GAF Scale Research Articles

Costs and efficacy ofolanzapine and risperidone in schizophrenia

Introduction: schizophrenia is a serious and long lasting psychiatric disease. The new “atypical” antipsychotic drugs, introduced in the 90s, have substantially improved the effectiveness of medical treatments, compared to previous neuroleptic drugs. Nowadays they tend to be used as first choice drugs. The ddd cost of atypicals may differ by 20% and health authorities may have an incentive to deliver the less costly drug, especially if they are generic. However the various drugs show differential effectiveness rates and a rational choice should consider both cost and effectiveness. Objective: the purpose of this analysis is to review the existing evidence on cost-effectiveness studies of olanzapine and risperidone, the two most prescribed drugs in Italy. Six published studies were identified, but attention was focused on two articles that reported consistent and methodologically sound results. Results: most reviewed studies are cost-minimization analyses, since effectiveness indicators show no significant statistical difference between the two drugs, and are inconclusive since the results depend on the evaluation setting. However one observational retrospective study showed a significant severity reduction over 12 months for patients treated with olanzapine (-2.46 on HoNOS scale; p<0.05), compared to a smaller non significant reduction of the risperidone group (-0.57). Despite the higher drug cost, the average total cost per reduced severity score was lower for olanzapine than for risperidone patients (€ 4,554 vs. € 10,897). The only medical and related health care costs for risperidone patients were higher than total costs for olanzapine patients. Another study comparing cohorts of patients with similar starting severity showed a significant severity reduction and global functioning increase over 12 months for olanzapine but no significant increase for risperidone patients (-0.35, p<0.01 on CGI scale; +3.66, p <0.05 on GAF scale, compared respectively to -0.27, p<0.05 and +2.00 n.s.). Again average cost per reduced severity/increased functioning score was higher for risperidone than olanzapine patients (€ 4,568 vs. € 4,170 for CGI and € 2,284 vs. € 1,139 for GAF scales respectively). Conclusion: the use of olanzapine in the treatment of schizophrenia is the most cost-effective alternative for the SSN (Italian National health service), as it minimizes the cost per score of severity reduction or functioning increase. Even if the price of risperidone were to be reduced by 50% (becoming a generic), total 12 months treatment costs would exceed those of olanzapine in its highest ddd (30 mg).

Self-Reported Sleep Latency in Postmenopausal Women

The ain of this study was to access how self-reported sleep latency (SRSL) was affected by sleep habits, mood, and circadian rhythm in postmenopausal women. Subjects (n=384, 67.9±7.7 yr) completed sleep and mood questionnaires, sleep log and actigraphic data. The major urinary melatonin metabolite (6-sulphatoxymelatonin, aMT6s) was assayed in fractional urine specimens for two 24-hr intervals. Although SRSL (26.5±24.4 min) and actigraphic sleep latency (ASL; 27.8±20.0 min) were correlated (rs=0.361, p<0.001), the short SRSLs tended to be underestimated whereas the long SRSLs tended to be overestimated as compared to ASL. SRSL was positively correlated with the scales of insomnia, mood and hot flash, hypertension, use of anti-hypertensive drugs and the acrophase and the offset of aMT6s. SRSL was negatively correlated with the global assessment of functioning scale in DSM-IV (GAF scale), and light exposure and wrist activity. Multiple linear regression analysis showed that the best-fit model to predict SRSL was light exposure, GAF scale, and use of anti-hypertensive drugs. SRSL may be determined by psychophysiological factors as well as circadian rhythm function. Therapeutic approaches suggested for trouble falling asleep might include increased daylight exposure, improvements in general health, and modification of anti-hypertensive pharmacotherapy.

Évaluation d’un an de parcours de patients schizophrènes en service psychiatrique liégeois: One-year follow-up and mobility assessment of schizophrenic patients in the liege psychiatric care network

