Disability and service use among homeless people living with psychotic disorders

BACKGROUND: The prevalence of psychosis and needs for care among homeless people were studied in inner Melbourne. METHOD: This was a two-stage nested study within the Australian National Survey of People Living with Psychotic Illness. A screen for psychosis was administered to a representative sample of men and women living in marginal housing in a mental health service catchment area. A selected subsample of 82 screen-positive respondents was interviewed using the Diagnostic Interview for Psychosis (DIP), a semistructured, standardized interview with three modules: (i) demography, functioning and quality of life; (ii) diagnosis; and (iii) service use. RESULTS: An unexpectedly high prevalence of people living with psychotic disorders (estimated lifetime prevalence 42%, 95% CI=37-47%) may reflect a concentration of vulnerable people in the shrinking marginal housing supply in the inner city areas. Disability in everyday, occupational and social functioning is greater for this subgroup than for other people living with psychosis in Australia. Most people were single and unemployed, and many reported social isolation and feeling unsafe. Substance use disorders were common. Most people were using health services, including specialist mental health services, but few were receiving rehabilitation, vocational or housing support. CONCLUSIONS: Despite high levels of contact with a well-organized, sectorized mental health service in an affluent country, this pocket of several hundred people had high levels of persisting disability and needs. The literature and local experience suggest that changing this situation is likely to require co-ordinated policy and practice between the health, welfare and housing sectors.     

Psychosocial treatment compliance scale for people with psychotic disorders

OBJECTIVE: Psychosocial treatment compliance is essential for effective treatment outcomes. A psychometrically valid compliance scale is required for identifying possible obstacles causing treatment non-compliance and testing the effectiveness of compliance therapy. This study developed a scale to measure psychosocial treatment compliance of people with psychotic disorders and established its psychometric properties. METHOD: An initial item pool was generated by literature review and contacts with psychiatric professionals. The content validity and cultural relevancy of this scale were examined by experienced researchers, mental health professionals and mental health consumers which resulted in the 17-item Psychosocial Treatment Compliance Scale (PTCS). Some 108 adults with a DSM-IV diagnosis of psychosis verified by certified psychiatrists were recruited from mental hospitals and social service settings in Hong Kong. Self-stigma, self-esteem, self-efficacy, insight and attitudes to medication of the participants were measured by relevant assessment instruments through interviews. Case therapists then filled in the PTCS and recorded their demographic data. SPSS version 11.0 was used for data analysis. RESULTS: Exploratory factor analysis revealed a two-factor solution (participation and attendance) accounting for 70.74% of the variance. Test-retest reliability and internal consistency were 0.90 and 0.96, respectively, for 'participation'; and 0.86 and 0.87, respectively, for 'attendance'. Its convergent validity was supported by the correlational relationships with measures on self-stigma, self-esteem, self-efficacy, insight and attitudes to medication. CONCLUSION: PTCS is a reliable and valid scale which may be used to measure the compliance to psychosocial treatment of people with psychotic disorders.     

A systematic review of psychological interventions for excessive alcohol consumption among people with psychotic disorders

Baker AL, Hiles SA, Thornton LK, Hides L, Lubman DI. A systematic review of psychological interventions for excessive alcohol consumption among people with psychotic disorders. Objective: Excessive alcohol consumption is common among people with psychotic disorders. While there is an extensive literature on the efficacy of psychological treatments for excessive drinking, few studies have examined interventions addressing this issue among people with psychotic disorders. Method: Systematic searches in PubMed and PsycINFO were conducted to identify randomized controlled trials comparing manual-guided psychological interventions for excessive alcohol consumption among individuals with psychotic disorders. Of the 429 articles identified, seven met inclusion criteria. Data were extracted from each study regarding study sample characteristics, design, results, clinical significance of alcohol consumption results, and methodological limitations. Results: Assessment interviews, brief motivational interventions, and lengthier cognitive behavior therapy have been associated with reductions in alcohol consumption among people with psychosis. While brief interventions (i.e. 1-2 sessions) were generally as effective as longer duration psychological interventions (i.e. 10 sessions) for reducing alcohol consumption, longer interventions provided additional benefits for depression, functioning, and other alcohol outcomes. Conclusion: Excessive alcohol consumption among people with psychotic disorders is responsive to psychological interventions. It is imperative that such approaches are integrated within standard care for people with psychosis.     

