Search

This study investigated the connection between childhood violence exposure and violent behavior in adults with schizophrenia spectrum disorders (SSDs). The case-control study included 398 SSD patients: 221 cases with a history of severe interpersonal violence in the past and 177 controls with no history of violence. The findings indicated that cases were significantly more likely to report childhood exposure to all forms of witnessed or personally sustained violence both within and outside the family, with those who had witnessed intra-familial violence being more likely to assault a family member in adulthood. Cases reported exposure to violence before the age of 12 years significantly more frequently than controls, and those with early-life violence exposure were significantly more likely to report that they were in a state of intense anger when they behaved violently. A dose-response relationship was observed, with evidence of an increased risk of later violence when the exposure occurred before the age of 12 and an increased likelihood of intrafamilial violence. The evidence suggests that childhood violence exposure was associated with an increased risk of violent behavior in adult SSD patients, and early exposure was linked to an increased likelihood of physical violence occurring in states of intense anger., Competing Interests: Declaration of Competing Interest The authors declare there is no conflict of interests., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Background: There has been a substantial change in the law on the provision of secure health services for offender-patients in Italy, a country currently with the lowest general psychiatry bed availability per head of the population in Europe, raising questions about possible differences in offender-patient admissions between European countries., Aims: In this multicentre case-control study, our aim was to compare the socio-demographic, clinical and criminological characteristics of a sample of Italian forensic in-patients with schizophrenia or similar psychosis with patients in a similar diagnostic range in specialist in-patient services elsewhere in Europe., Methods: Secure hospital unit in-patients with psychosis were recruited across five European countries (Italy, Austria, Germany, Poland and England). Consenting patients were interviewed by researchers and assessed using a multidimensional standardised process. Within country similarities between Austria, Germany, Poland and England were confirmed., Results: Overall, 39 Italian participants had had fewer years of education than the 182 patients in the other countries and were less likely to have ever had skilled or professional employment. The Italian patients had been older at first contact with any mental health services than the other Europeans. Diagnosed comorbidity rates were similar, but the Italian group reported higher levels of disability. Although the other European forensic patients were more likely to be undergoing treatment at the time of their index offence, they were also more likely to have been poorly compliant with treatment. The rate of suicide-related behaviours was significantly lower among the Italian patients than among the others., Conclusions: Notwithstanding similar diagnoses, important differences emerged between patients in Italian forensic mental health resident services and those in four other European countries, some possibly reflecting less access to earlier relevant services in Italy. Others, including lower disability ratings among the Italian patients and a lower rate of suicide-related behaviours, may indicate that the Italian reforms carry benefits. This is worthy of further evaluation., (© 2023 The Authors. Criminal Behaviour and Mental Health published by John Wiley & Sons Ltd.)

Background: The relationship between schizophrenia and violence is complex. The aim of this multicentre case-control study was to examine and compare the characteristics of a group of forensic psychiatric patients with a schizophrenia spectrum disorders and a history of significant interpersonal violence to a group of patients with the same diagnosis but no lifetime history of interpersonal violence., Method: Overall, 398 patients (221 forensic and 177 non-forensic patients) were recruited across five European Countries (Italy, Germany, Poland, Austria and the United Kingdom) and assessed using a multidimensional standardised process., Results: The most common primary diagnosis in both groups was schizophrenia (76.4%), but forensic patients more often met criteria for a comorbid personality disorder, almost always antisocial personality disorder (49.1 v. 0%). The forensic patients reported lower levels of disability and better social functioning. Forensic patients were more likely to have been exposed to severe violence in childhood. Education was a protective factor against future violence as well as higher levels of disability, lower social functioning and poorer performances in cognitive processing speed tasks, perhaps as proxy markers of the negative syndrome of schizophrenia. Forensic patients were typically already known to services and in treatment at the time of their index offence, but often poorly compliant., Conclusions: This study highlights the need for general services to stratify patients under their care for established violence risk factors, to monitor patients for poor compliance and to intervene promptly in order to prevent severe violent incidents in the most clinically vulnerable.

Aims: The purpose was to compare the frequency of needs of patients with schizophrenia in forensic services across five European countries as assessed by both the patients and their care staff., Methods: Patients with schizophrenia and a history of significant interpersonal violence were recruited from forensic psychiatric services in Austria, Germany, Italy, Poland and England. Participants' needs were assessed using the Camberwell Assessment of Needs-Forensic Version (CANFOR). Multiple linear regression analyses were used to identify predictors of numbers of needs., Results: In this sample, (n = 221) the most commonly reported need according to patients (71.0%) and staff (82.8%) was the management of psychotic symptoms. A need for information was mentioned by about 45% of staff and patients. Staff members reported a significantly higher number of total needs than patients (mean 6.9 vs. 6.2). In contrast, staff members reported a significantly lower number of unmet needs than patients (mean 2.0 vs. 2.5). Numbers of total needs and met needs differed between countries. Unmet needs as reported by patients showed positive associations with the absence of comorbid personality disorder, with higher positive symptom scores and lifetime suicide or self-harm history. Significant predictors of unmet needs according to staff were absence of comorbid personality disorder and higher positive as well as negative symptom scores according to PANSS., Conclusions: Staff rated a significantly higher number of total needs than patients, while patients rated more unmet needs. This indicates that patients' self-assessments of needs yield important information for providing sufficient help and support., (© 2022. The Author(s).)

