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Biomedical subjects

R Giel

Publications and source records attributed to R Giel.

At least 19 recordsLinked to original sources
PubMed2001

Recovery from psychotic illness: a 15- and 25-year international follow-up study.

BACKGROUND: Poorly defined cohorts and weak study designs have hampered cross-cultural comparisons of course and outcome in schizophrenia. AIMS: To describe long-term outcome in 18 diverse treated incidence and prevalence cohorts. To compare mortality, 15- and 25-year illness trajectory and the predictive strength of selected baseline and short-term course variables. METHODS: Historic prospective study. Standardised assessments of course and outcome. RESULTS: About 75% traced. About 50% of surviving cases had favourable outcomes, but there was marked heterogeneity across geographic centres. In regression models, early (2-year) course patterns were the strongest predictor of 15-year outcome, but recovery varied by location; 16% of early unremitting cases achieved late-phase recovery. CONCLUSIONS: A significant proportion of treated incident cases of schizophrenia achieve favourable long-term outcome. Sociocultural conditions appear to modify long-term course. Early intervention programmes focused on social as well as pharmacological treatments may realise longer-term gains.

Adult↗
PubMed2000

Psychometric properties of the schedules for clinical assessment in neuropsychiatry (SCAN-2.1).

BACKGROUND: The Schedules for Clinical Assessment in Neuropsychiatry (SCAN), the successor of the ninth version of the Present State Examination (PSE-9), is one of the latest instruments developed by the World Health Organisation for the assessment of psychiatric disorders. So far, the psychometric properties have only been established for certain sections of the instrument. The present study is the first to test the psychometric properties of SCAN-2.1 for most of the disorders covered by the SCAN, and was carried out prior to a survey conducted in the Nijmegen Health Area (the Netherlands). METHODS: Interviewers were psychology graduates with little clinical experience. Two designs were used. In one design, pairs of independent live interviews with the same respondent were compared (test-retest situation). In the other, ten videotaped interviews by experts were rated by each of the interviewers (standardized situation), and the outcomes were compared with those of the other interviewers as well as with a reference score. RESULTS: In the test-retest situation the kappa coefficient for diagnostic caseness was qualified as substantial (0.62) and for diagnostic categories and diagnostic groups as moderate to good (0.24 to 0.64). In the standardized situation using videotaped interviews by experts, sensitivity as well as specificity proved to be substantial to almost perfect. The agreement per interviewer with regard to the reference diagnoses ranged from 87% (diagnostic group) to 94% (diagnostic caseness). Agreement on the syndrome level (without duration and interference criteria of DSM-IV) was excellent. CONCLUSIONS: Although the instrument is traditionally used by experienced clinicians, this study shows that less experienced (but well trained) interviewers can apply SCAN reliably. Special attention should be paid to the items without explicit interview questions, as they tend to be more sensitive to neglect than the items with interview questions.

Humans↗
PubMed1999

The prehistory of psychiatry in Ethiopia.

Ethiopian psychiatry has changed considerably during the last few years with an increasing number of Ethiopian doctors and nurses trained in psychiatry. In the paper is given an outline of the history of psychiatry in Ethiopia from 1965 onwards. Important improvements in the Amanuel Mental Hospital in Addis Ababa which for long was the only psychiatric facility in the country, the establishment of the Department of Psychiatry at the Medical Faculty of the University of Addis Ababa and the introduction of psychiatry in the curriculum of the medical faculty are important steps. Recently training of nurses and doctors in psychiatry has led to the establishment of psychiatric clinics in 26 district hospitals throughout the country staffed with psychiatric nurses supervised by psychiatrists from Amanuel Hospital in Addis Ababa. The development of psychiatric research in Ethiopia is also outlined.

Ethiopia↗
PubMed1998

Stability and change in needs of patients with schizophrenic disorders: a 15- and 17-year follow-up from first onset of psychosis, and a comparison between 'objective' and 'subjective' assessments of needs for care.