Risk factors for homelessness among patients admitted to a state mental hospital

OBJECTIVE: This study measured the overall prevalence of homelessness and tested a priori hypothesized risk factors for homelessness among patients admitted to a state hospital. The risk factors included male gender, age under 40 years, black race, urban residence, schizophrenia-related diagnosis, alcohol abuse, and drug abuse. METHOD: For 377 patients admitted to a New York state mental hospital, the 3-month, 3-year, and lifetime prevalences of homelessness were assessed. The associations between these prevalences and the hypothesized risk factors were measured by relative risks in univariate analyses and by odds ratios derived from a logistic regression in multivariate analyses. RESULTS: The 3-month prevalence of homelessness was 19%, the 3-year prevalence was 25%, and the lifetime prevalence was 28%. In univariate analyses, significant associations included drug abuse with 3-month prevalence, 3-year prevalence, and lifetime prevalence; urban residence with 3-year prevalence and lifetime prevalence; and age under 40 years with 3-month prevalence. In the logistic regression analyses, the only significant associations were urban residence with 3-year prevalence and lifetime prevalence. Male gender, black race, alcohol abuse, and schizophrenia-related diagnosis had little or no relation to homelessness. CONCLUSIONS: The overall prevalence of homelessness in these patients was remarkably high. Several strong risk factors for homelessness in the general population had only a moderate effect or no effect on homelessness in this population. Risk factors for homelessness in psychiatric patients may be somewhat different from those in the general population.     

Risk of repeat offending among violent female offenders with psychotic and personality disorders

OBJECTIVE: The aim of this study was to examine the rate of criminal recidivism among female homicide offenders evaluated by forensic psychiatrists, to compare this rate with that of other violent female offenders, and to analyze the explanatory variables of recidivism. METHOD: This was a retrospective study of all women (N=132) sent for forensic psychiatric examination after being convicted of homicide or attempted homicide in Finland during 1982-1992; subjects were followed up until mid-1999. Data were collected from the national crime register, the prisoner record, and Statistics Finland. The authors compared the rate of violent repeat offending in this group with that of other violent women and analyzed the explanatory variables of recidivism. RESULTS: During the follow-up period, 23% of the study group committed a repeat offense, 15% of which were violent and 3% of which were homicides. Almost half of all repeat offenses occurred within the first 2 years after the index offense. There was no statistically significant difference in violent recidivism between the study group and other violent female offenders. Of those who committed repeat offenses, 81% were diagnosed with a personality disorder, and 10% were diagnosed with psychosis. Criminality prior to the index event, alcohol or drug dependency, and young age significantly raised the risk and rapidity of further offenses. CONCLUSIONS: The risk of recidivism was high in this study group yet was similar to that of other violent female offenders. The risk was high very early after release. It seems that women and men who are violent and have personality disorders are comparable in their risk of recidivism.     

Risk factors for first-time homelessness in low-income women

Determinants of first-time homelessness were evaluated in Sacramento, California and Lehigh Valley, Pennsylvania. First-time homeless women had more cumulative risks for homelessness than low-income never-homeless women, even with the putative advantage of higher levels of education. Solutions to homelessness should address more than one dimension of risk.     

Risk factors for the emergence of psychotic disorders in adolescents with 22q11.2 deletion syndrome

OBJECTIVE: The 22q11.2 deletion syndrome is the most common known genetic risk factor for the development of schizophrenia. The authors conducted a longitudinal evaluation of adolescents with 22q11.2 deletion syndrome to identify early risk factors for the development of psychotic disorders. METHOD: Sixty children, 31 with 22q11.2 deletion syndrome and 29 comparison subjects with idiopathic developmental disability matched for age and IQ, underwent a baseline evaluation between 1998 and 2000; of these, 51 children (28 and 23 in the two groups, respectively) underwent follow-up evaluation between 2003 and 2005. A standardized comprehensive psychiatric, psychological, and adaptive functioning evaluation was conducted in both waves. Participants with 22q11.2 deletion syndrome were also genotyped for the catechol O-methyltransferase (COMT) Met/Val polymorphism and underwent magnetic resonance imaging scans. RESULTS: The two groups had similar baseline neuropsychiatric profiles. At follow-up, 32.1% of subjects with 22q11.2 deletion syndrome had developed psychotic disorders as compared with 4.3% of comparison subjects. In the 22q11.2 deletion syndrome group, baseline subthreshold psychotic symptoms interacted both with the COMT genotype and with baseline symptoms of anxiety or depression to predict 61% of the variance in severity of psychosis at follow-up evaluation. Lower baseline verbal IQ was also associated with more severe psychotic symptoms at follow-up evaluation. CONCLUSIONS: Genetic, cognitive, and psychiatric risk factors for the evolution of psychotic disorders in 22q11.2 deletion syndrome during adolescence were identified. Early intervention in the subgroup of children with subthreshold signs of psychosis and internalizing symptoms (especially anxiety symptoms) may reduce the risk of developing psychotic disorders during adolescence.     

Correlates of loneliness among persons with psychotic disorders

Social Psychiatry and Psychiatric Epidemiology - Persons diagnosed with schizophrenia spectrum disorders (SSDs) often experience pervasive feelings of loneliness, which are considered a significant...     

