Psychoeducation for schizophrenia in the Czech Republic: curriculum modification based on opinions of service users and providers.

OBJECTIVE: The authors examined current knowledge about psychoeducation for schizophrenia in Czech Republic. METHODS: The authors sent a screening survey to 550 mental health-care facilities and administered a detailed questionnaire to 113 providers of mental health and social services and to 200 service users. The authors also carried out 14 focus groups and 16 individual interviews. RESULTS: Forty-six departments provided some type of psychoeducation for schizophrenia; of these, 16 provided family psychoeducation for patients and relatives and 1 provided psychoeducation only for relatives. Service users who received psychoeducation performed significantly better in the test of knowledge than did service users who did not receive psychoeducation. CONCLUSION: The authors propose a service user-driven curriculum based on information delivery followed by skills training. Psychiatrists should learn to explain schizophrenia relapse neurobiology to laypeople and to address relatives' frustrations.

The attitudes of older adults living in institutions and their caregivers to ageing.

OBJECTIVES: The aim of this study was to explore the attitudes of older people living in institutions and their caregivers to ageing. Recent outcomes showed prevailing negative social stereotype to ageing in CR. METHODS: The Attitudes to Ageing Questionnaire (AAQ-24) was used in two waves of data collection to measure attitudes of 400 randomly selected residents of 19 Senior Residential Homes. The reduced sample of 220 seniors and 276 professional carers employed at twelve Senior Residential Homes completed 12 items of general form (AAQ-12). All respondents expressed their agreement or disagreement with the statements presented in the questionnaire regarding positive or negative attitudes to ageing. RESULTS: The AAQ total score proved significant influence of gender, having children, self-perceived health, depression, and quality of life. Subscale scores (psychosocial losses, physical changes, psychological growth) were significantly influenced by gender, age, activities limitations, having own children, depression, self-perceived health status, and quality of life. Globally, the attitudes of professional caregivers to ageing were more positive compared to the attitudes of older people living in institutions. Older adults showed higher agreement with negative statements about ageing. There was no difference between professional caregivers and older people in the positive attitudes to ageing expressed as the growth potential. Physical activity, wisdom, better ability to cope with life and contacting young generation were effective in the positive attitudes of both groups.

Trends in hospital admissions for eating disorders in a country undergoing a socio-cultural transition, the Czech Republic 1981-2005.

OBJECTIVE: To test the hypothesis that the socio-cultural transition in the 1990s in Eastern Europe was associated with an increase in admissions for eating disorders (ED). METHOD: Cases of ICD-9 and ICD-10 ED in 1981, 1986 and 1992-2005 and first admissions for ICD-10 anorexia nervosa (AN) in 1994-2005 were retrieved from the Czech national register of hospital admissions. Age- and sex-adjusted admission rates (per 100,000) were calculated and time trends tested by Poisson regression. RESULTS: The admission rate for ED in females aged 10-39 quadrupled from 2.6 (95% CI 2.1-3.0) in 1981 to 10.6 (95% CI 9.8-11.5) in 2001, and remained elevated till 2005. The rate of first-time admissions for AN in 10- to 39-old females increased from 4.5 (95% CI 3.6-5.4) in 1994 to 7.5 (95% CI 6.3-8.6) in 1999, followed by a non-significant decrease. CONCLUSION: Temporal association of an increase in admissions with socio-cultural transition suggests that risk of severe ED including AN is culture-dependent.

[Education in schizophrenia: how patients and their relatives assess the relapse prevention programme PREDUKA]. / Edukace u schizofrenie: Jak pacienti a príbuzní hodnotí program prevence relapsu PREDUKA.

Antipsychotic medication and early relapse warning signs detection are the cornerstone of relapse prevention in schizophrenia spectrum disorders. Many patients do not use antipsychotic medication because of lack of information about its preventive effects and the risk of relapse. We introduce PREDUKA--PREventive EDUcational programme for relapse prevention. The goal of the programme is to deliver the information about schizophrenia to patients and their relatives. 178 patients and 252 relatives (118 mothers and 51 fathers) took part in 25 one-day psychoeducational programmes in 6 centres in the Czech Republic between January 2008 and June 2009 and anonymously fulfilled a short questionnaire. Patients and relatives assessed the programme with an average mark 1.4 (1 best, 5 worst). 49.4% patients and 49.0% relatives had received enough information about psychotic disorders during their hospitalization. Moreover 94.1% patients and 95.7% relatives confirmed acquiring new information on how to live with psychosis as a result of PREDUKA programme. 59.6% patients and 73.8% relatives were interested in ITAREPS - Information Technology Aided Relapse Prevention Programme. Mothers were significantly more interested (82.2%) than fathers (62.2%) (p = 0.031). Expressed high interest of patients and their relatives in both programmes indicates their readiness to become active and competent partners in the long-term treatment of schizophrenia spectrum disorders.

