{"title":"Cognition as an outcome measure in schizophrenia.","authors":"Michael S Kraus, Richard S E Keefe","doi":"10.1192/bjp.191.50.s46","DOIUrl":"https://doi.org/10.1192/bjp.191.50.s46","url":null,"abstract":"<p><strong>Background: </strong>Cognitive deficits are a core feature of schizophrenia. These deficits are not caused by medication or symptoms, and have a dramatic negative effect on real-world functioning.</p><p><strong>Aims: </strong>To critically examine a selection of the most common batteries used to assess cognition in schizophrenia.</p><p><strong>Method: </strong>Literature review of cognitive assessment batteries for use in schizophrenia.</p><p><strong>Results: </strong>A wide variety of neurocognitive test batteries have been developed or adapted to assess cognition in schizophrenia. These differ in time requirements, repeatability, ease of administration, degree of face validity, availability of co-normative data and degree to which results can be parsed into separate domains of cognitive functioning. The most appropriate depends on the setting and the question being addressed.</p><p><strong>Conclusions: </strong>Cognitive outcome measures have reshaped our understanding of schizophrenia and will be essential tools for unravelling the aetiology ofthe disease and designing more effective interventions.</p>","PeriodicalId":77411,"journal":{"name":"The British journal of psychiatry. Supplement","volume":"50 ","pages":"s46-51"},"PeriodicalIF":0.0,"publicationDate":"2007-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1192/bjp.191.50.s46","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27092322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Social outcomes in schizophrenia.","authors":"Stefan Priebe","doi":"10.1192/bjp.191.50.s15","DOIUrl":"10.1192/bjp.191.50.s15","url":null,"abstract":"<p><strong>Background: </strong>Outcomes reflecting the social situation are widely considered as important in the treatment of people with schizophrenia.</p><p><strong>Aims: </strong>To review concepts of social outcomes in schizophrenia and the corresponding assessment instruments.</p><p><strong>Method: </strong>Non-systematic literature review and reflection on conceptual and methodological issues.</p><p><strong>Results: </strong>Concepts of social outcomes in schizophrenia lack agreed definitions and theoretical models. A fundamental issue is the distinction between objective and subjective indicators. More research has focused on subjective indicators, which are only weakly correlated with objective life situation and show consistent correlations with mood. Various assessment instruments have been developed pragmatically, particularly to measure quality of life and social functioning, and the literature provides extensive data for comparison.</p><p><strong>Conclusions: </strong>Established instruments exist to measure social outcomes in schizophrenia. Their use requires an awareness of the specific strengths and limitations.</p>","PeriodicalId":77411,"journal":{"name":"The British journal of psychiatry. Supplement","volume":"50 ","pages":"s15-20"},"PeriodicalIF":0.0,"publicationDate":"2007-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27088691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Iain Kooyman, Kimberlie Dean, Samuel Harvey, Elizabeth Walsh
{"title":"Outcomes of public concern in schizophrenia.","authors":"Iain Kooyman, Kimberlie Dean, Samuel Harvey, Elizabeth Walsh","doi":"10.1192/bjp.191.50.s29","DOIUrl":"https://doi.org/10.1192/bjp.191.50.s29","url":null,"abstract":"<p><strong>Background: </strong>Schizophrenia is known to be associated with a range of adverse outcomes, which have an impact atthe societal level and are therefore of public concern.</p><p><strong>Aims: </strong>To examine the epidemiology and methods for measuring six adverse outcomes in schizophrenia: violence, victimisation, suicide/self-harm, substance use, homelessness and unemployment.</p><p><strong>Method: </strong>A review ofthe literature was carried out for each adverse outcome, with attention to critical appraisal of existing measurement tools.</p><p><strong>Results: </strong>Schizophrenia is associated strongly with all six outcomes, although research has mainly focused on violence. Each outcome acts as a risk factor for at least some of the other outcomes. There are few standardised or validated measures for these 'hard' outcomes. Each measure has inherent biases but a growing trend is for these to be minimised by using multiple measures.</p><p><strong>Conclusions: </strong>A single instrument which systematically measures multiple societal outcomes of schizophrenia would be extremely useful for both clinical and research purposes.</p>","PeriodicalId":77411,"journal":{"name":"The British journal of psychiatry. Supplement","volume":"50 ","pages":"s29-36"},"PeriodicalIF":0.0,"publicationDate":"2007-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1192/bjp.191.50.s29","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27092319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Schizophrenia outcome measures in the wider international community.","authors":"Mohan Isaac, Prabhat Chand, Pratima Murthy","doi":"10.1192/bjp.191.50.s71","DOIUrl":"https://doi.org/10.1192/bjp.191.50.s71","url":null,"abstract":"<p><strong>Background: </strong>Outcome of schizophrenia has been described as favourable in low- and middle-income countries. Recently, researchers have questioned these findings.