Risk factors for substance use disorders among inpatients with major affective disorders in Taiwan Chinese

An assessment of potential risk factors for substance use disorders was performed in 49 patients with major affective disorders in a general hospital acute care unit in Taiwan. The major depression patients were noted to have a higher prevalence of substance use disorder than bipolar disorder patients (p = 0.011). Those patients with substance use disorders were noted to be significantly male-predominated (p = 0.043), to have a later onset age of affective disorder (p = 0.009), and to have more visits to the emergency room in the recent one year (p = 0.009). The sedatives-hypnotics-anxiolytics was the most frequently used forms of drug abuse. The major depression patients had a significantly higher sedative-hypnotics-anxiolytics use disorder rate than the bipolar disorder patients (p = 0.001). All patients with alcohol use disorder were noted to have other substance use disorders as well. Fifty six percent of those patients with substance use disorder were poly-substance users. Eighty three percent of the male patients with substance use disorder had poly-substance use disorder.     

Risk factors for suicide and attempted suicide among young people

OBJECTIVE: Suicide rates in young people have increased during the past three decades, particularly among young males, and there is increasing public and policy concern about the issue of youth suicide in Australia and New Zealand. This paper summarises current knowledge about risk factors for suicide and suicide attempts in young people. METHOD: Evidence about risk factors for suicidal behaviour in young people was gathered by review of relevant English language articles and other papers, published since the mid-1980s. RESULTS: The international literature yields a generally consistent account of the risk factors and life processes that lead to youth suicide and suicide attempts. Risk factor domains which may contribute to suicidal behaviour include: social and educational disadvantage; childhood and family adversity; psychopathology; individual and personal vulnerabilities; exposure to stressful life events and circumstances; and social, cultural and contextual factors. Frequently, suicidal behaviours in young people appear to be a consequence of adverse life sequences in which multiple risk factors from these domains combine to increase risk of suicidal behaviour. CONCLUSIONS: Current research evidence suggests that the strongest risk factors for youth suicide are mental disorders (in particular, affective disorders, substance use disorders and antisocial behaviours) and a history of psychopathology, indicating that priorities for intervening to reduce youth suicidal behaviours lie with interventions focused upon the improved recognition, treatment and management of young people with mental disorders.     

Risk factors for self-injurious behaviours among 222 young children with autistic disorders

The aim of this study was to identify risk factors for self-injurious behaviours (SIBs) in children with autistic disorders. The occurrence of SIB was examined in comparison with the following variables: chronological age, sex, adaptive skills, speech level, associated medical condition, degree of autism and parental social class. The subjects were 222 children aged under 7 years and all of them fulfilled the ICD-10 criteria for infantile autism. Retrospective data were collected on demographic characteristics and medical condition. Children were assessed in terms of speech, degree of autism and adaptive skills in communication, socialization and daily living skills domains. Results indicated that 50% of the children experienced SIB and 14.6% had severe SIBs. Lower chronological age, associated perinatal condition, a higher degree of autism and a higher daily living skills delay were risk factors of SIBs but parental class, sex and epilepsy were not.     

Symptom factors in early-onset psychotic disorders

OBJECTIVE: To examine the factor structure of symptom ratings in early-onset psychotic illnesses. METHOD: Subjects were drawn from a 2-year prospective study of early onset psychotic disorders. Principal components analysis with orthogonal (varimax) rotation was used to create factors from baseline ratings on the Schedule for Positive Symptoms, the Schedule for Negative Symptoms, and the Brief Psychiatric Rating Scale for Children. RESULTS: Youths with schizophrenia (n = 27), bipolar disorder (n = 22), and psychosis not otherwise specified (n = 20) were included. Four symptom factors were identified: negative symptoms, positive symptoms, behavioral problems, and dysphoria. Negative symptoms were predictive of the diagnosis of schizophrenia and treatment with antipsychotic medications. Neither behavior problems nor dysphoria were predictive of diagnosis. In subjects who completed follow-up assessments at year 1 (n = 49) and year 2 (n = 39), negative symptoms and behavioral problems predicted poorer functioning. CONCLUSIONS: The four factors are clinically relevant, with both treatment planning and prognostic implications. Negative symptoms best differentiated schizophrenia from the other disorders. Behavior problems and dysphoria were nonspecific problems that occurred in all three disorders, which likely leads to misdiagnosis in community settings.     

