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Schizophrenia is a heterogeneous and severe psychotic disorder. Epidemiological findings have suggested that the exposure to infectious agents such as Toxoplasma gondii (T. gondii) is associated with an increased risk for schizophrenia. On the other hand, there is evidence involving the catechol-O-methyltransferase (COMT) Val105/158Met polymorphism in the aetiology of schizophrenia since it alters the dopamine metabolism. A case−control study of 141 patients and 142 controls was conducted to analyse the polymorphism, the prevalence of anti-T. gondii IgG, and their interaction on the risk for schizophrenia. IgG were detected by ELISA, and genotyping was performed with TaqMan Real-Time PCR. Although no association was found between any COMT genotype and schizophrenia, we found a significant association between T. gondii seropositivity and the disorder (χ2 = 11.71; p-value < 0.001). Furthermore, the risk for schizophrenia conferred by T. gondii was modified by the COMT genotype, with those who had been exposed to the infection showing a different risk compared to that of nonexposed ones depending on the COMT genotype (χ2 for the interaction = 7.28, p-value = 0.007). This study provides evidence that the COMT genotype modifies the risk for schizophrenia conferred by T. gondii infection, with it being higher in those individuals with the Met/Met phenotype, intermediate in heterozygous, and lower in those with the Val/Val phenotype.

The aims of this study were to determine the prevalence of severe mental illness (SMI) in patients in contact with mental health services and to determine the factors associated with SMI. A total of 260 patients who met diagnostic criteria for SMI were assessed using the Global Assessment of Functioning (GAF) scale and Health of the Nation Outcome Scales. The overall prevalence of SMI was 6.08 per thousand. According to the three different cutoff points with GAF, the prevalence of SMI ranged from 5.38 per thousand under the weak criterion (GAF < 70) to 1.01 per thousand under the strict criterion (GAF < 50). In the regression model, the dependent variable (presence of SMI) was defined using a GAF < 60, and the variables independently associated with the dependent variable were years of disease duration since diagnose, mental health service use, alcohol or other substance abuse, and depressive anxiety and other psychological symptoms.

Objective: Existing measures of needs in severe mental illness have been developed mainly from professionals' viewpoints and are Eurocentric. Our aim was to standardize a measure of the needs of people with schizophrenia across several cultures and based on users' own viewpoints., Method: An instrument to measure needs, based on qualitative data on users', carers' and professionals' views, was tested in 164 people with schizophrenia or related psychoses in six countries. Participants underwent face-to-face interviews, one third of which were repeated 30 days later. Principal axis factoring and Promax rotation evaluated scale structure; Horn's parallel combined with bootstrapping determined the number of factors; and intra-class correlation assessed test-retest reliability., Results: The instrument contained four factors: (1) health needs; (2) work and leisure needs; (3) existential needs; and (4) needs for support in daily living. Cronbach's α for internal consistency was 0.81, 0.81, 0.77 and 0.76 for factors 1-4 and 0.81 for the scale as a whole. Correlation between factors was of moderate range for the first three factors (0.41-0.50) and low for the fourth factor (0.14-0.29). Intra-class correlation coefficient for test-retest reliability was 0.74 (0.64-0.82) for the whole scale. Mean item score on needs for support in daily living was lower than for the other factors., Conclusions: The MARISTÁN Scale of Needs evaluates needs from the patient perspective and it is a valid instrument to measure the needs of people with severe mental illness across cultures.

Objective: To examine existential questions in the daily life of people with schizophrenia and their caregivers., Methods: Qualitative study with focus groups. 146 people with schizophrenia (55% men) and 80 caregivers (75% women) participated. They came predominantly from primary and secondary health services of Argentina, Brazil, Chile, Spain, England and Venezuela. Each group had between six and ten participants. The data was explored through a content analysis process., Results: Four omnipresent existential themes were identified from the discussions: the need for personal development and to find meaning in life; the need to be respected and not suffer discrimination or stigma; the conflict resulting from the loss of autonomy; the importance of understanding the illness and recognizing it as an illness. The existential questions were closely associated with objective needs, such as the lack of occupational opportunities and employment, which generally result in a life without meaning., Conclusions: It is necessary to develop a new type of health care in which both the consideration for the person with schizophrenia and their subjectivity are as important as biological treatment. Health promotion strategies need to combat stigma and use mechanisms of occupational inclusion.

The current study aims to discover the opinions of patients and their (informal and formal) carers concerning the mental health care of individuals with long term schizophrenic disorders within different contexts and cultures. It's a qualitative study with focus groups,in which 6 research centers (from Argentina, Brazil, Chile, Spain, England and Venezuela) participated. Eight focus groups were conducted in each center, totaling 303 individuals in 46 groups. The data were analyzed with the aid of the Qualitative Solutions and Research/Non-numerical Unstructured Data Indexing program (QSR NUD*IST 4.0). The perception regarding the quality of care is influenced by the professional-patient relationship and the availability of resources. Poor quality of care is also perceived as discrimination. People with schizophrenia in general consider themselves to be ostracized by professionals and services and lacking in more humanized care. In the contexts in which community care is less advanced, the complaints center on resources and services that do not meet demands. On the other hand, in more developed contexts criticism centers more on the attitude of the professionals and the professional patient relationship. Over and above the need for resources and services, people with schizophrenia require more humanized health care.

