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Background: Most studies about the problems and needs of schizophrenia carers included only one care-giving relative, usually the patients' mothers.Methods: 101 mothers and fathers of the same patients suffering from schizophrenia were included into this study. Their needs were assessed by means of the "Carers' Needs Assessment for Schizophrenia".Results: Mothers reported significantly more often problems than fathers concerning stress due to earlier life events and burn-out. Mothers needed interventions such as individual psychoeducation or family counselling more than twice as often as fathers. Overall, mothers reported higher numbers of problems and needs for intervention than fathers. The number of mothers' problems was predicted by not living with a partner and by a shorter duration of the patients' illness. The number of mothers' needs was predicted by more psychiatric symptoms, not living with a partner and a shorter duration of the patients' illness. Among fathers we could not identify any predictors, neither for the number of problems nor for the number of needs.Conclusions: Fathers and mothers often report problems and frequently need professional support. Overall, mothers exhibited more problems and needs for interventions than fathers. The differences between mothers and fathers indicate the importance of considering the carer's gender in clinical work. [ABSTRACT FROM AUTHOR]

Background: A variety of interventions are available to support the caregivers of dementia patients. For the purposes of service planning, we developed an instrument to assess the needs of these caregivers and to determine whether needs are met. The reliability and validity of this new instrument was also investigated.Methods: The development of the Carers' Needs Assessment for Dementia (CNA-D), was based on in-depth interviews and a focus group. The combined inter-rater and test-retest reliability was investigated among 45 dementia caregivers. Correlations of the CNA-D with the Zarit Burden Inventory were used to analyze concurrent validity. Content validity was investigated by performing a separate survey among 40 caregivers and 40 professionals.Results: The CNA-D is a semi-structured research interview including 18 problem areas. For each problem area, the CNA-D offers several possible interventions. The relevance of the problem areas and the interventions (content validity) was confirmed by most of the study participants. Significant positive associations were found between the total score of the Zarit Burden Inventory and the number of problems and the number of unmet needs according to the CNA-D. The agreement between the interviewers was "excellent" (kappa above 0.75) in 73.7% of the problem areas and in 69.9% of the interventions.Conclusions: The CNA-D is a valid and reliable instrument for comprehensively assessing the needs of dementia caregivers. [ABSTRACT FROM AUTHOR]

Objective: To explore the usefulness of "anhedonia", "fatigue" and "depressed mood" as screening symptoms for predicting a depressive episode in physically ill patients., Method: 290 patients filled in a modified version of the Patient Questionnaire and were subsequently assessed by psychiatrists with the Composite International Diagnostic Interview (CIDI; ICD-10 version)., Results: 63 patients suffered from a current depressive episode according to the CIDI. If at least two of the three symptoms were used for screening positively (ICD-10 algorithm), the sensitivity was 93.2% and the specificity 72.7%, while the simpler algorithm of DSM-IV - requiring depressed mood or anhedonia to be present - yielded a slightly higher sensitivity (95.2%) and a slightly lower specificity (66.5%). One in five patients with a depressive episode did not report "depressed mood"., Limitation: It remains unclear how relevant the three core symptoms of depression are for the diagnosis of an ICD-10 depression in people who are not physically ill., Conclusion: The fact that both diagnostic algorithms yielded comparable results suggests that the more parsimonious DSM-IV algorithm is preferable and "fatigue" could be left out as a screening symptom. Since "depressed mood" was absent in a substantial proportion of patients, special attention has to be paid to "anhedonia". Medical students and non-psychiatric clinicians should be especially trained to ask for anhedonia, so that cases of depression will not be overlooked., (Copyright 2010 Elsevier B.V. All rights reserved.)

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: The aim of the present study was to estimate the need for psychiatric consultation services and psychiatric inpatient referral among inpatients of non-psychiatric hospital departments, and to assess the actual utilization of these services., Methods: The study was carried out among 728 inpatients of physical rehabilitation wards, medical, surgical, and gynecological wards in Austrian hospitals. Psychiatric case identification was performed by research psychiatrists using the Clinical Interview Schedule (CIS). Diagnoses were given according to DSM-III-R. The assessment of need for consultation and inpatient referral was based on the clinical judgments of research psychiatrists., Results: Overall, 34.2% of the inpatients were cases according to the CIS-criteria, 51.8% of them needing either psychiatric consultation or inpatient referral according to research psychiatrists. In 66.7% of those for whom research psychiatrists had stated a need, this need was not met ("unmet need"), while only 33.3% of them had their need met. In contrast, a psychiatric consultation was performed among 5% of those patients not needing psychiatric services according to the research psychiatrists ("overprovision"). Variables of the health care system (i.e. department type and catchment area of the hospital) were among the predictors for "met needs"., Conclusion: The rate of actual psychiatric consultations and admissions to psychiatric wards was markedly lower than the need according to research psychiatrists' judgment.

