Abstract
Background
Schizophrenia has a variety of clinical profiles, disabilities and outcomes requiring responsive management and the devotion of considerable resources. The primary objective of the European Schizophrenia Cohort (EuroSC) is to relate the types of treatment and methods of care to clinical outcome. Secondary objectives include the assessment of treatment needs in relation to outcome, the calculation of resource consumption associated with different methods of care, and the identification of prognostic factors.
Method
EuroSC is a naturalistic follow-up of a cohort of people aged 18 to 64 years, suffering from schizophrenia and in contact with secondary psychiatric services. The study was done in nine European centres, in France (N=288), Germany (N=618), and Britain (N=302). Participants were interviewed at 6-monthly intervals for a total of 2 years. This initial paper describes the methods used and presents clinical and social baseline data.
Results
The clinical and socio-demographic differences between patients from the different countries were small. However, patients from Britain were considerably more likely than their continental counterparts to have a history of homelessness, rooflessness or imprisonment, even when social and clinical differences between the samples were controlled.
Conclusions
The samples were largely similar in clinical terms. Thus, the social differences between the samples seem likely to be due more to the societal context and may reflect relatively benign situations in the continental locations of our study.
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References
Addington D, Addington J, Schissel B (1990) A depression rating scale for schizophrenics. Schizophr Res 3:247–251
Addington D, Addington J, Maticka-Tyndale E, Joyce J (1992) Reliability and validity of a depression rating scale for schizophrenia. Schizophr Res 6:201–208
American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders, 4th edn, revised. American Psychiatric Association, Washington, DC
Barnes TR (1989) A rating scale for drug-induced akathisia. Br J Psychiatry 154:276–672
Bauer M, Kunze H, von Cranach M, Fritze J, Becker T (2001) Psychiatric reform in Germany. Acta Psychiatr Scand 104(Suppl 401):27–39
Bebbington PE, Marsden L, Brewin CR (1997) The need for psychiatric treatment in the general population: the Camberwell Needs for Care Survey. Psychol Med 27:821–834
Bebbington PE, Brugha TS, Hill T, Marsden L, Window S (1999) A validation of the Health of the Nation Outcome Scales (HoNOS). Br J Psychiatry 174:389–394
Bebbington P, Brugha T, Jenkins R, Lewis G, Farrell M, Meltzer H (2000) Neurotic disorders and the use of services: a report from the National Survey of Psychiatric Morbidity. Psychol Med 30:1369–1376
Bebbington PE, Kuipers L (2003) Schizophrenia and psychosocial stresses. In: Hirsch SR, Weinberger D (eds) Schizophrenia. Blackwell, Oxford, pp 611–634
Beecham J, Knapp M (1992) Costing psychiatric interventions. In: Thornicroft G, Brewin CR, Wing JK (eds) Measuring mental health needs. Gaskell, London
Bell M, Milstein R, Beam-Goulet J, Lysaker P, Cicchetti D (1992) The posItive and Negative Syndrome Scale and the Brief Psychiatric Rating Scale. J Nerv Mental Disord 180:723–728
Brazier J, Jones N, Kind P (1993) Testing the validity of the EuroQol and comparing it with the SF-36 health survey questionnaire. Q Life Res 2:169–180
Burns T, Fiander M, Kent A, Ukoumunne OC, Byford S, Fahy T, Kumar KR (2000) Effects of case-load size on the process of care of patients with severe psychotic illness. Report from the UK700 trial. Br J Psychiatry 177:427–433
Chisholm D, Knapp M (2002) The economics of schizophrenia care in Europe: the EPSILON study. Epidemiol Psychiatr Soc 11:12–17
Cooper JE, Kendell RE, Gurland BJ, Sharpe L, Copeland JRM, Simon R (1972) Psychiatric diagnosis in New York and London. Maudsley Monograph No. 20. Oxford University Press, London
Dausch BM, Miklowitz DJ, Richards JA (1996) Global Assessment of Relational Functioning Scale (GARF): II. Reliability and validity in a sample of families of bipolar patients. Fam Proc 35:175–189
Draine J, Salzer MS, Culhane DP, Hadley TR (2002) Role of social disadvantage in crime, joblessness, and homelessness among persons with serious mental illness. Psychiatr Serv 53:565–573
Gaite L, Vazquez-Barquero JL, Borra C, Ballesteros J, Schene A, Welcher B, Thornicroft G, Becker T, Ruggeri M, Herran A, Koeter M, Meijer K, Monden M, Sijsenaar M, Van-Wijngaarden B, Knudsen HC, Larsen A, Martiny K, Schou C, Beecham J, Brooks L, Chisholm D, Griffiths G, Grove J, Knapp M, Leese M, McCrone P, Padfield S, White IR, Arrizabalaga AA, Castanedo SH, Retuerto MP, Bourgon EV, Amaddeo F, Bisoffi G, Cristofalo D, Dall'Agnola R, Lasalvia A, Tansella M (2002) Quality of life in patients with schizophrenia in five European countries: the EPSILON study. Acta Psychiatr Scand 105:283–292
