No abstract

The HoNOS-12 does not measure a single, underlying construct of mental health status. Nevertheless, the instrument can be utilized in a reduced version (HoNOS-6), as a clinically acceptable outcome scale (measuring self-perceived clinical and social needs for community support, rather than global mental disorder) for routine use in a community setting population.

BackgroundThe purpose of the current study was the psychometric evaluation of the Health of the Nation Outcome Scales (HoNOS), an instrument developed to meet the necessity of a clinically acceptable outcome scale for routine use in mental illness services.MethodsThe study participants included 2,162 outpatients and residential inpatients (rated on the HoNOS on three occasions during the year 2000) with a range of mental illnesses in different diagnostic groups from ten Mental Health Departments, located in the area of Milan (Italy). Principal Component Analysis, Confirmatory Factor Analysis, Discriminant Analysis and Partial Credit Rasch Model were used to assess two sources of validity: the internal structure and the relationships with other variables.ResultsThe results of the 12-item HoNOS demonstrate a significant departure from uni-dimensionality, confirmed by the Rasch analysis (which identified three misfitting items). However, HoNOS scores demonstrate stability and precision of item difficulties over time. Discriminant analysis showed that HoNOS scores have an acceptable level of discriminatory power in predicting the severity of patients' conditions (as represented by setting).ConclusionsIt was concluded that the Italian version of the HoNOS does not measure a single, underlying construct of mental health status. The internal structure validity analysis recommends a note of caution to use a summary index of the HoNOS scores, given the presence of multidimensionality and misfit. Nonetheless, the finding that the instrument is more multidimensional than unidimensional does not preclude the use of the HoNOS as a clinically valid tool for routine outcome assessment. In fact, item scores have demonstrated sufficient reliability (over diagnostic groups and care settings) and high precision in time, indicating that HoNOS items can be utilized as valid measurement instruments in longitudinal analyses.

HoNOS possesses satisfactory sensitivity and validity to be used in the routine assessment in early intervention programmes.

The present study was carried out to investigate the routine use of second-generation antipsychotic drugs in the Italian psychiatric care system. Seven outpatient psychiatric services enrolled a consecutive case series of patients who were being treated, or had started treatment, with clozapine, olanzapine, risperidone, or quetiapine. Information on sociodemographic and clinical variables, current psychotropic drug use, side-effects and past use of typical drugs was collected. In addition, patient symptoms and functional status were evaluated by the Health of the Nation Outcome Scale. Patients receiving off-label prescribing of second-generation antipsychotics were identified. A total of 209 patients were collected. In comparison with patients receiving other second-generation antipsychotics, living in residential facilities, unemployment, long psychiatric histories, and problems with activities of daily living and living conditions were more common in clozapine-treated patients. Nearly 80 % of patients receiving clozapine had schizophrenia compared to less than 50 % of those receiving other second-generation antipsychotics. Overall, 109 patients (52 %) received off-label prescriptions of second-generation antipsychotic drugs. This survey indicates that clozapine was mostly reserved for severe cases and poor responders; the high rate of off-label prescriptions highlights the gap existing between recommendations derived from randomised clinical trials and the current use of drugs.