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Relapsing versus non relapsing course of schizophrenia: a cohort study in a community based mental health service

Published online by Cambridge University Press:  18 May 2011

Vittorio Di Michele ,
Francesca Bolino ,
Monica Mazza ,
Rita Roncone  and
Massimo Casacchia
Vittorio Di Michele*
Affiliation:
Department of Mental Health, Mental Health Center of Pescara, Pescara, Italy University of L'Aquila, Department of Psychiatry, L'Aquila, Italy
Francesca Bolino
Affiliation:
Department of Mental Health, Mental Health Center of Pescara, Pescara, Italy
Monica Mazza
Affiliation:
University of L'Aquila, Department of Psychiatry, L'Aquila, Italy
Rita Roncone
Affiliation:
University of L'Aquila, Department of Psychiatry, L'Aquila, Italy
Massimo Casacchia
Affiliation:
University of L'Aquila, Department of Psychiatry, L'Aquila, Italy
*
Address for correspondence: Dr. V. Di Michele, via Berardinucci 95, 65123 Pescara (Italy). Fax: +39-085-4253440 E-mail: [email protected]
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Summary

Aim - We examined the effect of several clinical variables on the tendency to relapse and to require hospitalization in a cohort of patients, living in the community and followed up naturalistically for seven years. Method - Forty-six patients affected by schizophrenia and schizoaffective disorder, according to both DSM-IV and ICD-10 criteria, were assessed by Positive and Negative Syndrome Scale and Life Skills Profile (LSP). All patients consecutively enrolled, were assessed in a stable clinical phase of illness and treated as usual by their reference psychiatrist. Social and clinical outcome was assessed yearly for seven years after the study entry and analyzed with survival analysis. Results - Patients who did not relapse, were characterized by higher functioning, lower positive symptoms, higher ability in self-care and non-turbulence and higher IQ at their baseline clinical evaluation. These variables were entered in a Cox regression model to corroborate the predictive power on the relapsing course of illness. Only IQ and non-turbulence scores of LSP were entered in the equation (Wald method: p=0.007 and p=0.002 respectively). Conclusions - Several factors interact with the course of illness and influence the tendency to require hospitalization. In the present study we report that non-turbulence is a significant predictor of a non-relapsing course of illness. Further studies are needed to clarify the role of other mediating variables.

Declaration of Interest: none.

Keywords

schizophreniahospitalizationoutcomecommunity psychiatry.
Type
Original Articles
Information
Epidemiology and Psychiatric Sciences , Volume 16 , Issue 1 , March 2007 , pp. 50 - 58
Copyright
Copyright © Cambridge University Press 2007

