Four behavioural syndromes of schizophrenia: a replication in a second inner-London epidemiological sample

Behavior Problems Inventory (BPI): Psychometric characteristics of an instrument for routine assessment of persons with psychoses and related disorders

This study explores the psychometric characteristics of the Behavior Problems Inventory (BPI), an instrument for routine clinical assessment of behavior problems in outpatients with psychosis based on information provided by key family informants. Six hundred and twenty-one patients diagnosed with psychosis and bipolar affective disorder (ICD-10 F20-F31) attended at Community Mental Health Units were evaluated in routine reviews using the BPI and the Social Functioning Scale (SFS). Twenty-five subjects were simultaneously administered the Social Behavior Schedule (SBS) and 28 were again administered the BPI eight weeks later. The instrument shows adequate psychometric characteristics with high internal consistency and robust temporal reliability, as well as satisfactory concurrent and construct validity. Factor analysis identified three factors: Underactivity/Social Withdrawal, Active Problems and Lack of Impulse Control, with adequate saturation of the items on each of the factors. The BPI is easy to apply, reliable and valid, takes up little of valuable clinical time, allowing routine assessment in public service contexts for persons diagnosed with psychosis and bipolar affective disorder for whom key family informants are available.

Relationship between behavioural problems and use of mental health services in patients with severe mental illness and the mediating role of the perceived burden of care

Mental health models proposed for predicting more use of mental health resources by patients with severe mental illness are including a wider variety of predictor variables, but there are still many more remaining to be explored for a complete model. The purpose of this study was to enquire into the relationship between two variables, behaviour problems and burden of care, and the use of mental health resources in patients with severe mental illness. Our hypothesis was that perceived burden of care mediates between behaviour problems of patients with serious mental illness and the use of mental health resources. The Behaviour Problem Inventory, which was filled out by the main caregiver, was used to evaluate 179 patients cared for in a community mental health unit. They also answered a questionnaire on perceived family burden. A structural equation analysis was done to test our hypothesis. The results showed that both the behaviour problems and perceived burden of care are good predictors of the use of mental health resources, where perceived burden of care mediates between behaviour problems and use of resources. These variables seem to be relevant for inclusion in complete models for predicting use of mental health resources.

Patient Profiles in Dutch Forensic Psychiatry Based on Risk Factors, Pathology, and Offense

Forensic psychiatry embodies a highly heterogeneous population differing widely in terms of diagnoses, crimes committed, and risk factors. All of these are vitally important for treatment indications and should be accounted for in research. However, there is limited empirical knowledge of patient profiles. This study constructed patient profiles on the basis of the three domains mentioned above. Participants were found guilty of having committed crimes due to psychiatric disorders and were admitted to Forensic Psychiatric Center (FPC) 2landen or FPC De Kijvelanden in the Netherlands. Retrospective data were retrieved from patient files. Diagnoses were assessed according to the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR) criteria and risk factors according to the Historical Clinical Future-30 (HKT-30) instrument. Latent class analysis was conducted to define typologies; external variables were included for validation. Four different classes or "patient risk profiles," with varying psychopathologies, risk factors, and crimes, were identified. Results were consistent with previous studies, and external validation with the Psychopathy Checklist-Revised (PCL-R) two-factor model and the four facets of the PCL-R agreed with results found. Results display specific risk factors for specific psychopathology/offense combinations.

Predictors in use of mental health resources: The role of behaviour problems in patients with severe mental illness

BACKGROUND

In recent years, more variables are being included in the use of mental health resource prediction models. Some studies have shown that how well the patient can function is important for this prediction. However, the relevance of a variable as important as behaviour problems has scarcely been explored.

AIM

This study attempted to evaluate the effect of behaviour problems in patients with severe mental illness on the use of mental health resources.

METHOD

A total of 185 patients at a Community Mental Health Unit were evaluated using the Behaviour Problem Inventory. Later, a bivariate logistic regression was done to identify what behaviour problems could be specific predictors of use of mental health resources.

RESULTS

The results showed that the general index of behaviour problems predicts both use of hospitalization resources and outpatient attention. Underactivity/social withdrawal is the best predictor of all the different areas.

CONCLUSION

These results confirm the role of behaviour problems as predictors of the use of mental health resources in individuals with a severe mental illness.

Community outreach for patients who have difficulties in maintaining contact with mental health services: longitudinal retrospective study of the Japanese outreach model project

BACKGROUND

Japan still has the highest ratio of beds devoted to psychiatric patients in the world. In 2011, in order to reduce re-hospitalization of patients who became disconnected from regular contact with outpatient medical services, the Japanese Ministry established the Japanese Outreach Model Project (JOMP). In this study, we will explicate the JOMP project protocol and investigate the rate and length of hospital admission, impairments of social function and problematic behavior at the follow-up period (6- and 12-month) and time of services provided by JOMP.

METHOD

This longitudinal retrospective study used survey data collected from 32 outreach teams of 21 prefectures in Japan during September 2011 to July 2013. The outcome variables were assessed at baseline, 6-month and 12-month as to whether or not participants had been admitted to the hospital. Data from 162 participants with mental illness who had difficulties in maintaining contact with mental health services were analyzed. Repeated measures analysis of variance provided a significant effect of the intervention over time.

RESULTS

The rate of hospital admission of JOMP participants was 24.1% at 6-months and 27.2% at the 12-month follow-up. The average length of hospital-stay at baseline and 12-months was 38.7 days (SD 84.7). Compared with the baseline, the average score of the Global Assessment Functioning and the Social Behavioral Schedule were significantly improved after the 6-month and 12-month follow-up. The activity log showed that among the most often delivered JOMP services were to "prevent exacerbation of somatic symptoms" and "care for families".

