GAF Scale Research Articles

Quality of life in a 20-year follow-up study of people suffering from schizophrenia

Aims1. To assess the changes in quality of life indicators in schizophrenia sufferers at three measurement points: 7, 12 and 20years after the first hospitalization. 2. To assess changes in the level of functioning and psychopathological state. 3. To assess the relationships between quality of life, the level of functioning and the severity of symptoms. MethodA sample group of fifty-two people diagnosed with schizophrenia was investigated using the Lehman's QOLQ, the GAF scale and BPRS. ResultsA deterioration was noted in the subjective and objective areas of family life and health, subjectively assessed social relationships and objectively assessed finances. The better functioning sub-group returned better scores for the following objective quality of life indicators: free time, family life, health, social relationships and financial situation. The sub-group in remission obtained better results for general, subjective quality of life and for subjectively assessed health, as well as better scores for objectively assessed free time, social relationships, financial situation and health. An improvement in general, subjective quality of life was seen in the sub-group whose symptoms had grown more severe. ConclusionsThe decline in subjective and objective quality of life in the areas of health and family life, in the subjective evaluation of social relationships and in the objective assessment of financial situation was associated with a deterioration in functioning and an absence of symptom remission. The improvement in general, subjective quality of life in the sub-group with severe symptoms may be evidence of the formation of adaptive mechanisms.

Influence of gender on Tourette syndrome beyond adolescence

Although boys are disproportionately affected by tics in Tourette syndrome (TS), this gender bias is attenuated in adulthood and a recent study has suggested that women may experience greater functional interference from tics than men. The authors assessed the gender distribution of adults in a tertiary University-based TS clinic population and the relative influence of gender and other variables on adult tic severity (YGTSS score) and psychosocial functioning (GAF score). We also determined retrospectively the influence of gender on change in global tic severity and overall TS impairment (YGTSS) since adolescence. Females were over-represented in relation to previously published epidemiologic surveys of both TS children and adults. Female gender was associated with a greater likelihood of tic worsening as opposed to tic improvement in adulthood; a greater likelihood of expansion as opposed to contraction of motor tic distribution; and with increased current motor tic severity and tic-related impairment. However, gender explained only a small percentage of the variance of the YGTSS global severity score and none of the variance of the GAF scale score. Psychosocial functioning was influenced most strongly by tic severity but also by a variety of comorbid neuropsychiatric disorders.

Effect of Work Performance on Global Functioning of Persons with Mental Illness Receiving Psychiatric Rehabilitation Services at a Tertiary Neuro-psychiatric, Super-Speciality Hospital at Bangalore, India: A Pilot Study

Psychiatric rehabilitation can help in making significant changes in all the spheres of functioning. A pre-experimental design was selected to invite four male and one female patient to pilot test a rehabilitation model wherein supported work was offered by the treating facility. There was increase in mean work performance on the Griffith’s scale as well as mean social, occupational functioning and symptom reduction on the MIRECC GAF scale after six months when compared to baseline values. When work performance increased, there was significant (ϒ = 0.932, p = 0.021) decrease in symptoms. This pilot study may help pave the way to recovery for patients with mental illness.

Stresses and Disability in Depression across Gender.

Depression, though generally episodic, results in lasting disability, distress, and burden. Rising prevalence of depression and suicide in the context of epidemiological transition demands more attention to social dimensions like gender related stresses, dysfunction, and their role in outcome of depression. Cross-sectional and follow-up assessment of men and women with depression at a psychiatric tertiary centre was undertaken to compare their illness characteristics including suicidal ideation, stresses, and functioning on GAF, SOFAS, and GARF scales (N = 107). We reassessed the patients on HDRS-17 after 6 weeks of treatment. Paired t-test and chi-square test of significance were used to compare the two groups, both before and after treatment. Interpersonal and marital stresses were reported more commonly by women (P < 0.001) and financial stresses by men (P < 0.001) though relational functioning was equally impaired in both. Women had suffered stresses for significantly longer duration (P = 0.0038). Men had more impairment in social and occupational functioning compared to females (P = 0.0062). History of suicide attempts was significantly associated with more severe depression and lower levels of functioning in case of females with untreated depression. Significant cross-gender differences in stresses, their duration, and types of dysfunction mandate focusing on these aspects over and above the criterion-based diagnosis.

