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.

Subjective versus interviewer assessment of global quality of life among persons with schizophrenia living in the community: a Nordic multicentre study.

BACKGROUND: Few studies have investigated differences between subjective and externally assessed quality of life in individuals with a severe mental illness. In a sample of 387 patients with schizophrenia living in the community the present study investigated the association between subjective and interviewer-rated quality of life, clinical and sociodemographic factors related to the two assessments, and if discrepancies in the assessments were related to any clinical or social features of the patients. METHOD: The study was a Nordic multicentre study with a cross-sectional design. Instruments used were the Lancashire Quality of Life Profile, the Brief Psychiatric Rating Scale, the Interview Schedule for Social Interaction, Camberwell Assessment of Needs and General Assessment of Functioning. RESULTS: The correlation between subjective and interviewer-rated quality of life was moderate (ICC = 0.33). More severe affective symptoms, fewer emotional relations and a lower monthly income were related to poorer subjectively rated quality of life but in a stepwise multiple regression analysis accounted for only 14.1% of the variance. Poorer interviewer-rated quality of life was mainly related to a more severe psychopathology but also to a lower monthly income, fewer emotional relations and not being employed. Together these factors accounted for 45.5% of the variance. A greater discrepancy between the subjective and the interviewer rating was found in patients with less affective symptoms, unemployment, and a better social network. CONCLUSION: Only a moderate correlation between subjective and interviewer-assessed global quality of life was found, implying that the sources of assessment differed, as was also shown in subsequent regression models. It is concluded that both perspectives on the patient's quality of life may be valuable for treatment planning, especially in cases where differences in quality of life assessment related to the patient's psychopathology may be expected.

Neurocognitive and psychopathological correlates of self-monitoring ability in schizophrenia.

In a previous study reported by our group one salient finding was that many patients with schizophrenia appeared to be unable to judge their own quality of life (QoL) and that this inability was associated with negative symptoms. The association between negative symptoms, poor self-monitoring capacity and lack of insight might be explained by a common underlying factor, i.e. neurocognitive impairment. Fifty schizophrenic patients were examined by symptom ratings and a comprehensive neuropsychological test battery. The cognitive performance of the patients was very poor. The major findings of the present study were the association between clinically rated Lack of judgement (PANSS G12) and 1) a set of standard performance and executive indices of the computerised tests, and 2) difference scores between objective performance/strategies and self-ratings of the same attributes. There appears to be a substantial contribution of cognitive and executive problems to the poor judgement and lack of insight of schizophrenic patients, and these problems can to some extent be assessed objectively.

Schizophrenia and contact with health and social services: a Nordic multi-centre study.

BACKGROUND: In a Nordic multi-centre study investigating the life and care situation of persons with schizophrenia living in the community, factors explaining use of health and social services were examined. METHOD: Four hundred and eighteen individuals with schizophrenia from 10 sites were interviewed about their contact with different services (support functions within and outside the mental health services, general practitioners (GPs), physicians in the mental health, psychotherapy, day-care and inpatient treatment), psychopathology, social network and needs for care. RESULTS: Physicians and support contacts within the mental health system were most used and GPs and psychotherapy least. Three groups of variables were stabile predictors of contact: rural-urban differences, diagnoses (hebephrenic schizophrenia associated with less contact with physicians in the mental services and more with GPs) and health needs as experienced by the patients. No differences between the centres with regard to total service use were found, but the patterns of contact reflected urban-rural variance. A low number of health needs predicted contact with physicians within the mental health services, whereas a high number of such needs was related to contact with GPs and support functions within the mental health services. Social relations exhibited the highest number of unmet needs. CONCLUSIONS: Contact with physicians working in the mental health services was much more common than contact with GPs. Based on a broad spectre of demographic, clinical and network variables, it was not possible to find models that explained substantial parts of the variance of service use. Patterns of contact were different in rural, town and city-surroundings, and with the exception of psychotherapy, the rural pattern was characterized by use of less specialized services. The importance of health needs and diagnosis as predictors of contact illustrate the profound and lasting effects on health of having a diagnosis of schizophrenia.

The relationship of needs and quality of life in persons with schizophrenia living in the community. A Nordic multi-center study.

The relationship between needs for care and support and subjective quality of life was investigated in a cross-sectional multi-center study including 418 individuals with schizophrenia from 10 centers in Nordic countries. Needs in 22 domains were investigated by interviews with key workers and their patients using the Camberwell Assessment of Need scale, and quality of life by the Lancashire Quality of Life Profile. The results showed that key workers rated slightly more needs than patients. To have more unmet needs, as rated by both key workers and patients, were correlated to a worse overall subjective quality of life, while met needs showed no such association. A regression analysis, controlling for clinical and social characteristics of the patients, showed more unmet needs to be associated with a worse quality of life, accounting for 6% out of a total of 41% explained variance in subjective quality of life. Regression analyses of the relationship of unmet needs in specific life domains and overall quality of life showed that unmet needs in five domains as perceived by patients accounted for 17% of the explained variance in overall quality of life. More than half of this variance was related to an unmet need in the domain of social relationships. It is concluded that unmet needs are of specific importance in needs assessment and that attention must be paid to separate met needs for care and services from unmet needs, since the latter seem more important to consider in order to improve outcome of interventions with regard to quality of life. Specific attention should in this context also be paid to unmet needs concerning social relationships and problems with accommodation.

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.