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This study examines the initial impact of a broadly participatory planning process in the Czech Republic during 2016–2017, aimed at both reducing inpatient care and expanding community mental health systems, on policy and programmatic decision making. A central focus of the study involves the trade-offs between and efforts to integrate shared decision making with evidence-based planning methods within the context of a national psychiatric reform strategy, particularly one involving a former Soviet bloc state. Given the uniqueness of the Czech experience, an exploratory case study methodology is used, one involving ten interviews with key informants and examination of a wide variety of documents. Results include the development of broad new decision and oversight structures, and the initial implementation of community mental health services. The nation faces some of the same trade-offs found elsewhere, such as in the United States, between an inclusive participatory process, and one that systematically incorporates empirical rational and evidence and best practices within bounded parameters. Implications for new psychiatric deinstitutionalization initiatives are identified, including development of a national mental health authority, a professional workforce, new funding strategies, multi-level service coordination, mechanisms to assure transparency, among others.

With the development of dialysing and treating process the life expectancy is extended and the patient's need of an improved quality of life (QoL) arises as well, but still not enough close to the level of a healthy population. We performed an area assessment of quality of life (QoL) in patients on peritoneal dialysis (PD) in the Czech Republic (n = 95; male/female = 49/46, average age 56.9 ± 12.8; total time on PD from 0.25 to 224 months; average time of PD 29.1 ± 32.4 months). Rating in QoL of patients with end stage renal disease (ESRD) treated with peritoneal dialysis (PD) is significantly decreased as compared with average values of Czech standards, especially in the domain “physical health” (p

Background This paper describes the development of an Attitudes to Disability Scale for use with adults with physical or intellectual disabilities (ID). The aim of the research was to design a scale that could be used to assess the personal attitudes of individuals with either physical or ID. Method The measure was derived following standard WHOQOL methodology as part of an international trial. In the pilot phase of the study, 12 centres from around the world carried out focus groups with people with physical disabilities, people with ID, with their carers, and with relevant professionals in order to identify themes relevant for attitudes to disability. Items generated from the focus groups were then tested in a pilot study with 1400 respondents from 15 different centres worldwide, with items being tested and reduced using both classical and modern psychometric methods. A field trial study was then carried out with 3772 respondents, again with the use of both classical and modern psychometric methods. Results The outcome of the second round of data collection and analysis is a 16-item scale that can be used for assessment of attitudes to disability in physically or intellectually disabled people and in healthy respondents. Conclusions The Attitudes to Disability Scale is a new psychometrically sound scale that can be used to assess attitudes in both physically and intellectually disabled groups. The scale is also available in both personal and general forms and in a number of different language versions.

SummarySchizophrenia is connected with increased frequency of physical illness and reduced life expectancy compared to general population. Life-style factors, social adversity, poor health knowledge, symptoms of schizophrenia-spectrum disorders, treatment effects and stigma are involved. There is evidence that patients recognize the problem, accept interventions when offered, and comply with medical advice. Wellness programmes (specific healthcare programmes) promote healthy lifestyle, screen potential risk factors, prevent social isolation and promote destigmatization.