</p><p><strong>Aims: </strong>To examine the outcome studies carried out in different countries specifically looking at those from low- and middle-income countries.</p><p><strong>Methods: </strong>Long-term course and outcome studies in schizophrenia were reviewed.</p><p><strong>Results: </strong>A wide variety of outcome measures are used. The most frequent are clinical symptoms, hospitalisation and mortality (direct indicators), and social/occupational functioning, marriage, social support and burden of care (indirect indicators). Areas such as cognitive function, duration of untreated psychosis, quality of life and effect of medication have not been widely studied in low- and middle-income countries.</p><p><strong>Conclusions: </strong>The outcome of schizophrenia appears to be better in low- and middle-income countries. A host of sociocultural factors have been cited as contributing to this but future research should aim to understand this better outcome. There is a need for more culture-specific instruments to measure outcomes.</p>","PeriodicalId":77411,"journal":{"name":"The British journal of psychiatry. Supplement","volume":"50 ","pages":"s71-7"},"PeriodicalIF":0.0,"publicationDate":"2007-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1192/bjp.191.50.s71","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27092257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Hospitalisation as an outcome measure in schizophrenia.","authors":"Tom Burns","doi":"10.1192/bjp.191.50.s37","DOIUrl":"https://doi.org/10.1192/bjp.191.50.s37","url":null,"abstract":"<p><strong>Background: </strong>People with schizophrenia comprise the majority of patients with severe mental illness recruited to recent mental health service studies of new teams (e.g. assertive outreach, crisis resolution). Reduction in hospitalisation has been the most consistent outcome measure in these studies, but results are inconsistent.</p><p><strong>Aims: </strong>To understand inconsistency of results from studies using hospitalisation as an outcome measure.</p><p><strong>Method: </strong>The advantages and disadvantages of hospitalisation are explored, including the ways in which it is recorded. Regional variation in outcomes and the impact of control services are reviewed.</p><p><strong>Results: </strong>Hospitalisation has face validity as an outcome but translates poorly between differing healthcare contexts. These variations can be exploited positively to distinguish potentially effective ingredients in community care (outreach, combined health and social care, team structure) from redundant components.</p><p><strong>Conclusions: </strong>Hospitalisation is a good proxy outcome measure in schizophrenia care in randomised controlled trials, but the dangers of extrapolating to new contexts require care.</p>","PeriodicalId":77411,"journal":{"name":"The British journal of psychiatry. Supplement","volume":"50 ","pages":"s37-41"},"PeriodicalIF":0.0,"publicationDate":"2007-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1192/bjp.191.50.s37","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27092320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Patient-reported outcomes in schizophrenia.","authors":"Rosemarie McCabe, Marya Saidi, Stefan Priebe","doi":"10.1192/bjp.191.50.s21","DOIUrl":"10.1192/bjp.191.50.s21","url":null,"abstract":"<p><strong>Background: </strong>Patient-reported outcomes are increasingly used to evaluate the care of people with schizophrenia.</p><p><strong>Aims: </strong>To review established and emerging patient-reported outcomes in schizophrenia research, assessmenttools and key findings.</p><p><strong>Method: </strong>A non-systematic review addressing relevant constructs, the associated scales and key empirical findings.</p><p><strong>Results: </strong>Patient-reported outcomes in schizophrenia relate either to evaluation of illness and benefit from treatment or to resilience of the self. Of the former, needs for care, treatment satisfaction and the therapeutic relationship are most common. Less common are symptoms, insight, attitude towards medication, and clinical communication. Increasing expectations of treatment have led to new measures assessing resilience ofthe self, including empowerment, self-esteem, sense of coherence and recovery. Scores of different patient-related outcomes overlap and are influenced by a general tendency, largely influenced by mood, for more or less positive appraisal.</p><p><strong>Conclusions: </strong>The conceptual and empirical basis for different patient-reported outcomes varies, with most data available for treatment satisfaction. More than one such outcome should be used only if there is a specific hypothesis. For new patient-reported outcomes, relative independence from existing constructs should be demonstrated.</p>","PeriodicalId":77411,"journal":{"name":"The British journal of psychiatry. Supplement","volume":"50 ","pages":"s21-8"},"PeriodicalIF":0.0,"publicationDate":"2007-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27092318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Measurement of long-term outcomes in observational and randomised controlled trials.","authors":"Richard Hodgson, Chris Bushe, Robert Hunter","doi":"10.1192/bjp.191.50.s78","DOIUrl":"https://doi.org/10.1192/bjp.191.50.s78","url":null,"abstract":"<p><strong>Background: </strong>Randomised controlled trials (RCTs) are the gold standard for evaluating treatment efficacy. However, the outcomes of RCTs often lack clinical utility and usually do not address real-world effectiveness.