Cette étude a pour but d’évaluer à un an d’intervalle l’évolution symptomatologique et sanitaire des patients schizophrènes de l’échantillon de l’étude épidémiologique menée précédemment par la Plate-forme psychiatrique de Liège (Belgique) au sein de son réseau d’institutions. L’étude vise également à examiner la mobilité institutionnelle des patients, c’est-à-dire la mesure dans laquelle ceux-ci changent de structure ou de type de soins. Les outils utilisés furent le DSM IV pour les diagnostics, le RPM et le PECC pour la symptomatologie, ainsi qu’un questionnaire spécifique reprenant une ligne du temps pour la mobilité. Ces données ont été récoltées pour 178 patients constituant notre échantillon. Pendant l’année qui a séparé les deux prises d’information, le décès de 4 patients a été observé. Les données concernant la symptomatologie et celles concernant la mobilité sont décrites et ensuite analysées et mises en relation. Tant les résultats univariés que multivariés confirment que la mobilité est influencée surtout par l’âge des patients, le type de schizophrénie et la symptomatologie. Les proportions relatives du type de schizophrénie en fonction du type de structure de soins restent stables et la mobilité des patients présente certaines caractéristiques. Des hypothèses explicatives de ces relations sont présentées. The study was aimed at assessing the clinical evolution and mobility of schizophrenic patients within the healthcare network of the Psychiatric Platform of Liege (Belgium) after a one-year follow-up period. The study material consisted of a random sample of 184 patients with schizophrenia drawn from the population of schizophrenic patients treated in the Liege psychiatric care network. The characteristics of these patients have been described previously (18). The 184 patients were followed-up for one-year and reassessed at the end of this period. Mobility ( ie , changes between psychiatric care institutions, including home) was recorded for each patient within the institutional network. The diagnosis of schizophrenia was based on the DSM IV. Demographic, social and global functioning (GAF scale) data were collected from the « Résumé psychiatrique Minimum (RPM) », a clinical summary which has been imposed by the Belgian Ministry of Public Health for each psychiatric hospital stay. Symptom components were derived from the Psychosis Evaluation tool for Common Use by Caregivers (PECC). Among the 184 patients enrolled in the initial analysis, 6 refused to participate in the follow-up study. The 178 remaining schizophrenic patients included 131 men (74 %) and 47 women (26 %) with a mean age of 43.1 ± 13.6 and 48.8 ± 14.9 years, respectively (p < 0.05). The majority of patients (53 %) suffered from paranoid schizophrenia. At baseline, 63 % of the patients were hospitalised full-time, 6 % part-time and 31 % received ambulatory care. During the one-year follow-up period, 4 patients died, including one from suicide. When considering mobility, 48 % of the patients experienced at least one change of institution, whereas 52 % of the patients didn’t change at all (see figure 1 ). The total number of changes over the 1-year period amounted 189, yielding a mean value of 1.1 changes per patient per year. Changes mostly occurred between institutions of similar care setting (see figure 2 ). Transfers (30 %) were also observed directly between hospital and home. A multivariate Poisson regression analysis showed that the number of changes was unrelated to gender and initial care setting but decreased with age (p < 0.0001). It was also higher for patients with schizo-affective disorders (2.5 ± 1.9, p < 0.01) or with residual type (1.2 ± 1.8 ; p < 0.05) than for patients with other types of schizophrenia (ranging from 0.3 ± 0.5 to 0.9 ± 1.4). No association was found with initial GAF or PECC, except for negative symptoms (p < 0.05). After one year, despite the high proportion of institutional changes (48 % of the patients), the distribution of the patients according to care setting remained the same (p = 0.77). However, GAF scores significantly improved from 39.7 ± 16.1 to 44.4 ± 16.1 (p < 0.0001) and likewise for total PECC scores (70 ± 19.1 vs 63.2 19.4, p < 0.001). Excitatory and disease perception items of the PECC remained unchanged. The present study reveals that mobility within the institutional network did affect about half of the schizophrenic patients. Mobility was related to age, type of schizophrenia and disease evolution. Changes occur mainly between psychiatric structures of similar care setting but also directly from hospital to home without passing through an intermediate care structure. Further efforts should be made to provide schizophrenic patients with a more coordinated care provision throughout the course of their disease.

Long-term follow-up: psychosocial outcome of Belgian transsexuals after sex reassignment surgery

Abstract Background To establish the benefit of sex reassignment surgery (SRS) for persons with a gender identity disorder, follow-up studies comprising large numbers of operated transsexuals are still needed. Aims The authors wanted to assess how the transsexuals who had been treated by the Ghent multidisciplinary gender team since 1985, were functioning psychologically, socially and professionally after a longer period. They also explored some prognostic factors with a view to refining the procedure. Method From 107 Dutch-speaking transsexuals who had undergone SRS between 1986 and 2001, 62 (35 male-to-females and 27 female-to-males) completed various questionnaires and were personally interviewed by researchers, who had not been involved in the subjects' initial assessment or treatment. Results On the GAF (DSM-IV) scale the female-to-male transsexuals scored significantly higher than the male-to-females (85.2 versus 76.2). While no difference in psychological functioning (SCL-90) was observed between the study group and a normal population, subjects with a pre-existing psychopathology were found to have retained more psychological symptoms. The subjects proclaimed an overall positive change in their family and social life. None of them showed any regrets about the SRS. A homosexual orientation, a younger age when applying for SRS, and an attractive physical appearance were positive prognostic factors. Conclusion While sex reassignment treatment is an effective therapy for transsexuals, also in the long term, the postoperative transsexual remains a fragile person in some respects.

