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- Harvey, P. D., et al.
(författare)
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Functional Capacity and Functional Disability in Schizophrenia : A Cross-National Study in New York and Sweden
- 2008
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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.
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| 2. |
- Harvey, P.D, et al.
(författare)
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Performance-based measurement of functional disability in schizophrenia: a cross-national study in the United States and Sweden
- 2009
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Ingår i: American Journal of Psychiatry. - : American Psychiatric Association Publishing. - 0002-953X .- 1535-7228. ; :166, s. 821-827
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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.
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| 4. |
- Helldin, L, et al.
(författare)
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Costs for Schizopsychotic Patients in Sweden
- 2009
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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.
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| 6. |
- Helldin, L, et al.
(författare)
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Increase of symptom remission in psychosis : Integrating science and service in the Swedish CLIPS study
- 2009
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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
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| 9. |
- Hjärthag, Fredrik, 1973-
(författare)
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Assessing Family Burden of Psychotic Illness in Clinical Practice
- 2009
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The purpose of this thesis was twofold. One purpose was to create a user-friendly instrument to be used in regular clinical practice to collect information regarding family burden of psychotic illness. The second purpose was to study how family burden could be linked to the patients’ level of functioning, the patients’ cognition and the patients’ own experience of their illness. Two studies were conducted. In the first study (Paper I) the instrument Burden Inventory for Relatives to persons with Psychotic disturbances (BIRP) was created. This instrument contained ten statements and showed good psychometrical properties for those dimensions that were investigated. The instrument measures three dimensions of experienced family burden: practical burden, emotional burden, and the relatives’ own health. In the second study (Paper II) the second part of this thesis purpose was investigated. Results showed that increased family burden could be tied to the patients’ impaired functioning as well as to the patients’ higher self ratings regarding distress. The cognitive connection to family burden is not totally clear though, and should be further investigated. A theoretical model which explains the experienced family burden of psychotic illness is also presented within this thesis. The conclusions of this thesis are that BIRP is a useful instrument in regular clinical practise for measuring experienced family burden, and that the patients’ level of functioning and the patients’ own experience of their illness were correlated to the family burden experienced.
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| 12. |
- Hjärthag, Fredrik, 1973-, et al.
(författare)
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How is family burden correlated to the patients' symptoms, function, quality of life and attitude to medication?
- 2008
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Ingår i: European Neuropsychopharmacology. ; 18:4, s. 468-
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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.
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| 13. |
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| 14. |
- Hjärthag, Fredrik, 1973-, et al.
(författare)
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Psychometric Properties of the Burden Inventory for Relatives of Persons with Psychotic Disturbances
- 2008
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Ingår i: Psychological Reports. - : Ammons Scientific. - 0033-2941 .- 1558-691X. - 9789170632273 ; 103, s. 323-335
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Tidskriftsartikel (refereegranskat)abstract
- Earlier studies have shown that close relatives are heavily burdened when a family member has schizophrenia. The current purpose was twofold, (1) to examine the psychometric properties for a test of the burden of family members, one used in Swedish clinical practice (the Care Burden Scale for Relatives) and (2) develop a shortened version with the same or better psychometric properties. Ninety-nine close relatives, 34 men and 65 women, of the same number of patients who had been diagnosed either with schizophrenia or with schizoaffective disorder, were studied. Participants completed the Care Burden Scale for Relatives and a visual analogue scale measuring perceived global burden on which the total burden was assessed. Patients of the close relatives were assessed on clinical tests often used in the psychiatric care, in an attempt to validate the external criteria, such as severity of symptoms and level of functioning. The resulting instrument, Burden Inventory for Relatives of persons with Psychotic disturbances, showed good psychometric properties which simplifies data collection from relatives of patients with psychotic disturbances. In this study, relatives of those patients not in remission evinced a significant greater family burden.
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| 15. |
- Karilampi, Ulla, et al.
(författare)
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Verbal learning in schizopsychotic outpatients and healthy volunteers as a function of cognitive performance levels
- 2007
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Ingår i: Archives of clinical neuropsychology. - : Oxford University Press (OUP). - 0887-6177 .- 1873-5843. ; 22:2, s. 161-174
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE The aim was to analyze and compare neurocognitive test profiles related to different levels of verbal learning performance among schizopsychotic patients and healthy volunteers. METHOD A single-center patient cohort of 196 participants was compared with an equal-sized volunteer group to form three cognitive subgroups based on the shared verbal learning performance. RESULTS 43.9% of the patients had normal learning ability. Despite this, all patients underperformed the volunteers on all subtests with the exception of working memory, and, for those with high learning ability, even verbal facility. All patients also presented equally poor visuomotor processing speed/efficacy. CONCLUSION A global neurocognitive retardation of speed-related processing in schizophrenia is suggested.
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| 17. |
- Unenge Hallerbäck, Maria, 1962, et al.
(författare)
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The Reading the Mind in the Eyes Test: test-retest reliability of a Swedish version.
- 2009
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Ingår i: Cognitive Neuropsychiatry. - London : Informa UK Limited. - 1354-6805 .- 1464-0619. ; 14:2, s. 127-143
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: The Reading the Mind in the Eyes Test is a widely used facial affect recognition test. The present study aimed to provide Swedish nonpatient reference values, examine test-retest reliability, and to elucidate strengths and weaknesses of the instrument. METHODS: A Swedish version of the test was completed by 158 university students. Fifty-eight participants completed the test twice, 3 weeks apart. The Bland Altman method was used to examine the test-retest reliability. RESULTS: Distribution of responses of the 158 participants is detailed and compared with the English version. The limits of agreement was +/-4.3. CONCLUSIONS: A test score variation in the range of +/-4 (out of 24 possible) is to be expected for the same individual. When the Reading the Mind in the Eyes Test is used, one has to take into account that an obtained test score must be regarded as an approximation.
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