Need for care was studied in a Dutch incidence cohort of patients with schizophrenic disorders 15 and 17 years from first onset of psychosis. Long-term course of the disorders varied from complete remission and full community participation to chronic psychosis and long-term hospital stay. Fifty patients were assessed twice with the Needs For Care Assessment Schedule (NFCAS, Brewin and Wing 1989); at the latter follow-up an assessment was also made using the Camberwell Assessment of Need (CAN, Phelan et al. 1995). The NFCAS is an investigator- or professional-based instrument which provides an 'objective' assessment of needs. Need for care was recorded in 22 areas of clinical and social functioning. Comparison of the two assessments over a 2-year period demonstrated a high stability on the individual items (mean 88%, mostly concerning the absence of a problem twice), but did not show the expected stability of need status among this group of patients with chronic disorders. One in five patients (22%) had no needs at all on both occasions and 56% of the patients showed a change in needs. There was more negative than positive change: 28% suffered from new unmet needs at the 17-year follow-up, while only 12% had improved their status to no needs. About one-third (36%) had at least one unmet need, mostly regarding psychotic symptoms, dyskinesia or underactivity. The CAN provides a 'subjective' assessment of needs according to the view of patients themselves. The problems patients reported most commonly were in the areas of day-time activities, social relationships and information on their condition and treatment, for all which they asked for more help than they received. This patient-based instrument produces slightly higher numbers of problems and unmet needs, and a lower ratio between met and unmet needs. There is an overall percentage of 21% of disagreement between patient and investigator view regarding the unmet need status. Agreement between the two instruments on the nature of the problems with unmet needs was lacking altogether.

Adult↗
PubMed1998

Natural course of schizophrenic disorders: a 15-year followup of a Dutch incidence cohort.

Data are presented on the 15-year natural course of schizophrenia and other nonaffective functional psychoses in a cohort of 82 first-contact cases from a circumscribed area in the Netherlands. The subjects were suffering from functional psychosis with International Classification of Diseases-Ninth Revision (ICD-9) diagnoses 295, 297, or 298.3-9 (broad definition of schizophrenia) on entry. Standardized assessments of psychopathology, psychological impairments, negative symptomatology, social disability, and use of mental healthcare were used. The study reveals a pattern of chronicity and relapses with a high risk of suicide: Two-thirds of the subjects had at least one relapse and after each relapse 1 of 6 subjects did not remit from the episode; 1 of 10 committed suicide; and 1 of 7 had at least one episode with affective psychotic symptoms that started on average 6 years after the onset of the schizophrenic disorder. Diagnoses were reclassified in five patients, according to DSM-III-R criteria for a bipolar disorder. The predictive power--in terms of time in psychosis and in partial or full remission--of demographic, illness, and treatment variables at onset of the illness was very limited. Insidious onset and delays in mental health treatment are risk factors that predict a longer duration of first or subsequent episodes. The importance of mental health treatment in regard to outcome is probably subject to change because an early warning and intervention strategy could prevent further damage and deterioration. Our data support the need for an adequate relapse prevention program as a priority for our mental health services.

Activities of Daily Living↗
PubMed1996

Assessment of the need for care 15 years after onset of a Dutch cohort of patients with schizophrenia, and an international comparison.

Assessment of needs for care is crucial in the evaluation of ongoing changes from institutional care to various forms of day- and outpatient treatment. Do patients really do better in the community and are they adequately cared for? The 15-year follow-up of a Dutch incidence cohort of patients with schizophrenia and other functional non-affective psychoses showed that 47 (out of 63) patients had positive ratings of symptoms and disabilities. They were assessed by means of the Needs for Care Assessment Schedule, which articulates the problems and corresponding interventions resulting in a judgement of met or unmet need for treatment or assessment. There was a mean of 2.1 clinical problems and 2.1 social problems per patient. Few problems were considered to generate unmet needs: 14% of the clinical problems and only 7% of the social problems. Nevertheless, 32% of the patients had one or more unmet needs. These results were compared with data from six research centres in the United Kingdom (Camberwell, Oxford and South Glamorgan), Canada (Montreal), Italy (Verona) and Finland (Tampere). Despite differences in health care settings in the four countries, the ratio of met to unmet needs (about 4-5 to 1) among chronic, mostly schizophrenic patients is more or less the same with the exception of an apparently underserved hostel population in Oxford and the Finnish patient population probably due to high expectations with respect to independent community living.

Adolescent↗
PubMed1995

Positive life change and recovery from depression and anxiety. A three-stage longitudinal study of primary care attenders.