Perceptual organization in first episode schizophrenia and ultra-high-risk states

Deficits in perceptual organization have been consistently reported in schizophrenia, as has an association between these deficits, disorganized symptoms, and poorer premorbid functioning and prognosis, suggesting that they may be an index of illness severity or progression. It is unclear, however, whether the impairment is present at, or before the first psychotic episode. This study examined perceptual organization in young people considered to be at high-risk for schizophrenia, defined by the “close-in” strategy [Yung, A.R., McGorry, P.D., McFarlane, C.A., Jackson, H.J., Patton, G.C., Rakkar, 1996. Monitoring and care of young people at incipient risk of psychosis. Schizophrenia Bulletin, 22, 283–303]. The high-risk group ( n = 70) was compared to first-episode patients ( n = 54), and nonpatients ( n = 24) using a task with known sensitivity to perceptual organization deficits in schizophrenia, and whose scores have predicted long-term outcome and disorganized symptomatology in past studies [Knight, R.A., Silverstein, S.M., 1998. The role of cognitive psychology in guiding research on cognitive deficits in schizophrenia. In Lenzenweger, M., Dworkin, R.H., (Eds.), Origins and Development of Schizophrenia: Advances in Experimental Psychopathology. APA Press, Washington DC, pp. 247–295.; Silverstein, S.M., Knight, R.A., Schwarzkopf, S.B., West, L.L., Osborn, L.M. Kamin, D., 1996b. Stimulus configuration and context effects in perceptual organization in schizophrenia. Journal of Abnormal Psychology 105, 410–420.; Silverstein, S.M., Schenkel, L.S., Valone, C., Nuernberger, S., 1998a. Cognitive deficits and psychiatric rehabilitation outcomes in schizophrenia. Psychiatric Quarterly 69, 169–191.; Silverstein, S.M., Bakshi, S., Chapman, R.M., Nowlis, G., 1998b. Perceptual organization of configural and nonconfigural visual patterns in schizophrenia: effects of repeated exposure. Cognitive Neuropsychiatry 3, 209–223]. There were no differences between groups, and the first-episode group demonstrated non-significantly more sensitivity to stimulus organization than the other groups. When the high-risk group was broken down into its 3 subgroups (A—family history of psychotic illness and recent drop of 30+ points in the GAF scale; B—history of attenuated psychotic symptoms; C—brief limited intermittent psychotic symptoms), only group A demonstrated evidence of impairment, but this group differed significantly only from first- and young, later-episode schizophrenia patients, not from nonpatients. These findings are consistent with recent data on pre-attentive processes in schizophrenia which indicate that performance is not impaired and may even be enhanced, early in the illness, with dysfunctions beginning with increased chronicity.

Clinician reports of personality pathology of patients beginning and patients ending psychoanalysis

The purpose of this work was to use a clinician Q-sort procedure to describe the personality pathology and adaptive functioning of patients beginning and ending psychoanalysis. With a cross-sectional design, we compared a group of patients beginning and a group of patients ending psychoanalysis. Twenty-six psychoanalysts described a patient beginning psychoanalysis and 26 described a patient ending psychoanalysis using the Shedler-Westen Assessment Procedure 200 (SWAP-200). Each clinician also completed questions about themselves, the patient, and the treatment. The most characteristic SWAP-200 items describing patients beginning and patients ending psychoanalysis provide a meaningful picture of the two groups. Among patients at the end of psychoanalysis, scores were significantly lower on the SWAP-200 Paranoid, Schizotypal, Borderline, Histrionic, and Dependent scales and scores were significantly higher on the SWAP-200 High functioning scale and the DSM-IV GAF scale. Common characteristics of patients beginning psychoanalysis were anxiety, guilt, and shame. Common characteristics of patients ending psychoanalysis were conscientiousness and responsibility, striving to live up to moral and ethical standards, and enjoyment of challenges. The findings demonstrate the usefulness of a clinician report measure for the study of psychoanalytic psychotherapy and psychoanalysis.

