| 1. |
- Harvey, P. D., et al.
(författare)
-
Functional Capacity and Functional Disability in Schizophrenia : A Cross-National Study in New York and Sweden
- 2008
-
Konferensbidrag (refereegranskat)abstract
- Background: Functional disability is a central feature of schizophrenia and has been reported to occur across different countries and systems of care. Recent advances in the assessment of disability have separeted the measuremet of functional capacity: the ability to perform skills required for everyday functioning from the measurement of real-world functional outcomes. This presentation reports on a cross-national study of the correlation between functional capacity measured with the UCSD Performance-based Skills Assessment, Brief version (UPSA-B), casemanager ratings of patient everyday functioning with the Specific Levels Of Functioning (SLOF), and occurrence of real-world functional milestones, including independent living, employment, and marital status. Patients with schizophrenia who lived in an urban American setting and a generally rural region in Sweden were compared on their functional capacity performance and real-world outcomes. Metods:Samples of schizophrenia patients in Sweden (n=146) and New York (n=244) performed the UPSA-B and a neuropsychological assessment and were rated by their case managers. Information from archival records and case managers was used to determine the occurence of the different real world outcomes, including living independently and having ever experienced a stable romantic relationship.Results: Performance on the UPSA-B was essentially identical in the two patient samples, with a total raw score in the New York sample 13.8 and the score in the Swedish sample 13.8. Scores on the case manager ratings of everyday activities were also strikingly similar (New York:49; Sweden:49). Further, the correlation between UPSA-B scores and ratings of everyday activities were quite similar, New York: r=.36 Sweden: r=.27 as were the correlations between NP performance and UPSA-B scores, New York: r=.58; Sweden: r=.55. Also, the proportion of cases who had never been married or had a close relationship was 59% in New York and 64% in Sweden. In notable contrast, 80% of the Swedish patients and 46% of the New York patients were living independently.Implications: Performance-based measures of functional capacity were very similar across samples of people with schizophrenia in very different living environments. These results are consistent with previous studies showing that performance-based measures of cognition are also quite similar across different countries in people with schizophrenia. While measures of functional ability and case manager estimates of patients' real-world outcomes were very similar in level of impairment and correlational structure, real-world residential outcomes were very different. These data suggest that cultural and social support systems can lead to very divergent outcomes in individuals who have evidence of the same levels of ability and potential.
|
|
| 2. |
- Harvey, P.D, et al.
(författare)
-
Performance-based measurement of functional disability in schizophrenia: a cross-national study in the United States and Sweden
- 2009
-
Ingår i: American Journal of Psychiatry. - : American Psychiatric Association Publishing. - 0002-953X .- 1535-7228. ; :166, s. 821-827
-
Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Recent advances in the assessment of disability in schizophrenia have separated the measurement of functional capacity from real-world functional outcomes. The authors examined the similarity of performance-based assessments of everyday functioning, real-world disability, and achievement of milestones in people with schizophrenia in the United States and Sweden. METHOD: The UCSD Performance-Based Skills Assessment-Brief Version (UPSA-B) and a neuropsychological assessment were administered to schizophrenia patients living in rural areas in Sweden (N=146) and in the New York City area (N=244), and patients' functioning was rated by their case managers. Information from records and case managers was used to determine the frequency of living independently, working, and having ever experienced a stable romantic relationship. RESULTS: Performance on the UPSA-B was essentially identical in the two samples (New York, mean score=13.84; Sweden, mean score=13.30), as were scores on the case manager ratings of everyday activities (New York, mean=49.0; Sweden, mean=48.8). The correlations between UPSA-B score, neuropsychological test performance, and case manager ratings did not differ across the two samples. The proportion of patients who had never had a close relationship and the rate of vocational disability were also nearly identical. However, while 80% of the Swedish patients were living independently, only 46% of the New York patients were. CONCLUSIONS: While scores on performance-based measures of everyday living skills were similar in people with schizophrenia across cultures, real-world residential outcomes were very different. These data suggest that cultural and social support systems can lead to divergent real-world outcomes among individuals who show evidence of the same levels of ability and potential.
|
|
| 3. |
|
|
| 4. |
- Helldin, L., et al.
(författare)
-
A functional comparison of patients with schizophrenia between the North and South of Europe
- 2012
-
Ingår i: European psychiatry. - : Cambridge University Press (CUP). - 0924-9338 .- 1778-3585. ; 27:6, s. 442-444
-
Tidskriftsartikel (refereegranskat)abstract
- Introduction: The main objective of this study was to compare clinical and functional outcomes of patients with schizophrenia in Italy and Sweden with a special focus on daily functioning performance and real life milestones. Also, to study if outcome is to be regarded as a consequence of premorbid function, the level of symptom control and functional capacity or if other influences, such as cultural differences, must parallel be considered. Method: Ninety-five patients from three centres, Milan and Naples in Italy and Trollhattan in Sweden were investigated. The Positive and Negative Syndrome Scale and the UCSD Performance-Based Skills Assessment - Brief version were used together with patients' school history and their status of accommodation and occupation. Results: Patients in Trollhattan were more likely to live independently and patients in Naples to have a work or take part in education. Differences in symptoms and the performance test were present but subtle. Discussion: Differences in real life milestones were not explained by corresponding differences in symptoms, premorbid function or the performance-based test. It is therefore not appropriate only to present functional outcome as an expression of how successful treatment has been. (C) 2011 Elsevier Masson SAS. All rights reserved.
|
|
| 5. |
|
|
| 6. |
|
|
| 7. |
- Helldin, L, et al.
