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Predicting rehabilitation outcome in schizophrenia
221
~'l' INFORMAL CAREGIVERS AND SCHIZOPHRENIA: A PILOT STUDY N. Dharwadkar, J. Kulkarni Academic Unit. Dandenong Hospital. Dept. Psychological Medicine. Monash University. 134 Cleeland Street. Dandenong, Victoria3175. Australia A pilot study was undertaken to assess the differences in burden of care between carers of inpatients suffering from schizophrenia and to assess the differences between female and male carers. The sample consisted of 14 patients with diagnosis of schizophrenia and carers. The patients were assessed using the PANSS. Their carers were assessed using the GHQ. Female carers had a significantly higher burden of care compared to males (t=2.57, p=0.025). There was no significant difference in the GHQ score as related to the sex of the patient (t= -0.04, p=0.973). It was interesting to note that there was no significant linear correlation between the burden of care and the severity of symptoms (r= -0.0075. p=O.980). The delivery of servicesare relevant to the impact of caregiving on the carer. The effectiveplanning of mental health services for caregivers should include a partnership between caregivers and health professionals including the provision of a structured program geared towards providing information, problem solving and emotional support to the vulnerable group.
en ADHERENCE TO SCHIZOPHRENIA PORT FAMILY TREATMENT RECOMMENDATIONS Lisa Dixon, Jack Scott, Alan Lyles, Maureen Fahey, Ann Skinner, Andrew Shore University of Maryland. DepartmentofPsychiatry. 685 W BaltimoreSt. MSTF/Room 300. Baltimore. MD21201. USA The Schizophrenia PORT literature review provides the basis for the following recommendation on family interventions: Patients who have ongoing contact with their families should be offered a family psychosocial intervention which provides a combination of education about the illness. family support. crisis intervention. and problem solving skills training. Primary and secondary data reveal probable poor compliance with this recommendation in clinical practice. Less than one percent of persons with schizophrenia on Medicare in 1991 received a family therapy service. Younger persons were more likely to receive this service. Of persons with schizophrenia in Georgia who have Medicaid (N=9934), 7.4% received a family therapy service. Younger, Caucasian and male patients were more likely to receive a family service. A sample of directly interviewed treated schizophrenia patients in Georgia and Ohio (N=719)
revealed that only 30% of their families had received information about mental illness. Patients who were younger, with more education, and referred from the community rather than the hospital were more likely to report receiving family education. Dissemination efforts suggested that the most important obstacles to implementation perceived by a group of Ohio providers was uncertainty about agency and intervention funding.
e,7f QUALITY OF SUBJECfIVE LIFE EXPERIENCE IN SCHIZOPHRENIA· SPECTRUM DISORDERS Sharon G. Dott, David P. Walling DepartmentofPsychiatryand Behavioral Sciences. University of Texas Medical Branch. Galveston. Texas 77555-0428. USA Quality of life (QOL) is an increasingly important issue in the treatment of individuals with schizophrenia-spectrum disorders. The increased focus on QOL results from many recent factors including the advent of novel pharmacotherapies, increased presence of the severe mentally ill in community treatment, and a focus on patient rights and issues. This paper examines subjective life enjoyment in individual's diagnosed with schizophrenia-spectrum disorders. The purpose of this research was to assess subjects ability to recognize symptom improvement, reliability in responding to subjective questioning, and to evaluate change over time. QOL was measured using the Quality of Life Enjoyment and Satisfaction Scale (Q-LES-Q), a sixty-item scale measuring satisfaction with five different life domains. All subjects (n-66) were assessed upon admission and discharge from either a psychiatric hospital or a community crisis facility. Subjects were diagnosed with either schizophrenia (n-40) or schizoaffective disorder (n-26). Results suggest the internal consistency of the Q-LES-Q (Cronbach's alpha=0.957) when used with this population. Additionally, subjects were relatively consistent in recognizing improvement over time based on analysis of pre/post scores. The data presented, along with ongoing factor analytic studies, suggest the efficacy of the Q-LES-Q for accurately assessing QOL in severe mentally ill populations.