Is there a dysfunction in the visual system of depressed patients?

BackgroundThe aim of the current study was to identify a possible locus of dysfunction in the visual system of depressed patients.Materials and MethodsFifty Major Depressive patients aged 21–60 years and 15 age-matched controls took part in the study The diagnosis was obtained with the SCAN v 2.0. The psychometric assessment included the HDRS, the HAS, the Newcastle Scales, the Diagnostic Melancholia Scale and the GAF scale. Flash Electroretinogram and Electrooculogram were performed in all subjects. The statistical analysis included ANCOVA, Student's t-test and Pearson Product Moment Correlation Coefficient were used.ResultsThe Electro-oculographic findings suggested that all subtypes of depressed patients had lower dark trough and light peak values in comparison to controls (p < 0.001), while Arden ratios were within normal range. Electroretinographic recordings did not reveal any differences between patients and controls or between subtypes of depression.DiscussionThe findings of the current study provide empirical data in order to assist in the understanding of the international literature and to explain the mechanism of action of therapies like sleep deprivation and light therapy.

Analisis factorial y validación de la versión en español de la escala Brief Psychiatric Rating Scale en Colombia.

A validation study was directed toward an evaluation of the Brief Psychiatric Rating Scale (BPRS) in a Spanish-language version in Colombia. The BPRS is important because it is one of the most widely used scales in clinical and research settings in mental health. The BPRS was administered to 149 psychiatric impatients and the scores evaluated for factorial structure and internal consistency. Test-retest and inter-rater reliability were assessed in a sub-sample of 30 patients. Concurrent validity was analyzed by comparing scores on BPRS with scores on GAF scale. Sensitivity to change was evaluated by comparing scores in two clinically different settings. Principal component factor analysis indicated a structure with three domains: schizophreniform, bipolarity and depression. The instrument showed good internal consistency (Cronbach's alpha = 0.79). Coefficients corresponding to inter-rater and test-retest reliability were 0.94 and 0.82 respectively. Correlation between BPRS and GAF was 0.7 (Spearman). Within-subjects ANOVA showed the scale to be an instrument good sensitivity for detecting changes in of clinical characteristics. We concluded that the Spanish language version evaluated in Colombia to be a valid clinical-report instrument with adequate psychometric properties.

Dr. Centorrino and Colleagues Reply

Back to table of contents Previous article Next article Letter to the EditorFull AccessDr. Centorrino and Colleagues ReplyFRANCA CENTORRINO, M.D., JESSICA L. GOREN, Ph.D., JOHN HENNEN, Ph.D., PAOLA SALVATORE, M.D., JAMES P. KELLEHER, M.D., and ROSS J. BALDESSARINI, M.D., FRANCA CENTORRINOSearch for more papers by this author, M.D., JESSICA L. GORENSearch for more papers by this author, Ph.D., JOHN HENNENSearch for more papers by this author, Ph.D., PAOLA SALVATORESearch for more papers by this author, M.D., JAMES P. KELLEHERSearch for more papers by this author, M.D., and ROSS J. BALDESSARINISearch for more papers by this author, M.D., Belmont, Mass.Published Online:1 Mar 2005https://doi.org/10.1176/appi.ajp.162.3.632-aAboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: We appreciate the response of Dr. Citrome et al. and agree with their points on the use of antipsychotic polytherapy. Polytherapy may, in fact, be a result of shortened length of inpatient hospitalization and the subsequent perceived need to treat patient symptoms more aggressively. It is also possible that the patients discharged receiving polytherapy may be a subset of more refractory patients; however, we were not able to gather such information from this specific study. We recognize the limitations of a retrospective study. The brief period over which the patient information was recorded leaves room for interpretation as to whether the rate of polytherapy was due, at least in part, to cross-titration or was rather a deliberate long-term plan. There is no doubt that more randomized, double-blind studies are needed to ascertain the clinical benefits of antipsychotic polytherapy.The points addressed by Drs. Strous and Lerner are valid and warrant further investigation. Combination antipsychotic therapy may be used more frequently in patients who have failed to respond to monotherapy. Failure to respond to monotherapy treatment and the need to treat nonresponsive patients more aggressively, therefore, may result in a longer length of stay and an increased incidence of adverse events. Because of the retrospective nature of this study and the limited period of time over which patient information was gathered, it was not possible to separate the cohort by level of treatment responsiveness. However, patients in the monotherapy and polytherapy groups were matched by diagnosis and severity of illness (as assessed by the Clinical Global Impression scale and the GAF scale) in order to make more accurate comparisons. A prospective study in which monotherapy and polytherapy are compared in a group of patients who are more homogenous in terms of level of responsiveness to antipsychotic medications would be a worthy and valuable endeavor.We agree with Dr. Case and his associates that there are inherent limitations in the retrospective rating of symptoms in a review of inpatient medical records and, more specifically, that there are items in the Positive and Negative Syndrome Scale that are more difficult than others to score retrospectively. However, since all items of the Positive and Negative Syndrome Scale were scored in the same manner for both the monotherapy and polytherapy patients, we do not feel that any bias in rating affected our comparison of the two groups. FiguresReferencesCited byDetailsCited bySocial Psychological Factors and Suicidal Intent Among Suicide Attempters in Rural ChinaJournal of Nervous & Mental Disease, Vol. 205, No. 1Association of the HTR2A 102T/C polymorphism with attempted suicidePsychiatric Genetics, Vol. 25, No. 4 Volume 162Issue 3 March 2005Pages 632-a-633 Metrics PDF download History Published online 1 March 2005 Published in print 1 March 2005

