OBJECTIVE:This article describes the development and testing of the Functional Recovery tool (FR tool), a short instrument for assessing functional recovery during routine outcome monitoring of people living with serious mental illnesses. METHODS:To assess functional recovery, mental health professionals conducted semistructured interviews with people living with serious mental illnesses on three areas of social functioning: daily living and self-care, work and study, and social contacts. Functioning in each of these areas over the past 6 months was rated on a 3-point scale: 0 (independent), 1 (partially independent), and 2 (dependent). The dichotomous overall outcome of the tool is defined as independent functioning in all areas. We analyzed interrater and test-retest reliability, sensitivity to change, and correlations with constructs that are assumed to be similar to the FR tool (quality of life in daily living, work, and social contacts) or divergent from it (symptomatic functioning). RESULTS:The FR tool was administered to 840 individuals with serious mental illnesses in Dutch mental health care services, 523 of whom were followed up for 1 year (response rate 62%). The tool was easy to complete and was appropriate for policy evaluation and practice. However, when it was combined with more elaborate instruments, it added little extra clinical information. Interrater and test-retest reliability, convergent and discriminant validity, and sensitivity to change were rated sufficient to good. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE:The FR tool could be a useful measure of functional recovery in addition to current measures of symptomatic remission and personal recovery in routine outcome monitoring. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Altered emotional experiences in response to antipsychotics may increase the burden of disease in patients with schizophrenia. In a large cross-sectional study, patients with schizophrenia completed the Subjects Reaction to Antipsychotics questionnaire (SRA) to assess whether they attributed altered emotional experiences (flattened affect or depressive symptoms) to their antipsychotics. Association with antipsychotic D2 receptor affinity and occupancy was examined using logistic regression. We compared antipsychotic-attributed emotional experiences between patients using antipsychotic monotherapy and combination therapy. Of the 1298 included patients, 23% attributed flattened affect to their antipsychotics and 16% attributed depressive symptoms to their antipsychotics, based on the SRA. No differences were observed between antipsychotics in patients on monotherapy. We discuss that within these patients’ relatively low dose range, altered emotional experiences did not appear to relate to the level of D2 receptor affinity of antipsychotic monotherapy. Patients using antipsychotic combination therapy (22%) were more likely to attribute depressive symptoms to their antipsychotics than patients using antipsychotic monotherapy (OR [95%CI]=1.443 [1.033–2.015]); possibly due to higher D2 receptor occupancies as estimated by dose equivalents.

This study compares stigmatizing attitudes of different healthcare professionals towards psychiatry and patients with mental health problems.

The authors regret an error in Fig. 2 of this manuscript. The figure shows the PANSS scores for the hallucination item (P3) for the rTMS groups, aggregating the left and the bilateral treatment group, compared to the placebo group. The X axis plots the time points at which measurements were available: before the start of the treatment and immediately following the 6-day treatment protocol. The Y axis shows the score on the P3 item. Bubble sizes represent the number of subjects with a particular score on the Y axis.

BACKGROUND:Instruments are used for routine outcome monitoring of patients with severe mental illness in order to measure psychiatric symptoms, care needs and quality of life. By adding an instrument for measuring functional remission a more complete picture can be given of the complaints, the symptoms and general functioning, which can give direction to providing care for patients with severe mental illness.AIM:To describe the development and testing of a new instrument of functional remission (FR) among people with a psychotic disorder or another serious mental disorder (SMI) as an addition to the symptomatic remission (SR), according to international criteria.METHOD:The FR-assessment involves assessment by a mental health professional who conducts a semi-structured interview with the patient and his or her family and/or uses patient files relating to the three areas of functioning: daily living and self-care; work, study and housekeeping; and social contacts. These areas are rated on a three-point scale of 0: independent; 1: partially independent; 2: dependent. The assessment covers a period of six months, in accordance with the measurement of symptomatic remission and should be part of regular routine outcome monitoring (ROM) procedures. The FR-instrument was used in 2012 with 840 patients from eight Dutch mental care institutions and included a one-year follow-up among 523 patients (response 62%).RESULTS:The results showed that the instrument is relatively easily to complete. It was also relevant for clinical practice, although further research is needed because of the raters' low response. Intra- and inter-rater reliability, discriminating and convergent validity, and sensitivity to change were rated sufficient to good.CONCLUSION:If the FR-instrument becomes part of regular ROM-procedures and is used as a measure of societal participation, it could be a useful addition to current measures of symptomatic remission.