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PREDICTING REHABILITATION OUTCOME IN SCHIZOPHRENIA Andrew Ferdinandi, Ph.D., Simcha Pollack, Ph.D.,
Paul C. Bermanzohn, M.D. QueensDay Center.87-80 Merrick Blvd. Jamaica. N. Y. 11432. USA Objectives: The purpose of this study was to examine the effectiveness of the Rehabilitation Readiness Assessment
222
Ratings (RRA) as a predictor of successful rehabilitation outcome in subjects with chronic schizophrenia. Methods: As part of their clinical treatment, 32 schizophrenic patients attending a continuing day treatment program participated in a Rehabilitation Assessment Group for eight one hour sessions in which each subject's readiness to set a goal in the environments of living, learning, working and socializing was assessed. Six months later, each subject was interviewed to determine the degree to which changes had been accomplished in these four environments. Results: There was a statistically significant positive correlation between the degree of expressed rehabilitation readiness with a particular environment in patients ' lives and their ability to effect a change. There was no correlation between age, or length of treatment and the degree to which they made a change in that particular environment. Conclusion: These data suggest that a patient's expressed readiness for rehabilitative change is the best predictor of making change. Also, that satisfaction and dissatisfaction is not limited to a single domain but seems to be generalized across the four environments.
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SUCCESSFUL VOCATIONAL FUNCTIONING IN SCHIZOPHRENIA James M. Gold, Nancy L. Bryant, Katalin Vladar, Robert W . Buchanan Maryland Psychiatric Research Center. Department of Psychiatry, University of Maryland. Baltimore M aryland 21228. USA
Follow up studies in schizophrenia have documented successful vocational functioning in 10-30% of patients . However, the neurobiological characteristics associated with vocational outcome remain poorly understood. This exploratory study contrasts the neuropsychological and brain structural characteristics of patients who demonstrate good vocational functioning (GVF), patients with poor vocational functioning (PVF), and healthy controls. The Level of Functioning Scale was used to assess vocational outcome. Comparison of the two patient groups revealed that GVF patients had superior neuropsychological performance, relative to the PVF group, across multiple measures, with moderate to large effect sizes (0.4-1.0). In contrast, the two patient groups did not differ on the degraded stimulus CPT, a putative vulnerability marker, with both groups demonstrating deficits relative to healthy controls. MRI data were examined in 8 GVF, 8 PVF, and 8 controls matched on age, gender, race (all right handed). Both GVF patients and healthy controls demonstrated asymmetries in temporal and frontal lobe volumes (R>L) which were lacking in PVF patients. The results suggests that poor vocational outcome in schizophrenia may be associated with neurodevelopmental factors that impact cortical specialization-lateralization,
whereas GVF patients appear to have a more 'focal' illness, both cognitively and in terms of brain structure.
b31 DISSEMINATING TREATMENT RECOMMENDATIONS FROM THE SCHIZOPHRENIA P.O.R.T. Howard H. Goldman Department ofPsychiatry, University ofMaryland School of Medicine; Baltimore. MD21201. USA
Elizabeth A. McGlynn RAND Corporation. Santa Monica, CA 90406. USA
Here we focus on the dissemination of the Schizophrenia PORT treatment recommendations. The five communities involved in the Schizophrenia PORT data collection were also selected to participate in the plan to disseminate the recommendations, permitting the PORT to track the impact of the effort. In March and April, 1996, providers, patients , and their families in each of the communities were exposed to a one-day continuing education program on a selection of treatment recommendations focusing on psychopharmacology, family interventions, assertive community treatment and inpatient care. In addition, pairs of the communities were involved in supplementary dissemination strategies: for example, 'academic detailing' was used to amplify the dissemination of the psychopharmacologic recommendations during the autumn of 1996 and training in specific techniques of family supportive interventions were begun in June, 1996. The feasibility of these strategies will be assessed, and their impact will be evaluated, examining patterns of pract ice abstracted from clinical records.
.
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QUALITY OF LIFE IN SCHIZOPHRENIA: AFFILIATIVE AND INSTRUMENTAL DOMAINS Marianne S. Goodman, James W. Hull, Kenneth G. Terkelsen, Thomas E. Smith Department ofPsychiatry, Cornell University Medical College. White Plains. NY 10605, USA
This study of 67 chronically mentally ill outpatients with psychotic disorders examined subjective quality of life scores from Lehman's Quality of Life (QOL) interview. Factor an~Y· ses identified 'Affiliative' and 'Instrumental' constructs which accounted for 67% of the variance in subjective satisfac~on ratings . The results suggest that the global satisfacti~n ratulg may be derived from instrumental ~ncc:rns an~ IS not a summation of individual domain subjective ratings" ,Th~ findings further clarify the concept of life satisfaction 10 this population of severely mentally ill individ?als. and suggest modifications in bow quality of life information IS evaluated.
