Lifespan in schizophrenia spectrum disorders (SSD) is up to 20 years shorter than average. Introduction of new antipsychotic pharmaceuticals has not made any major improvement. Parallel care is provided as usual standard care (USD) in out-patients settings. The study aim was to evaluate if inclusion of Measurement Based Care (MBC) may prolong patients' lifespan. In total, 171 patients were followed with annual semi-structured examinations of psychiatric status, social situation, and somatic illnesses over 20 years, by case managers. Findings indicate that MBC contributed to prolonged lifespan in SSD from 55.6 to 69.4 years from beginning to end of the study.

Individuals with schizophrenia spectrum disorders (SSD) have significantly lower life-expectancy than healthy people. Previously, we have identified baseline neurocognitive function in general and verbal memory and executive function in particular as related to mortality nearly two decades later. In this study, we aim to replicate these findings with a larger and age-matched sample. The patient group consisted of 252 individuals, 44 of whom were deceased and 206 alive. Neurocognition was assessed with a comprehensive battery. Results showed that the deceased group, compared to the living group, had significantly more severe neurocognitive deficits across nearly all domains. There were no differences in sex, remission status, psychosis symptoms, or function level between the groups. Immediate verbal memory and executive function were the strongest predictors of survival status. These results were nearly identical to our previous studies, and we conclude that baseline neurocognitive function is an important predictor for mortality in SSD. Clinicians should be mindful of this relationship in patients with significant cognitive deficits.

Abstract Background Schizophrenia patients that lack capacity or motivation to follow treatment instructions show reduced possibility for stable improvement of clinical status and an increased risk for recurrent symptomatic episodes. The aim of this study is to assess the relationship between components known to be important for treatment adherence: patients’ satisfaction with pharmacological treatment, illness severity, cognitive capacity and insight in symptoms and disease. Methods Data are derived from 507 patients enrolled in a long-term prospective study in Sweden. All parameters were assessed at baseline for a cross-sectional relational analysis. Insight as well as remission state were also determined each year in a 3-year follow-up longitudinal study. Results Patients satisfied with treatment show less severe symptoms, are more often in remission and show a higher degree of insight in symptoms and disease. Neither satisfaction with treatment nor insight correlates to cognition in this study. During follow-up, insight scores increased in parallel to the number of patients in remission in the group where patients alternate between remission and not-remission. Insight in symptoms increased first and thereafter insight regarding underlying cause, is else schizophrenia as a disease. Conclusions Patients that clinically do better are more satisfied with treatment and show more insight in their symptoms and disease. Positive treatment results appear to directly improve patients’ satisfaction and insight, suggesting those to be a state phenomenon secondary to treatment outcome. This supports the need for stable symptomatic remission as treatment goal.

Symptomatic remission for patients with schizophrenia spectrum disorder is to some extent associated with a better functional outcome, and a higher level of insight of symptoms. Additional studies show that patients who overestimates their low function have no difference in level of total clinical symptoms compared to the ordinary functioning group. The aim of the present study is to examine whether overestimating functioning is associated with longitudinal symptomatic remission pattern. A total of 115 outpatients within the ongoing CLIPS-study (Clinical Long-term Investigation of Psychosis in Sweden), all diagnosed with schizophrenia spectrum disorder, were followed for five years. Remission status was assessed once a year with the Positive and Negative Syndrome Scale (PANSS), placing each participant in one out of three groups based on their long-term remission pattern (stable remission, unstable remission, non-remission). Furthermore, based on the individual result on UPSA-B combined with their self-rated level of function, the participants were divided into four groups (Ordinary function, accurate estimators; Ordinary function, under-estimators (due to a low degree of participants this group was excluded in the analysis); Low function, over-estimators; Low function, accurate estimators). Differences in long term remission patterns for the different groups based on insight of functioning were compared using non-parametric analyzes. Our analysis show statistically significant differences in long term symptomatic remission pattern, based on patients’ insight of functioning. Results from the post hoc test demonstrate differences in long term symptomatic remission pattern between the groups low function, accurate estimators and low function, over-estimators, indicating a higher degree of remission in the over-estimator’s group. It also shows differences in long term symptomatic remission pattern between low function, accurate estimators and ordinary function, accurate estimators, indicating ordinary function being associated with a higher degree of remission. The results show that not only better functioning is related to a higher likelihood of achieving long-term remission, but also overestimating ones’ low function. The results suggest that patients believing in an ordinary function, even if it means overestimating, could have an advantage in clinical long-term outcome of the disorder. Alternatively, it could also be that being in remission, leads to an overestimation of one’s function. Finally, the remission criterion is based on structured interviews with the PANSS. If the patients who overestimate their function also overestimate their symptomatic status, being in remission could be a false understanding, made by the clinicians based on the patients’ overestimation. The findings show how complex the schizophrenia spectrum disorder is, and the importance of several parallel examinations within different areas to be able to individualize the treatment for each patient.

A promising progress in the search for determinants of functional outcomes is defined as introspective accuracy (the self-assessment ability). Research about patients’ ability of rating their psychotic symptoms is established, but there is still a lack of knowledge about how patients perceive other important features of their illness, such as their level of functioning. The methods most frequently used to measure patients’ functioning are self-report questionnaires and reports from relatives and healthcare professionals. A previous study showed a significant relationship where patients, who overestimate their functioning, consistently got high scores in interview-based assessment regarding real-world functional performance. The aim of the present study was to explore if relationships between functional capacity and functional performance differ regarding patient’s introspective accuracy. Data collection took place within the ongoing project Clinical Long-term Investigation of Psychosis in Sweden (CLIPS), examining psychiatric outpatients. In this study, 222 patients with schizophrenia participated. They were divided into two groups; unimpaired introspective accuracy and impaired introspective accuracy, based on their self-rating ability and on their UCSD Performance-based Skills Assessment-Brief (UPSA-B) results. The two groups were assessed by clinicians and relatives and compared regarding functional performance on The Specific Level of Functioning Scale (SLOF). Pearson correlation were used to obtain correlation coefficients between functional capacity (UPSA-B) and functional performance (SLOF) in the two groups. The correlation between UPSA-B and SLOF were statistically significant, both when assessed by clinicians and relatives. The strength of the correlation coefficient was changed when the patients were divided into the two groups of introspective accuracy. It increased for patients who were aware of their functioning, slightly higher in the assessment by relatives, and showed a non-significant result for the patients who were not as aware of their functioning. A more detailed analysis showed that the SLOF domains assessed by clinicians that significantly correlated with UPSA-B was ‘Ability to take care of oneself’, ‘Activities’, and ‘Capacity to work’. The two later domains were also significant when the assessments were made by relatives. The present study focusses on the difficulties of producing objective and valid reports in the field of functional outcomes. The result also mirrors previous study results where patients who are not aware of their function, will be more difficult to assess. There were no major differences between the assessments made by clinicians and relatives. Our findings are important since impaired self-awareness could lead to less or inadequate support and treatment in the end. As a consequence of our findings, it is important to measure introspective accuracy independently of which method of functional performance that are being used. Introspective accuracy is also central to study in future investigations.