EPA-0304 – Qualitative study of clinicians’ experience with rating of the global assessment of functioning (gaf) scale

Qualitative study of clinicians’ experience with rating of the Global Assessment of Functioning (GAF) scale The GAF is a worldwide known rating scale for severity of illness in psychiatry and very much used in research papers. GAF covers the spectrum from positive mental health to severe psychopathology on a 100-points scale (1–100). From systematic literature reviews (Aas 2010; 2011), we know there are problems with GAF, including reliability and validity problems. How good GAF is, is an important question. Systematic literature searches have not identified qualitative studies of clinicians experience with GAF. To collect information which can play a role in work to improve GAF. An interview guide (with 28 questions) for qualitative interviews of clinicians was developed, with focus on issues considered important for an improved GAF (Aas 2010; 2011). Purposive sampling is used and sample size decided by saturation. Respondents varies in, for example: profession (psychiatrists, psychologists), experience with diagnostic categories, years of experience from psychiatry, and organization they work for. The qualitative interviews have resulted in a considerable amount of information. Collected information confirms that clinicians have unique experiences of importance for further work towards an improved GAF.

EPA-1149 – Assessment of negative and affective symptoms in a group of women with schizophrenia who are in treatment with paliperidone long acting injection

Evaluate the psychopathological changes in a group of women who suffer schizophrenia, before and after beginning treatment with paliperidone long acting injection. We focus on affective and negative symptons. We recruit the women from Vallecas Villa Mental Health Centre who initiate paliperidone long acting injection, from 1st of January of 2013. We use for the assessment: Positive and Negative Syndrome Scale (PANSS), Hamilton Depression Rating Scales (HDRS), Clinical Global Impression-Schizophrenia (CG-ISCH), Global Assessment Scale (GAF), Subjective Wellbeing under Neuroleptics (SWN-K) before beginning the treatment and 2 months later. Our sample was formed by 20 women, only one left the treatment for secondary effects. In baseline all women were severely ill to moderate ill in Clinical Global Impression Scale. The results in baseline and two months after treatment can be read in table 1. The patients improve in all the scales: in GAF scale the functionality of the patients change from 48 to 62. This recovery seems related with the improvement in affective and negative symptoms, but not with positive symptoms (in fact in baseline mild-moderate). Schizophrenia is more than positive symptoms, sometimes the lack of functionality is related with other group of symptoms that initially are considered secondary: affective and negative. TABLE 1 Baseline After AGE A 40,23 (9,4) PANSS-P 21,92 (8,9) 13,84 (5,9) PANSS-N 25,23 (8,1) 18,76 (6,5) PANSS-PG 50 (10,5) 36,53 (12,26) PANSS-Total 97,15 (20,02) 69,15 (22,13) EAAG 48,07 (11,99) 62,3 (10,53) HAMILTON 18,15 (6,3) 10,38 (8,3) SWN-K 58,76 (11,27) 74,15 (18,14)

EPA-0364 – Craving and satisfaction levels in substance use patients with comorbid psychosis

