses: a rural group of 19 patients living in villages with < or =300-10,000 inhabitants and far away from a large city, and an urban group of 19 patients living in a major city with 250,000 inhabitants. The patients were matched pair-wise for sex, age, global assessment of functioning (GAF) and psychiatric symptoms (modified PANSS, total score). Seventeen of the pairs were diagnosed with schizophrenia, and two pairs with delusional disorder. The symptoms profile indicated more negative symptoms and less positive symptoms for the rural group, compared with the urban group, with a significantly lower degree of spontaneity in the rural group. No group differences were found in the QLS-100, or in the specific quality of life variables according to LQLP. However, the rural group had significantly higher self-rating of the general quality of life variables of the LQLP, i.e. satisfaction with well-being, general health and mental health. The results are discussed in view of a possible relation between negative symptoms and impairments in social cognition and insight.