Objective: In accordance with the definition of health by the World Health Organization, outcome measures beyond mere syndromic recovery, such as quality of life ratings, would aid psychiatric practice and research. This is the first study of psychiatric diagnosis and illness stage specific profiles of subjective quality of life (SQOL) impairment. Method: Patients ( n = 150) hospitalized at the Prague Psychiatric Center rated their SQOL using the Schwartz Outcome Scale at admission and discharge. Severity of illness and clinical improvement were measured by the Clinical Global Impression Scale. Results: The highest and lowest SQOL at admission were reported by patients with psychosis and mood disorders respectively ( F = 7.3, df = 2,147, P < 0.001). SQOL improved significantly during hospitalization in all diagnostic categories ( F = 90.0, df = 1,147, P < 0.001), with the smallest and largest improvement in patients with psychosis and mood disorders, respectively ( F = 5.6, df = 2,147, P = 0.005). There was a trend for differences in ratings of clinical improvement by patients, compared with psychiatrists, across diagnostic categories ( F= 2.9, df = 2,147, P = 0.06), with significant differences only in patients with anxiety disorders. These patients also reported the lowest SQOL at discharge ( F = 3.0, df = 2,147, P = 0.05). Global improvement correlated with improvement in SQOL only in patients with mood disorders ( r = −0.4, P = 0.005). Conclusions: Main psychiatric diagnostic categories differ in SQOL and in association between SQOL and treatment. These differences may reflect illness-specific mechanisms, such as depressive symptoms in mood disorders, low insight in psychotic patients, aggravation of anxiety before discharge in patients with anxiety disorders, and may aid in planning of specific treatment interventions. Objectif: Conformément à la définition de la santé de l'Organisation mondiale de la santé, des mesures des résultats qui iraient au-delà du simple soulagement des symptômes, comme par exemple des cotes de la qualité de vie, seraient utiles à la pratique et à la recherche en psychiatrie. La présente est la première étude portant sur le diagnostic psychiatrique, et les profils spécifiques des stades de la maladie, de la déficience de la qualité de vie subjective (QDVS). Méthode: Des patients ( n = 150) hospitalisés au Centre psychiatrique de Prague ont coté leur QDVS au moyen de l'Echelle de résultats de Schwartz, lors de l'admission à l'hôpital et du congé. La gravité de la maladie et les améliorations cliniques ont été mesurées à l'aide de l'Impression clinique globale. Résultats: La QDVS la plus élevée et la plus faible à l'admission a été déclarée par les patients souffrant de psychose et de troubles de l'humeur, respectivement ( F = 7,3, df = 2,147; P < 0,001). La QDVS s'améliorait significativement durant l'hospitalisation dans toutes les catégories diagnostiques ( F = 90,0, df = 1,147; P < 0,001), les plus modestes et les plus grandes améliorations se manifestant chez les patients souffrant de psychose et de troubles de l'humeur, respectivement ( F = 5,6, df = 2,147; P = 0,005). Il y avait une tendance aux différences entre les cotes des améliorations cliniques données par les patients, comparativement à celles des psychiatres dans toutes les catégories diagnostiques ( F = 2,9, df = 2,147; P = 0,06), mais les différences n'étaient significatives que chez les patients souffrant de troubles anxieux. Ces patients déclaraient aussi la QDVS la plus faible au moment du congé ( F = 3,0, df = 2,147; P = 0,05). L'amélioration globale corrélait avec l'amélioration de la QDVS seulement chez les patients souffrant de troubles de l'humeur ( r = −0,4; P = 0,005). Conclusions: Les principales catégories diagnostiques psychiatriques diffèrent en matière de QDVS et dans l'association entre la QDVS et le traitement. Ces différences peuvent refléter des mécanismes propres à la maladie, comme les symptômes dépressifs dans les troubles de l'humeur, une faible introspection chez les patients psychotiques, l'aggravation de l'anxiété avant le congé chez les patients souffrant de troubles anxieux, et peuvent aider à planifier des interventions thérapeutiques spécifiques.

This retrospective study analyses the differences between suicide with and without previous parasuicide. The Czech Republic was one of the countries with the traditionally highest level of suicide mortality. During collapse of the communist regime and deep societal changes in the Czech Republic after the year 1989 the escalation of suicides was expected. Mortality from suicides decreased, however the gender and age differences increased.A total of 2,711 suicides in the Czech Republic (1996-2000) were studied. Effects of socioeconomic characteristics, psychiatric diagnosis and care, and lifetime history of parasuicide on the risk of death from suicide were estimated using logistic regression.Twenty-three percent of persons who committed suicide had a prior history of parasuicide and almost twenty percent of them received no psychiatric care after the attempt. Young males with basic education, economically active and diagnosed with substance abuse related disorders and the elderly were least likely to receive psychiatric care before their suicide death.Implications for age specific primary and secondary prevention are discussed.