Psychological predictors of admission and discharge global assessment of functioning scale scores for geropsychiatric inpatients

This study examined psychological predictors of Global Assessment of Functioning Scale scores (GAF) at intake and at discharge for geropsychiatric inpatients. A total of 301 predominantly male geropsychiatric inpatients were recruited from the Houston Veterans Affairs Medical Center. Path analysis was used to test a model proposing causal paths of psychological predictors (cognitive status, depression, agitation, general psychiatric status) to GAF scores on admission and discharge. At admission, all four psychological predictors had positive paths to the admission GAF scale scores but at discharge, only two (i.e., cognitive status and general psychiatric status) of the four psychological predictors had positive paths to the discharge GAF scale scores. The admission GAF scale scores also had a positive path to the discharge GAF scale scores. The overall functioning level of geropsychiatric inpatients may be predicted by measures which assess overall cognitive status and general psychiatric functioning during hospitalization. Results prompt consideration of a modified global scale specifically reflecting an older adult's activities during this period of life.

Psychometric validation of a generic health-related quality of life measure (EQ-5D) in a sample of schizophrenic patients

SUMMARYObjective: The aim of this study was to evaluate the construct validity of a generic health related quality of life (HRQOL) instrument – the EQ-5D – in a sample of schizophrenic patients receiving antipsychotic treatment.Research design and methods: A total of 2128 schizophrenic patients treated with olanzapine, 417 treated with risperidone, and 112 with haloperidol responded to the EQ-5D. The study also assessed the effect of patient age, gender, and co-morbidity variables on patient's HRQOLMain outcomes measures: EQ-5D scores at the start of treatment and after 3 and 6 months of therapy were compared with results from the Clinical Global Impression (CGI) severity of illness scale and the (GAF) scale. The effect of antipsychotics and sociodemographic variables on patient's HRQOL over time was tested through a three-factor doubly multivariate repeated measures MANCOVA.Results: High scores in the GAF scale and low scores in the CGI were linked with high scores on the EQ-5D scale. The correlational effects observed between the EQ-5D and the clinical indices ranged from 0.33 to 0.54. A significant effect of ‘visit time’ as well as an interaction of ‘visit time’ x drug, ‘visit time’ x gender, and ‘visit time’ x co-morbidity was observed.Conclusions: Results suggest the EQ-5D is a valid instrument capable of detecting HRQOL differences between schizophrenic patients with different degrees of severity of illness.

