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- Alem, Atalay, et al.
(författare)
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Clinical course and outcome of schizophrenia in a predominantly treatment-naive cohort in rural Ethiopia
- 2009
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Ingår i: Schizophrenia Bulletin. - : Oxford University Press (OUP). - 0586-7614 .- 1745-1701. ; 35:3, s. 646-654
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Tidskriftsartikel (refereegranskat)abstract
- The established view that schizophrenia may have a favorable outcome in developing countries has been recently challenged; however, systematic studies are scarce. In this report, we describe the clinical outcome of schizophrenia among a predominantly treatment-naive cohort in a rural community setting in Ethiopia. The cohort was identified in a 2-stage sampling design using key informants and measurement-based assessment. Follow-up assessments were conducted monthly for a mean duration of 3.4 years (range 1-6 years). After screening 68 378 adults, ages 15-49 years, 321 cases with schizophrenia (82.7% men and 89.6% treatment naive) were identified. During follow-up, about a third (30.8%) of cases were continuously ill while most of the remaining cohort experienced an episodic course. Only 5.7% of the cases enjoyed a near-continuous complete remission. In the final year of follow-up, over half of the cases (54%) were in psychotic episode, while 17.6% were in partial remission and 27.4% were in complete remission for at least the month preceding the follow-up assessment. Living in a household with 3 or more adults, later age of onset, and taking antipsychotic medication for at least 50% of the follow-up period predicted complete remission. Although outcome in this setting appears better than in developed countries, the very low proportion of participants in complete remission supports the recent observation that the outcome of schizophrenia in developing countries may be heterogeneous rather than uniformly favorable. Improving access to treatment may be the logical next step to improve outcome of schizophrenia in this setting.
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- Allerby, Katarina, 1980, et al.
(författare)
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Person-Centered Psychosis Care (PCPC) In An Inpatient Setting : Ward Level Data And Staff Workload
- 2019
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Ingår i: Schizophrenia Bulletin. - : Oxford University Press. - 0586-7614 .- 1745-1701. ; 45:Supplement 2, s. S304-S304
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Tidskriftsartikel (refereegranskat)abstract
- Background: The person-centered care approach has been little tested in inpatient settings for persons with schizophrenia. An intervention, PersonCentered Psychosis Care (PCPC), was created to increase person-centered care through an educational intervention for staff. The education had a participatory approach where participants were involved in shaping the education and creating projects aimed at care development. The PCPC intervention focused on the patient’s narrative, the creation of a partnership between the patient and staff, and on coming to an agreement between the patient and staff concerning the care. The present study aims to compare staff experienced workload and ward level data before and after implementation of the intervention.Methods: The study was carried out on 4 hospital wards (43 beds) at the Psychosis Clinic, Gothenburg, Sweden. Data was collected during a 6-month pre-intervention period, followed by an implementation period of 3 years, and finally a post intervention data collection period (9 months). During both data collection periods, one nurse per ward filled out a measure of daily subjective workload (a VAS scale with 0 indicating no burden at all and 10 indicating the highest imaginable burden). Additional ward level data (length of hospital stay, involuntary interventions, rehospitalization rates) were collected via the clinic’s electronic monitoring system.Results: The pre-intervention ratings (n=505) showed a mean subjective workload of 5.48 (SD=1.94). The post intervention workload (n=465) showed a mean of 4.51 (SD=2.08) which represents a significant reduction of experienced workload (t (968) = p <.0005). Analyses regarding length of hospital stay, involuntary interventions, and rehospitalization rates are underway and will be presented.Discussion: The findings indicate an improvement in the work environment for hospital staff and provide a quantitative result in line with staff experiences previously reported in our focus group study. The before and after design has its limitations, but the positive findings motivate further testing with a more rigorous design such as a cluster randomized study.
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- Barth, C, et al.
(författare)
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In Vivo Amygdala Nuclei Volumes in Schizophrenia and Bipolar Disorders
- 2021
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Ingår i: Schizophrenia bulletin. - : Oxford University Press (OUP). - 1745-1701 .- 0586-7614. ; 47:5, s. 1431-1441
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Tidskriftsartikel (refereegranskat)abstract
- Abnormalities in amygdala volume are well-established in schizophrenia and commonly reported in bipolar disorders. However, the specificity of volumetric differences in individual amygdala nuclei is largely unknown. Patients with schizophrenia disorders (SCZ, N = 452, mean age 30.7 ± 9.2 [SD] years, females 44.4%), bipolar disorders (BP, N = 316, 33.7 ± 11.4, 58.5%), and healthy controls (N = 753, 34.1 ± 9.1, 40.9%) underwent T1-weighted magnetic resonance imaging. Total amygdala, nuclei, and intracranial volume (ICV) were estimated with Freesurfer (v6.0.0). Analysis of covariance and multiple linear regression models, adjusting for age, age2, ICV, and sex, were fitted to examine diagnostic group and subgroup differences in volume, respectively. Bilateral total amygdala and all nuclei volumes, except the medial and central nuclei, were significantly smaller in patients relative to controls. The largest effect sizes were found for the basal nucleus, accessory basal nucleus, and cortico-amygdaloid transition area (partial η2 > 0.02). The diagnostic subgroup analysis showed that reductions in amygdala nuclei volume were most widespread in schizophrenia, with the lateral, cortical, paralaminar, and central nuclei being solely reduced in this disorder. The right accessory basal nucleus was marginally smaller in SCZ relative to BP (t = 2.32, P = .05). Our study is the first to demonstrate distinct patterns of amygdala nuclei volume reductions in a well-powered sample of patients with schizophrenia and bipolar disorders. Volume differences in the basolateral complex (lateral, basal, and accessory basal nuclei), an integral part of the threat processing circuitry, were most prominent in schizophrenia.
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- Bhavsar, V, et al.
(författare)
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COULD CLOZAPINE REDUCE VIOLENT OFFENDING?
- 2018
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Ingår i: SCHIZOPHRENIA BULLETIN. - : Oxford University Press (OUP). - 0586-7614 .- 1745-1701. ; 44, s. S67-S67
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)
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