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.

Application of 360° virtual reality videos in the assessment of paranoia in schizophrenia patients: a pilot study. / Zastosowanie wirtualnej rzeczywistosci w formie filmów 360° do oceny nasilenia paranoi u pacjentów ze schizofrenia: badanie pilotazowe.

OBJECTIVES: Virtual Reality (VR) has been widely used in psychiatry, including psychotic disorders. The main advantage of VR is its high ecological validity and controllability of the virtual environment. Our main goal was to test whether, similarly to computer-generated VR, 360-degree videos are able to elicit a state of social paranoia in prone individuals. METHODS: Sixteen schizophrenia patients and twenty-three healthy individuals were assessed using Leibowitz Social Anxiety Scale and additionally, in the patient group, the Positive and Negative Syndrome Scale (PANSS-6) and Peters Delusional Inventory (PDI) were used. The participants viewed four 360-degree videos with and without social content on a VR headset. Meanwhile, subjects' heart rate was measured continuously. After the exposure, both groups were assessed with Social State Paranoia Scale (SSPS) and asked about momentary anxiety and sense of presence. RESULTS: The schizophrenia patients reported higher momentary anxiety, although the results of SSPS did not differ significantly between groups. In the control group the heart rate decreased between first non-social and social video, whereas in the patient group it did not differ significantly. There was a significant correlation of paranoid ideation experienced on daily basis (PDI) and elicited in VR (SSPS) in the patient group. CONCLUSIONS: In conclusion, paranoid responses can be triggered in patients with schizophrenia by 360-degree videos.

Flexible and Integrative Psychiatric Care Based on a Global Treatment Budget: Comparing the Implementation in Germany and Poland.

Background: The past decade has witnessed the establishment of flexible and integrative treatment (FIT) models in 55 German and Polish psychiatric catchment areas. FIT is based on a global treatment budget (GTB), which integrates funding of all acute psychiatric hospital services for a regional population. Prior research has identified 11 specific program components of FIT in Germany. In this paper we aim at assessing the applicability of these components to the Polish context and at comparatively analysing FIT implementation in Poland and Germany. Methods: Qualitative interviews about the applicability of the 11 FIT-specific components were conducted with the program managers of the Polish FIT models (n = 19). Semi-quantitative data on the FIT-specific components were then collected in 19 Polish and 10 German FIT models. We assessed the grading of each component, their overall degree of implementation and compared them between the two countries. In all study hospitals, structural and statistical parameters of service delivery were collected and compared. Results: The qualitative results showed that the German FIT-specific components are in principle applicable to the polish context. This allowed the comparative assessment of components grading and degree of implementation, which showed only subtle discrepancies between German and Polish FIT models. The little discrepancies point to specific aspects of care such as home treatment, peer support, and cooperation with non-clinical and social welfare institutions that should be further integrated in the components' definition. Conclusions: The specific program components of FIT as first defined from the German experience, serves as a powerful tool to measure, and evaluate implementation of integrated psychiatric care both within and between health systems.

[The prospective assessment of the influence of duration of untreated psychosis (DUP) on the course of schizophrenia]. / Prospektywna ocena wplywu czasu nie leczonej psychozy na przebieg schizofrenii.

AIM: This study is a part of a prospective schizophrenia research project run in Krak6w. The general objective of the project is a long-time observation of people with schizophrenia, starting from the first episode through the years of living with the illness, the assessment of treatment results and predictors. The goal of this study was to investigate whether the level of DUP before the first admission may have a prognostic value in regard to the further course of the illness. METHOD: Four indicators of treatment results were observed: the number of relapses, the overall time of inpatient hospitalisations, the number of inpatient hospitalisations and the severity of psychopathological symptoms assessed in 3, 7 and 12 years since the first hospitalisation. DUP was estimated during a clinical interview with a patient and his/her family at the index admission. The severity of symptoms was assessed with BPRS-SA, the UCLA version. RESULTS: The increase of the number of relapses in follow-up assessments was more prominent in the group with longer DUP (p < 0.001). The decrease of the results of BPRS (symptom improvement) was more prominent in patients with short DUP. They had significantly lower results compared to patients with long DUP at each assessment except the index hospitalisation (p equaled respectively: 0.449; 0.002; 0.012; 0.034 and 0.014). The decrease of positive symptoms was larger in patients with short DUP - significant in all except the 7-year follow-up (p equaled respectively: 0.230; < 0.001, 0.011; 0.214; <0.001). CONCLUSIONS: (1) A relationship was found between the duration of untreated psychosis and the dynamics of general and positive symptoms and the number of relapses. (2) There was no significant relationship between the duration of untreated psychosis and the dynamics of negative symptoms, whereas the relationship between the time and number of re-hospitalisations was on the brink of statistical significance. (3) A replication of some and the lack of confirmation of other long-time results observed by other researchers prompts us to conclude that there still is a need for further studies concerning the duration of untreated psychosis