Introduction Long-acting atypical antipsychotics have been widely used in the treatment of substance use disorders and comorbid psychosis. Objectives To investigate the impact of long-acting injectable paliperidone palmitate (PPLAI) on craving and satisfaction levels in dual psychotic patients. Methods An open-label, non-interventional, prospective study was conducted in 42 dual psychotic outpatients who received PPLAI in monotherapy. Craving and satisfaction levels in patients and relatives were assessed by using the Visual Analogue Scale (VAS). We used the Clinical Global Impression Scale (CGI) to assess clinical severity and global improvement, and the GAF scale to assess global functioning. 35 patients completed the study and underwent a systematic assessment at baseline and after 3 and 6 months. Results After 6 months of treatment, mean craving scores decreased in patients treated with PPLAI when compared to baseline scores (4.9 vs 2.3). Mean satisfaction levels in dual psychotic patients increased (6.0 vs 9.1), and satisfaction levels in their relatives improved after 6 months (5.2 vs 9.5). Patients receiving PPLAI showed a statistically significant decrease in consumption relapses, had lower scores in CGI for clinical severity (CGISI), higher scores in global improvement (CGI-GI), and higher scores in global functioning. Conclusions After 6 months of PPLAI treatment, psychotic patients with substance use had lower craving levels. Satisfaction levels were higher in patients and their relatives. Consumption relapses decrease and patients had higher scores in global functioning.

Insight in schizophrenia–course and predictors during the acute treatment phase of patients suffering from a schizophrenia spectrum disorder

BackgroundTo analyse insight of illness during the course of inpatient treatment, and to identify influencing factors and predictors of insight. MethodsInsight into illness was examined in 399 patients using the item G12 of the Positive and Negative Syndrome Scale (“lack of insight and judgement”). Ratings of the PANSS, HAMD, UKU, GAF, SOFAS, SWN-K and Kemp's compliance scale were performed and examined regarding their potential association with insight. The item G12 was kept as an ordinal variable to compare insight between subgroups of patients. ResultsAlmost 70% of patients had deficits in their insight into illness at admission. A significant improvement of impairments of insight during the treatment (p<0.0001) was observed. At admission more severe positive and negative symptoms, worse functioning and worse adherence were significantly associated with poorer insight. Less depressive symptoms (p=0.0004), less suicidality (p=0.0218), suffering from multiple illness-episodes (p<0.0001) and worse adherence (p=0.0012) at admission were identified to be significant predictors of poor insight at discharge. ConclusionThe revealed predictors might function as treatment targets in order to improve insight and with it outcome of schizophrenia.

Group art therapy as an adjunctive treatment for people with schizophrenia: a randomised controlled trial (MATISSE).

To examine the clinical effectiveness and cost-effectiveness of referral to group art therapy plus standard care, compared with referral to an activity group plus standard care and standard care alone, among people with schizophrenia. A three-arm, parallel group, single-blind, pragmatic, randomised controlled trial. Participants were randomised via an independent and remote telephone randomisation service using permuted blocks, stratified by study centre. Study participants were recruited from secondary care mental health and social services in four UK centres. Potential participants were aged 18 years or over, had a clinical diagnosis of schizophrenia, confirmed by an examination of case notes, and provided written informed consent. We excluded those who were unable to speak sufficient English to complete the baseline assessment, those with severe cognitive impairment and those already receiving arts therapy. Group art therapy was delivered by registered art therapists according to nationally agreed standards. Groups had up to eight members, lasted for 90 minutes and ran for 12 months. Members were given access to a range of art materials and encouraged to use these to express themselves freely. Activity groups were designed to control for the non-specific effects of group art therapy. Group facilitators offered various activities and encouraged participants to collectively select those they wanted to pursue. Standard care involved follow-up from secondary care mental health services and the option of referral to other services, except arts therapies, as required. Our co-primary outcomes were global functioning (measured using the Global Assessment of Functioning Scale - GAF) and mental health symptoms (measured using the Positive and Negative Syndrome Scale - PANSS) at 24 months. The main secondary outcomes were level of group attendance, social functioning, well-being, health-related quality of life, service utilisation and other costs measured 12 and 24 months after randomisation. Four hundred and seventeen people were recruited, of whom 355 (85%) were followed up at 2 years. Eighty-six (61%) of those randomised to art therapy and 73 (52%) of those randomised to activity groups attended at least one group. No differences in primary outcomes were found between the three study arms. The adjusted mean difference between art therapy and standard care at 24 months was -0.9 [95% confidence interval (CI) -3.8 to 2.1] on the GAF Scale and 0.7 (95% CI -3.1 to 4.6) on the PANSS Scale. Differences in secondary outcomes were not found, except that those referred to an activity group had fewer positive symptoms of schizophrenia at 24 months than those randomised to art therapy. Secondary analysis indicated that attendance at art therapy groups was not associated with improvements in global functioning or mental health. Although the total cost of the art therapy group was lower than the cost of the two comparison groups, referral to group art therapy did not appear to provide a cost-effective use of resources. Referring people with established schizophrenia to group art therapy as delivered in this randomised trial does not appear to improve global functioning or mental health of patients or provide a more cost-effective use of resources than standard care alone. Current Controlled Trials ISRCTN 46150447. This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 16, No. 8. See the HTA programme website for further project information.