Multiple Versus Single Antipsychotic Agents for Hospitalized Psychiatric Patients: Case-Control Study of Risks Versus Benefits

Since use of multiple drugs to treat psychiatric patients is increasing, and research on this practice is rare, the authors carried out a retrospective case-control study of multiple versus single antipsychotic treatment in psychiatric inpatients. Inpatient treatment groups receiving either antipsychotic monotherapy or polytherapy were matched in terms of age, sex, diagnostic category, and admission clinical ratings (Global Assessment of Functioning [GAF] and Clinical Global Impression [CGI]), which yielded 70 subject pairs. They were compared in terms of total chlorpromazine-equivalent daily dose, changes in total daily dose, length of hospitalization, incidence of adverse effects, and changes in clinical ratings (CGI, GAF, Positive and Negative Syndrome Scale score) between admission and discharge. Initial doses were closely similar at admission for both treatment groups, but the median total final antipsychotic dose was 78% higher for those receiving antipsychotic polytherapy versus monotherapy. Also, median length of stay in the hospital was 55% (8.5 days) longer, and risk of adverse effects was 56% higher with polytherapy, whereas clinical improvement scores were similar (within 11%) for both treatments. Short-term treatment with multiple antipsychotics was associated with major increases in drug exposure, adverse events, and time in the hospital but with no apparent gain in clinical benefit. These findings require further testing in controlled prospective studies.

Relationship among Dexamethasone Suppression Test, personality disorders and stressful life events in clinical subtypes of major depression: An exploratory study

BackgroundThe present study aimed to investigate the relationship between dexamethasone suppression test, personality disorder, stressful life events and depression.MaterialFifty patients (15 males and 35 females) aged 41.0 ± 11.4 years, suffering from Major Depression according to DSM-IV criteria entered the study.MethodDiagnosis was obtained with the aid of the SCAN v 2.0 and the IPDE. Psychometric assessment included the HDRS, HAS, the Newcastle Scale (version 1965 and 1971), the Diagnostic Melancholia Scale, the Personality Deviance Scale and the GAF scale. The 1 mg DST was used.Statistical AnalysisIncluded MANOVA, ANOVA with LSD post hoc test and chi-square test.ResultsSixteen (32%) patients were non-suppressors. Eight patients without Personality Disorder (PD) (23.5%), and 5 of those with PD of cluster B (50%) were non-suppressors. Atypical patients were the subtype with the highest rate of non-suppression (42.85%). No difference between suppressors and non-suppressors was detected in any of the scales.DiscussionThe results of the current study suggest that pathological DST is not a core feature of major depression. They also suggest that there are more than one subtypes of depression, concerning the response to stress. It seems that the majority of depressed patients (50%) does not experience high levels of stress either in terms of self reported experience or neuroendocrine function. The rest of patients however, either experience high levels of stress, or manifest its somatic analogue (DST non-suppression) or have a very low threshold of stress tolerance, which makes them to behave in a hostile way.

Psychiatric treatment seeking and psychosocial impairment among young adults with depression

Background: We report data on 1-year prevalence and comorbidity of depression, related impairment, treatment need, and psychiatric treatment among young adults. Methods: A sample of young urban adults ( n=245) mean age 21.8 years was screened from a baseline population of 706 high-school students and given a semistructured clinical interview to evaluate 12-month prevalence of depression, psychosocial functioning according to DSM-IV GAF scale, need for psychiatric treatment, and use of mental health services. Results: One in 10 young adults suffered from depression with associated psychosocial impairment, the female-to-male-ratio being approximately 2:1. Most depressive disorders were comorbid with other DSM-IV disorders, depression usually occurring secondary to other disorders. Comorbidity was related to impairment, treatment need, and treatment contacts. Less than half of the depressed young adults had ever contacted mental health services, and less than one-third reported treatment contacts during the index episode. Males were less likely than females to report previous treatment contacts or intention to refer to mental health services for their problems, but treatment contacts during the index episode were reported equally often by both sexes. Conclusions: A minority of the severely depressed young adults with associated impairment had sought treatment. Except for subjects with dysthymia, no gender difference emerged in treatment contact rates during the 12-month depression episode. Comorbidity showed important clinical implications by its relation to severity of depression and treatment contacts.

The recovery from alcohol problems over the life course: The Lundby longitudinal study, Sweden

The aim of this paper is to ‘look behind the statistics’ and to study alcohol-related problems over time and to portray the recovery (treated and untreated) from these problems over the life course in a subset of 41 males, defined as DSM-IV alcoholics from the Lundby general population project. The subjects were interviewed with semi-structured interviews by a psychiatrist. There was only minimal attrition. An analysis was made of the distribution of alcohol-related problems among the current alcoholic group compared to the recovered one at follow-up. Due to the limited number of subjects the calculations were mainly descriptive. The dominant problems were medical (64% vs. 25%), mental (45% vs. 17%), family (27% vs. 0%) and work (18% vs. 8%). The overall functioning assessed by the GAF scale implied a change from continuous to transient symptoms and problems in the recovered group. The subjects' attributions of reasons for recovery were social stabilization (84%), treatment (58%), family and peer pressure (58%) and medical complications (33%). It is argued that the qualitative findings might be used to complement the large statistical investigations in order to understand how to link alcohol-related problems and social consequences to the life course studies.

