Predictors of clinical and social outcomes after hospitalization in schizophrenia
Tóm tắt
A prospective cohort study of schizophrenia was carried out in São Paulo, Brazil, in order to investigate clinical and social outcomes in schizophrenia and related psychoses after hospitalization. A sample of 124 individuals who were living in a defined catchment area and had been consecutively admitted to psychiatric hospitals in that area with clinical diagnoses of non-affective functional psychoses was followed up for 2 years. Assessments of clinical status and social adjustment at inclusion and at 2-year follow-up were carried out by means of standardized instruments, the PSE and the DAS. At the end of the follow-up period, 120 subjects (96.8%) were traced, and 103 (83.1%) were re-assessed. At the second assessment, the proportion of subjects with a nuclear syndrome of schizophrenia had halved (from 68.3% to 32.7%), 23.8% were symptom free and 60.2% showed at least one psychotic symptom. Presence of psychotic symptoms at follow-up was best predicted by educational level (less than 4 years of formal education) and an initial DSM-III-R diagnosis of schizophrenia. The distribution of global social adjustment levels at 2-year follow-up was similar to that observed at the outset, with approximately one third of subjects showing good, one third showing intermediate and one third showing poor global social adjustment. Social disability was best predicted by longer duration of illness, worse social adjustment levels at inclusion and lower educational level.
Tài liệu tham khảo
Alves DSN, Seidl EMF, Schechtman A, Silva RC (1992) Elementos para uma análise da assistência em saúde mental no Brasil. J Bras Psiquiatria 41: 423–426
American Psychiatric Association (1987) Diagnostic and statistical manual of mental disorders (DSM-III-R), 3rd edn, revised. American Psychiatric Association, Washington, DC
Biehl H, Maurer K, Schubart C, Krumm B, Jung E de (1986) Prediction of outcome and utilization of medical services in a prospective study of first onset schizophrenics. Eur Arch Psychiatry Neurol Sci 236: 139–147
Caetano R, Gentil V (1983) Glossario das definicoes dos sintomas incluidos na 9a. edicao do PSE. Instituto de Psiquiatria da FMUSP (mimeo), São Paulo
Carone BJ, Harrow M, Westermeyer JF (1991) Posthospital course and outcome in schizophrenia. Arch Gen Psychiatry 48: 247–253
Chaves AC, Sarin LM, Mari JJ (1990) Escala de avaliação de incapacitação psiquiátrica (DAS). Escola Paulista de Medicina (mimeo), São Paulo
Conway AS, Melzer D, Hale AS (1994) The outcome of targeting community mental health services: evidence from the West Lambeth schizophrenia cohort. Br Med J 308: 627–630
Craig TJ, Kovasznay B (1988) Utilization of services. In: Tsuang MT, Simpson JC (eds) Handbook of schizophrenia, vol 3. Nosology, epidemiology and genetics. Elsevier, Amsterdam, pp 399–436
Davies LM, Drummond MF (1994) Economics and schizophrenia: the real cost. Br J Psychiatry 165 (Suppl 25): 18–21
Dean AG, Dean JA, Burton AH, Dicker RC (1990) Epi Info, Version 5.01: a word processing, database, and statistics program for epidemiology on microcomputers. USD Inc., Georgia
Done DJ, Crow TJ, Johnstone EC, Sacker A (1994) Childhood antecedents of schizophrenia and affective illness: social adjustment at ages 7 and 11. Br Med J 309: 699–703
Duncan BB, Schmidt MI, Achutti AC, Polanczyk CA, Benia LR, Maia AA (1993) Socioeconomic distribution of noncommunicable disease risk factors in urban Brazil: the case of Porto Alegre. Bull Pan Am Health Organ 27: 337–349
Geddes J, Mercer G, Frith CD, MacMillan F, Owens DGC, Johnstone EC (1994) Prediction of outcome following a first episode of schizophrenia. Br J Psychiatry 165: 664–668