Objective: Neurocognitive impairment has been extensively studied in people with schizophrenia spectrum disorders and seems to be one of the major determinants of functional outcome in this clinical population. Data exploring the link between neuropsychological deficits and the risk of violence in schizophrenia has been more inconsistent. In this study, we analyse the differential predictive potential of neurocognition and social cognition to discriminate patients with schizophrenia spectrum disorders with and without a history of severe violence., Methods: Overall, 398 (221 cases and 177 controls) patients were recruited in forensic and general psychiatric settings across five European countries and assessed using a standardized battery., Results: Education and processing speed were the strongest discriminators between forensic and non-forensic patients, followed by emotion recognition. In particular, increased accuracy for anger recognition was the most distinctive feature of the forensic group., Conclusions: These results may have important clinical implications, suggesting potential enhancements of the assessment and treatment of patients with schizophrenia spectrum disorders with a history of violence, who may benefit from consideration of socio-cognitive skills commonly neglected in ordinary clinical practice., (© 2021. The Author(s).)

Objective: Based on the research version of the Carers' Needs Assessment for Schizophrenia (CNA-S) a shortened clinical version was developed for routine assessment of interventions needed by the caregivers of schizophrenia patients in everyday clinical work., Methods: The development of this questionnaire (including a manual explaining its use) was based on results from earlier studies and suggestions from Austrian researchers involved in previous studies using the research version. Based on discussions with researchers the questionnaire and the manual were improved step by step. A clinical test version was investigated for feasibility and practicability in two waves of 15 caregivers of schizophrenia patients each., Results: More than 90% of caregivers perceived the clinical version of the CNA-S as a useful instrument to assess all relevant aspects of caregivers' needs and problems. They reported feeling well during the interview for the CNA-S. Clinicians using the clinical version of the CNA-S reported similar views., Conclusion: These results suggest that the clinical version of the CNA-S is both feasible and practicable in everyday clinical work.

Objective: Most studies about the burden of schizophrenia carers included only one care-giving relative, usually the patients' mothers. The present study intended to analyse differences of the level of burden between mothers and fathers of the same patients., Methods: 101 mothers and 101 fathers of the same patients suffering from schizophrenia were included into this study. They were assessed by means of the "Involvement Evaluation Questionnaire" and the "Carers' Needs Assessment for Schizophrenia"., Results: Mothers showed significantly higher scores than fathers regarding the subscores "Tensions" and "Urging". Multiple linear regression analyses showed positive associations between the frequency of mothers' as well as fathers' unmet needs and dimensions of caregiver involvement., Conclusion: Unmet needs among mothers and fathers have negative effects on their burden. The differences between mothers and fathers indicate the importance of considering the carer's gender in clinical work., (© Georg Thieme Verlag KG Stuttgart · New York.)

Objective: The purpose of the present study was to investigate the problems and needs for interventions among caregivers of patients with schizophrenia who were the first time in contact with psychiatric services., Methods: 93 family caregivers of schizophrenia patients during the first contact with services were investigated by means of the the "Carer's Needs Assessment for Schizophrenia" (CNA-S)., Results: The most frequent problems of caregivers of first contact patients with schizophrenia were insufficient information on mental illness and concerns about the patient's future. Individual psychoeducation was needed significantly more often among caregivers of first contact patients than among those having been previously in contact with psychiatric services., Conclusion: Those being the first time in contact with psychiatric services need some specific interventions significantly more often than later., (© Georg Thieme Verlag KG Stuttgart · New York.)

Objective: Relatives of persons with schizophrenia have an essential role in informal caregiving. This may result in a high level of burden. Aim of the study was to investigate, if the frequency of unmet needs among relatives caring for schizophrenia patients increases the risk for burden among these relatives., Methods: 135 relatives of patients with schizophrenia or schizoaffective disorder were investigated by means of the "Involvement Evaluation Questionnaire" (IEQ) and the "Carer's Needs Assessment for Schizophrenia" (CNA-S)., Results: Multiple linear regression analyses showed positive associations between the frequency of caregivers' unmet needs and the IEQ-subscores "tension" and "worrying". Further, the IEQ-subscore "worrying" was significantly lower among caregivers of outpatients than among caregivers of inpatients or day hospital patients. The IEQ-subscore "urging" was significantly associated with patient's negative symptoms., Conclusion: Unmet needs among caring relatives have negative effects on their burden. Further, the patients' type of treatment setting (inpatient, outpatient, day hospital) seems to predict caregivers' burden., (© Georg Thieme Verlag KG Stuttgart · New York.)