99. Safety and effectiveness of olanzapine versus other antipsychotic drugs in the treatment of outpatients with schizophrenia

Prospective, comparative, non-randomized, open, observational study, including 2949 outpatients with schizophrenia who were followed up for 6 months after receiving a new prescription of an antipsychotic. Safety was evaluated collecting adverse events and global clinical status was measured through CGI and GAF Scales. A total of 2128 patients received olanzapine, as monotherapy or in combination (Olanzapine group), and 821 received other antipsychotics (Control group). There were no statistical differences between treatment groups at baseline regarding age, gender, disease duration, severity of symptoms, and EPS. Incidence of adverse events and specifically extrapyramidal symptoms was significantly lower in the olanzapine group compared to the control group (p < 0.001). Mean change in the CGI and the GAF was significantly higher in the olanzapine group compared to the control group (p < 0.001). Despite the limitations of an observational study, these results shows that olanzapine is safe and effective in non-selected schizophrenic outpatients, and are consistent with results of previous controlled trials.

A randomized controlled single blind study of the efficacy of clonazepam and lithium in the treatment of acute mania

This study is a randomized controlled trial of 40 patients suffering from bipolar affective disorder, manic phase (DSM IV). The patients were treated with either clonazepam or lithium. There were no differences between the two groups at 4 weeks on any of the efficacy measures, which included the BPRS, MAS, CGI and GAF scales. Side-effects were comparably mild in both groups. Clonazepam may be an effective treatment for acute mania. © 1997 John Wiley & Sons, Ltd.

Urgent need for a Need Assessment Scale in monitoring social support: A validation study on the Swedish version of the Camberwell Assessment of Need

Ericson BG, Hansson J-H, Teike T. Urgent need for a Need Assessment Scale in monitoring social support. A validation study on the Swedish version of the Camberwell Assessment of Need. Nord J Psychiatry 1997;51:173–182. Oslo. ISSN 0803–9488.In the aftermath of the desinstitutionalion process the social needs of patients with severe mental illness have been put on the agenda both for policy makers and professional groups working in this field. To be able to develop carefully designed monitoring systems to attend to this group of patients, there is an urgent need for assessment tools in this work. The Camberwell Assessment of Need is a form for a comprehensive assessment of the needs of people with a severe mental illness. The content and construct validity of the Swedish CAN version was tried out on a group of 45 patients from the Department of Psychiatric Rehabilitation at the County Hospital of Jönköping, Sweden, using in interviews a survey of need areas, the GAF functioning scale, and a quality of life scale (QLS-100). The overall result shows a rather weak correlation between assessment made by the GAF scale and assessment by key workers with the CAN. However, when the data are broken down, some interesting correspondences are found. Using the chi-square test the need areas accommodation, self-care, and daytime activities correspond with high and low GAF score, respectively. Somewhat surprisingly, the QLS-100 scores and the patient scores of the CAN show an even poorer correspondence. We interpret this as showing that where the QLS-100 invites to judgements on a desired quality of life, CAN judgements are more directed toward assessing factual circumstances in the individual's everyday lie. We advocate further validity and reliability studies, since continuous changes in the support systems call for careful reasoning in addressing the difficult question of the relation between support and need

Global Assessment of Relational Functioning scale (GARF): I. Background and rationale. Group for the Advancement of Psychiatry Committee on the Family.

The Committee on the Family of the Group for the Advancement of Psychiatry has introduced the Global Assessment of Relational Functioning (GARF), a scale that describes and quantifies the relational context within which patients live and problems occur. The GARF is intended to serve as a device that alerts clinicians to pay attention to the evaluation not only of individuals but also of relational functioning. In this article, we describe from a historicals perspective the scientific and political context within which this scale was developed. The GARF is analogous to Axis V of the DSM GAF scale (Global Assessment of Functioning) that is used to assess individual functioning. The GARF is a composite derivative of three major dimensionalized constructs, namely, joint problem solving, organization, and emotional climate. We provide five clinical vignettes to illustrate the process of arriving at GARF ratings. Finally, we discuss caveats and limitations for use of the GARF at present, and make recommendations for research projects and training methods that may enhance the value of this instrument in the future.