The aim of our case-control study was to compare selected psychological and social characteristics between diabetic patients with and without the DF (controls).104 patients with and 48 without DF were included into our study. Both study groups were compared in terms of selected psychosocial characteristics.Compared to controls, patients with DF had a significantly worse quality of life in the area of health and standard of living as shown by lower physical health domain (12.7 ± 2.8 versus 14.7 ± 2.5; P0.001) and environment domain (14.1 ± 2.2 versus 15 ± 1.8; P0.01) that negatively correlated with diabetes duration (r = -0.061; P = 0.003). Patients with DF subjectively felt more depressed in contrast to controls (24.5 versus 7.3%; P0.05); however, the depressive tuning was objectively proven in higher percentage in both study groups (83.2 versus 89.6; NS). We observed a significantly lower level of achieved education (P0.01), more patients with disability pensions (P0.01), and low self-support (P0.001) in patients with the DF compared to controls. In the subgroup of patients with a previous major amputation and DF (n = 6), there were significantly worse outcomes as in the environment domain (P0.01), employment status, and stress readaptation (P0.01) in contrast to the main study groups.Patients with DF had a predominantly worse standard of living. In contrast to our expectations, patients with DF appeared to have good stress tolerability and mental health (with the exception of patients with previous major amputation) and did not reveal severe forms of depression or any associated consequences.

Objectives. Relapse prevention is one of the most important goals of long-term schizophrenia management, as relapse is both distressing and costly. Family intervention supplementation to standard treatment could reduce the relapse rate. This study assessed the influence of a short-term, clinically based, and profesionally led family psychoeducation programme on a 1-year relapse rate. Methods. A total of 120 patients were recruited upon discharge from two psychiatric hospitals in Prague: (1) Site A (N=86), where family psychoeducation is offered to all patients with schizophrenia, schizoaffective disorder, and acute psychotic episode with schizophrenic symptoms; and (2) Site B (N=34), where no such programme was offered. Results. Compared to nonparticipants, psychoeducation participants had a shorter average length of rehospitalization stay (5.89 vs. 17.78 days, P=0.045) in a 1-year follow-up after discharge. The probability of rehospitalization during a 1-year follow-up was higher for patients from the site that did not provide psychoeducation. Conclusions. A shorter average length of rehospitalization of psychoeducation participants, a high turnout of first-episode patients, and positive responses of psychoeducation participants suggest that family psychoeducation should be supplemented early in the course of the illness to achieve favourable treatment outcomes and minimize adverse health and the social consequences of schizophrenia.

The authors examined current knowledge about psychoeducation for schizophrenia in Czech Republic. The authors sent a screening survey to 550 mental health-care facilities and administered a detailed questionnaire to 113 providers of mental health and social services and to 200 service users. The authors also carried out 14 focus groups and 16 individual interviews. Forty-six departments provided some type of psychoeducation for schizophrenia; of these, 16 provided family psychoeducation for patients and relatives and 1 provided psychoeducation only for relatives. Service users who received psychoeducation performed significantly better in the test of knowledge than did service users who did not receive psychoeducation. The authors propose a service user-driven curriculum based on information delivery followed by skills training. Psychiatrists should learn to explain schizophrenia relapse neurobiology to laypeople and to address relatives’ frustrations.