</p><p><strong>Aims: </strong>To review how traditional RCTs may be triangulated with other methodologies such as observational studies and pragmatic trials by highlighting recently reported studies, outcomes used and their respective merits.</p><p><strong>Method: </strong>Literature review focusing on drug treatment.</p><p><strong>Results: </strong>Recently reported observational and some pragmatic studies show a degree of consistency in reported results and use outcomes that have face validity for clinicians.</p><p><strong>Conclusions: </strong>No single experimental paradigm or outcome provides the necessary data to optimise treatment of mental illness in the clinical setting.</p>","PeriodicalId":77411,"journal":{"name":"The British journal of psychiatry. Supplement","volume":"50 ","pages":"s78-84"},"PeriodicalIF":0.0,"publicationDate":"2007-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1192/bjp.191.50.s78","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27092258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Health economic measures in schizophrenia research.","authors":"Paul McCrone","doi":"10.1192/bjp.191.50.s42","DOIUrl":"https://doi.org/10.1192/bjp.191.50.s42","url":null,"abstract":"<p><strong>Background: </strong>It is essential in economic evaluations of schizophrenia interventions that all relevant costs are identified and measured appropriately. Also of importance is the way in which cost data are combined with information on outcomes.</p><p><strong>Aims: </strong>To examine the use of health economics in evaluations of interventions for schizophrenia.</p><p><strong>Methods: </strong>A review of the key methods used to estimate costs and to linkcosts and outcomes was conducted.</p><p><strong>Results: </strong>Costs fall on a number of different agencies and can be short term or long term. Cost-effectiveness analysis and cost-utility analysis are the most appropriate methods for combing cost and outcome data.</p><p><strong>Conclusions: </strong>Schizophrenia poses a number of challenges for economic evaluation.</p>","PeriodicalId":77411,"journal":{"name":"The British journal of psychiatry. Supplement","volume":"50 ","pages":"s42-5"},"PeriodicalIF":0.0,"publicationDate":"2007-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1192/bjp.191.50.s42","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27092321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Outcome measures in early psychosis; relevance of duration of untreated psychosis.","authors":"Swaran P Singh","doi":"10.1192/bjp.191.50.s58","DOIUrl":"https://doi.org/10.1192/bjp.191.50.s58","url":null,"abstract":"<p><strong>Background: </strong>Duration of untreated psychosis (DUP) is considered an important predictor of short-term clinical outcome.</p><p><strong>Aims: </strong>To explore the evolution ofthe concept of DUP synthesise the evidence for its predictive value, highlightthe problems in measurement, and consider the potential pitfalls of using DUPas a measure of the effectiveness of early intervention services.</p><p><strong>Method: </strong>A survey of recent literature was conducted.</p><p><strong>Results: </strong>Several studies and two systematic reviews confirm that DUP has a robust but moderate effect on outcome in schizophrenia. Studies vary widely in how DUP is defined and measured, since identifying precise time points when psychosis emerges and remits is conceptually ambiguous and clinically difficult.</p><p><strong>Conclusions: </strong>Standardised measurement of DUP is a vital first step in allowing comparisons between studies. Duration of untreated psychosis is a relevant measure only of the early detection function of early intervention services.</p>","PeriodicalId":77411,"journal":{"name":"The British journal of psychiatry. Supplement","volume":"50 ","pages":"s58-63"},"PeriodicalIF":0.0,"publicationDate":"2007-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1192/bjp.191.50.s58","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27092324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Evolution of outcome measures in schizophrenia.","authors":"Tom Burns","doi":"10.1192/bjp.191.50.s1","DOIUrl":"https://doi.org/10.1192/bjp.191.50.s1","url":null,"abstract":"<p><p>Outcome has been a key concern in schizophrenia since Kraepelin first identified the disorder. The outcomes that researchers and clinicians use and value in their work with it have changed to reflect evolving theories about it and the available interventions. This supplement tracks those changes and examines the merits and use of structured approaches to understand this most complex disorder.</p>","PeriodicalId":77411,"journal":{"name":"The British journal of psychiatry. Supplement","volume":"50 ","pages":"s1-6"},"PeriodicalIF":0.0,"publicationDate":"2007-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1192/bjp.191.50.s1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27088689","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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