Hafner H, Heiden W van der (1991) Evaluating effectiveness and cost of community care for schizophrenic patients. Schizophr Bull 17: 441–451
Harrison G, Mason P (1993) Schizophrenia — falling incidence and better outcome? Br J Psychiatry 163: 535–541
Huber G, Gross G, Schuttler R (1975) A long-term follow-up study of schizophrenia: psychiatric course of illness and prognosis. Acta Psychiatr Scand 52: 49–57
Jablensky A, Sartorius N, Ernberg G, Anker M, Korten A, Cooper JE, Day R, Bertelsen A (1992) Schizophrenia: manifestations, incidence and course in different cultures. A World Health Organization ten-country study. Psychol Med Monogr (Suppl) 20
Jong A de, Giel R, Slooff CJ, Wiersma D (1985) Social disability and outcome in schizophrenic patients. Br J Psychiatry 147: 631–636
Kavanagh S (1994) The costs of schizophrenia. Ment Health Res Rev 1: 25–26
Leon CA (1989) Clinical course and outcome of schizophrenia in Cali, Colombia. A 10-year follow-up study. J Nerv Ment Dis 177: 593–606
Marneros A, Deister A, Rohde A (1990) Psychopathological and social status of patients with affective, schizophrenic and schizo-affective disorders after long-term course. Acta Psychiatr Scand 82: 352–358
Melzer D, Hale AS, Malik SJ, Hogman GA, Wood S (1991) Community care for patients with schizophrenia one year after hospital discharge. Br Med J 303: 1023–1026
Menezes PR, Mann AH (1993) Characteristics of hospital treated schizophrenia in São Paulo, Brazil. Soc Psychiatry Psychiatr Epidemiol 28: 267–274
Menezes PR, Scazufca M (1993) Estudo de confiabilidade da versão em português da “Escala de Avaliação Psiquiátrica (WHO/ DAS)”. Revista ABP-APAL 15: 65–67
Osis MJ, Hardy E, Faundes A, Alves G (1993) Factors associated with prenatal care among low income women in the State of São Paulo, Brazil. Rev Saude Publica 27: 49–53
Raftery J (1992) Mental health services in transition: the United States and the United Kingdom. Br J Psychiatry 161: 589–593
Rössler W, Salize HJ (1994) Longitudinal statistics of mental health care in Germany. Soc Psychiatry Psychiatr Epidemiol 29: 112–118
Schubart C, Krumm B, Biehl H, Schwartz R (1986) Measurement of social disability in a schizophrenic patient group. Soc Psychiatry 21: 1–9
Schubart C, Krumm B, Biehl H, Maurer K, Jung E (1987) Factors influencing the course and outcome of symptomatology and social adjustment in first-onset schizophrenics. In: Hafner H, Gattaz WF, Janzarik W (eds) Search for the causes of schizophrenia. Springer, Berlin Heidelberg New York, pp 98–106
SERC, Statistics and Epidemiology Research Corporation (1991) Epidemiological graphics, estimation, and testing package (EGRET), version 0.26.6. SERC, Seattle, Washington
Strathdee G, Thornicroft G (1993) The principles of setting up mental health services in the community. In: Bhugra D, Leff J (eds) Principles of social psychiatry. Blackwell, Oxford, pp 473–489
Tsuang MT, Fleming JA (1987) Long-term outcome of schizophrenia and other psychoses. In: Hafner H, Gattaz WF, Janzarik W (eds) Search for the causes of schizophrenia. Springer, Berlin Heidelberg New York, pp 88–97
Westermeyer JF, Harrow M (1988) Course and outcome in schizophrenia. In: Tsuang MT, Simpson JC (eds) Handbook of schizophrenia, vol 3. Nosology, epidemiology and genetics. Elsevier, Amsterdam, pp 205–244
Wing JK, Cooper JE, Sartorius N (1974) Measurement and classification of psychiatric symptoms: an instruction manual for the PSE and CATEGO Program. Cambridge University Press, London
World Health Organization (1975) International classification of diseases, 9th edn. WHO, Geneva
World Health Organization (1979) Schizophrenia: an international follow-up study. Wiley, New York
World Health Organization (1988) Psychiatric Disability Assessment Schedule (WHO/DAS). WHO, Geneva