Burden of caregivers of people suffering from schizophrenia versus symptom severity, social functioning and treatment satisfaction of patients treated by a CMHT. / Obciazenie opiekunów osób chorujacych na schizofrenie a nasilenie objawów, funkcjonowanie spoleczne i satysfakcja z leczenia pacjentów leczonych w ZLS.

OBJECTIVES: This study aims to assess the caregivers' burden in schizophrenia amongst patients treated by Community Mental Health Teams (CMHTs) and its relation to patients' demographic, clinical and social characteristics, with emphasis on their satisfaction with care, and to evaluate the correlation of selected characteristics of caregivers with the level of their burden. METHODS: A total of 65 patient-caregiver dyads remaining in home treatment were included. Caregivers were assessed with demographic questionnaires, and the Caregiver Burden Inventory (CBI). The patients were assessed with the Positive and Negative Syndrome Scale (PANSS), the Verona Service Satisfaction Scale (VSSS-54), the Disability Assessment Schedule (WHODAS 2.0), the Social Network Index (SNI) and with the UCLA Loneliness Scale. Data were analysed using multiple linear regression. RESULTS: Increased caregiver burden was associated with: greater symptom severity in patients, lower satisfaction with staff professionalism, and a high level of emotional expressiveness in relationships. The regression model explaining 57% of the variance in the caregivers' emotional burden consisted of four factors: the patient's positive syndrome intensity, patient's remaining in an emotional relationship, gender i.e. higher burden amongst female caregivers of male patients, and smaller social network. CONCLUSIONS: The caregivers' burden severity is related to patients' sociodemographic, clinical and social characteristics and their satisfaction with treatment. The emotional burden of caregivers is impacted by: greater symptom severity, especially the positive syndrome, lower patient satisfaction with staff professionalism, and a high expression of emotions in family relationships. The patient's and caregiver's gender and education level, the patient's degree of disability, them being in a relationship and social support network size are also significant.

Satisfaction with care in patients with schizophrenia treated in a pilot-program model and traditional care. / Satysfakcja z opieki u pacjentów chorujacych na schizofrenie w modelu pilotazowym i opiece tradycyjnej.

OBJECTIVES: The purpose of this study was to compare satisfaction with care in patients with schizophrenia in two CMHT models: traditional and pilot program group with concurrent assessment of symptom severity and social functioning. METHODS: Ninety patients with schizophrenia treated in Community Mental Health Teams were included in the study, 60 in the traditional model and 30 in the pilot-program model.A demographic data questionnaire, the Positive and Negative Syndrome Scale (PANSS), the Verona Service Satisfaction Scale (VSSS-54), the Disability Assessment Schedule (WHODAS), the Social Network Index (SNI),and a scale measuring loneliness (UCLA Loneliness Scale) were used. RESULTS: The pilot-program group was characterized by significantly lower age of subjects (p=0.048), less psychiatric medication use (p=0.027), higher total(p<0.001) and positive (p<0.001) symptom severity in PANSS, smaller social network (p=0.003), less role activity in social network (p<0.001), higher level of loneliness (p=0.001) and higher level of disability (p<0.001). The pilot-program group had significantly higher satisfaction with involvement of families in the therapeutic process(p = 0.024). CONCLUSIONS: In the pilot-program group, younger, more severely ill patients with higher severity of symptoms and worse social functioning were included in the treatment with no differences in the number of hospitalizations between the groups. It can be concluded that CMHT in the pilot-program Mental Health Centers (MHCs) protects this group of patients from hospitalization. There was also higher satisfaction with family involvement in the therapeutic process in the pilot-program group. A valuable continuation of the study would be to evaluate the treatment outcomes in all CMHTs operating under the pilot-program MHCs.

Predictors of Satisfaction with Care in Patients Suffering from Schizophrenia Treated Under Community Mental Health Teams.