Holub D, Flegr J, Dragomirecka´E, Rodriguez M, Preiss M, Nova´kT,Cˇerma´k J, Hora´cˇek J, Kodym P, Libiger J, Ho¨schl C, Motlova´LB.Differences in onset of disease and severity of psychopathology betweentoxoplasmosis-related and toxoplasmosis-unrelated schizophrenia.Objective: Toxoplasmosis is a lifelong parasitic disease that appears tobe associated to schizophrenia. However, no distinguishing attributes inToxoplasma-infected schizophrenia patients have been described as yet.Method: We searched for differences in symptom profile, cognitiveperformance and treatment response between 194 Toxoplasma-free and57 (22.7%) Toxoplasma-infected schizophrenia patients treated inPrague Psychiatric Centre between 2000 and 2010.Results: Infected and non-infected patients differed in severity ofsymptoms (P = 0.032) measured with the Positive and NegativeSymptom Scale (PANSS). Infected patients scored higher in positivesubscale of PANSS, but not in the general and negative subscales.Infected men scored higher also in Total PANSS score, and negative,reality distortion, disorganisation and cognitive scores. Higher PANSSscores of positive, negative and disorganised psychopathology wereassociated with the lower titres of anti-Toxoplasma antibodiessuggesting that psychopathology deteriorates with duration of parasiticinfection. Infected patients remained about 33 days longer in hospitalduring their last admission than uninfected ones (P = 0.003).Schizophrenia started approximately 1 year earlier in infected men andabout 3 years later in infected women, no such difference was observedin uninfected subjects.Conclusion: Latent toxoplasmosis in schizophrenia may lead to moresevere positive psychopathology and perhaps less favourable course ofschizophrenia.

Antipsychotic medication and early relapse warning signs detection are the cornerstone of relapse prevention in schizophrenia spectrum disorders. Many patients do not use antipsychotic medication because of lack of information about its preventive effects and the risk of relapse. We introduce PREDUKA--PREventive EDUcational programme for relapse prevention. The goal of the programme is to deliver the information about schizophrenia to patients and their relatives. 178 patients and 252 relatives (118 mothers and 51 fathers) took part in 25 one-day psychoeducational programmes in 6 centres in the Czech Republic between January 2008 and June 2009 and anonymously fulfilled a short questionnaire. Patients and relatives assessed the programme with an average mark 1.4 (1 best, 5 worst). 49.4% patients and 49.0% relatives had received enough information about psychotic disorders during their hospitalization. Moreover 94.1% patients and 95.7% relatives confirmed acquiring new information on how to live with psychosis as a result of PREDUKA programme. 59.6% patients and 73.8% relatives were interested in ITAREPS - Information Technology Aided Relapse Prevention Programme. Mothers were significantly more interested (82.2%) than fathers (62.2%) (p = 0.031). Expressed high interest of patients and their relatives in both programmes indicates their readiness to become active and competent partners in the long-term treatment of schizophrenia spectrum disorders.

This paper describes the development of an add-on module for the World Health Organization WHOQOL measures of quality of life for use with adults with physical or intellectual disabilities. The add-on module, known as the WHOQOL-DIS, was derived following standard WHOQOL methodology and is designed to assess people with disabilities.In the pilot phase of the study, 12 centres from around the world carried out focus groups with people with physical disabilities, people with intellectual disabilities, with their carers, and with relevant professionals in order to identify gaps in the coverage of the WHOQOL-BREF that were relevant for their quality of life. Items generated from the focus groups were then tested in a pilot study with 1,400 respondents from 15 different centres worldwide, with items being tested and reduced using both classical and modern psychometric methods. A field trial study was then carried out with almost 3,800 respondents, again with the use of both classical and modern psychometric methods.The outcome of the two rounds of data collection and analysis is a 12-item module that can be used in conjunction with the WHOQOL-BREF or the WHOQOL-100 for assessment of quality of life in physically or intellectually disabled people. Further modifications are also proposed for the use of the WHOQOL-BREF with adults with intellectual disabilities, including simplification of wording of some of the items, the use of a three-point response scale, and the inclusion of smiley faces.