BACKGROUND: The objective was to examine the relationship between positive life change (PLC) and recovery from depression and anxiety. Following Brown et al (1988, 1992), we hypothesised: (a) that an excess of PLC would be found in the 3-month period before recovery compared with base rates ('excess hypothesis') and (b) that fresh-start and anchoring subtypes of PLC would trigger recovery from depression and anxiety respectively ('specificity hypothesis'). METHOD: One hundred and seventy primary care patients with a depressive and/or anxiety disorder, selected from 1994 consecutive attenders, were assessed at baseline and at 1-year and 3.5-year follow-ups on life change (LEDS) and psychopathology (PSE and Course Interview). RESULTS: Our results appeared to confirm the excess hypothesis regarding depression and anxiety (twofold excess was found prior to recovery), but not regarding mixed anxiety/depression. They did not support the specificity hypothesis. CONCLUSIONS: PLC facilitates recovery but is neither a necessary nor sufficient condition for remission. Difficulty reduction is the most important recovery-enhancing factor.

Adaptation, Psychological↗
PubMed1995

Assessment of the prevalence of psychiatric disorder in young adults.

BACKGROUND: The effectiveness of different assessment procedures for determining prevalence rates of psychiatric disorder in young adults was investigated. METHOD: In a two-stage multi-method procedure, the Young Adult Self-Report, the Schedules for Clinical Assessment in Neuropsychiatry (SCAN), the Structured Interview for Personality Disorders (Revised), and the Global Assessment of Functioning (GAF) Scale were used to assess prevalence rates in 706 19-24-year-olds from the general population. Furthermore, individuals' subjective perception of distress and referral to mental health services were assessed. RESULTS: The prevalence of any SCAN/DSM-III-R disorder was 19.3% (95% confidence interval: 11.2-27.4%). Most subjects who received a SCAN/DSM-III-R diagnosis were only mildly impaired. The highest prevalence rates of dysfunctioning (GAF score below 61) without referral to mental health services were for dissociative disorder (2.3%), sleep disorder (2.1%), alcohol dependence (1.3%) and affective disorder (1.8%). CONCLUSION: Instruments that assess functional impairment in addition to DSM-III-R diagnoses are indispensable in prevalence studies.

Adolescent↗
PubMed1995

Time trends in the care-based incidence of schizophrenia.

BACKGROUND: Several studies have suggested a declining first-admission rate for schizophrenia. This study examines the care-based incidence of schizophrenia in a Dutch register area. METHOD: Data from Groningen psychiatric case register were used to compare first-admission rates for schizophrenia over 1976-90 with those of other functional psychoses, and to consider various potential biases. RESULTS: Diagnostic habits probably affected time trends in incidence rates. Using a broader definition of schizophrenia, no evidence was found for a decrease in the incidence of schizophrenia. Although first admissions to intramural services showed a (non-significant) decrease, this effect seemed to be neutralised when all mental health services were taken into account. CONCLUSIONS: Care-based studies of time trends in psychiatric disorders should embrace all mental health services. Furthermore, unless a diagnostic classification system with univocal criteria is used, bias caused by changing diagnostic habits cannot be ruled out.

Hospitalization↗
PubMed1995

Costs and benefits of hospital and day treatment with community care of affective and schizophrenic disorders.

BACKGROUND: A randomised controlled trial of day treatment with community care for patients with schizophrenic and affective disorders, referred for in-patient psychiatric treatment, was conducted to evaluate patterns of treatment and the course of illness with its psychosocial consequences over a period of two years. METHOD: Seventy patients, of whom 34 had affective and 36 had schizophrenic disorder, were assigned to the experimental condition (day treatment with ambulatory and domiciliary care), and 33 patients, of whom 16 had affective and 17 had schizophrenic disorder, were assigned to the control condition of standard clinical care. RESULTS: Day treatment with community care was feasible for 40.6% of the affective patients and 33.3% of the schizophrenic patients. The direct treatment costs of both disorders, based on numbers of in- and day-patient days and out-patient contacts over two years, appeared more or less the same. Patients benefited equally from day treatment as from in-patient treatment, although there were some gains in self-care and in functioning in the household among experimentals. Although schizophrenics were socioeconomically worse off, and also suffered from more (severe) symptoms and social disabilities than the affective patients at entry into the study, they were similar at two years. This finding is unexpected, compared with other follow-up studies. Extra cost for patients and families were not observed. Patients and their families in the experimental condition were significantly more satisfied with the treatment. Experimental patients spent much more time at home during admission, remained much less time in secluded wards, and were more compliant with treatment. CONCLUSIONS: Day treatment could be considered a cost-effective alternative to in-patient treatment.