The aim of this study was to assess satisfaction with care and to identify the predictors of this variable among sociodemographic, clinical and social data in a group of patients suffering from schizophrenia under treatment in community mental health teams. The study included 90 patients with a diagnosis of schizophrenia under the care of community mental health teams. Positive and Negative SyndromeScale, Verona Service Satisfaction Scale, Disability Assessment Schedule, Social Network Index and a loneliness scale (UCLA Loneliness Scale)were used in the study. Prognostic factors for higher satisfaction with care in the multivariate model involved: level of disability (Beta = -0.46, p < 0.001), duration of treatment under a CMHT (Beta = 0.36, p < 0.001), age (Beta = -0.37,p < 0.001), and education (Beta = -0.30, p = 0.002). The model explained 43% of the variance in the dependent variable. 1.Satisfaction with care in a CMHT was high. 2. Higher patient satisfaction could be predicted based on a lower level of disability, longer duration of treatment under a CMHT, lower age and lower education.

Efficacy of home treatment of patients with mental disorders - a research review.

Purpose: The aim of this study is to review research on the efficacy of home treatment for mental disorders compared to other forms of community-based treatment. The first section describes studies comparing treatment as usual with CMHT (Community Mental Health Team), the second section compares CMHT with more intensive forms of community-based care, such as CM (Case Management) and ACT (Assertive Community Treatment, and the third section focuses on interventions that are alternatives to hospitalization, described as CRT or MCHT (Crisis Resolution Team or Mobile Crisis Home Treatment). Views: The community-based model of psychiatric health care is nowadays recognized as the best systemic solution to improve its organization and functioning. In comprehensive care in the community, home treatment plays an important role. Treatment teams most often take the form of a general Community Mental Health Team - CMHT, which, like community mental health services in Poland, provides a wide range of interventions. There are several forms of treatment within CMHTs: ACT, CM, CRT and MHCT. Comment: Home treatment is more effective compared to standard inpatient and post-hospital care. Care under a Community Mental Health Team reduces the number and duration of hospitalizations and is characterized by higher treatment satisfaction. For patients with psychotic disorders, more intensive forms of community-based care - such as ACT, CM, and CRT - are particularly valuable and effective.

Differences in subjective quality of life of people with a schizophrenia diagnosis between participants in Occupational Therapy Workshops and those working in a Sheltered Employment Establishment. / Róznice w subiektywnej jakosci zycia osób z diagnoza schizofrenii pomiedzy uczestnikami Warsztatów Terapii Zajeciowej a osobami pracujacymi w Zakladzie Pracy Chronionej.

OBJECTIVES: The research objective was to compare the course of illness among patients with schizophrenia undergoing rehabilitation in Occupational Therapy Workshops (OTW) or employed in the Vocational Development Center "Pensjonat u Pana Cogito" (VDC), with particular focus on quality of life (QoL), and to analyse the relations between QoL and general, social, and cognitive functioning, psychopathological condition and insight in the two groups. METHODS: The sample comprised 52 subjects (VDC = 25 and OT = 27). The following tools were used: the LQoLP (for quality of life assessment) by Oliver, the PANSS, GAF, and SOFAS scales, the MoCA, RAVLT and RHLB cognitive tests, and the insight questionnaire "My thoughts and feelings". RESULTS: Differences were found between the groups, to the VDC group's advantage, in such areas of subjective QoL as: family relationships (p . 0.05), somatic health (p . 0.05) and selfesteem (p . 0.05). In the VDC group, QoL correlated negatively with symptoms of distress and positively with overall insight into symptoms, while in the OTW group it correlated negatively with cognitive function and positively with insight as a reaction to information from others. CONCLUSIONS: For people with schizophrenia obtaining and retaining employment in a VDC translates into better outcomes in important areas of quality of life such as family relationships, overall health, and self-esteem. Poorer QoL was associated with the severity of symptoms, in particular depressive symptoms. People employed in the VDC benefited to a greater extent from autonomous control of symptoms, while among the OTW group an important role was played by others.