1. Very long-term outcome of psychotic disorders in rural areas of Greece
ΕΤΑΙΡΕΙΑ ΠΡΟΑΓΩΓΗΣ ΨΥΧΙΚΗΣ ΥΓΕΙΑΣ ΗΠΕΙΡΟΥ
Society for the promotion of Mental Health in Epirus
V Peritogiannis, T Manthopoulou, P Gioti, A Gogou, N Menti, V Mavreas
Background
Few studies have addressed the issue of very long-term outcome of community dwelling patients with schizophrenia and related psychoses [1, 2]. Research has yielded significant differences among different countries, depending on definition of outcome, the measures and the patient population. In general, only a minority of patients in western countries are considered to have a favorable outcome. The objective of the present study was to measure the very long-term outcome in community dwelling patients with psychotic disorders in rural areas in Greece.
Materials and Methods
This is a cross-sectional study. All patients with a diagnosis of schizophrenia and related disorders (F20-F29 according to ICD-10) and illness duration ≥15 years who were engaged to treatment with the Mobile Mental Health Unit of Ioannina and Thesprotia, northwest Greece were examined over a three-month period with the Greek version [3] of the Health of the Nation Outcome Scale (HoNOS) scale. Good outcome was defined as the scores in all of the HoNOS items were ≤2.
Results
HoNOS scores were recorded for 55 patients, mostly men (72.7%), with a mean age of 59.1 years, and mean disease duration 32.1 years. One-fifth of the patients had a history of alcohol/substance abuse. The majority of patients (65.5%) were living with a caregiver, usually an elderly parent. Importantly, in 6 cases there were more than one family member suffering a psychotic disorder, and in other 6 occasions the supposed caregiver was suffering a severe mental disorder, namely bipolar disorder in 4 cases. Physical morbidity was recorded in almost 40% of patients. The vast majority (89.1%) were receiving a disability pension. A total of 34.5% of the patients were rated as having a good outcome. Outcome was found not to be related to history of substance/alcohol abuse.
Good, 34,5%
Moderate/poor, 65,5%
Conclusions
In our community based sample of treatment engaged patients with schizophrenia spectrum disorders very long-term outcome is fairly good for a significant proportion of patients. Contrary to previous research, a history of alcohol/substance abuse was found not to be related to outcome. The possible impact of rural residency on very long term outcome has to be studied further. The HoNOS scale may be a useful instrument for the estimation of patients’ outcome in different settings and populations.
References
1. Wiersma D, Nienhuis FJ, Sloof CJ, Giel R. Natural course of schizophrenic disorders: a 15-year follow-up of a Dutch incidence cohort. Schizophr Bull 1998;24:75– 85.
2. Thara R. Twenty-Year Course of Schizophrenia: The Madras Longitudinal Study. Can J Psychiatry 2004:49;564–569
3. Adamis D, Papanikolaou V, Michailidis M, Macdonald AJD. Validation of the Greek version of the Health of the Nation Outcome Scales for Elderly People (HoNOS65+, version 3). Aging Ment Health 2013; 17: