GLOBAL FUNCTIONING OF PATIENTS WITH DIFFERENT DIAGNOSES Aleš Logar, Peter Pregelj University Psychiatric Clinic Ljubljana GLOBAL FUNCTIONING OF PATIENTS WITH DIFFERENT DIAGNOSES

Psychiatric emergency unit (PEU) established at Outpatient Psychiatry Centre of University Psychiatric Clinic Ljubljana in 2004 outpatient unit, operating during working hours (8:00 AM – 16:00 PM Monday till Friday) a psychiatric nurse and a psychiatrist patiets may arrive through their own request or a referral from another doctor (GP or other specialities) after examination and initial treatment patients are referred to further out- or inpatient treatment at presentation evaluated patients with Clinical Global Ipressions scale (CGI) and Global Assessment Scale (GAS)

Clinical Global Impressions Scale (CGI) developed for use in NIMH-sponsored clinical trials to provide a brief assessment of the clinician's view of the patient's global functioning prior to and after initiating a study medication two components: CGI-Severity component CGI-Improvement component

Clinical Global Impressions Scale (CGI) seven-point scale: 1=normal, not at all ill, 2=borderline mentaly ill, 3=mildly ill, 4=moderately ill, 5=markedly ill, 6=severely ill, 7=among the most extremely ill patients

Global Assessment Scale (GAS) a single rating scale for evaluating the overall functioning of a subject from psychological or psychiatric sickness to health designed for the use of clinicians, the data can be collected from patients, reliable informant, or a case record scale values range from 1, which represents the hypothetically sickest individual, to 100, the hypothetically healthiest

Global Assessment Scale (GAS) divided into ten equal intervals: 1 to 10, 11 to 20, and so on to 81 to 90 and 91 to 100 91-100 doing very well 81-90 doing well 71-80 doing all right, minor impairment 61-70 some problems in one area only 51-60 some noticable problems in more than one area 41-50 obvious problems, moderate imapirment or severe in one area 31-40 serious problems, major impairment in several areas and unable to function in one area 21-30 severe porblems, unable to function in almost all situations 11-20 very severely impaired, considerable supervision is required for safety 1-10 extremely imapaired, constant supervision is required for safety 0 means not enough data

Global Assessment Scale (GAS) Global Assessment of Functioning Scale (GAF) was later developed from GAS GAF was in 1987 introduced as a 5th axis of 5 axis classification system developed for the 3rd edition of The Diagnostic and Statistical Manual of Mental Disorders (DSM III) 5th axis renounced with DSM V in 2015).

Hypothesis global functioning of patients examined and treated at PEU was different in different diagnostic groups

Methods: diagnostic groups of patients from ICD 10: F 00-09 organic, incl. symptomatic, mental disorders F 10-19 disorders due to psychoactive substance use F 20-29 schizophrenia, scizotypal and delusional disorders F 30-39 mood (affective) disorders F 40-49 neurotic, stress related and somatophorm disorders F 90-99 with onset usually in childhood and adolescence data from medical documentation about patient's age, gender, diagnoses and her/his overall functioning that was gathered at presentation in PEU

735 patients evaluated with Clinical Global Impressions-Severity scale (CGI) 618 patients evaluated with Global Assessment Scale (GAS) global functioning of patients compared according to diagnostic groups (F00-09, F10- 19, F20-29, F30-39, F40-49, F90-99) patients assigned to different diagnostic groups according to their main clinical diagnosis, comorbidities were diagnosed but not taken in account statistically

Results majority: fewest: similar numbers neurotic, stress-related and somatoform disorders mood disorders fewest: organic, including simptomatic, mental disorders similar numbers mental and behavioral disorders due to psychoactive substance use schizophrenia, schizotypal and delusional disorders behavioural and emotional disorders with onset usually occuring in childhood and adolescence and unspecified mental disorder

CGI N GAS F 00-09 41 37 F 10-19 87 73 F 20-29 61 F 30-39 202 156 F 40-49 266 225 F 90-99 66 735 618

Heaviest impairment of global functioning: schizophrenia, schizotypal and delusional disorders (CGI=5,05, GAS=47,57) organic, including simptomatic, mental disorders (CGI=3,98, GAS=49,03) Less affected: mood disorders (CGI=3,80, GAS=58,70) mental and behavioral disorders due to psychoactive substance use (CGI=3,39, GAS=62,18)

Best functioning: neurotic, stress-related and somatoform disorders (CGI=3,06, GAS=67,26) behavioural and emotional disorders with onset usually occuring in childhood and adolescence and unspecified mental disorder (CGI=2,79, GAS=70,02) Average score: CGI=3,53 3 – mildly and 4 – moderately ill GAS=61,76 61 - 70 – some problems in one area only (59 - 60 – some noticable problems in more than one area)

CGI p=0,05: p=0,05: p=0,05: p=0,05: p=0.05: p=0.05: F20-29 F20-29 F00-09 F20-29 F00-09 F00-09 F40-49 F10-19 F40-49 F20-29 F20-29 F90-99 F30-39 F90.99 F30-39 F30-39 F40-49 F90-99

GAS P=0,05 p=0,05 p=0,05 p=0,05 p=0,05 p=0,05 F10-19 F00-09 F10-19 F00-09 F00-09 F00-09 F30-39 F20-29 F30-39 F20-29 F20-29 F20-29 F40-49 F40-49 F40-49 F30-39 F30-39 F90-99 F90-99 F90-99

Conclusions data confirms that global funcioning is associated with type of mental disorder impairment of global functioning is the heaviest in schizophrenia and organic disorders global functioning of patients with neurotic, stress-relating disorders and behavioral and emotional disorders is least affected possibly useful in work capacity evaluation