Aripiprazole augmentation in 13 patients with refractory obsessive-compulsive disorder: A case series

Objectives. The primary treatment for obsessive–compulsive disorder (OCD) is selective serotonin reuptake inhibitors (SSRI). However, approximately a third of patients do not respond to SSRIs and remain chronically affected. Methods. Therefore, we added aripiprazole to SSRI therapy for 13 patients with treatment-refractory OCD (subjects who failed to respond to SSRI therapy for at least 2 months, and for an average of 508 days). Participants underwent at least 7 weeks of treatment with aripiprazole augmentation. Results. Patients were evaluated using the Y-BOCS and GAF scales. Aripiprazole (3–12 mg)/SSRI co-therapy significantly improved Y-BOCS and GAF scores. However, many patients needed to take antiparkinsonian drugs to control extrapyramidal symptoms. Conclusions. These results suggest that aripiprazole augmentation of SSRI therapy may be effective for treatment-refractory OCD.

P-362 - Brain derived neurotrophic factor, cognition and functioning of patients with first psychotic episode

Brain-derived neurotrophic factor (BDNF) promotes growth and maintenance of connections and participates in plasticity mechanisms.The cognition an the functioning of patients with a first episode of psychotic (FEP) is altered. We analyze the relation between the BDNF, the cognitive performance and prognosis in patients with FEP. 45 patients with a FEP from the Basque Country, diagnosed using the SCID-I and DSM-IV. Plasma BDNF levels were measured using the BDNF Sandwich ELISA Kit. All patients were assessed clinically three times over a year using PANSS, GAF and Strauss Carpenter scales. Battery of cognitive tests (Wechsler Memory Scale and WAIS-III) was applied six months after the acute episode. Positive correlation between BDNF levels after six months of treatment and five cognitive domains: abstract verbal reasoning (r = 0.468), motor and processing speed (r = 0.397), learning capacity (r = 0.559), immediate memory (r = 0.409) and delayed memory (r = 0.382). Also, the patients with lower BDNF plasma levels at baseline, at 6 months follow-up had worse social activity (0.61 vs. 0.89; p = 0.041) and functioning (0.69 vs. 0.93; p = 0.044).The BDNF levels increased along the follow up, after the pharmacological treatment (basal-1 month: Z = −2.88; p ≤ 0.004 and 1–6 months: Z = −2.23; p ≤ 0.05). Our results suggest that BDNF is associated with cognitive impairment seen after a FEP and their prognosis. After the pharmacological treatment, the BDNF levels increase significantly and at 6 moths of treatment there were normal levels. Further investigations of the role of this neurotrophin in the symptoms associated with onset of psychosis are warranted.

Altered brain function directly related to structural abnormalities in people at ultra high risk of psychosis: Longitudinal VBM-fMRI study