The Schwartz Outcomes Scale-10 (SOS-10) is a 10-item scale developed to measure the effectiveness of psychiatric treatments. Using standard methodology, we translated the scale into Czech and examined the psychometric properties of the Czech version. 207 in-patients admitted to Prague Psychiatric Center were included in the study. All patients completed the SOS at admission and discharge. The SOS-10 scale was also administered to 170 persons from the general population. Reliability, validity and sensitivity to treatment change of the Czech SOS-10 were analyzed. The Cronbach's alpha coefficient was 0.92. The item-total correlation coefficients varied from 0.56 to 0.82. The SOS-10 correlated well with condition-specific measures including depression (BDI) and anxiety (BAI) and a global self-rated symptom severity scale (CGI). The SOS-10 also had significant correlations with the Health, Basic needs, Relationship, and Leisure time domains of the Czech version of the Subjective Quality of Life Analysis (SQUALA-CZ). The scale discriminated well between patients and controls, with patients scoring significantly lower on all SOS items. The patient sample's admission and discharge scores were significantly different, indicating that the scale is sensitive to treatment changes. We concluded that the Czech SOS-10 is valid with reliability and factor structure similar to the American language version.

Introduction Six-week day-treatment programme for out-patients with schizophrenia-spectrum disorders in the stabilization phase of treatment consists of family psychoeducation, lifestyle improvement intervention, social skills training and art therapy. Objectives and aims In one-year prospective follow-up field study we assess relapse frequency, psychopathology (PANSS) and quality of life (Social Integration Survey). We analyze differences between patients participating after their first-episode of psychosis and multi-episode patients. Methods 211 patients entered the project between January 2006 and June 2010. Psychopathology and Quality of life were assessed at the entry of the programme, at the end of the programme (week 6) and at 1-year follow-up (N = 118, males N = 63, average age 28,3; first episode N = 52). Results Psychopathology decreased after programme significantly and PANSS scores remained low in one-year follow-up. Social quality of life assessed by SIS improved after programme significantly in Behaviour to strangers, Communication, Activities of daily living and Empathy and remained high in one-year follow-up. Overall one-year relapse rate in participants was 10% (N = 11), in first-episode patients 6% (N = 3). Conclusions Participation at the structured day-treatment programme offered to patients early in the stabilization phase of treatment improves quality of life, prevents social isolation and promotes treatment adherence. As a result one-year relapse rate remains low. Acknowledgement This project was supported by Ministry of Education and Youth, Czech Republic CNS 2005-2009 1M0517; Ministry of Health, Czech Republic IGA MZ CR, NS 1036-3 and VZCR MZ0PCP 2005.

IntroductionWe introduce clinically-based 6-week structured group day-treatment programme for out-patients with schizophrenia-spectrum disorders in the stabilization phase of the treatment. It consists of family psychoeducation, lifestyle improvement intervention, social skills training and art therapy.Objectives and aimsTo assess relapse frequency, psychopathology (PANSS) and quality of life (Schwartz Outcomes Scale-10, WHO-QOL BREF and Social Integration Survey) we designed one-year prospective follow-up field study.MethodsAfter informed consent procedure 144 patients entered the project. Psychopatology and Quality of life were assessed at the entry of the programme, at the end of the programme and at one-year follow-up (N = 86).ResultsPsychopathology decreased after programme significantly and PANSS scores remained low in one-year follow-up. Quality of life assessed by SOS-10 improved after programme significantly. Scores of WHOQOL-BREF raised significantly in Subjective health domain and Psychological health. In one-year follow-up Environment domain improved significantly. Social quality of life (SIS) improved in Behaviour to strangers, Communication, Activities of daily living and Empathy. Quality of life in patients was lower compared to common population, improved after the programme and this improvement was stable in one-year follow-up. One-year relapse rate in participants was 12%.ConclusionsWe conclude that participation at the group day-treatment programme early after discharge is beneficial as it improves quality of life, prevents social isolation and early non-compliance and ensures continuity of care.AcknowledgementThis project was supported by Ministry of Education and Youth, CR: CNS 2005–2009 1M0517; Ministry of Health, CR: IGA MZ CR, NS 1036-3 and VZCR MZ0PCP 2005.