European network for promoting the physical health of residents in psychiatric and social care facilities (HELPS): background, aims and methods.

BACKGROUND: People with mental disorders have a higher prevalence of physical illnesses and reduced life expectancy as compared with the general population. However, there is a lack of knowledge across Europe concerning interventions that aim at reducing somatic morbidity and excess mortality by promoting behaviour-based and/or environment-based interventions. METHODS AND DESIGN: HELPS is an interdisciplinary European network that aims at (i) gathering relevant knowledge on physical illness in people with mental illness, (ii) identifying health promotion initiatives in European countries that meet country-specific needs, and (iii) at identifying best practice across Europe. Criteria for best practice will include evidence on the efficacy of physical health interventions and of their effectiveness in routine care, cost implications and feasibility for adaptation and implementation of interventions across different settings in Europe. HELPS will develop and implement a "physical health promotion toolkit". The toolkit will provide information to empower residents and staff to identify the most relevant risk factors in their specific context and to select the most appropriate action out of a range of defined health promoting interventions. The key methods are (a) stakeholder analysis, (b) international literature reviews, (c) Delphi rounds with experts from participating centres, and (d) focus groups with staff and residents of mental health care facilities.Meanwhile a multi-disciplinary network consisting of 15 European countries has been established and took up the work. As one main result of the project they expect that a widespread use of the HELPS toolkit could have a significant positive effect on the physical health status of residents of mental health and social care facilities, as well as to hold resonance for community dwelling people with mental health problems. DISCUSSION: A general strategy on health promotion for people with mental disorders must take into account behavioural, environmental and iatrogenic health risks. A European health promotion toolkit needs to consider heterogeneity of mental disorders, the multitude of physical health problems, health-relevant behaviour, health-related attitudes, health-relevant living conditions, and resource levels in mental health and social care facilities.

Demographic and psychosocial correlates of quality of life in the elderly from a cross-cultural perspective.

We compared the quality of life (QOL) of older adults in a post-communist country (the Czech Republic) with those living in traditional western democracies. The sample comprised 1981 respondents aged 60+ (from 60 to 99). The subjective QOL was measured using the WHOQOL-BREF and the add-on module for older adults, the WHOQOL-OLD. The findings showed higher score of depressive symptoms measured by the GDS scale and lower QOL in Czech sample as compared to other centres. Analyses of factors related to QOL of older adults showed similar patterns for the Czech sample and other centres with depression emerging as the strongest determinant of reduced QOL Findings also underline that subjective quality of life measurement reflects cross-country differences in accordance with objective indicators of national prosperity.

The epidemiology of major depressive episodes: results from the International Consortium of Psychiatric Epidemiology (ICPE) Surveys.

Absence of a common diagnostic interview has hampered cross-national syntheses of epidemiological evidence on major depressive episodes (MDE). Community epidemiological surveys using the World Health Organization Composite International Diagnostic Interview administered face-to-face were carried out in 10 countries in North America (Canada and the US), Latin America (Brazil, Chile, and Mexico), Europe (Czech Republic, Germany, the Netherlands, and Turkey), and Asia (Japan). The total sample size was more than 37,000. Lifetime prevalence estimates of hierarchy-free DSM-III-R/DSM-IV MDE varied widely, from 3% in Japan to 16.9% in the US, with the majority in the range of 8% to 12%. The 12-month/lifetime prevalence ratio was in the range 40% to 55%, the 30-day/12-month prevalence ratio in the range 45% to 65%, and median age of onset in the range 20 to 25 in most countries. Consistent socio-demographic correlates included being female and unmarried. Respondents in recent cohorts reported higher lifetime prevalence, but lower persistence than those in earlier cohorts. Major depressive episodes were found to be strongly co-morbid with, and temporally secondary to, anxiety disorders in all countries, with primary panic and generalized anxiety disorders the most powerful predictors of the first onset of secondary MDE. Major depressive episodes are a commonly occurring disorder that usually has a chronic-intermittent course. Effectiveness trials are needed to evaluate the impact of early detection and treatment on the course of MDE as well as to evaluate whether timely treatment of primary anxiety disorders would reduce the subsequent onset, persistence, and severity of secondary MDE.