Background Several studies have indicated that people with prodromal signs of psychosis show alterations in the structure and function of the brain when they first present to clinical services. However, the longitudinal course of these abnormalities, and how they relate to subsequent clinical and functional outcome is relatively unclear. Methods A cohort of subjects at ultra high risk of psychosis were studied using functional magnetic resonance imaging (fMRI) in conjunction with the N-Back task, and volumetric MRI at first clinical presentation and again after one year. Levels of psychopathology and global functioning were assessed at the same time points using the CAARMS, PANSS, and the GAF scale. Results At baseline, the high risk group showed reduced activation during the task in the left middle frontal gyrus, supramarginal gyrus and inferior parietal lobule, and reduced gray matter volume in the left middle and medial frontal gyri, left insula and the right anterior cingulate gyrus. Within the high-risk group, there was a positive correlation between the magnitude of the functional and structural alterations in the left middle frontal gyrus. Between presentation and follow up, the severity of perceptual disorder and thought disorder (rated by the CAARMS), and of general psychopathology (rated by the PANSS general score) decreased, and the level of global functioning improved. This clinical and functional improvement was associated with a longitudinal increase in activation in the anterior cingulate and right parahippocampal gyrus. The change in anterior cingulate response was directly correlated with the improvement in the GAF score. Conclusions In subjects presenting with prodromal signs of psychosis, reduced prefrontal activation during a working memory task is associated with a reduction in gray matter volume in the same area. Changes in anterior cingulate activation were correlated with functional improvement in this group, consistent with the role of this region in multiple cognitive and social processes.

Évolution du trouble de la personnalité borderline : revue de la littérature

Borderline personality disorder (BPD) is a serious mental disorder associated with severe emotional, behavioral, cognitive and interpersonal dysfunction, extensive functional impairment and frequent self-destructive behaviour, including deliberate self-harm and suicidal behaviour. For quite some time, BPD has been viewed as a chronic disorder and borderline patients as extremely difficult to treat, doomed to a life of misery. However, those views are changing and there is an increasing recognition that BPD has a far more benign course than previously thought. The purpose of this study is to show how those views changed over time by reviewing longitudinal studies of the course of BPD. We have reviewed the literature published from 1968 to March 2009, using the following key words: borderline personality disorder, outcome, follow-up studies with some additional references. The aim of the longitudinal studies conducted prior to the DSM definition of BPD criteria was to determine whether borderline patients could become psychotic over time, but no such evidence was found even though their functioning was at a relatively low level. The studies conducted after the introduction of BPD in the DSM in 1980 tested the stability and the specificity of BPD diagnosis, concluding that the criteria were relatively stable in the short run since the majority of patients continued to meet them at the follow-up assessments. However, those studies had many methodological drawbacks which limited their generalizability such as small sample sizes, high attrition rates, the absence of comparison groups, etc. Four retrospective studies of the 15-year outcome of borderline patients obtained virtually identical results despite methodological differences, showing that the global functioning of borderline patients improved substantially over time with mean scores of the GAF scale falling within a mild range of impairment. One 27-year retrospective study showed that borderline patients continued to improve as they grew older, only 8% of the cohort still meeting criteria for BPD. Two recent carefully designed prospective studies showed that the majority of BPD patients experienced a substantial reduction in their symptoms far sooner than previously expected. After six years, 75% of patients diagnosed with BPD severe enough to be hospitalized achieve remission by standardized diagnostic criteria and after 10 years, the remission rate raises up to 88%. Recurrences are rare, no more than 6% over six years. The dramatic symptoms (suicidal behaviour, self-mutilation, queasy psychotic thoughts) resolve relatively quickly, but abandonment concerns, feeling of emptiness and vulnerability to dysphonic states is likely to remain in at least half the patients. This contrasts with the natural course of many Axis I disorders, such as mood disorders, where improvement rates may be somewhat higher and more rapid but recurrences are more frequent. The findings of longitudinal studies raise doubts about the validity of the definition in the DSM, which implies that personality disorders must necessarily be chronic. However, it should be noted that even the most encouraging findings do not show full recovery since the majority of patients seem to suffer from some residual symptoms. These findings have very important clinical implications and borderline patients should be told that they can expect improvement, no matter how intense their current emotional pain. However, we still lack evidence-based findings on mechanisms that lie behind the recovery process in BPD. Future research should explore the mechanisms of recovery in BPD.

