Durability of the efficacy of integrated care in schizophrenia: a five-year randomized controlled study.

OBJECTIVE: The aim of the study was to evaluate the durability of efficacy of the Integrated Care (IC) program in a Swedish context. The IC program is a person-centered flexible assertive community treatment approach delivered through a novel mechanism: a resource group clinical microsystem for each patient. METHODS: All patients with schizophrenia in a Gothenburg urban-sector catchment area were randomly assigned to either the IC or the Rational Rehabilitation (RR) programs. Sixty-six patients were interviewed and assessed by independent interviewers before treatment, after treatment (24 months), and at follow-up (five years). Analysis was by intention to treat. RESULTS: At the five-year follow-up, significant improvements were noted in social functioning and consumer satisfaction in the IC group (N=35) compared with the RR group (N=31). No patients were lost to services in either program. CONCLUSIONS: The major finding was the durability of efficacy of the IC program.

The self-assessment Global Quality of Life scale: Reliability and construct validity.

Abstract Objective. The aim was to establish psychometric properties of the Global Quality of Life Scale (GQL) for people with severe mental illness. Methods. GQL is a stand-alone visual analogue scale included in "The Quality Star", a minimal platform for clinical follow-up and efficiency documentation of mental health services in eight dimensions widely used in Sweden. Validating instruments included MANSA, Inventory of Problem and Solutions, Consumer Satisfaction Rating Scale, Perceived Global Distress, health screening using UKU-Side Effect Rating Scale, GAF, and Perceived Global Burden (for next of kin). Test-retest reliability of the GQL was examined between ratings at quarterly intervals during 1 year. Results. There were three main results: test-retest reliability at quarterly intervals was very satisfactory, concurrent validity with the initial item of life satisfaction scale of MANSA, "Life as a whole", was demonstrated and finally content validity was clarified by associations with a number of validating measures from several contexts in three studies. Conclusion. GQL have acceptable psychometric properties and is valid for serious mental ill persons. Its use as easy-to-use instrument for screening of perceived global quality of life was supported.

Self-reported consumer satisfaction in mental health services: validation of a self-rating version of the UKU-Consumer Satisfaction Rating Scale.

The UKU-Consumer Satisfaction Rating Scale (UKU-ConSat) for the evaluation of consumer satisfaction in mental health services was constructed for assessments by independent professional interviewers. In the present study, a patient self-reported version of the scale is validated against the original version. The Spearman's rank correlation between single items, subscores and the total of the original scale and the self-assessment version was found to be good. Another main finding was an acceptable unidimensionality of the self-rating version of the UKU-Consumer Satisfaction rating scale, evaluated by a Mokken analysis. Furthermore, the internal consistency by Cronbach's alpha was found to be satisfactory. The results show that the patient self-rating version is psychometrically sound and therefore suitable for use in ordinary clinical practice. Being a part of a concept for continuous quality control and development in mental health services, the self-rating version of the UKU-ConSat promotes an open collaborative dialogue between professionals and users. A further advantage is that it saves professional time.

Symptoms profile and quality of life in rural and urban patients with chronic psychoses.

The symptoms profile (modified Positive and Negative Syndrome Scale, PANSS) and the quality of life (Lancashire Quality of Life Profile, LQLP, and the Quality of Life Scale 100, QLS-100) were compared between two groups of patients with chronic psychoses: a rural group of 19 patients living in villages with < or =300-10,000 inhabitants and far away from a large city, and an urban group of 19 patients living in a major city with 250,000 inhabitants. The patients were matched pair-wise for sex, age, global assessment of functioning (GAF) and psychiatric symptoms (modified PANSS, total score). Seventeen of the pairs were diagnosed with schizophrenia, and two pairs with delusional disorder. The symptoms profile indicated more negative symptoms and less positive symptoms for the rural group, compared with the urban group, with a significantly lower degree of spontaneity in the rural group. No group differences were found in the QLS-100, or in the specific quality of life variables according to LQLP. However, the rural group had significantly higher self-rating of the general quality of life variables of the LQLP, i.e. satisfaction with well-being, general health and mental health. The results are discussed in view of a possible relation between negative symptoms and impairments in social cognition and insight.