Does the diabetic foot have a significant impact on selected psychological or social characteristics of patients with diabetes mellitus?

UNLABELLED: The aim of our case-control study was to compare selected psychological and social characteristics between diabetic patients with and without the DF (controls). METHODS: 104 patients with and 48 without DF were included into our study. Both study groups were compared in terms of selected psychosocial characteristics. RESULTS: Compared to controls, patients with DF had a significantly worse quality of life in the area of health and standard of living as shown by lower physical health domain (12.7 ± 2.8 versus 14.7 ± 2.5; P < 0.001) and environment domain (14.1 ± 2.2 versus 15 ± 1.8; P < 0.01) that negatively correlated with diabetes duration (r = -0.061; P = 0.003). Patients with DF subjectively felt more depressed in contrast to controls (24.5 versus 7.3%; P < 0.05); however, the depressive tuning was objectively proven in higher percentage in both study groups (83.2 versus 89.6; NS). We observed a significantly lower level of achieved education (P < 0.01), more patients with disability pensions (P < 0.01), and low self-support (P < 0.001) in patients with the DF compared to controls. In the subgroup of patients with a previous major amputation and DF (n = 6), there were significantly worse outcomes as in the environment domain (P < 0.01), employment status, and stress readaptation (P < 0.01) in contrast to the main study groups. CONCLUSIONS: Patients with DF had a predominantly worse standard of living. In contrast to our expectations, patients with DF appeared to have good stress tolerability and mental health (with the exception of patients with previous major amputation) and did not reveal severe forms of depression or any associated consequences.

Self and proxy rating of quality of life in adults with intellectual disabilities: results from the DISQOL study.

The aim of this study was to analyze the agreement between self and proxy reports of quality of life (QoL) in people with intellectual disabilities and to examine the factors which contribute to these differences. The study was conducted across six international centres in a sample of 614 adults with intellectual disabilities as well as two different samples of proxies (N=874) including both professional carers and relatives. QoL was assessed with the disability version of the WHOQOL-BREF. In both proxy samples results show a significant moderate association between the persons' QoL-assessment and the assessment of their proxies in all of the five QoL domains. There were significant mean differences in most items which varied in their direction. In general, people with disabilities rated their QoL higher than their proxies except for two items from the physical domain. The factors which most significantly contributed to these differences were proxy knowledge of the person as well as the WHODAS-disability score. Cross-cultural differences in the magnitude of concordance were observed. As a conclusion, the study shows a good agreement between the person-proxy QoL-assessments, and that the factors associated with disagreement are limited in this study. Future studies should elaborate the stability of concordance over time.

Subjective quality of life in psychiatric patients: diagnosis and illness-specific profiles.

OBJECTIVE: In accordance with the definition of health by the World Health Organization, outcome measures beyond mere syndromic recovery, such as quality of life ratings, would aid psychiatric practice and research. This is the first study of psychiatric diagnosis and illness stage specific profiles of subjective quality of life (SQOL) impairment. METHOD: Patients (n = 150) hospitalized at the Prague Psychiatric Center rated their SQOL using the Schwartz Outcome Scale at admission and discharge. Severity of illness and clinical improvement were measured by the Clinical Global Impression Scale. RESULTS: The highest and lowest SQOL at admission were reported by patients with psychosis and mood disorders respectively (F = 7.3, df = 2,147, P < 0.001). SQOL improved significantly during hospitalization in all diagnostic categories (F = 90.0, df = 1,147, P < 0.001), with the smallest and largest improvement in patients with psychosis and mood disorders, respectively (F = 5.6, df = 2,147, P = 0.005). There was a trend for differences in ratings of clinical improvement by patients, compared with psychiatrists, across diagnostic categories (F = 2.9, df = 2,147, P = 0.06), with significant differences only in patients with anxiety disorders. These patients also reported the lowest SQOL at discharge (F = 3.0, df = 2,147, P = 0.05). Global improvement correlated with improvement in SQOL only in patients with mood disorders (r = -0.4, P = 0.005). CONCLUSIONS: Main psychiatric diagnostic categories differ in SQOL and in association between SQOL and treatment. These differences may reflect illness-specific mechanisms, such as depressive symptoms in mood disorders, low insight in psychotic patients, aggravation of anxiety before discharge in patients with anxiety disorders, and may aid in planning of specific treatment interventions.