P01-228 - Oxidative stress and family environment in unaffected relatives of psychotic patients

ObjectivesOxidative stress suposses an imbalance between oxidants and antioxidants molecules. Negative and positive family environment have been related with worse and better outcomes respectively in schizophrenic patients.Our objetive is to determine antioxidant defense in healthy controls and unaffected relatives of early onset psychosis patients and to asses its relationship with familiar environment.MethodsWe included 82 healthy controls (HC) and 14 healthy controls with second degree family history of psychosis (HCWFHP), aged between 9 to 17.Total antioxidant status and lipid peroxidation test were determined in plasma and antioxidant enzime activities and glutathione levels were determined in erytrocytes.We used the Global Assesment Functioning scale (GAF) and the Family Environment Scale (FES). The FES is made up of ten subscales: cohesion, expressiveness, conflict, independence, achievement, intellectual-cultural, social, moral, organization and control.ResultsThe analyses showed a significant decrease in total antioxidant level in HCWFHP compared with the HC (U Mann Withney = 281.00, p=0.009, effect size= -0.78).HC and HCWFHP did not differ in the GAF scale, nevertheless the scores of HCWFHP were significantly higher in cohesion and intellectual-cultural dimensions of the FES (p=0.007, p=0.025).Adjusting by this two FES dimensions, antioxidant status remained significantly different between groups: OR= 10.86, p=0.009.DiscussionAlthough we cannot induce causative relations, we can state that family environment is not playing a role in inducing oxidative stress in these subjects. It could be hypothesized that families with affected relatives protect themselves with positive envionmental factors such as cohesion and intellectual-cultural activities.

P03-182 - ‘Mores’ project: clinical evaluation and need assessment of psychiatric patients living in two residential facilities in Modena, Italy

ObjectivesThe ‘MORES’ (MOdena RESidenze) project was a naturalistic study designed to assess clinical outcomes and to investigate psychosocial needs in two groups of patients currently admitted in two residential facilities characterized by different intensity of care (“low protection” vs. “high protection”).Methods32 patients (62%) in a Sheltered Housing (SH, low protection) and 20 patients (38%) in a Psychiatric Residence (PR, high protection) were assessed by means of a multi-dimensional and multiaxial system. Socio-demographic and clinical data were collected from patient charts. Clinicianadministered instruments (BPRS, GAF, CAN) and self-rating scales (LQL, VSSS, Empowerment Scale) were administered to all 52 patients. Chi-squared test and Mann-Whitney U-test were used to compare the two groups.ResultsThe most frequent diagnosis was Schizophrenia (n=41; 79%). No differences were found in socio-demographic and clinical characteristics between the two groups, as well as in psychometric scores. Scores at the BPRS, GAF, CAN and Empowerment scales revealed in both groups a medium-low degree of psychiatric symptomatology, low global functioning, high level of care needs (many of them satisfied, 73%) and a low level of empowerment, respectively. Self-perceived quality of life was poor (LQL: SH=4,57±0,31; PR=4,4±0,33), specifically related to the housing situation and VSSS (SH=3,81±0,85; PR=3,52±0,82) suggested poor satisfaction with mental health services.ConclusionThough no difference were found between the two groups, patients’ needs emerged clearly, suggesting need for further investigation to tailor more specific rehabilitation programs.

Validation of a new scale to assess quality of life in schizophrenic patients treated with antipsychotic drugs, the RSM-scale

The assessment of quality of life has become more important in clinical studies as a new outcome parameter in schizophrenia. Current used scales were not developed to measure quality of life in treated schizophrenic patients with regard to the efficacy and side effect profile of atypical antipsychotics. We developed a new scale – the RSM-scale – with an interviewer and a self-rating part. We defined a priori subscores and performed a factor analysis. The primary objective of this study was to evaluate this new scale in terms of validity and reliability. Inclusion criteria were a diagnosis of schizophrenia and a current inadequate response to treatment or side effects. As reference scales we used the Qualtiy of Life and the SWN-K scale. Psychopathology was measured using the PANSS, CGI and GAF scales. Side effect profiles were measured using the ESRS and UKU-scale. The study plan encompassed four visits over eight weeks. All together 145 patients participated in the study. Tests for reliability revealed a Cronbach's value of 0.915 for the self-rating part and of 0.913 for the interviewer rating part. The RSM scale reached adequate results for test-retest stability, discriminant validity, construct validity and scale score distribution. The overall correlation between both scales in all patients was mild to moderate, so the performance of a self-rating in addition to an interviewer rating makes sense to gain subjective information about quality of life in schizophrenic patients.

