- Email: [email protected]
Trans-institutionalization: Quality of life and treatment
300
treatment condition. Analyses of covariance were used to compare scores on meaures of adaptive functioning at nine months by treatment group with baseline scores used as covariates. Patients participating in CAT improved to a greater extent than patients in control conditions on multiple measures of adaptive function and on quality of life (p's<0.05). Results indicate that compensatory strategies may improve functional outcomes for stable patients living in the community.
B.338. Q U A L I T Y O F L I F E A N D D R U G ATTITUDE IN SCHIZOPHRENIA OUTPATIENTS I. Kurzthaler, A. Hofer, G. Kemmler, U. Eder, M. Honeder, M. H u m m e r , W.W. Fleischhacker
Dept, of Biological Psychiatry, University Clinics Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria We report on an analysis of a study, conducted to detect relations between side effects of antipsychotic medication, quality of life, and drug attitude in schizophrenic outpatients. This study includes patients who have a duration of illness over 1 year and whose discharge from an inpatient unit has been at least 6 weeks ago. Psychopathology is evaluated with Positive and Negative Syndrome Scale (PANSS). The severity of extrapyramidal symptoms is assessed by means of the St. Hans Rating Scale for Extrapyramidal Syndromes. The effects of other adverse events on the patients' daily activities are evaluated by means of the Udvalg for Kliniske Undersogelser ( U K U ) Side Effect Rating Scale. In addition the Lancashire Quality of Life profile and the Drug Attitude Inventory are applied. 60 patients have been screened. The results show that neuroleptic-induced akathisia and parkinsonism affect patients' quality of life, while only few relations between adverse events and drug attitude could be established. Moreover, a higher subjective quality of life in the physical health domain seems to be linked with a limited perception of both positive and negative effects of medication. This finding suggests that special attention should be paid to those patients who are in good physical health and are therefore tempted to stop taking medication.
B.339. T R A N S - I N S T I T U T I O N A L I Z A T I O N : QUALITY OF LIFE AND TREATMENT T.S. Stroup, J. R a n c
Campus Box 7160. University of North Carolina, Chapel Hill, NC, 27599-7160, USA Background: A major trend in the United States is the privatization of mental health services. In North Carolina, thousands of patients with schizophrenia have been discharged from state-run psychiatric hospitals to privately owned 'rest homes' that have no specialized services for persons with mental illness.
Method: The authors visited 18 randomly selected rest homes and conducted semi-structured, in-depth interviews with 45 residents diagnosed with serious mental illness (40 with schizophrenia or schizoaffective disorder). Life satisfaction was assessed using the Lehman Quality of Life Interview (QOLI). Administrators and 46 staff members were surveyed regarding their experience and job satisfaction. Results: All resident participants identified a specialty mental health provider. Forty-nine percent took atypical antipsychotic medications while 15% took depot forms of conventional neuroleptics. Responses to subjective questions on the QOLI indicated that participants were 'mostly satisfied' with their lives. However, responses to open-ended questions about daily life revealed tremendous boredom and unhappiness. Residents of smaller homes were more satisfied with their lives and living situation than residents of larger institutions. Rest home employees were dissatisfied with their pay and liked working with elderly persons; they were ambivalent about working with persons with mental illness. Discussion: Although access to psychiatric treatment and the appropriateness of this treatment appeared to be adequate, widespread dissatisfaction of residents and their caregivers suggest that quality of life in these quasi-institutions is poor. The lack of alternative housing arrangements and rehabilitative services are barriers to improved life satisfaction.
B.340. S U B J E C T I V E Q U A L I T Y O F L I F E I N SCHIZOPHRENIA: REDUNDANT WITH RELATED CONSTRUCTS? B. Hanewald, M Franz, T. Meyer, B. Gallhofer
Centrefor Psychiatry, School of Medich~e, Justus Liebig University, Am Steg 24, D-35385 Giessen, German)' Subjective quality of life (SQOL) is increasingly used as an outcome indicator in psychiatry. There is an ongoing controversy whether or not SQOL is redundant with related constructs such as depression, positive and negative affect, momentary well-being, self esteem, happiness, self-efficacy, rumination and somatic complaints, respectively. Therefore, the aim of this study was to measure these constructs in schizophrenic patients together with SQOL, to extract factors from these constructs and to investigate if they could account for the variance in SQOL. 70 schizophrenic short term inpatients (AW) and 65 schizophrenic long-stay patients (LS) as well as 73 healthy students (HS) were assessed. Factor-analysis found different factorstructures in all three groups. In the HS, an affective and cognitive factor could be identified. In contrast, within the LS positively vs. negatively connoted experiences were distinguished. In multiple regression analysis 54.3% (AW), 72.8% (LS) and 72.5% (HS) of variance of SQOL could be accounted for by the identified factors. Results indicate that different psychological factors contribute to SQOL judgements and that there is a substantial overlap of SQOL with other constructs. On the other hand there
treatment condition. Analyses of covariance were used to compare scores on meaures of adaptive functioning at nine months by treatment group with baseline scores used as covariates. Patients participating in CAT improved to a greater extent than patients in control conditions on multiple measures of adaptive function and on quality of life (p's<0.05). Results indicate that compensatory strategies may improve functional outcomes for stable patients living in the community.