Objective: In order to evaluate the effectiveness of the WPA campaign "Open the Doors - against Stigma and Discrimination because of Schizophrenia", five years upon completion of the campaign, a comparative study was performed to assess the possible changes in the general public's attitudes towards schizophrenia., Methods: Representative population survey, based on a Quota-sampling (n = 988); face-to-face interviews with standardized questionnaires., Results: The results of this study were somewhat sobering, with 22.3 % of the population not having any associations with the term "schizophrenia", 81.3 % not wanting to be further informed about the illness, and 64.1 % agreeing with the statement that patients suffering from schizophrenia are dangerous; compared to the survey in 1998, there was a significant increase within this category. Furthermore, an increase of social distance towards this group of patients has also been noted., Conclusion: It is to be asked whether a short intervention can change people's profound attitudes., (Georg Thieme Verlag KG Stuttgart. New York.)

Objective: To assess the extent to which persons suffering from schizophrenia are treated by psychotherapy in Austria, Methods: A questionnaire was sent to all psychotherapists who were registered according to the Austrian law for psychotherapy, Results: 5741 questionnaires were mailed and 1683 (29.3%) were returned. Of the answering psychotherapists 59% had done psychotherapy with a person suffering from schizophrenia before. 47% treated at least one client with a schizophrenic disorder during the last year. The methods applied by psychotherapists who had treated schizophrenic persons before were psychodynamic psychotherapy (30%), humanistic psychotherapy (35%), systemic psychotherapy (25%), behavior therapy (13%) and eclectic psychotherapy (25%). 59% of the participating psychotherapists stated that they would be willing to treat (further) persons suffering from schizophrenia. Most (84%) participants considered a special qualification for the psychotherapeutic treatment of schizophrenic persons as necessary, but 70% said that this topic was not covered sufficiently during training for psychotherapy., Conclusions: Among Austrian psychotherapist there is considerable interest in treatment of schizophrenic persons. There is a gap between the recommended treatments for schizophrenia according to EBM criteria and everyday practice.

Objective: This pilot study compares the level of distress and the need for support between carers of patients with anorexia (AN) and bulimia nervosa (BN) and carers of patients with schizophrenia., Methods: Thirty-two carers of patients suffering from AN and BN and 30 carers of patients with schizophrenia filled out the general health questionnaire (GHQ-12) and the burden inventory (BI). In addition, they were interviewed with a semi-structured research interview, the carers' needs assessment (CNA), to assess relevant problem areas as well as the need for helpful interventions. Patients with an eating disorder were interviewed with the eating disorder examination (EDE) and patients with schizophrenia with the positive and negative syndrome scale (PANSS) to assess the severity of the disorder., Results: The mean duration of illness was 5.3 years in the patients with eating disorders and 7.3 years in the patients with schizophrenia. Most of the carers were mothers or partners. In the CNA we found high numbers of problems as well as high numbers of unmet needs for interventions. The most frequently mentioned problem areas in all groups of carers were "disappointment caused by the chronic course of the illness, concerns about the patient's future" and "problems in communication with the patient". The most frequently reported need for support in all groups was "counseling and support by a professional". Carers of patients with BN reported a significantly lower number of problems and of needs for interventions compared to the carers of patients with AN and schizophrenia. Also in the BI and the GHQ-12 we found significantly lower total scores in carers of patients with BN. Carers of patients with AN and schizophrenia did not differ significantly in any of the assessments. The severity or duration of illness of the patients did not correlate with the carers' burden or needs., Conclusions: Carers of patients with an eating disorder and carers of patients with schizophrenia are burdened with similar problems and have high levels of unmet needs which are usually not addressed in clinical practice. Carers of anorectic patients have higher levels of difficulties in various areas compared to carers of bulimic patients and did not differ from carers of patients with schizophrenia.

Objective: The purpose of this study was to investigate differences between mothers and fathers of patients with schizophrenia or schizoaffective disorders concerning the time spent with the patients as well as other aspects of caring., Methods: 101 mothers and 101 fathers of the same patients suffering from schizophrenia or schizoaffective disorders according to ICD-10 were investigated., Results: The mean time spent in personal (i.e. face-to-face) or telephone contact with patients was significantly higher for mothers than for fathers. About the half of the mothers spent more time with the patients than the fathers, while 12% of fathers spent more time than the mothers. Among 40% of patients, mothers and fathers spent an equal amount of time for personal or telephone contact with the patients. Concerning other aspects of caring (legal representative of the patient, payment for patient's costs, caring for the patient's household) we could not find any differences between mothers and fathers., Conclusions: Concerning several aspects we could not confirm that mothers are more involved into the patients' care than the fathers. These findings are in contrast to the usual assumptions about familial caregivers based on the traditional gender-specific role models.