P03-256 The connections between social functioning and the quality of life in the population of people who lost their job

Objective:On the scale of negative events that can happen in life,losing a job is high up on it, as a risk factor in the development of different psychiatric diseases. The connection between social functioning and the quality of life with people who lost their job was not explicitly researched.Aims:The aim of this study was to evaluate the connection between social functioning and the quality of life in the population of people who lost their job, with a wide spectrum of psychiatric diseases.Method:Social functioning was appraised using the GRONINGEN SOCIAL BEHAVIOUR QUESTIONNAIRE -100 { GSB -100} and GLOBAL ASSESSMENT OF FUNCTIONING {GAF} scale. The quality of life was measured using WHO QUALITY OF LIFE ASSESSMENT INSTRUMENT (WHOQOL-100).A total of 80 patients aged 40 to 60 who lost their job during the previous year were included in this study.Results:The population of patients who lost their job shows a huge range of problems in the area of social functioning. The number of problems was significantly higher in comparison with the control group of healthy people, but also a little higher in comparison with a group of psychiatric patients who had not lost their job.Almost all GSB -100 scales were in negative interrelation with all QOL aspects, while the score on the GAF scale correlated positively with all QOL aspects.People who lost their job with problems in the aspects of social functioning have a lower score than those without such problems.

A Study on the Mental Health by GAF Scale of a Mental Disorder

Objectives. The purpose of this study is to identify mental patients' level through an analysis of relationship between mental factor and human-socialisticcharacteristic by GAF Scale.<BR> Methods. Studies conducted so far on mental disorder were reviewed and, based on such review, realistic measures were suggested in respect of mental health. For this purpose, questionnaires were prepared in line with the conceptual model set forth for the study and distributed to patients hospitalized in psycho-neuro clinics in J-provincial area. Data had been collected from December 1, 2007 to July 30, 2008 in reference to clinical charts and interviews made usually on the day of discharge. SPSS/WIN program was employed to process the collected data by means of such statistical techniques as frequency, percentage, t-test, and ANOVA.<BR> Result. (1) From the analysis into GAF scales by diagnosis, all of factors turned out to have statistical significance. High significance was found for schizophrenia at the scales below 60 but for affective, personality and mental disorders at the scales exceeding 60. (2) The analysis into areas of physical health by GAF scales couldn't confirm statistical significance for all factors except sleeping state. No disorder was felt at the scale 60 or higher while sleeping but serious level of sleep disturbance seemed to be experienced under 60. Benign symptoms such as auditory and visual hallucinations, ataraxia and insensibility were cited for reasons of sleep interruption by serious mental patients with GAF scales rated below 60. (3) The analysis into social relationship by GAF scales witnessed that support from peers had significant difference. From the analysis, it was found that men tal patients with scales higher than 60 were supported or aided by peers while those with scales below 60 were given least support or aid from their acquaintances. (4) With regard to analysis of GAF scales in the area of environment, it was found that little difficulties were experienced by patients with higher scales than 60 in using means of transportation but those with GAF scales below 60 bore serious hardship when using transportation.<BR> Conclusions. The third preventive measures applied to help mental patients adapt to society shall be planned to meet the requirements of their family members in connection with treatment and nursing of patients in hospitals, as well as admittance into and discharge from them since such measures can be easily and effectively carried out at home thanks to affirmative, receptive and less cost-bearing environment created by family members.<BR> In case of patients with serious mental disorder below 60 of GAF scales (category Ⅲ or below of mental disorder), long-term or frequent hospitalization used to lead their families to an immeasurable extent of economic burden. As a political measure to reduce such heavy burden on the government level, the Ministry of Health and Welfare is expected to fund the budget to alleviate medical expenses of mental disorder who have suffered from mental disorder for longer than 5 years at certain degree of disease as has been done for registration of patients with cancer or incurable disease.