B.338. Q U A L I T Y O F L I F E A N D D R U G ATTITUDE IN SCHIZOPHRENIA OUTPATIENTS I. Kurzthaler, A. Hofer, G. Kemmler, U. Eder, M. Honeder, M. H u m m e r , W.W. Fleischhacker
Dept, of Biological Psychiatry, University Clinics Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria We report on an analysis of a study, conducted to detect relations between side effects of antipsychotic medication, quality of life, and drug attitude in schizophrenic outpatients. This study includes patients who have a duration of illness over 1 year and whose discharge from an inpatient unit has been at least 6 weeks ago. Psychopathology is evaluated with Positive and Negative Syndrome Scale (PANSS). The severity of extrapyramidal symptoms is assessed by means of the St. Hans Rating Scale for Extrapyramidal Syndromes. The effects of other adverse events on the patients' daily activities are evaluated by means of the Udvalg for Kliniske Undersogelser ( U K U ) Side Effect Rating Scale. In addition the Lancashire Quality of Life profile and the Drug Attitude Inventory are applied. 60 patients have been screened. The results show that neuroleptic-induced akathisia and parkinsonism affect patients' quality of life, while only few relations between adverse events and drug attitude could be established. Moreover, a higher subjective quality of life in the physical health domain seems to be linked with a limited perception of both positive and negative effects of medication. This finding suggests that special attention should be paid to those patients who are in good physical health and are therefore tempted to stop taking medication.
B.339. T R A N S - I N S T I T U T I O N A L I Z A T I O N : QUALITY OF LIFE AND TREATMENT T.S. Stroup, J. R a n c
Campus Box 7160. University of North Carolina, Chapel Hill, NC, 27599-7160, USA Background: A major trend in the United States is the privatization of mental health services. In North Carolina, thousands of patients with schizophrenia have been discharged from state-run psychiatric hospitals to privately owned 'rest homes' that have no specialized services for persons with mental illness.
Method: The authors visited 18 randomly selected rest homes and conducted semi-structured, in-depth interviews with 45 residents diagnosed with serious mental illness (40 with schizophrenia or schizoaffective disorder). Life satisfaction was assessed using the Lehman Quality of Life Interview (QOLI). Administrators and 46 staff members were surveyed regarding their experience and job satisfaction. Results: All resident participants identified a specialty mental health provider. Forty-nine percent took atypical antipsychotic medications while 15% took depot forms of conventional neuroleptics. Responses to subjective questions on the QOLI indicated that participants were 'mostly satisfied' with their lives. However, responses to open-ended questions about daily life revealed tremendous boredom and unhappiness. Residents of smaller homes were more satisfied with their lives and living situation than residents of larger institutions. Rest home employees were dissatisfied with their pay and liked working with elderly persons; they were ambivalent about working with persons with mental illness. Discussion: Although access to psychiatric treatment and the appropriateness of this treatment appeared to be adequate, widespread dissatisfaction of residents and their caregivers suggest that quality of life in these quasi-institutions is poor. The lack of alternative housing arrangements and rehabilitative services are barriers to improved life satisfaction.
B.340. S U B J E C T I V E Q U A L I T Y O F L I F E I N SCHIZOPHRENIA: REDUNDANT WITH RELATED CONSTRUCTS? B. Hanewald, M Franz, T. Meyer, B. Gallhofer
Centrefor Psychiatry, School of Medich~e, Justus Liebig University, Am Steg 24, D-35385 Giessen, German)' Subjective quality of life (SQOL) is increasingly used as an outcome indicator in psychiatry. There is an ongoing controversy whether or not SQOL is redundant with related constructs such as depression, positive and negative affect, momentary well-being, self esteem, happiness, self-efficacy, rumination and somatic complaints, respectively. Therefore, the aim of this study was to measure these constructs in schizophrenic patients together with SQOL, to extract factors from these constructs and to investigate if they could account for the variance in SQOL. 70 schizophrenic short term inpatients (AW) and 65 schizophrenic long-stay patients (LS) as well as 73 healthy students (HS) were assessed. Factor-analysis found different factorstructures in all three groups. In the HS, an affective and cognitive factor could be identified. In contrast, within the LS positively vs. negatively connoted experiences were distinguished. In multiple regression analysis 54.3% (AW), 72.8% (LS) and 72.5% (HS) of variance of SQOL could be accounted for by the identified factors. Results indicate that different psychological factors contribute to SQOL judgements and that there is a substantial overlap of SQOL with other constructs. On the other hand there