Garratt AM, Ruta DA, Abdalla ME, Buckingham JK, Russell IT (1993) The SF36 health survey questionnaire: an outcome measure suitable for routine use within the NHS? Br Med J 306:1440–1444
Goldman HH, Skodol AE, Lave TR (1992) Revising AXIS V for DSM-IV: a review of measures of social functioning. Am J Psychiatr 149:1148–1156
Group for the Advancement of Psychiatry Committee on the Family (1996) Global Assessment of Relational Functioning Scale (GARF): I. Background and rationale. Group for the Advancement of Psychiatry Committee on the Family. Fam Proc 35:155–172
Guy W (1976) ECDEV Assessment manual for psychopharmacology. Revised DHEW Pub (AOM). National Institute for Mental Health, Rockville MD
Harding CM, Hall GM (1997) Long-term outcome studies of schizophrenia: do females continue to display better outcome as expected. Int Rev Psychiatry 9:409–418
Hurst NP, Jobanputra P, Hunter M, Lambert M, Lochhead A, Brown H (1994) Validity of EuroQol—a generic health status instrument—in patients with rheumatoid arthritis. Economic and Health Outcomes Research Group. Br J Rheumatol 33:655–662
Jenkinson C, Coulter A, Wright L (1993) Short form 36 (SF36) health survey questionnaire: normative data for adults of working age. Br Med J 306:1437–1440
Johnson S, Kuhlmann R, EPCAT Group (2000) The European Service Mapping Schedule (ESMS): development of an instrument for the description and classification of mental health services. Acta Psychiatr Scand 102(Suppl 405):14–23
Johnson S, Zinkler M, Priebe S (2001) Mental health service provision in England. Acta Psychiatr Scand 104(Suppl 410):47–55
Kay SR, Opler LA, Lindenmayer JP (1987) The Positive and Negative Syndromes Scale (PANSS) for schizophrenia. Schizophr Bull 13:261–276
Kay SR, Opler LA, Lindenmayer JP (1989) The Positive and Negative Syndrome Scale (PANSS): rationale and standardisation. Br J Psychiatry 155:59–65
Kay SR (1991) Positive and negative syndromes in schizophrenia. Brunner/Mazel, New York
Knapp M (1997) Costs of schizophrenia (review). Br J Psychiatry 171:509–518
Knapp M, Chisholm D, Leese M, Amaddeo F, Tansella M, Schene A, Thornicroft G, Vazquez-Barquero JL, Knudsen HC, Becker T (2002) EPSILON. European psychiatric services: inputs linked to outcome domains and needs: comparing patterns and costs of schizophrenia care in five European countries: the EPSILON study. European psychiatric services: inputs linked to outcome domains and needs. Acta Psychiatr Scand 105:42–54
Kovess V, Boisguerin B, Antoine D, Reynauld M (1995) Has the sectorization of psychiatric services in France really been effective? Soc Psychiatry Psychiatr Epidemiol 30:132–138
Lane RD, Glazer WM, Hansen TE, Berman WH, Kramer SI (1985) Assessment of tardive dyskinesia using the abnormal involuntary movement scale. J Nerv Ment Dis 173:353–357
Lang FH, Forbes JF, Murray GD, Johnstone EC (1997) Service provision for people with schizophrenia. I. Clinical and economic perspective. Br J Psychiatry 171:159–164
Lehman AF (1983) The effects of psychiatric symptoms on quality of life assessments among the chronic mentally ill. Eval Program Plann 6:143–151
Marwaha S, Johnson S (2004) Schizophrenia and employment. A review. Soc Psychiatry Psychiatr Epidemiol 39:337–349
Marwaha S, Johnson S, Bebbington P, Angermeyer M, Brugha T, Azorin J-M, Killian R, Hansen K, Toumi M (2005) Characteristics and correlates of employment in people with schizophrenia. Findings from the international EuroSC study. Br J Psychiatry (in press)
Mason P, Harrison G, Glazebrook C, Medley I, Croudace T (1996) The course of schizophrenia over 13 years. A report from the International Study on Schizophrenia (ISoS) coordinated by the World Health Organization. Br J Psychiatry 169:580–586
McCrone P, Leese M, Thornicroft G, Schene A, Knudsen HC, Vazquez-Barquero JL, Tansella M, Becker T, Chisholm D (2001) A comparison of needs of patients with schizophrenia in five European countries: the EPSILON study. Acta Psychiatr Scand 103:370–379
Norman RMG, Malla AK, Cortese L, Diaz F (1996) A study of the interrelationship between and comparative interrater reliability of the SAPS, SANS and PANSS. Schizophr Res 19:73–85
Overall JE, Gorham DR (1962) Brief Psychiatric Rating Scale. Psychol Rep 10:799–812