Directions for Health and Welfare Policy Setting : a case study of psychiatric patients

Objectives. The purpose of this study was to make a case analysis of psychiatric patients in their 20s to find out their lives and physical and mental state. It's basically meant to lay the foundation for health and welfare policy setting for psychiatric patients and suggest some of the right directions for mental health care projects.<BR> Methods. The subjects in this study were five psychiatric patients who were in their 20s and hospitalized at the department of psychiatry in a general hospital in North Jeolla Province. A survey was conducted from May 1 to Jun 30, 2008. The findings of the study were as follows:<BR> Result. As for general characteristics including gender, two of the five patients investigated were male, and the other three were female. By marital status, many were unmarried, and most of them benefitted from the health insurance. They weren't ordinarily engaged in social activities, and most of them were unemployed. Every patient complained of economic difficulties. Concerning their diseases, three got 55 on the GAF scale, and two got 65. Every patient had no family history of mental disease except one, and the duration of illness ranged from four to eleven years, which showed that they suffered from chronic mental disease. And they were repeatedly hospitalized. Regarding their state, they didn't find themselves to be properly supported. Their state upon hospitalization was marked by self-injury, anxiety, insecurity, hostile behavior, unstable mood and difficulties in controlling aggressiveness, which indicated that they were in a similar state. Some of them showed little intelligence. As to mental state, they were irritated, nervous and suffered from visual and auditory hallucinations, and they were depressed and felt an impulse to commit suicide. In regard to physical state, they suffered from chronic or acute diseases in addition to mental illness. In terms of nursing diagnosis, they were lost in wild fancies, and they were consequently likely to use violence or respond to others in a defensive manner. Besides, they were left out from others.<BR> Conclusions. In order to prevent mental illness, it's required to take measures to help people in general to get rid of stress and stay away from depression. The government should take legal actions to gather and share information on psychiatric patients to facilitate their treatment, and build a inpatient change system in view of inpatients change rate for different types of psychiatric patients to promote more energetic mental health care projects. Public mental health care projects should be enlarged to provide psychiatric patients with better treatment and expedite the rehabilitation of the mentally disabled in order to create a healthy society. In health and welfare projects, a separate budget should be earmarked for patients who suffer from severe illness and need long-term hospitalization so that they and their families could be relieved of the economic burden. Every local community should provide the mentally disabled with job rehabilitation training to guarantee their job security, and the government should prepare efficient policies and budget to facilitate their job rehabilitation.

Axis V – Global Assessment of Functioning Scale (GAF), further evaluation of the self-report version

Objective The study aimed to examine agreement between patients' and professional staff members' ratings on the Global Assessment of Functioning scale (GAF). Methods A total of 191 young adult psychiatric outpatients were included in a naturalistic, longitudinal study. Axis I and axis II disorders were assessed by means of the Structured Clinical Interview for DSM-IV. Before and after treatment, patients and trained staff members did a GAF rating. Agreement between GAF ratings was analyzed using the intra-class correlation coefficient (ICC). Results The overall intra-class correlation coefficients before and after treatment were 0.65 and 0.86, respectively. Agreement in different axis I diagnostic groups varied, but was generally lower before treatment as compared to after treatment (0.50–0.66 and 0.78–0.90, respectively). Excessive psychiatric co-morbidity was associated with the lowest inter-rater reliability. Agreement, with respect to change in GAF scores during treatment, was good to excellent in all groups. Conclusion Overall, agreement between patients' and professionals' ratings on the GAF scale was good before and excellent after treatment. The results support the usefulness of the self-report GAF instrument for measuring outcome in psychiatric care. However, more research is needed about the difficulties in rating severely disordered patients.