~'l' INFORMAL CAREGIVERS AND SCHIZOPHRENIA: A PILOT STUDY N. Dharwadkar, J. Kulkarni Academic Unit. Dandenong Hospital. Dept. Psychological Medicine. Monash University. 134 Cleeland Street. Dandenong, Victoria3175. Australia A pilot study was undertaken to assess the differences in burden of care between carers of inpatients suffering from schizophrenia and to assess the differences between female and male carers. The sample consisted of 14 patients with diagnosis of schizophrenia and carers. The patients were assessed using the PANSS. Their carers were assessed using the GHQ. Female carers had a significantly higher burden of care compared to males (t=2.57, p=0.025). There was no significant difference in the GHQ score as related to the sex of the patient (t= -0.04, p=0.973). It was interesting to note that there was no significant linear correlation between the burden of care and the severity of symptoms (r= -0.0075. p=O.980). The delivery of servicesare relevant to the impact of caregiving on the carer. The effectiveplanning of mental health services for caregivers should include a partnership between caregivers and health professionals including the provision of a structured program geared towards providing information, problem solving and emotional support to the vulnerable group.
en ADHERENCE TO SCHIZOPHRENIA PORT FAMILY TREATMENT RECOMMENDATIONS Lisa Dixon, Jack Scott, Alan Lyles, Maureen Fahey, Ann Skinner, Andrew Shore University of Maryland. DepartmentofPsychiatry. 685 W BaltimoreSt. MSTF/Room 300. Baltimore. MD21201. USA The Schizophrenia PORT literature review provides the basis for the following recommendation on family interventions: Patients who have ongoing contact with their families should be offered a family psychosocial intervention which provides a combination of education about the illness. family support. crisis intervention. and problem solving skills training. Primary and secondary data reveal probable poor compliance with this recommendation in clinical practice. Less than one percent of persons with schizophrenia on Medicare in 1991 received a family therapy service. Younger persons were more likely to receive this service. Of persons with schizophrenia in Georgia who have Medicaid (N=9934), 7.4% received a family therapy service. Younger, Caucasian and male patients were more likely to receive a family service. A sample of directly interviewed treated schizophrenia patients in Georgia and Ohio (N=719)
revealed that only 30% of their families had received information about mental illness. Patients who were younger, with more education, and referred from the community rather than the hospital were more likely to report receiving family education. Dissemination efforts suggested that the most important obstacles to implementation perceived by a group of Ohio providers was uncertainty about agency and intervention funding.
e,7f QUALITY OF SUBJECfIVE LIFE EXPERIENCE IN SCHIZOPHRENIA· SPECTRUM DISORDERS Sharon G. Dott, David P. Walling DepartmentofPsychiatryand Behavioral Sciences. University of Texas Medical Branch. Galveston. Texas 77555-0428. USA Quality of life (QOL) is an increasingly important issue in the treatment of individuals with schizophrenia-spectrum disorders. The increased focus on QOL results from many recent factors including the advent of novel pharmacotherapies, increased presence of the severe mentally ill in community treatment, and a focus on patient rights and issues. This paper examines subjective life enjoyment in individual's diagnosed with schizophrenia-spectrum disorders. The purpose of this research was to assess subjects ability to recognize symptom improvement, reliability in responding to subjective questioning, and to evaluate change over time. QOL was measured using the Quality of Life Enjoyment and Satisfaction Scale (Q-LES-Q), a sixty-item scale measuring satisfaction with five different life domains. All subjects (n-66) were assessed upon admission and discharge from either a psychiatric hospital or a community crisis facility. Subjects were diagnosed with either schizophrenia (n-40) or schizoaffective disorder (n-26). Results suggest the internal consistency of the Q-LES-Q (Cronbach's alpha=0.957) when used with this population. Additionally, subjects were relatively consistent in recognizing improvement over time based on analysis of pre/post scores. The data presented, along with ongoing factor analytic studies, suggest the efficacy of the Q-LES-Q for accurately assessing QOL in severe mentally ill populations.