Aims: The aim of this study was to estimate the effects of lifestyle interventions on bodyweight and other cardiometabolic risk factors in people with psychotic disorders. Additionally, the long-term effects on body weight and the effects on depressive symptoms were examined.Material and Methods: We searched four databases for randomized controlled trials (RCTs) that compared lifestyle interventions to control conditions in patients with psychotic disorders. Lifestyle interventions were aimed at weight loss or weight gain prevention, and the study outcomes included bodyweight or metabolic parameters.Results: The search resulted in 25 RCTs -only 4 were considered high qualityshowing an overall effect of lifestyle interventions on bodyweight (effect size (ES)=-0.63, p<0.0001). Lifestyle interventions were effective in both weight loss (ES=-0.52, p<0.0001) and weight-gain-prevention (ES=-0.84, p=0.0002). There were significant long-term effects, two to six months post-intervention, for both weight-gain-prevention interventions (ES=-0.85, p=0.0002) and weight loss studies (ES=-0.46, p=0.02). Up to ten studies reported on cardiometabolic risk factors and showed that lifestyle interventions led to significant improvements in waist circumference, triglycerides, fasting glucose and insulin. No significant effects were found for blood pressure and cholesterol levels. Four studies reported on depressive symptoms and showed a significant effect (ES=-0.95, p=0.05).Conclusion: Lifestyle interventions are effective in treating and preventing obesity, and in reducing cardiometabolic risk factors. However, the quality of the studies leaves much to be desired.

Individuals with major psychotic disorders such as schizophrenia are at increased risk for developing metabolic syndrome due to lifestyle- and treatment-related factors. Numerous interventions have been tested in inpatient and outpatient mental health settings to decrease risk factors. Diet and exercise represent the mainstay of weight loss treatment. With this background the review aimed to evaluate the effects of psychoeducation, diet and physical activity interventions on reduction of metabolic syndrome risk factors such as BMI, Body weight, biochemical profiles in schizophrenia.The authors conducted database searches of PsychINFO, MEDLINE, Pubmed, Proquest, EBSCO and the Cochrane Database of Systematic Reviews, and manual searches from 1968 to 2017. Search indentified 11 studies that met the inclusion criteria. Study quality was critically appraised by 2 reviewers using established criteria. The outcome measures were body mass index, body weight, waist circumference, lipid profile, fasting glucose.Interventions led to significant weight reduction (8 studies), reduced body mass index (5 studies), decreased waist circumference (4 studies) and lower blood glucose levels (5 studies). Dietician and nurse led interventions (6 studies). The studies showed non pharmacological interventions were effective in reducing risk factors.This review was able to demonstrate effectiveness of peychoeducation, diet and physical activity interventions were helpful to decrease and manage antipsychotic-induced weight gain. Results showed lifestyle interventions are safer and effective for promoting decrease or maintenance of weight and it can be delivered at low cost, safe and improves quality of life.

Self-report instruments for the assessment of depressive symptoms in patients with psychotic disorders are scarce. The Quick Inventory of Depressive Symptoms (QIDS-SR16) may be a useful self-report instrument, but has received little attention in this field. This paper aimed to test the psychometric properties of the QIDS-SR16 questionnaire in patients with a psychotic disorder.

Objective. Many patients with schizophrenia are not treated in line with evidence-based guidelines. This study examines the large-scale implementation of the National Multidisciplinary Guideline for schizophrenia in the Netherlands.Design. Observational, prospective study, with repeated measurement.Setting. Thirty mental healthcare teams in different regions of the Netherlands.Participants. Three hundred and fifty-nine clinicians with different professional backgrounds and 1489 patients suffering from schizophrenia.Intervention(s). Six evidence-based interventions for schizophrenia were implemented, in the context of a quality improvement collaborative: assertive community treatment (ACT) or its adapted version functional assertive community treatment (FACT), cognitive behavioural therapy, psycho-education, family interventions, individual placement support and pharmacotherapy.Main Outcome Measure(s). Professional performance, social functioning and relapse rates.Results. Improved professional performance, in line with guidelines. Availability of (F) ACT improved from 23 to 60%. Individual Placement Support improved from 20 to 53%. Complete care plans were composed for 38% of the patients and routine outcome monitoring was introduced in most teams. Social functioning improved slightly (HoNOS mean: from 6.2 to 5.6). Relapse rates did not improve during the course of the study.Conclusions. An intensive implementation programme can result in an improved delivery of evidence-based care, increased continuity of care and slightly improved outcomes for individuals with schizophrenia. More rigorous research designs have to confirm these findings.

Objective:Studying stigma in health care professionals may be helpful to address stigma in people with mental illness. The purpose of this study is to assess (stigmatising) attitudes of mental health care professionals (MHC), forensic psychiatric professionals (FP) and general practitioners (GP) in the Netherlands.Method:The Mental Illness Clinicians Attitude (MICA) questionnaire is used to assess stigmatising attitudes in three different groups of health care professionals. Scores range from 16 (minimum stigma) to 96 (maximum stigma). Additionally, background information was obtained including gender, age, work and personal experience.Results:All three groups of health care professionals had a positive attitude towards psychiatry and patients with a mental health problem. However, the total MICA score differed significantly between the three groups (p<0.001). GP's had the highest score (44) on stigmatising attitudes, followed by the FP's (39) and MH's (34). In our study population 25%-38% had personal experience with having a mental illness. Most stigmatising attitudes were found regarding protection of the public against patients with severe mental illness, telling colleagues about personal experience with mental illness and, appreciating psychiatry as less respectable compared to other medical disciplines.Conclusion:General practitioners showed in comparison to mental health care professionals a significantly higher stigmatising attitude. The scores still represent a mild positive attitude towards psychiatry and psychiatric patients. Although all three groups have a relatively positive attitude, there is still room for improvement.

