Outcome assessment of the VADO approach in psychiatric rehabilitation: a partially randomised multicentric trial.

BACKGROUND: Recent studies on representative samples of psychiatric services have shown that low proportions of cases received effective rehabilitation interventions. The following are likely to be the most important causes: the scarcity of mental health workers trained in social and work skills strategies and the absence of a structured framework to formulate rehabilitation practices. The aim of this study was to assess if a specific structured planning and evaluation manual, called VADO (Valutazione delle Abilità e Definizione degli Obiettivi--in english: Skills Assessment and Definition of Goals), is more effective than routine interventions in reducing disability in patients with schizophrenia. METHOD: Each of 10 mental health services were invited to recruit 10 patients with a schizophrenic disorder. Altogether 98 patients were recruited. Of these, 62 patients were randomly allocated to the intervention/experimental or a control group. The remaining group of 36 patients was not randomised and it was considered as a parallel effectiveness study. Assessment measures at the beginning of the study and at the one-year follow-up included the FPS scale of social functioning and the BPRS 4.0. Between group (VADO vs. Routine) and time effects were examined with ANOVA, Chi-square or Fisher exact. Clinical "improvement" was defined as an increase of at least ten points on the FPS or a decrease of at least 20% on BPRS scores. RESULTS: 31 of the 62 randomized patients received the experimental interventions, while 31 followed the routine ones. At follow-up, the experimental group showed statistically and clinically greater improvements in psychopathology and social functioning. Better outcomes of both social functioning and symptom severity were observed in non randomised patients (parallel effectiveness study). CONCLUSION: The results suggest that setting personalised and measurable objectives, as recommended by the manual, can improve the outcome of rehabilitation of severe mental disorders. Better outcomes in the parallel effectiveness study could be attributed to the greater confidence and enthusiasm of staff in centres where the VADO approach originated.

[Community attitudes towards mental illness and socio-demographic characteristics: an Italian study]. / Atteggiamenti verso la malattia mentale e caratteristiche socio-demografiche: uno studio in una città del nord Italia.

AIM: To assess the association between socio-demographic characteristics and community attitudes towards mentally ill people. METHOD: We assessed a sample of 280 subjects, stratified for sex and age, which has identified using the electoral registers of Brescia. A letter was sent to everyone in order to introduce the future potential study participant to the topics of the public attitudes towards mental illness and it included an invitation to take part in the study. After, 280 subjects were contacted by telephone. Finally, 174 persons, who expressed their willingness to collaborate, were visited by a team of four trained interviewers. The instruments used were: a semi-structured interview; the Community Attitudes to the Mentally Ill (CAMI) inventory, which is composed by 40 statements, concerning the degree of acceptance of mental health services and mentally ill patients in the community; and the Fear and Behavioural Intentions (FABI) inventory, which is composed by 10 items, concerning fears and behavioural intentions towards mentally ill people. 106 subjects refused to participate. RESULTS: Factor analysis of the CAMI revealed three components Physical distance and fear, Social isolation and Social responsibility and tolerance. Factor 1 is associated with: people >61 years old; people being divorced/widowed/living separated; people who haven't participated in social or volunteer activities. Factor 2 is associated with: people > 41 years old; people being schooled at a level that's higher than elementary level; unemployed people. Factor 3 doesn't present any associations. CONCLUSIONS: The results of this study outline the need to: a) promote interventions focused to improve the general attitude towards people with mental illness; b) to favour specific actions in order to prevent or eliminate prejudices in subgroups of the population.

[Correlation between subjective well-being and pharmacological therapy in patients with psychotic disorders]. / Benessere soggettivo e terapia farmacologica in pazienti inseriti in una struttura residenziale di riabilitazione psichiatrica. Uno studio esplorativo.

AIMS: The present study aims to investigate whether exists a meaningful relation between quality of life and subjective well being with regard to the pharmacological treatment (antipsychotic typical versus atypical) in a sample of people with psychotic disorders integrated in a Community Residential Rehabilitation Centre; to examine whether the different antipsychotic treatment is correlated to a different answer to the psychosocial rehabilitation intervention in terms of significant improvement in the positive and negative symptomatology, subjective well-being and quality of life. METHOD: All patients, who suffer from schizophrenia and schizoaffective disorder according to DSM-IV criteria, treated with antipsychotic and stabilized from at least one month, were enrolled in the study. RESULTS: 32 patients have participated in the study: 22 patients treated with atypical drugs and 10 with typical. The analysis of the collected data didn't show any significant statistical difference at baseline with regard to symptomatology, subjective well-being and quality of life. From the statistical analysis of the data to the endpoint, after a month of psychosocial rehabilitation, we found a statistically meaningful improvement in all the areas inquired in the group of the patients dealt with antipsychotic atypical drugs. CONCLUSION: The results confirm that the atypical antipsychotics are more effective, than the typical, to improve symptomatology, subjective well-being and quality of life of psychiatric patients.

[Stress, job satisfaction, and quality of life in the health professions: the role of burn-out and personality features]. / Stress, soddisfazione lavorativa e qualità della vita nei Servizi: il ruolo del "burn-out" e le caratteristiche di personalità.

Emotional exhaustion, depersonalisation and personal achievement represent the main dimensions of the "burn-out syndrome" (B.O.). The risk of B.O. is especially elevated among people working in helping professions. These professionals work in settings that are characterised by a very strong emotional involvement. The representative sample of this study consisted of 100 subjects of whom a part of them worked in a psychiatric setting and others who didn't. All of them have been assessed through the M.B.I. and the E.P.Q. The purpose of the present study was especially: 1) to explore the existence of B.O. and its level, and 2) to verify the existence of some personality characteristics of employees which could be considered as possible predictors of B.O. syndrome. The statistical analysis showed that the three B.O. dimensions and therefore the B.O. syndrome were within the group of persons working in helping professions. The outcomes of this study encouraged an intervention focused on three parts: job organisation, self-management of psychological well-being and teamwork effectiveness.