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References

Bibliografia

American Psychiatric Association 1994. Diagnostic and Statistical Manual for Mental Disorder, 4th ed.American Psychiatric Association: Washington DC.Google Scholar
Arseneault, L., Moffitt, T.E., Caspi, A. & Taylor, P.J. & Silva, P.A. 2000. Mental disorders and violence in a total birth cohort: results from the Dunedin Study. Archives of General Psychiatry 57, 979–986.Google Scholar
Bromet, E.J. & Fennig, S. 1999. Epidemiology and natural history of schizophrenia. Biological Psychiatry 46, 871–881.Google Scholar
Burns, T., Fioritti, A., Holloway, F., Malm, U. & Rossler, W. 2001 Case management and assertive community treatment in Europe. Psychiatric Services 52, 631–636.CrossRefGoogle ScholarPubMed
Butzlaff, R.L. & Hooley, J.M. 1998. Expressed emotion and psychiatric relapse: a meta-analysis. Archives of General Psychiatry 55, 547–552.Google Scholar
de Girolamo, G. & Cozza, M. 2000. The Italian psychiatric reform. A 20-year Perspective. International Journal of Law and Psychiatry 23(3-4), 197–214.CrossRefGoogle ScholarPubMed
Dickerson, F., Boronow, J.J., Ringel, N. & Parente, F. 1996. Neurocognitive deficits and social functioning in outpatients with schizophrenia. Schizophrenia Research 21, 75–83.Google Scholar
Di Michele, V. & Bolino, F. 2004. The natural course of schizophrenia and psychopathological predictors of outcome - A communitybased cohort study. Psychopathology 37 2, 98–104.CrossRefGoogle ScholarPubMed
Di Michele, V., Bolino, F., Di Zio, G. & Pincini, P. 2001. Symptoms and social functioning features are aggregate in a tripartite structure. Epidemiologia e Psichiatria Sociale 10 3, 186–193.CrossRefGoogle Scholar
Economou, M., Palli, A. & Falloon, I. 2005. Violence, misconduct and schizophrenia: Outcome after four years of optimal treatment. Clinical Practice and Epidemiology in Mental Health 1, 3–9.CrossRefGoogle ScholarPubMed
Eklund, M., Hansson, L. & Bejerholm, U. 2001. Relationship between satisfaction with occupational factors and health-related variables in schizophrenia outpatients. Social Psychiatry and Psychiatry Epidemiology 36, 79–85.Google Scholar
Gaebel, W 2004. Course, typologies, treatment principles, and research concepts. Pharmacopsychiatry 37, Suppl 2, 590–597.CrossRefGoogle ScholarPubMed
Guy, W. 1976. ECDEU Assessment Manual for Psychopharmacology. Revised. DHEW Publication No (ADM). US. National Institute of Health: Rockville.Google Scholar
Gaddini, A., Franco, F., Di Lallo, D. & Biscaglia, L. 2005. Hospitalisation for schizophrenia in acute psychiatric wards of the Lazio region: a 4-year follow-up study. Epidemiologia e Psichiatria Sociale 14 4, 227–234.CrossRefGoogle ScholarPubMed
Harding, C.M. & Keller, A.B. 1998. Long term outcome of social functioning. In Social Functioning in Schizophrenia (ed. Mueser, K. & Tamer, N.), pp 134–148. Allyn & Bacon: Needham Heights, MA.Google Scholar
Hodgins, S., Tiihonen, J. & Ross, D. 2005. The consequences of conduct disorder for males who develop schizophrenia: association with criminality, aggressive behavior, substance use and Psychiatric Services. Schizophrenia Research 78, 323–335.CrossRefGoogle ScholarPubMed
Junginger, J. & McGuire, L. 2004. Psychotic motivation and the paradox of current research on serious mental illness and rates of violence. Schizophrenia Bulletin 30, 21–30.CrossRefGoogle ScholarPubMed
Kallert, T.W., Leisse, M. & Winiecki, P. 2004. Needs for care of chronic schizophrenic patients in long term community treatment. Social Psychiatric and Psychiatry Epidemiology 39, 386–396.CrossRefGoogle ScholarPubMed
Kay, S.R., Abraham, F. & Opler, L.A. 1986. The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophrenia Bulletin 13, 261–276.CrossRefGoogle Scholar
Knapp, M., Mangalore, R. & Simon, J. 2004. The global costs of schizophrenia. Schizophrenia Bulletin 30, 279–293.Google Scholar
Lehman, A.F. 1998. Translating research into practice: the schizophrenia patients outcome research team (PORT) treatment recommendations. Schizophrenia Bulletin 24 1, 1–10.Google Scholar
Link, B.G., Andrews, H. & Cullen, F. 1992. The violent and illegal behavior of mental patients reconsidered. American Sociological Review 52, 275–292.Google Scholar
Modestin, J., Huber, A., Satirli, E., Malti, T. & Hell, D. 2003. Long-term course of schizophrenic illness: Bleuler's study reconsidered. American Journal of Psychiatry 160, 2202–2208.CrossRefGoogle ScholarPubMed
Mueser, K., Bond, G. & Drake, R. 1998. Models of community care for severe mental illness: a review of research on case management. Schizophrenia Bulletin 24, 37–74.CrossRefGoogle ScholarPubMed
Norman, R.M., Malla, A.K., Cortese, L., Cheng, S., Diaz, K., Mclntosh, E., McLean, T.S., Rickwood, A. & Voruganti, L.P. 1999. Symptoms V. Di Michele et al. and cognition as predictors of community functiong: a prospective analysis. American Journal of Psychiatry 156, 400–405.Google Scholar
Parker, G. & Hadzi-Pavlovic, D. 1995. The capacity of a measure of disability (the LSP) to predict hospital readmission in those with schizophrenia. Psychological Medicine 25, 157–163.Google Scholar
Raven, J.C. 1984. Matrici Colore Progressive 1938. O.S.- Organizzazioni Speciali: Firenze.Google Scholar
Robins, L.N. & Price, R.K. 1991. Adult disorders predicted by childhood conduct problems: Results from the NIMH epidemiologic catchment area project. Psychiatry 54, 116–132.CrossRefGoogle ScholarPubMed
Rosen, A., Hadzi-Pavlovic, D. & Parker, G. 1989 The Life Skills Profile: a measure assessing function and disability in schizophrenia. Schizophrenia Bulletin 15, 325–337.Google Scholar
Ruggeri, M., Lasalvia, A., Bisoffi, G., Thornicroft, G., Vazquez-Barquero, J.L., Becker, T., Knapp, M., Knudsen, H.C., Schene, A., Tansella, M. & the Epsilon study group 2003. Satisfaction with mental health services among people with schizophrenia in five European sites: results from EPSILON study. Schizophrenia Bulletin 29, 229–245.CrossRefGoogle ScholarPubMed
Ruggeri, M., Lasalvia, A., Tansella, M., Bonetto, C., Abate, M, Thornicroft, G., Allevi, L. & Ognibene, P. 2004. Heterogeneity of outcomes in schizophrenia 3-year follow-up of treated prevalent cases. British Journal of Psychiatry 18 4, 48–57.CrossRefGoogle Scholar
Sytema, S., Burgess, P. & Tansella, M. 2002. Does community care decrease length of stay and risk of rehospitalization in new patients with schizophrenic disorders? A comparative care register study in Groningen, the Netherlands; Victoria, Australia; and South Verona, Italy. Schizophrenia Bulletin 28, 273–281.Google Scholar
Taylor, P.J., Leese, M., Williams, D., Butwell, M., Daly, R. & Larkin, E. 1998. Mental disorder and violence: a special high security hospital study. British Journal of Psychiatry 172, 218–226.Google Scholar
Udechuku, A., Olver, J., Hallam, K., Blyth, F., Leslie, M., Nasso, M., Schlesinger, P., Warren, L., Turner, M. & Burrows, G 2005. Assertive community treatment of the mentally ill: service model and effectiveness. Psychiatry Quarterly 76 2, 97–106.Google Scholar
World Health Organization 1992. Classification of Psychiatric and Behavioral Syndromes, 10* Revision. WHO: Geneva.Google Scholar
Wykes, T., Leese, M., Taylor, R. & Phelan, M. 1998. Effects of community services on disability and symptoms. PRisM psychosis study 4. British Journal of Psychiatry 173, 385–390.CrossRefGoogle ScholarPubMed
Zizolfi, S., Santone, G., Borsetti, G. & de Girolamo, G. 2004. La valutazione del funzionamento sociale negli ospiti delle SR. In Le Strutture Residenziali e i loro Ospiti (Gruppo Nazionale PROGRES). U Pensiero Scientifico Editore: Roma.Google Scholar