Deinstitutionalization revisited: a 5-year follow-up of a randomized clinical trial of hospital-based rehabilitation versus specialized assertive intervention (OPUS) versus standard treatment for patients with first-episode schizophrenia spectrum disorders.

BACKGROUND: The effects of hospital-based rehabilitation including weekly supportive psychodynamic therapy compared with specialized assertive intervention and standard treatment has not previously been investigated in first-episode psychosis. The aim of the study was to examine long-term effect on use of institutional care of different intensive interventions for patients with first-episode schizophrenia spectrum disorder on use of psychiatric bed days and days in supported housing. METHOD: A total of 94 severely ill patients with first-episode schizophrenia spectrum disorders were included in a special part of the Copenhagen OPUS trial and randomized to either the specialized assertive intervention program (OPUS), standard treatment or hospital-based rehabilitation. RESULTS: It was a stable pattern that patients randomized to hospital-based rehabilitation spent more days in psychiatric wards and in supported housing throughout the 5-year follow-up period compared with the two other groups. Patients in OPUS treatment spent significantly fewer days in psychiatric wards and supported housing in the first 3 years compared with patients in hospital-based rehabilitation. Due to attrition and small sample size, differences in level of psychotic and negative symptoms at 5-year follow-up could not be evaluated. CONCLUSIONS: The study indicates that hospital-based rehabilitation together with weekly supportive psychodynamic therapy was associated with a continued increased use of psychiatric bed days and days in supported housing. The data cannot justify using hospital-based rehabilitation in first-episode psychosis.

The association between pre-morbid adjustment, duration of untreated psychosis and outcome in first-episode psychosis.

BACKGROUND: The association between the duration of untreated psychosis (DUP) and outcome of schizophrenia may be confounded by other factors such as poor pre-morbid adjustment. The aim of the present study was to examine the independent contributions of DUP and of pre-morbid adjustment to the clinical and social outcomes of schizophrenia. METHOD: A longitudinal, prospective, 2-year follow-up study of 423 patients with first-episode schizophrenia-spectrum psychosis was conducted. Patients were comprehensively assessed at entry, 1-year and 2-year follow-up. At entry, DUP was measured by IRAOS (an instrument for the assessment of onset and early course of schizophrenia) and pre-morbid adjustment was measured by the Pre-morbid Adjustment Scale (PAS) as 'pre-morbid social adaptation' and 'pre-morbid school adaptation'. Outcome measures included the Scale for the Assessment of Positive Symptoms (SAPS), the Scale for the Assessment of Negative Symptoms (SANS), the Social Network Schedule and social information. Multiple linear regression models were used for data analysis. RESULTS: The median DUP was 48 weeks, which is long compared to other studies. Longer DUP was independently associated with more psychotic symptoms at entry, 1-year and 2-year follow-up. Poorer pre-morbid social adaptation was independently associated with more negative symptoms and smaller social network at entry and 1-year follow-up. Poorer pre-morbid school adaptation was independently associated with poor vocational outcome at 1-year and 2-year follow-up. CONCLUSIONS: Longer DUP is associated with poorer 2-year outcome of psychosis in schizophrenia-spectrum disorders, when pre-morbid functioning and other prognostic factors are controlled for. Impaired pre-morbid development is independently associated with more negative symptoms and poorer social outcome.

Integrated treatment ameliorates negative symptoms in first episode psychosis--results from the Danish OPUS trial.

PURPOSE: To investigate the effect of integrated treatment on negative, psychotic and disorganised symptoms in patients with first episode psychosis. METHOD: A RCT comparing integrated treatment (IT) with standard treatment (ST) was conducted, including 547 patients, aged 18-45, diagnosed with schizophrenia spectrum disorders. All patients were assessed with SCAN, SAPS and SANS at entry and after 1 and 2 years. The IT consisted of assertive community treatment, multifamily groups, psycho-education and social skills training, and the caseload was 1:10 compared with 1:25 in ST. Since attrition was considerable, a mixed model analysis with repeated measurements was used to examine the possible effects of IT statistically. RESULTS: IT reduced both negative and positive symptoms significantly better than ST. Most marked were the results from the negative dimension, where all five global scores from SANS had a significantly better reduction in IT. Sub-analyses did not single out any one element in the integrated treatment that could explain this result. CONCLUSION: Integrated treatment significantly reduced both negative and psychotic symptoms, assumably due to the different psychosocial treatment elements that were provided in the IT. The results indicate that the integrated approach is crucial, since, most likely, many aspects of the integrated treatment have contributed to the reduction of symptoms.

Temperature dependency of skin susceptibility to water and detergents.

Exposure to water and detergents is an important factor for development of irritant contact dermatitis. The aim of the present study was to investigate the effect of temperature on the damaging effects of water and detergents on the skin. Twenty healthy volunteers participated in the study. Ten participants had right and left forearms immersed into a detergent (soap) solution for 2 days twice daily for 10 min. Another 10 participants had both forearms immersed into sterile water. Right and left forearms were randomized to immersion into 20 degrees C and 40 degrees C solutions, respectively. Reactions were evaluated clinically, and by measurement of transepidermal water loss, electrical capacitance and erythema. Immersions into 40 degrees C sodium lauryl sulphate solution caused significantly increased transepidermal water loss as compared to immersion into 20 degrees C sodium lauryl sulphate solution. Electrical capacitance and erythema were not significantly influenced by temperature. Immersion into water caused no significant changes in any observed parameter. Water temperature influences the irritant capacity of a detergent. Change of temperature may be a simple but important means for prevention of irritant contact dermatitis.

Localization of gonococci in the anterior oral cavity--a possible reservoir of the gonococcal infection?

In a 6 months period pharyngeal gonococci were detected by routine cultures in 74 (8%) of 951 patients with gonorrhoea. In approximately one third of the 74 patients, a positive culture from the pharynx was the only sign of a gonococcal infection. Fourteen (19%) of the 74 patients with pharyngeal gonorrhoea also had positive cultures of Neisseria gonorrhoea from vestibulum oris. In spite of thorough contact tracing and interview concerning sexual practices in all these patients and when possible their sexual partners, we were not able to show directly that gonococci located in the oral cavity and especially in its anterior part also served as a reservoir of infection. However, three patients with exclusively pharyngeal gonorrhoea denied genito-oral sexual intercourse and could probably have been infected by strictly oro-oral contact. It is concluded that the existence of pathogenic bacteria in the anterior oral cavity in a large proportion of patients with pharyngeal gonococcal infection strengthen the possibility of this localization as a source of the infection.