Activities of Daily Living↗
PubMed1994

Efficacy of psychiatric day treatment. Course and outcome of psychiatric disorders in a randomised trial.

The course of the psychopathology and social functioning in an experimental day-treatment group referred for inpatient psychiatric treatment is compared with that of a control group receiving standard inpatient care. During a follow-up period of 2 years subjects were interviewed three times. The interview comprised information about psychiatric symptoms, psychological functions, psychiatric diagnosis and social-role functioning. Apart from these discrete assessments an effort was made to map episodes of illness throughout the follow-up period. Upon entry the groups did not differ in terms of psychopathology or social functioning. At follow-up both groups had improved significantly with respect to symptomatology, psychological and social functioning. The extent to which the groups improved did not differ significantly regarding pathology, but self-care improved more in the experimental group. The average duration of episodes of illness was similar for the experimental and control group. During the 2-year follow-up patients suffered from a well-defined disorder during an average of 11 months. The fact that approximately 40% of them were still a psychiatric case after 2 years further underscores the severity of their pathology.

Activities of Daily Living↗
PubMed1992

Inpatient care in an eastern and a western European area. A comparative case-register study.

Inpatient point-prevalence and admission rates in both mental hospitals and psychiatric wards in general hospitals in East Bohemia and in Drenthe (the Netherlands) were compared. A higher point-prevalence rate was found in Drenthe as there was a higher rate of long-stay patients. However, in East Bohemia the admission rates were higher for all diagnostic categories, except for neuroses, the admission rates for neuroses were twice as high in Drenthe. The differences were explained by the availability of complementary in-patient services and more developed out- and day-patient facilities in Drenthe.

Adolescent↗
PubMed1992

Detecting psychopathology in young adults: the Young Adult Self Report, the General Health Questionnaire and the Symptom Checklist as screening instruments.

This study compares the screening capacity of an age-adjusted child-oriented questionnaire, the Young Adult Self Report (YASR) with two adult-oriented questionnaires, the General Health Questionnaire-28 (GHQ-28) and Symptom Checklist-90 (SCL-90) in a sample of young adults (18-25 years). The YASR performed just as well as the SCL-90 and both performed better than the GHQ-28. The relatively poor performance of the GHQ-28 compared with the YASR and SCL-90 could not be attributed to instrument characteristics or to the use of referral status as indicator of psychopathology. In assessing psychopathology in young adults an age-adjusted child-oriented instrument might be a good alternative to the existing adult-oriented instruments, especially when one takes into account the problem of data comparability over time in longitudinal studies in which children are followed into adulthood.

Adolescent↗
PubMed1992

Predicting feasibility of day treatment for unselected patients referred for inpatient psychiatric treatment: results of a randomized trial.

OBJECTIVE: Because previous studies of day treatment as an alternative to inpatient treatment had major disadvantages or methodological shortcomings, the authors conducted a randomized controlled trial to estimate and predict the extent to which day treatment is feasible for unselected patients referred for inpatient treatment. METHOD: Of 160 patients, 57 were randomly assigned to the control condition and 103 were assigned to the experimental condition. Control patients received standard clinical care. In the experimental condition, day treatment was attempted as soon as the patient's condition permitted. The average number of nights per week that experimental patients spent away from the hospital was compared to the average number of nights away for patients under standard care. RESULTS: Day treatment was satisfactory for 40% of the experimental patients but was completely infeasible for another 40%. The level of surveillance needed in the first week, physical illness, number of previous admissions, depressive symptoms, and treatment by qualified psychiatrists versus registrars were variables predictive of these differences. CONCLUSIONS: In this unselected group of patients, no absolute contraindications against day treatment were found. This suggests that the selection criteria applied in nearly all other controlled studies on the subject were unwarranted. The approach used in this study facilitated treatment in the least restrictive environment possible.

Adolescent↗