Very Long-Term Outcome of Community-Dwelling Patients With Schizophrenia Spectrum Disorders in Rural Greece

Nikolaou

2019

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Background: There is a dearth of studies on functioning in patients with psychotic disorders in rural areas. Aim: The objective of this study was to assess functioning in a population-based sample of patients with psychotic disorders who live in rural, remote and deprived areas in Greece, and to explore the differences in functioning across ages. Methods: The sample consisted of 61 patients with psychotic disorders that were engaged to treatment with a community mental health service. The mean age of patients was 54.2 years, and the mean illness duration was 26.5 years. Results: A total of 23 patients (37.7%) had score in the Global Assessment of Functioning scale >60, and were rated as adequately functioning, and 18 patients (29.5%) had score in Clinical Global Impression scale-Schizophrenia ⩽3 and could be rated as mildly or minimally ill. Functioning was found to be inversely related to the patients’ symptomatology. No correlation with age was found. Conclusion: This study suggests that a large proportion of patients with psychotic disorders in rural Greece may achieve a satisfactory level of functioning in the long-term, across the whole age range despite the not completely remitted symptomatology. More research is needed to clarify the factors associated with rural residency that may account for patients’ functioning.

Section: Discussionsupporting

confidence: 90%

Functioning in community-dwelling patients with schizophrenia spectrum disorders in rural Greece

Nikolaou

2019

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“…Finally, the measurement of other aspects of patients' outcome, such as psychopathology and functioning, were beyond the scope of this study. These issues have been recently addressed by other research by our team and results were encouraging (Peritogiannis et al, 2019;Peritogiannis & Nikolaou, 2020).…”

Section: Strengths and Limitationsmentioning

confidence: 61%

Decrease of hospitalizations and length of hospital stay in patients with schizophrenia spectrum disorders treated in a community mental health service in rural Greece

Gioti²,

Gogou³

et al. 2020

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Background: The treatment of severe and chronic mental disorders, such as schizophrenia and related syndromes, is largely based on community mental health services. Aims: The objective of the present study was to assess hospital admissions and length of hospital stay in patients with schizophrenia and related disorders, who are engaged to treatment with a Mobile Mental Health Unit (MMHU I-T) in a defined rural catchment area in Greece. Method: Data were retrieved retrospectively for 76 patients with schizophrenia and related disorders. For each patient, comparison was made for the same interval prior and after engagement to treatment with the MMHU I-T. Results: The average age of patients was 56 years and the mean illness duration was 28 years. The mean follow-up duration was 5.3 years. There was a statistically significant decrease in the annual average of the number of voluntary and involuntary hospitalizations and on days of hospital stay after treatment engagement with the MMHU I-T. Conclusions: Treatment of schizophrenia spectrum disorders in rural residents by the MMHUs may contribute to the reduction of patients’ admissions and length of hospital stay. Future research should address the cost-effectiveness of such interventions.

“…With the use of the Health of Nations Outcome Scale, it was found that 34.5% of patients had good outcome. Outcome was worse in patients living with other severely mentally ill family members (Peritogiannis et al, 2019). The most recent iHOPE-20 study has been conducted on an Irish incidence cohort of patients with a first episode of psychosis (FEP).…”

Section: Resultsmentioning

confidence: 99%

“…Long-term high-dose antipsychotic use and antipsychotic polypharmacy were associated with a poorer outcome and more severe social impairments in recent studies, but this finding may reflect treatment resistance and does not imply causality (Moilanen et al, 2016; Velthorst et al, 2017). Finally, patients with psychotic disorders who were members of families with other severe mentally ill members were found to have worst outcome (Peritogiannis et al, 2019).…”

Section: Predictors Of Outcomementioning

confidence: 99%

Very long-term outcome of psychotic disorders

Gogou²,

Samakouri

2020

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Background: The outcome of schizophrenia and related psychoses is generally modest, and patients display high rates of disability. Aims: The aim of the review is to present an up-to-date account of the research on the very long-term outcome of psychotic disorders. Method: We conducted a search in the PubMed and Scopus databases for articles published since the publication of the very long-term data of the World Health Organization’s International Study of Schizophrenia (the ISoS study), over the last 18 years (from 2002 to 2019). Studies were included if they reported on at least 15-year outcome and if they had used valid and reliable tools for the estimation of the patients’ outcome in terms of symptomatology and functioning. Results: A total of 16 studies were included in this review, involving 1,391 patients with schizophrenia and related psychoses. Most were single-center studies, with moderate size samples of patients, and 11 were prospective studies. Very long-term outcome of psychotic disorders varies considerably among studies. Good outcome ranges from 8% to 73.8%, and it appears to be better in developing countries, whereas differences are less apparent among Western countries (8%–40.3%). Studies in different settings have used different methods involving a variety of samples of patients to estimate their outcome, whereas definitions of good and poor outcome also varied among studies. Longer duration of untreated psychosis was associated with worse outcome in some studies. Schizophrenia was found to have poorer long-term prognosis compared to other schizophrenia spectrum disorders. A large proportion of patients, ranging from 19% to 48.2%, were not on medication. Conclusion: Recent evidence on the very long-term outcome of psychotic disorders is in line with previous reports and suggests that prognosis remains rather modest. There are several limitations of current research regarding outcome definitions and study design that should be addressed by future research.