Phelan M, Slade M, Thornicroft G, Dunn G, Holloway F, Wykes T, Strathdee G, Loftus L, McCrone P, Hayward P (1995) The Camberwell Assessment of Need (CAN). The validity and reliability of an instrument to assess the needs of people with severe mental illness. Br J Psychiatry 167:589–595
Psychopharmacology Research Branch NIMH (1976) Abnormal Involuntary Movement Scale (AIMS). In: Guy W (ed) Assessment manual for psychopharmacology (revised). NIMH, Rockville, MD, pp 534–537
Ruggeri M, Lasalvia A, Bisoffi G, Thornicroft G, Gazquez-Barquero JL, Becker T, Knapp M, Knudsen HC, Schene A, Tansella M (2003) Satisfaction with mental health services among people with schizophrenia in five European sites: results from the EPSILON study. Schizophr Bull 29:229–245
Salvador-Carulla L, Haro JM, Cabases J, Madoz V, Sacristan JA, Vazquez-Barquero JL (1999) Service utilization and costs of first-onset schizophrenia in two widely differing health service areas in North-East Spain. PSICOST Group. Acta Psychiatr Scand 100:335–343
Sartorius N, Kuyken W (1994) Translation of health status instruments. In: Orley J, Kuyken W (eds) Quality of life assessment: international perspectives. Springer, Berlin Heidelberg New York, pp 2–18
Schene AH (1990) Objective and subjective dimensions of family burden. Towards an integrative framework for research. Soc Psychiatry Psychiatr Epidemiol 25:289–297
Schene AH, Wijngaarden B (1992) The involvement evaluation questionnaire. Department of Psychiatry, University of Amsterdam, Amsterdam
Schwarz D, Lellouch J (1967) Explanatory and prognostic attitudes in therapeutic trials. J Chronic Dis 20:637–648
Simpson S, Angus R (1970) A rating scale for extrapyramidal side effects. Acta Psychiatr Scand Suppl. 212:11–19
Slade M, Phelan M, Thornicroft G (1998) A comparison of needs assessed by staff and an epidemiologically representative sample of patients with psychosis. Psychol Med 28:543–550
Slade M, Loftus L, Phelan M, Thornicroft G, Wykes T (1999) The Camberwell assessment of need. Gaskell, London
Spitzer RL, Williams JB, Gibbon M, First MB (1992) The Structured Clinical Interview for DSM-III-R (SCID). I: rationale, and description. Arch Gen Psychiatry 49:624–629
Thornicroft G, Tansella M, Becker T, Knapp M, Leese M, Schene A, Vazquez-Barquero JL (2004) The personal impact of schizophrenia in Europe. Schizophr Res 69:125–132
Tracy K, Adler LA, Rotrosen J, Edson R, Lavori P (1997). Interrater reliability issues in multicentre trials. Part I: theoretical concepts and operational procedures used in Department of Veterans Affairs Cooperative Study #394. Psychopharmacol Bull 33:53–57
van Agt HM, Essink-Bot ML, Krabbe PF, Bonsel GJ (1994) Test–retest reliability of health state valuations collected with the EuroQol questionnaire. Soc Sci Med 39:1437–1444
Van-Wijngaarden B, Schene A, Koeter M, Becker T, Knapp M, Knudsen HC, Tansella M, Thornicroft G, Vazquez-Barquero JL, Lasalvia A, Leese M (2003) People with schizophrenia in five countries: conceptual similarities and intercultural differences in family caregiving. Schizophr Bull 39:573–586
Walsh E, Buchanan A (2003) Criminal and violent behaviour in schizophrenia. In: Murray R, Jones P, Susser E, van Os J, Cannon M (eds) The epidemiology of schizophrenia. CUP, Cambridge
Weiden P, Rapkin B, Mott T, Zygmunt A, Goldman D, Horvitz-Lennon M, Frances A (1994) Rating of Medication Influences (ROMI) scale in schizophrenia. Schizophr Bull 20:297–310
Wing JK, Babor T, Brugha T, Burke J, Cooper JE, Giel R, Jablensky A, Regier R, Sartorius N (1990) SCAN: Schedules for Clinical Assessment in Neuropsychiatry. Arch Gen Psychiatry 47:589–593
World Health Organization (1973) The international pilot study of schizophrenia. WHO, Geneva
World Health Organization (1992). SCAN: Schedules for Clinical Assessment in Neuropsychiatry. WHO, Geneva
Acknowledgements
This study was funded by an unrestricted research grant from Lundbeck A/S and a grant from the German Federal Ministry of Education and Research in the framework of the Research Association Public Health Saxony (grant no. 01EG9732/7). The first six authors of the paper received indirect support (in honoraria and travel funds) from Lundbeck A/S to participate in project management meetings. We are particularly grateful to the participants who gave of their time over the course of the study, and to the clinical teams who supported the project.
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Bebbington, P.E., Angermeyer, M., Azorin, JM. et al. The European Schizophrenia Cohort. Soc Psychiat Epidemiol 40, 707–717 (2005). https://doi.org/10.1007/s00127-005-0955-5
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DOI: https://doi.org/10.1007/s00127-005-0955-5