Introduction: The geographical distribution of mental health disorders is useful information for epidemiological research and health services planning., Objective: To determine the existence of geographical hotspots with a high prevalence of schizophrenia in a mental health area in Spain., Method: The study included 774 patients with schizophrenia who were users of the community mental health care service in the area of South Granada. Spatial analysis (Kernel estimation) and Bayesian relative risks were used to locate potential hotspots. Availability and accessibility were both rated in each zone and spatial algebra was applied to identify hotspots in a particular zone., Results: The age-corrected prevalence rate of schizophrenia was 2.86 per 1,000 population in the South Granada area. Bayesian analysis showed a relative risk varying from 0.43 to 2.33. The area analysed had a non-uniform spatial distribution of schizophrenia, with one main hotspot (zone S2). This zone had poor accessibility to and availability of mental health services., Conclusion: A municipality-based variation exists in the prevalence of schizophrenia and related disorders in the study area. Spatial analysis techniques are useful tools to analyse the heterogeneous distribution of a variable and to explain genetic/environmental factors in hotspots related with a lack of easy availability of and accessibility to adequate health care services.

Introduction: Since community-based health care was introduced, the use of mental health services by patients with serious mental disorders has been an issue of much interest. However, our knowledge of intervening factors is both scarce and partial., Objective: To study socio-demographic variables which may predict time-lapse (in days) between each out-patient contact among a cohort of schizophrenia patients., Method: Data comes from the South Granada Schizophrenia Case Register. We used Cox's regression analysis to study the influence of the socio-demographic variables in the time lapsed between out-patient contacts., Results: After adjusting for all other socio-demographic variables included, we found that to live in a rural area and being younger independently predicted a longer time-lapse between out-patient contacts while being retired predicted a shorter interval between such contacts. Other variables such as sex, educational level and marital status did not determine such length between out-patients contacts., Conclusion: Socio-demographic variables, and not only psychopathological ones, determine mental health out-patient service use.

Introduction: The disease-cost study, based on the study of cohorts of patients through their visits to the mental health system, requires knowledge on the cost of each health care unit. However, lack of standardized procedures limits the external validity of the results obtained. When methodological information regarding the procedures applied is available, it makes it possible to compare the internal validity and to understand the suppositions on which the cost estimations have been made., Methods: Cost-units for the health care received by a cohort of patients diagnosed of schizophrenia were estimated. The study was performed by a community-based team and at several hospital premises belonging to the Andalusia Health Service. A sensitivity analysis was conducted whenever necessary., Results: Both in inpatients and outpatients care, personnel represents the biggest cost, this proportion being higher within the outpatient care. Among the professional categories the care given by the psychiatrists is the most expensive. Time load is similar for the different categories except for the psychiatrist., Conclusions: Cost unit estimates are lower than that which has been published internationally and within Spain. However, the findings must be carefully considered due to the influence that the different methodological options may have.

Introduction: The assessment of the needs for care for long term severe ill patients has been one of the areas of greatest interest since the community mental health system was established., Objective: This study has aimed to describe the needs for care of a group of schizophrenic patients and to know if these needs are met by the public mental health network., Methods: A cohort of 83 schizophrenic patients was selected. The diagnosis was confirmed by the SCAN method. The Needs for Care Assessment instrument was used to assess the needs for care of the patients., Results: The positive psychotic symptoms (98%) followed by slowness and underactivity (71%) are the most common clinical problems between the patients of the cohort. In regards to skills and abilities, the most common are those related with work (49%) and house keeping (domestic work, getting meal and domestic shopping, with 42, 41 and 41%, respectively). In regards to the state of the need, 81% of the clinical problems are covered while this is only 40% in the social area., Conclusions: The clinical needs of the schizophrenic patients can be met by the mental health services established, oriented to the community care. However, attending social needs requires more rehabilitation, occupational and residential resources to be developed.

Introduction: For clinicians and care providers, the use of hospital facilities by patients with schizophrenia is one of the areas of most concern in the field of mental health studies. The objective of this study is to determine those characteristics which relate to hospital admissions for this group of patients., Method: A one year follow up study for a group of 83 patients with schizophrenia in contact with mental health services was carried out to identify the socio-demographic, clinical and care needs' variables related to hospital admissions., Results: As a result of the multivariate models applied, male patients presenting hyperactivity, thought disturbance, deliria and exaggerated interpretation, socially embarrassing behaviour and use of drugs were shown to be those with a greater probability of hospital admission.

Background: To optimise appropriate planning of services, the care needs in patients with chronic mental illness, the organisms or individuals that cover these needs, and the relationships between specific needs and sociodemographic variables should be identified. This study was designed to assess needs in a population of persons with mental illness., Methods: The Camberwell Assessment of Need (CAN) questionnaire was used to obtain and report quantitative information on needs. A total of 246 patients diagnosed as having schizophrenic disorder and 246 staff members of public mental health services, all living and working in the province of Granada (southern Spain, n = 187) or the city of Madrid (central Spain, n = 56), completed the questionnaire. Regression analysis was used to identify correlations between needs and sociodemographic variables., Results: Mean needs score was 6.5; the most frequent needs were those related with daytime activities, company, psychotic symptoms, psychological distress, basic education and money management. The sociodemographic variables most closely associated with these needs were: not living with a life partner, low educational level, and receiving state benefits. The type of help these patients received was mainly from the family (informal help); public services (formal help) covered mainly clinical needs., Conclusions: The needs of persons with schizophrenic disorder do not differ from those of members of the more marginalised groups in Spanish society. Care provided by family members often represents a considerable burden on relatives.