Social contacts and loneliness in people with psychotic and mood disorders

BackgroundSocial relations can be measured through: a) objective indicators, i.e. the number of social contacts in a given time interval or b) subjective indicators, i.e. feelings of loneliness. Comparing subjective and objective indicators in patients with psychotic and mood disorders may help to understand whether diagnosis-specific interventions should be designed for increasing their social relations. In this study we assessed social contacts outside home, work environments and mental health services, which may be increased by these interventions. We also explored feelings of loneliness which could influence readiness of patients to participate in interventions.Methods100 patients in outpatient mental health care were asked to: a) list their social contacts; b) report their feelings of loneliness on a validated five point Likert scale. Multiple logistic regression models were used to test associations of diagnostic categories with: a) having more than one social contact in the previous week; b) reporting at least moderate feelings of loneliness.ResultsPatients had on average 1.7 (SD = 1.7) social contacts in the previous week (median = 1.0); 77 patients reported at least moderate feelings of loneliness. Patients with psychotic disorders (n = 30) showed a statistical trend towards having just one or no contacts in the week before the assessment (Odds ratio, OR = 2.246, p = .087). Patients with mood disorders were more likely to report at least moderate feelings of loneliness (OR = 2.798; p < .05).ConclusionsPatients with psychotic disorders, compared to those with mood disorders, may be less likely to report feeling lonely although they tend to have less social contacts. Strategies to enhance social relations of people with psychotic disorders may include approaches to increase patients' drive to establish new social contacts and to emotionally support them in this process.     

Risk factors for completed suicide in schizophrenia and other chronic psychotic disorders: a case-control study

OBJECTIVE: Despite an increased risk for suicide among individuals diagnosed with psychotic disorders, risk factors for completed suicide remain largely unexamined in this population. Using a case-control design, this study aimed to investigate clinical and behavioural risk factors for suicide completion in schizophrenia and other chronic psychotic disorders. METHOD: A total of 81 psychotic subjects were examined; of these, 45 died by suicide. Proxy-based interviews with, on average, 2 informants were conducted using the SCID I and II interviews and a series of personality trait assessments. RESULTS: Psychotic individuals at risk for suicide are most readily identified by the presence of depressive disorders NOS, moderate to severe psychotic symptoms and a family history of suicidal behaviour. They also exhibited fewer negative symptoms, had more comorbid diagnoses and, contrary to findings in other populations, we found that cluster A and C personality trait symptoms seem to have protective effects against suicide in schizophrenics and other chronic psychotic suicides. CONCLUSIONS: Our study suggests that behavioural mediators of suicide risk, such as impulsive-aggressive behaviours, do not play a role in schizophrenic and chronic psychotic suicide. This is contrary to findings in other diagnostic groups, thus implying heterogeneity in predisposing mechanisms involved in suicide.     

Motivations that maintain substance use among individuals with psychotic disorders

This study quantitatively examined reasons for substance use among individuals with psychotic disorders and explored the relationship of these reasons to substance use problems and dependence. Sixty-nine people with psychotic disorders were interviewed using a battery of questionnaires called the Substance Use Scale for Psychosis (SUSP). Symptoms and medication side effects were also measured. A factor analysis revealed similar motives for substance use (mostly alcohol and cannabis use) as in the general population: "enhancement," "social motives," "coping with unpleasant affect," and "conformity and acceptance." A fifth factor, "relief of positive symptoms and side effects," demonstrated limited reliability. "Coping" and "enhancement" motives were found to lead to substance use problems and dependence. Mediator analysis indicated that worse symptoms lead to stronger motives for substance use, which in turn lead to stronger psychological dependence on that substance. These findings have the potential to inform effective treatment for substance use in psychosis.     

Understanding and preventing criminal recidivism among adults with psychotic disorders

The high prevalence of adults with psychotic disorders in the criminal justice system has received much attention recently, but our understanding of this problem is marked by diverging opinions. Mental health professionals point to deinstitutionalization and our fragmented mental health system as primary causes. Criminologists minimize the role of mental illness and contend that persons with and without mental illness are arrested for the same reasons. Meanwhile, practice guidelines offer little guidance to clinicians about how to address the problem. Drawing upon contemporary crime prevention principles as well as current knowledge of psychotic disorders and their treatment, this article presents a conceptual framework for understanding and preventing criminal recidivism. The framework highlights the importance of individual and service-system risk variables and emphasizes the central role of treatment nonadherence as a mediator between modifiable risk variables and recidivism. On the basis of the conceptual framework described in this article, three necessary elements of intervention are presented for preventing recidivism among adults with psychotic disorders: competent care, access to services, and legal leverage. Research is needed to further define and test these intervention elements as foundations for future service delivery efforts.     

Risk of psychiatric treatment for mood disorders and psychotic disorders among migrants and Dutch nationals in Utrecht,The Netherlands

Purpose  

While there are consistent reports of a high psychosis rate among certain groups of migrants in Europe, there is little information on their risk for mood disorders. The aim of this study was to investigate the risk of receiving psychiatric treatment for mood disorders or psychotic disorders, comparing migrants and Dutch nationals in an ethnically mixed catchment area. A second aim was to calculate the 1-year prevalence rates of psychotic disorders in first-generation migrants.