A cluster analysis of patients with schizophrenia in community care.

In a sample of patients with schizophrenia, four clusters were identified and service use and relatives' satisfaction analyzed. In the first cluster, patients' severity of illness was mild and their use of services low. In the second, patients' disability was more severe; psychiatric symptoms were low in severity, family burden was moderate, and use of community services was more intensive. In the third cluster, patients had serious disability and severe positive symptoms; their families suffered distressing burdens, and their use of hospital and community services was intensive. In the fourth cluster, patients' disability was very severe, negative symptoms were prominent, and relatives' burden was moderate; use of hospital services was frequent, and use of community services was less so.

[Problems of patients with schizophrenic disorders and of their families]. / I problemi dei pazienti con disturbi schizofrenici e delle loro famiglie.

OBJECTIVE: To evaluate psychopathological symptoms, disabilities and family burden in schizophrenic patients and to analyse predictors of family burden and relatives' satisfaction. DESIGN: Descriptive study of 203 patients with an ICD 10--F2 diagnosis (schizophrenia and related disorders) in contact with the Desio Department of Mental Health on 31st December 1994. SETTING: The Desio Department of Mental Health. MAIN OUTCOME MEASURES: The patients have been evaluated in three areas: disability (by ADC-DAS), psychiatric symptoms (by 24 items BPRS) and family burden (by Family Problems questionnaire). The outpatient, hospital and residential care contacts of the patients have been collected for six months by our service information system. For each area (DAS, BPRS and FP) a principal component analysis and a rotation of the significant components have been performed. Eleven factors, derived from three scales, have been retained as explanatory variables. Finally, a multiple regression analysis has been performed to assess the influence of explanatory variables on the set of response variables regarding family burden and relatives' satisfaction. RESULTS: One third of patients suffer of moderate-severe positive symptoms, while negative symptoms are less frequent. Manic symptoms are rare while depressive ones more frequent. Disability, related to work and sexual problems, is frequent; social withdrawn, underactivity, lack of participation in household duties and lack of self care are less frequent. Family burden is severe in one third of relatives, mainly in social relationships. Disability is the main predictor of family burden; manic and positive symptoms, time spent by the carer with the patient and carer's social support are less important. Satisfaction with services is predicted by family burden. CONCLUSIONS: To be more responsive to the needs of patients and relatives we should increase activities in rehabilitation and family support areas. Further analysis of severity of psychosocial and psychiatric problems, based on an epidemiological based sample, could give interesting results on the case-mix of different services.

[Cost of psychiatric patients by disability type]. / Il costo dei pazienti psichiatrici per classi di gravità.

OBJECTIVE: The study of the relation between treatment costs and disability of psychiatric patient groups. DESIGN: Perspective assessment of costs and disability of 1371 adult psychiatric patients in charge at two Operative Psychiatric Units (OPU), followed during an average period of 9 months. Data are related to all OPU's psychiatric services, including ambulatory, full or half-residential and psychiatric departments of acute hospital services. SETTING: OPUs of Magenta (MI) and Desio (MI). METHOD: The disability level has been measured by Health of the Nation Outcome Scales (HoNOS) filled in at the inclusion of the patient in the study and every three-months on average thereafter. Besides other HoNOSs have been filled in both at admission and discharge from psychiatric departments of acute hospitals, Residential Centres of psychiatric Therapies and Rehabilitation and Guarded Communities. All patients have been grouped using the main psychiatric diagnosis (first digit ICD-10) and the maximum disability level shown in the whole period of the study. Direct costs of publicly financed psychiatric services have only been considered. Their attribution to each patient has been made applying standard costs or tariffs (diagnostic procedures) to the data perspectively collected by the regional Register and a purposely designed protocol. RESULTS: Total cost of 1371 patients has been 9771.1 million lire with a cost per patient of 7,127,000 lire (sd 19,499,000) and a cost per "day in charge" of 27,172 lire (sd 68,358). The cost per day has been found unrelated with the length of observed time frame. At the inclusion the mean level of disability has been 4.26 points (sd 3.73) and 3.19 points (sd 3.26) at the end of the study. Its value, measured at maximum level shown by each problem in the whole period of study, has been 6.00 points (sd 4.64). Disability and treatment cost of each patient did result directly related (r = 0.626, p = 0.0001). All patients have been grouped in 12 classes with a significant (p = 0.0001) overall difference on both their disability level and treatment cost. CONCLUSIONS: All adult psychiatric patients could be grouped in disability related classes which sometimes have also a different treatment cost. A study on a greater number of patients is needed to confirm these results. It may also provide a more reliable basis for a new financing system of psychiatric services.