Objectives: The aim of the present study was to investigate the burden of minor relatives of schizophrenia patients and of the needs for support for the relatives., Methods: 135 relatives of patients with schizophrenia or schizoaffective disorders were assessed by using the "Involvement Evaluation Questionnaire" and the "Carers' Needs Assessment for Schizophrenia"., Results: 24.4% of the total sample (N=33) had minor (i.e. below 18 years) siblings (N=18) or children (N=15). If the patient had minor siblings, almost the half of the adult relatives reported moderate or severe problems. However, among those patients who had to take care for minor children, only a fifth reported moderate or severe problems. Among the patients' offsprings being under the age of 16 behavioural disturbances, reduced appetite and other consequences of the disease were reported frequently., Conclusions: These results indicate that patients with schizophrenia or schizoaffective disorders often have minor relatives in their family frequently suffering from marked burden.

Objective: For the purpose of service planning, an instrument was developed for the systematic assessment of interventions needed by the caregivers of schizophrenia patients., Method: The development of this instrument was based on in-depth interviews and focus groups. It consists of 18 areas describing common problems of schizophrenia caregivers. For each of these problem areas several possible interventions are offered. Concurrent validity, inter-rater and retest reliability were tested among 50 caregivers., Results: The kappa values for the inter-rater reliability are predominantly excellent (kappa > 0.75). The values for the retest reliability show a wide range between excellent (kappa > 0.75) and fair agreement (kappa 0.40-0.60). The significant correlations found between summary scores of this new instrument and several sub-scales of the Family Problem Questionnaire support the assumption that the concurrent validity is satisfactory., Conclusion: These results suggest that this instrument is both valid and reliable.

Objective: Nonadherence to antipsychotic regimens is considered to be one of the main reasons for hospital readmission. This study assessed the extent of nonadherence in the month before inpatient treatment., Methods: Ninety-five consecutive patients with an ICD-10 diagnosis of a psychotic disorder (F20) were surveyed about adherence at admission to psychiatric inpatient treatment at a hospital in Linz, Austria. Adherence was assessed on the basis of self-report and by interviewing multiple informants. Episodes of inpatient treatment during the year after discharge were assessed prospectively., Results: Fifty-four patients (57 percent) were rated as partially or fully nonadherent. Compared with patients with good adherence, those who were nonadherent had lower mean scores on the Global Assessment of Functioning (41.4 compared with 47.2), more often received compulsory treatment (52 percent compared with 22 percent), more often had impaired insight into their illness at admission (63 percent compared with 24 percent) and discharge (41 percent compared with 13 percent), and had more days of inpatient treatment in the year after discharge from the index episode (mean of 44.8 days compared with 20.6 days). Adherence was significantly better among patients in regular contact with their psychiatrist and among younger patients. Nonadherent patients who gained insight during treatment had significantly fewer days of inpatient treatment during the next year than those whose insight was still low at discharge (mean of 19.2 days compared with 73.2 days)., Conclusions: Nonadherence is an important contributor to the need for inpatient treatment and is associated with a less favorable course of treatment. The best predictor of further inpatient treatment is insight into illness at discharge.

Objective: To determine the effects of a psychoeducational intervention on the individual concepts of illness of patients suffering from schizophrenia., Method: 27 patients with a diagnosis of schizophrenia according to ICD-10 were interviewed with open ended questions about their concept of illness at admission to a day hospital and after 10 weeks of attending a psychoeducational program. Questions concerned terminology, diagnosis, prognosis, interventions and aetiology. A qualitative analysis of these data is presented., Results: The terms used to describe the illness were mostly colloquial. Highly individualized and heterogeneous concepts of illness, aetiology and helpful interventions and a positive view regarding prognosis prevailed. Changes over time were limited and arbitrary., Conclusions: The concepts offered by professionals were adopted in a very limited way, which can be understood in the context of highly individualized ways of coping with diagnosis and illness.

All definitions of schizophrenia rely more or less on Kraepelin's hypothesis, Bleuler's theory or Schneider's pragmatic criteria. After a discussion on how these assumptions are referred to in classical and operational diagnostic systems in Europe, the results of a survey of 1983 literature are presented to show what kinds of assessments European workers currently employ. Lastly, guidelines are presented to enable psychopharmacological research to make the best use of the diagnostic systems to suit its purposes: essentially, which system or systems (the polydiagnostic approach for example) one should choose depends upon the symptoms the medication to be tested is supposed to treat, keeping in mind that patient sampling varies according to the system in question.