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: To our knowledge, there are no studies investigating the non-cognitive symptoms of patients with dementia such as depression, agitation, or delusions among general hospital inpatients. The aim of this study was to investigate the frequency of such non-cognitive symptoms among medical inpatients and to analyze their impact on the length of hospital stay and on admission to nursing homes., Method: The sample consisted of 372 elderly inpatients admitted to four internal medical departments (i.e., not including psychiatric wards) in Austria. Patients were investigated by research psychiatrists using the Clinical Interview Schedule. For the analyses of the non-cognitive symptomatology, only marked and severe symptoms were included. To identify predictors for the length of hospital stay and for nursing home placement, multivariate regression procedures were used., Results: Of all inpatients, 27.4% met criteria for dementia according to DSM-III-R. Of those with dementia, 27.8% had marked or severe non-cognitive symptoms. A diagnosis of dementia markedly increased the risk for nursing home referral and prolonged the duration of inpatient treatment. Among the demented, both, cognitive and non-cognitive symptoms turned out to be significant predictors for nursing home placement and for prolonged duration of acute hospital stay, even when controlling for other independent variables., Conclusions: Non-cognitive symptoms occur frequently among medical inpatients with dementia and considerably increase both the duration of inpatient treatment and the risk of nursing home placement. Since such non-cognitive symptoms are treatable, they should receive attention from the hospital staff.

Objective: To find out whether the use of hospital days in all psychiatric inpatient services in the province of Lower Austria is equally distributed among patients or whether subgroups with different intensity of hospital day use can be identified, and if so, how these subgroups can be characterized., Methods: Data collected for administrative purposes for all three inpatient services of Lower Austria were analyzed for the years 1996 to 2000. Record Linkage allowed to identify patients who had used several of these hospitals within the respective study periods. Cumulative hospital days per patient were calculated for each of the years studied and the distribution of these cumulative hospital days was analyzed., Results: Of the 202 996 hospital days accrued in the year 1996, 44.5 % were consumed by patients who continuously stayed in hospital during the whole year ("static" population). In 2000 this percentage had dropped to 16.3 %; also the total number of hospital days had decreased by one third to 141 738. Of those patients, who had at least once been admitted and/or discharged during a specific year ("dynamic population"), a stable proportion of around 17.0 % were responsible for 50.0 % of all hospital days. These patients were more frequently of female sex, significantly younger, had more often repeated admissions and suffered more frequently from schizophrenia than the rest of the group., Conclusions: The astonishing finding that, despite substantial change in the system of psychiatric care over five years, the percentage of patients with high values for cumulative hospital days remains constant, warrants further analyses. In such analyses not only patient and illness characteristics should be studied (which is suggested by the terms "heavy users" and "high utilizers"), but also factors such as the social context of the patient, the existence or non-existence of community psychiatric services and their functioning, as well as existing or non-existing financial incentives for single services.

Because of the increasing life expectancy it is generally assumed that the number of demented individuals will steeply rise in the next decades. Dementia is a main reason for requiring extensive nursing care. Therefore, estimations of the future number of demented subjects in Austria are necessary for planning appropriate services. Since the age structure of the Austrian population has already changed during the last decades, the development of the number of demented individuals during the last five decades is compared with the estimations for the next five decades. These estimations are based on the population projections for Austria and on all available international meta-analyses of prevalence and incidence surveys. Estimations of the number of people suffering from dementia and of those developing dementia within one year are presented for the period between 1951 and 2050. In 1951, the number of dementia sufferers was 35,500; by 2050 this number will increase to 233,800. At present, 90,500 elderly people with dementia live in Austria. Thus, in the next decades, the number of people suffering from dementia will rise more steeply than the in the past. If the projected life expectancy leads to a prolonged duration of illness the number of dementia sufferers will be markedly higher. On the other hand, the working force will decrease in the next decades. Therefore, while in 1951 there were 120 employable persons per demented person, in 2050 there will be only 17 employable persons per demented person. Extensive planning of the future care of demented people is an urgent necessity.