(författare)
-
Costs for Schizopsychotic Patients in Sweden
- 2009
-
Konferensbidrag (refereegranskat)abstract
- 199 patients in Western Sweden with chronic psychotic illness are studied. The aim is to provide up-to-date costs for a defined patient population with schizopsychotic disorders in Sweden. Patients have the diagnoses of schizophrenia, schizoaffective disorder or delusional disorders. We identify the actual clinical management of illness and explain cost variability. Costs are combined with information on outcomes and severity of the disorder.Total costs per patient-year amount to 62.320 Euro. Direct costs correspond to 41% and indirect costs to 59% of total costs. Inpatient and outpatient care corresponds to 7% each of total costs, while costs for special housing and assistance at home is estimated to 22% of total costs. Medication only corresponds to 3% of total costs.We conclude that costs differ between patients depending on illness severity. Also a reallocation has taken place during the last 15 years between different cost items, from direct costs to indirect costs and from in-patient care at hospitals to out-patient care and assistance at home. The main cost driver is indirect costs due to decreased working ability and premature death. Special housing and home-assistance is the second largest cost item. In-patient care corresponds to 7% of total costs, which 15 years ago amounted to 50% of total costs. This reflects the change in care of schizopsychotic patients. Instead of treating patients at institutions, patients are now to a large extent living in their own housing but often receiving some kind of assistance at home provided by the local municipality.
|
|
| 8. |
|
|
| 9. |
|
|
| 10. |
- Helldin, L, et al.
(författare)
-
Increase of symptom remission in psychosis : Integrating science and service in the Swedish CLIPS study
- 2009
-
Konferensbidrag (refereegranskat)abstract
- The Clinical Long term Investigation of Psychosis in Sweden (CLIPS), is a naturalistic longitudinal study, in which about 300 patients diagnosed with schizophrenia, schizoaffective disorder or delusional disorder are evaluated regularly. Besides being a guideline for treatment, the evaluations are also used for scientific research after informed consent, hence combining regular health service with science in a concrete way. As a likely consequence of the annual structured assessments, the percentage of patients in remission has raised from 35 % to about 50 % in the last three years. Several scientific articles have been published on several psychosis related topics within the frame of the CLIPS study, proving that science can be successfully integrated with clinical practise for better evidence based health care, including a higher percentage of patients in remission
|
|
| 11. |
|
|
| 12. |
|
|
| 13. |
|
|
| 14. |
- Hjortsberg, C, et al.
(författare)
-
Direct and indirect costs for psychotic illness in Sweden
- 2010
-
Rapport (refereegranskat)abstract
- In this study the direct and indirect costs for a defined patient population with psychotic illness in Sweden was estimated. The cost analyses are based on data from the Clinical Long-term Investigation of Psychosis in Sweden (CLIPS), which was an ongoing, single-centre, epidemiological study at the time of this study. A bottom-up costing approach was used to estimate the total costs for schizophrenia, schizoaffective and delusional disorders in Sweden for 2007. Resource use were captured for the patients during one year. 199 patients with a mean age of 51 (63% men) were followed for 12 months. They had a mean (median) of 6.4 (0) inpatient-days, 1.4 (1.2) physician visits, 18.6 (8.4) nurse visits, 1.2 (0) counsellor visits and 6.3 (1.2) visits to other staff including tests and diagnostic procedures per patient- year. The mean cost in our study amounted to 578,000 per patient year which translates to an estimated cost of illness of 16.8 billion SEK for Sweden. Schizophrenia and related disorders significantly interferes with professional activities and as a result, the total burden on society is great. A reallocation has taken place the last 15 years, between different cost items, from direct costs to indirect costs and from in-patient care at hospitals to out-patient care and assistance at home.
|
|
| 15. |
|
|
| 16. |
|
|
| 17. |
|
|
| 18. |
- Hjärthag, Fredrik, 1973-, et al.
(författare)
-
How is family burden correlated to the patients' symptoms, function, quality of life and attitude to medication?
- 2008
-
Ingår i: European Neuropsychopharmacology. ; 18:4, s. 468-
-
Tidskriftsartikel (refereegranskat)abstract
- Earlier research has concluded that symptom severity is an important factor for explaining family burden related to psychotic illness. Some studies also point out the impaired function of the ill person as a contributing factor to the burden. However, there are few investigations that also considerate the ill persons own view of his/her quality of life and attitude to medication. This study investigates how persons with psychosis symptom severity, functional disability, quality of life and attitude to medication, could be correlated to family burden.
|
|
| 19. |
|
|
| 20. |
- Olsson, A-K, et al.
(författare)
-
Psychometric properties of a performance-based measurement of functional capacity
- 2012
-
Ingår i: Psychiatry Research. - : Elsevier. - 0165-1781 .- 1872-7123. ; 197:3, s. 290-294
-
Tidskriftsartikel (refereegranskat)abstract
- The UCSD Performance-based Skills Assessment - Brief version (UPSA-B) describes the functions of patients without negative influences of environmental factors such as unemployment or shortage in housing. The aim of the present study is to further explore the psychometric properties of the UPSA-B as well as to ensure that the Swedish version can be used in clinical practice and for research purposes. Participants were 211 patients, 135 men and 76 women, diagnosed with schizophrenia, schizoaffective disorder, or delusional disorder. Results indicate that the UPSA-B is a reliable instrument with good psychometric properties regarding validity and reliability. The instrument also had a capacity to reveal differences between various patient groups, both diagnostic groups and groups based on remission status. The conclusion drawn is that the UPSA-B is a valuable instrument that could be used in future cross-national studies to describe the level of functioning for patients with schizophrenia and other psychotic illnesses.
|
|