~"'Zcr
PREDICTING REHABILITATION OUTCOME IN SCHIZOPHRENIA Andrew Ferdinandi, Ph.D., Simcha Pollack, Ph.D.,
Paul C. Bermanzohn, M.D. QueensDay Center.87-80 Merrick Blvd. Jamaica. N. Y. 11432. USA Objectives: The purpose of this study was to examine the effectiveness of the Rehabilitation Readiness Assessment
222
Ratings (RRA) as a predictor of successful rehabilitation outcome in subjects with chronic schizophrenia. Methods: As part of their clinical treatment, 32 schizophrenic patients attending a continuing day treatment program participated in a Rehabilitation Assessment Group for eight one hour sessions in which each subject's readiness to set a goal in the environments of living, learning, working and socializing was assessed. Six months later, each subject was interviewed to determine the degree to which changes had been accomplished in these four environments. Results: There was a statistically significant positive correlation between the degree of expressed rehabilitation readiness with a particular environment in patients ' lives and their ability to effect a change. There was no correlation between age, or length of treatment and the degree to which they made a change in that particular environment. Conclusion: These data suggest that a patient's expressed readiness for rehabilitative change is the best predictor of making change. Also, that satisfaction and dissatisfaction is not limited to a single domain but seems to be generalized across the four environments.
~!c>
SUCCESSFUL VOCATIONAL FUNCTIONING IN SCHIZOPHRENIA James M. Gold, Nancy L. Bryant, Katalin Vladar, Robert W . Buchanan Maryland Psychiatric Research Center. Department of Psychiatry, University of Maryland. Baltimore M aryland 21228. USA
Follow up studies in schizophrenia have documented successful vocational functioning in 10-30% of patients . However, the neurobiological characteristics associated with vocational outcome remain poorly understood. This exploratory study contrasts the neuropsychological and brain structural characteristics of patients who demonstrate good vocational functioning (GVF), patients with poor vocational functioning (PVF), and healthy controls. The Level of Functioning Scale was used to assess vocational outcome. Comparison of the two patient groups revealed that GVF patients had superior neuropsychological performance, relative to the PVF group, across multiple measures, with moderate to large effect sizes (0.4-1.0). In contrast, the two patient groups did not differ on the degraded stimulus CPT, a putative vulnerability marker, with both groups demonstrating deficits relative to healthy controls. MRI data were examined in 8 GVF, 8 PVF, and 8 controls matched on age, gender, race (all right handed). Both GVF patients and healthy controls demonstrated asymmetries in temporal and frontal lobe volumes (R>L) which were lacking in PVF patients. The results suggests that poor vocational outcome in schizophrenia may be associated with neurodevelopmental factors that impact cortical specialization-lateralization,
whereas GVF patients appear to have a more 'focal' illness, both cognitively and in terms of brain structure.
b31 DISSEMINATING TREATMENT RECOMMENDATIONS FROM THE SCHIZOPHRENIA P.O.R.T. Howard H. Goldman Department ofPsychiatry, University ofMaryland School of Medicine; Baltimore. MD21201. USA
Elizabeth A. McGlynn RAND Corporation. Santa Monica, CA 90406. USA
Here we focus on the dissemination of the Schizophrenia PORT treatment recommendations. The five communities involved in the Schizophrenia PORT data collection were also selected to participate in the plan to disseminate the recommendations, permitting the PORT to track the impact of the effort. In March and April, 1996, providers, patients , and their families in each of the communities were exposed to a one-day continuing education program on a selection of treatment recommendations focusing on psychopharmacology, family interventions, assertive community treatment and inpatient care. In addition, pairs of the communities were involved in supplementary dissemination strategies: for example, 'academic detailing' was used to amplify the dissemination of the psychopharmacologic recommendations during the autumn of 1996 and training in specific techniques of family supportive interventions were begun in June, 1996. The feasibility of these strategies will be assessed, and their impact will be evaluated, examining patterns of pract ice abstracted from clinical records.
.
~:n
QUALITY OF LIFE IN SCHIZOPHRENIA: AFFILIATIVE AND INSTRUMENTAL DOMAINS Marianne S. Goodman, James W. Hull, Kenneth G. Terkelsen, Thomas E. Smith Department ofPsychiatry, Cornell University Medical College. White Plains. NY 10605, USA
This study of 67 chronically mentally ill outpatients with psychotic disorders examined subjective quality of life scores from Lehman's Quality of Life (QOL) interview. Factor an~Y· ses identified 'Affiliative' and 'Instrumental' constructs which accounted for 67% of the variance in subjective satisfac~on ratings . The results suggest that the global satisfacti~n ratulg may be derived from instrumental ~ncc:rns an~ IS not a summation of individual domain subjective ratings" ,Th~ findings further clarify the concept of life satisfaction 10 this population of severely mentally ill individ?als. and suggest modifications in bow quality of life information IS evaluated.