Analysis of parasuicide, psychiatric care and completed suicides, implications for intervention strategy (Czech Republic, 1996-2000).

BACKGROUND: This retrospective study analyses the differences between suicide with and without previous parasuicide. The Czech Republic was one of the countries with the traditionally highest level of suicide mortality. During collapse of the communist regime and deep societal changes in the Czech Republic after the year 1989 the escalation of suicides was expected. Mortality from suicides decreased, however the gender and age differences increased. METHODS: A total of 2,711 suicides in the Czech Republic (1996-2000) were studied. Effects of socioeconomic characteristics, psychiatric diagnosis and care, and lifetime history of parasuicide on the risk of death from suicide were estimated using logistic regression. RESULTS: Twenty-three percent of persons who committed suicide had a prior history of parasuicide and almost twenty percent of them received no psychiatric care after the attempt. Young males with basic education, economically active and diagnosed with substance abuse related disorders and the elderly were least likely to receive psychiatric care before their suicide death. CONCLUSIONS: Implications for age specific primary and secondary prevention are discussed.

A brief mental health outcomes measure: translation and validation of the Czech version of the Schwartz Outcomes Scale-10.

The Schwartz Outcomes Scale-10 (SOS-10) is a 10-item scale developed to measure the effectiveness of psychiatric treatments. Using standard methodology, we translated the scale into Czech and examined the psychometric properties of the Czech version. 207 in-patients admitted to Prague Psychiatric Center were included in the study. All patients completed the SOS at admission and discharge. The SOS-10 scale was also administered to 170 persons from the general population. Reliability, validity and sensitivity to treatment change of the Czech SOS-10 were analyzed. The Cronbach's alpha coefficient was 0.92. The item-total correlation coefficients varied from 0.56 to 0.82. The SOS-10 correlated well with condition-specific measures including depression (BDI) and anxiety (BAI) and a global self-rated symptom severity scale (CGI). The SOS-10 also had significant correlations with the Health, Basic needs, Relationship, and Leisure time domains of the Czech version of the Subjective Quality of Life Analysis (SQUALA-CZ). The scale discriminated well between patients and controls, with patients scoring significantly lower on all SOS items. The patient sample's admission and discharge scores were significantly different, indicating that the scale is sensitive to treatment changes. We concluded that the Czech SOS-10 is valid with reliability and factor structure similar to the American language version.

Relapse prevention in schizophrenia: does group family psychoeducation matter? One-year prospective follow-up field study.

Objectives. Relapse prevention is one of the most important goals of long-term schizophrenia management, as relapse is both distressing and costly. Family intervention supplementation to standard treatment could reduce the relapse rate. This study assessed the influence of a short-term, clinically based, and profesionally led family psychoeducation programme on a 1-year relapse rate. Methods. A total of 120 patients were recruited upon discharge from two psychiatric hospitals in Prague: (1) Site A (N=86), where family psychoeducation is offered to all patients with schizophrenia, schizoaffective disorder, and acute psychotic episode with schizophrenic symptoms; and (2) Site B (N=34), where no such programme was offered. Results. Compared to nonparticipants, psychoeducation participants had a shorter average length of rehospitalization stay (5.89 vs. 17.78 days, P=0.045) in a 1-year follow-up after discharge. The probability of rehospitalization during a 1-year follow-up was higher for patients from the site that did not provide psychoeducation. Conclusions. A shorter average length of rehospitalization of psychoeducation participants, a high turnout of first-episode patients, and positive responses of psychoeducation participants suggest that family psychoeducation should be supplemented early in the course of the illness to achieve favourable treatment outcomes and minimize adverse health and the social consequences of schizophrenia.