The aim was to explore weight and body mass index (BMI) changes by baseline BMI in patients completing three years of monotherapy with various first- and second-generation antipsychotics in a large cohort in a post hoc analysis of three-year observational data. Data were analyzed by antipsychotic and three baseline BMI bands: underweight/normal weight (BMI <25 kg/m 2 ), overweight (25–30 kg/m 2 ) and obese (>30 kg/m 2 ). Baseline BMI was associated with subsequent weight change irrespective of the antipsychotic given. Specifically, a smaller proportion of patients gained ≥7% baseline bodyweight, and a greater proportion of patients lost ≥7% baseline bodyweight with increasing baseline BMI. For olanzapine (the antipsychotic associated with highest mean weight gain in the total drug cohort), the percentage of patients gaining ≥7% baseline weight was 45% (95% CI: 43–48) in the underweight/normal weight BMI cohort and 20% (95% CI: 15–27) in the obese BMI cohort; 7% (95% CI: 6–8) of the underweight/normal cohort and 19% (95% CI: 13–27) of the obese cohort lost ≥7% baseline weight. BMI has an association with the likelihood of weight gain or loss and should be considered in analyses of antipsychotic weight change.

Background: Monitoring patients' experiences with antipsychotics may help to improve medication adherence and outcome. We aimed to develop a shorter version of a comprehensive 74-item self-report questionnaire suitable for routine monitoring of desired and undesired effects of antipsychotics.Methods: Included were patients with psychotic disorders from seven mental health care organizations in The Netherlands, using antipsychotic medication, who completed the Subjects' Response to Antipsychotics (SRA-74). Exploratory factor analysis (EFA) and similarity analysis based on mutual information were used to identify the latent factor structure of the SRA. Items were reduced according to their metric properties and clinical relevance upon consensus by an expert panel, using a Delphi procedure of three rounds. We determined the internal consistency of the shorter version using Cronbach's alpha.Results: SRA data of N = 1478 patients (mean age of 40 years, 31% females) were eligible for analysis. EFA extracted thirteen factors from the SRA-74, including four factors for desired effects (e. g. recovery of psychosis, cognition and social functioning) and nine factors for undesired effects (e. g. weight gain, flattened affect and increased sleep). Based on this solution 12 items were eliminated for statistical reasons. The expert panel eliminated another 28 items with redundant content, resulting in a 34-item version. The SRA-34 includes 10 desired and 24 clinically relevant undesired effects. Both the subscales for desired and undesired effects have a Cronbach's alpha coefficient of 0.82.Conclusions: The SRA-34 can be used to evaluate desired and undesired effects of antipsychotics in routine clinical practice and research. (C) 2013 Elsevier B. V. All rights reserved.

BACKGROUND:Weight change data from randomized clinical trials are often of limited duration and trials do not always report a full range of clinically relevant categorical end points.METHOD:We conducted a post hoc analysis of data from the observational Worldwide Schizophrenia Outpatient Health Outcomes database (2000-2005) on weight change in 4,626 patients completing 3 years of antipsychotic monotherapy with amisulpride, clozapine, olanzapine, quetiapine, risperidone, and oral and depot first-generation antipsychotics (FGAs). Reported outcomes included mean and categorical weight changes and the trajectories of different measures of weight change.RESULTS:Mean weight gain was lowest with amisulpride (1.8 kg; 95% CI, 0.2-3.3) and highest with olanzapine (4.2 kg; 95% CI, 3.9-4.5). Weight change for all antipsychotics was most rapid during the first 6 months; subsequent weight change was slower but did not plateau. All drugs showed considerable individual variation in weight change. The proportion losing ≥7% of their baseline bodyweight was highest with quetiapine (10%; 95% CI, 7%-16%) and lowest with depot FGAs (5%; 95% CI, 3%-10%). Between 7% and 15% of patients moved into an overweight or obese body mass index (kg/m2)category (≥25).CONCLUSIONS:The degree of weight gain varied between antipsychotics. All antipsychotics were associated with significant (≥7%) weight loss and gain from baseline. The mean rate of weight gain was maximal during the first 6 months but continued over 3 years without a plateau in this specific cohort. Patients should receive regular monitoring of weight throughout treatment.

UNLABELLED This study examined the quality of mental health care for people with schizophrenia in eight regions in The Netherlands as assessed by the QUARTS: Quality Assessment of Regional Treatment Systems for Schizophrenia. The focus was on determining whether the introduction of multidisciplinary guidelines improved quality in service provision. METHODS The QUARTS, a standardized interview instrument, addresses the availability of and satisfaction with services from the perspectives of clinicians, patients, families, and community organizations. The first QUARTS assessment was done about the time the guidelines were introduced in The Netherlands (2005), and the second was two to four years later. RESULTS In all regions progress was made in the availability of care elements, although progress was limited for evidence-based rehabilitation interventions. CONCLUSIONS Key clinicians in all regions perceived the guidelines as an important factor in improving the quality of schizophrenia care. QUARTS can be a helpful instrument for service monitoring and development.