CONCLUSION

These results suggest that JOMP has a strong potential to both reduce readmission rates and the length of hospital stay compared with the Japanese regular outpatient care by public insurance, and improve social function and problematic behavior. The JOMP teams provided long-term support for families. As of April 2014 JOMP was included in the National Health Insurance program in a limited way therefore an evaluation of JOMP team fidelity on readmissions must be examined.

Measuring community functioning in schizophrenia with the Social Behaviour Schedule

BACKGROUND

Current emphasis on community integration requires reliable and valid measures of social behaviour; existing assessments largely overlap with symptoms or provide little detail on functioning. This study aims to re-assess the Social Behaviour Schedule (SBS) to fulfil this measurement role.

METHODS

Internal consistency, construct validity and test-retest reliability were investigated in 421 community out-patients with schizophrenia. Concurrent validity was assessed against the Life Skill Profile (LSP), in 143 additional patients.

RESULTS

A 17-item SBS supported the construct validity of four factors: Antisocial Behaviour, Depressed Behaviour, Social Withdrawal and Thought Disturbance. It showed good test-retest reliability and rated significant social behaviour in a community sample. Weak correlations were observed with positive and negative symptoms. With the exception of Depressed Behaviour, the SBS factors showed strong correlations with the LSP.

CONCLUSION

SBS-17 is a valid measure assessing relevant community social functioning factors with relatively few items. The SBS could be useful both in research and in clinical settings.

Temperament and executive dysfunctions in schizophrenia

Recent studies suggest that both executive dysfunction and personality traits combine with symptoms to affect the social outcome of persons with schizophrenia. This study was designed to investigate how personality traits influence executive function in schizophrenia. Forty-four patients with schizophrenia and twenty-two healthy subjects were assessed for personality using the temperament and character inventory. Different aspects of executive function were assessed using the Auditory Digit Span (forward and backward) and the Wickens' test for proactive interference and release. The results showed that the influences of the various temperament dimensions on specific aspects of executive functions differ between patients and healthy subjects. On some dimensions, schizophrenia appears to reduce the cognitive differences related to temperament. On other dimensions, schizophrenia tends to reverse the cognitive differences related to temperament observed in healthy people. These results suggest that the temperamental profile of schizophrenia patients may well be of important prognostic value in the planning of cognitive enhancement therapy.

The measurement of social disablement and assessment of psychometric properties of the Social Behaviour Schedule (SBS-BR) in 881 Brazilian long-stay psychiatric patients

BACKGROUND

Data on the prevalence of social disablement in long-stay psychiatric patients, and the assessment of the psychometric properties of the instruments that evaluate social behaviour in this population are scarce in Brazil. Therefore, this cross-sectional study aimed to estimate the prevalence rates of social disablement in a population of long-stay psychiatric patients from the Rio de Janeiro metropolitan area, and assessed the psychometric properties of the Social Behaviour Schedule (SBS).

METHOD

Data were collected from a population of 881 psychiatric patients housed in the Municipal Mental Health Institute using the 21-item SBS.

RESULTS

Most of the patients were women (59%), the mean age was 65.8 years (SD = 11) and the mean length of stay was 37.3 years (SD = 11.5). Of the population, 50.6% were scored as having poor self-care, 46% with little spontaneous communication, 41.1% with poor attention span, and 37.1% with underactivity. Comparing our data with international studies that used the same instrument, we found that our population was more disabled than the others, especially on the social withdrawal factor. Regarding psychometric properties, the inter-rater kappa was 0.709, the inter-informant kappa was 0.500, and the Cronbach's alpha coefficient was 0.766. The groups of patients in the six settings of the institute presented significant statistical differences in the total score (F = 11.447, p < 0.001).

CONCLUSIONS

This study demonstrates the high rates of social disablement in this population. The precarious conditions of the institution where the patients have been living for decades and unmet individual care may have exacerbated their social disablement. Furthermore, the SBS-BR had satisfactory psychometric properties, particularly reliability, showing it to be an adequate instrument for measuring social disablement in Brazil.

The dimensional symptom structure of schizophrenia and its association with temperament and character

Recent studies suggest that personality may influence symptom expression and social functioning in schizophrenia. This study investigated the relationships between personality and symptom dimensions in schizophrenia patients. Fifty-two schizophrenia patients and 25 five healthy subjects were assessed using the Temperament and Character Inventory (TCI). The patients were also assessed for positive and negative symptoms using SAPS and SANS and scored according to Andreasen's (1995: Andreasen, N.C., Arndt, S., Alliger, R., Miller, D., Flaum, M. 1995. Symptoms of schizophrenia. Methods, meanings, and mechanisms. Arch. Gen. Psychiatry, 52, 341-351) classical three dimensional model and by the five dimensional model of Toomey et al. (1997: Toomey, R., Kremen, W.S., Simpson J.C., Samson, J.A., Seidman, L.J., Lyons, M.J., Faraone, S.V., Tsuang, M.T. 1997. Revisiting the factor structure for positive and negative symptoms: evidence from a large heterogeneous group of psychiatric patients. Am. J. Psychiatry, 154, 371-377). Comparisons between patients and controls revealed significant differences on various TCI scores consistent with a global disorganization of personality in schizophrenia involving both basic neurophysiological and potentially genetically determined traits (i.e. temperament) and developmental aspects of personality (i.e. character). Correlation analysis showed distinct associations between symptoms and personality dimensions. The results suggest that the negative and disorganized dimensions of schizophrenia are related temperamental factors, whereas the psychotic symptoms are more related to characterological abnormalities. The observed patterns of associations also underline the heterogeneity of the classical negative and positive dimensions of schizophrenia.