Successful schizophrenia management should concentrate on treatment non-adherence, lack of information about the disease, poor insight, depressive symptoms, cognitive decline and stressful family atmosphere. We introduce clinically-based 6-week structured comprehensive program for out-patients with schizophrenia-spectrum disorders in the stabilization phase of the treatment. The group program consists of individual and family psychoeducation, life style improvement intervention, social skills training, cognitive rehabilitation and information technology aided relapse prevention program (ITAREPS). To assess the feasibility and effectiveness we designed one-year prospective follow-up field study. Data on psychopathology (PANSS) and quality of life (Schwartz Outcomes Scale, WHO-QOL-BREF and Social Integration Survey) will be presented. Preliminary analyses (N=58) show statistically significant improvement in total PANSS scores and in quality of life (psychological domain, WHO-QOL-BREF). Patients and their relatives welcome the opportunity to participate in such a comprehensive program.AcknowledgementThis project was supported by CNS 2005-2009 1M000237520 MSMT CR from Ministry of Education and Youth, Czech Republic.

Objectives: The aim of this study was to explore the attitudes of older people living in institutions and their caregivers to ageing. Recent outcomes showed prevailing negative social stereotype to ageing in CR. Methods: The Attitudes to Ageing Questionnaire (AAQ-24) was used in two waves of data collection to measure attitudes of 400 randomly selected residents of 19 Senior Residential Homes. The reduced sample of 220 seniors and 276 professional carers employed at twelve Senior Residential Homes completed 12 items of general form (AAQ-12). All respondents expressed their agreement or disagreement with the statements presented in the questionnaire regarding positive or negative attitudes to ageing. Results: The AAQ total score proved significant influence of gender, having children, self-perceived health, depression, and quality of life. Subscale scores (psychosocial losses, physical changes, psychological growth) were significantly influenced by gender, age, activities limitations, having own children, depression, self-perceived health status, and quality of life. Globally, the attitudes of professional caregivers to ageing were more positive compared to the attitudes of older people living in institutions. Older adults showed higher agreement with negative statements about ageing. There was no difference between professional caregivers and older people in the positive attitudes to ageing expressed as the growth potential. Physical activity, wisdom, better ability to cope with life and contacting young generation were effective in the positive attitudes of both groups.

Toxoplasma is considered as one of the most promising candidates of infectious agent that might trigger psychotic disorder in predisposed subjects or modulate the course of the disease. A clinical pattern has not been established yet in Toxoplasma infected schizophrenia patients. Psychopathological, cognitive and treatment response features of Toxoplasma seropositive and seronegative individuals suffering from schizophrenia spectrum disorder has been studied in China, Czech Republic, Ethiopia, Germany, Turkey, United States and other countries to determine whether schizophrenia and Toxoplasma infection co-morbidity modifies clinical presentation and illness course. Prague Psychiatric Centre project consisted of 251 patients with schizophrenia spectrum disorder consecutively admitted to between 2000 and 2010. Toxoplasma-infected patients spent more days in hospital during their last admission compared to Toxoplasma-free patients (p = 0.003; mean difference 32.9 days). Schizophrenia started approximately one year earlier in Toxoplasma-infected men and about 3 years later in Toxoplasma-infected women than in Toxoplasma-free patients, which corresponds to gender related toxoplasmosis incidence curves in the Czech Republic. All infected patients scored higher in the Positive Subscale of Positive and Negative Symptom Scale (PANSS). The PANSS scores and composite PANSS scores also correlated negatively with the concentration of anti-Toxoplasma antibodies indicating the increase of psychopathology with infection duration. Our findings support the hypothesis that toxoplasmosis may represent a risk factor for schizophrenia spectrum disorders.