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International Forum
Additional updates will be posted here. Check back often!
Henriette Andreasen, Contact Address The OPUS project is a clinical treatment and research project. All the psychiatric wards in Hovedstadens Sygehusfællesskab (HS)(The joint hospitals of the Capital), as well as some in Århus Amt. I have chosen to focus on the section of the project concerned with HS, or more precisely OPUS/Vesterbro (OPUSV). I choose this focus because due to my conditions of employment I am already part of the projects control group. I will however, begin by describing the joint OPUS project and then go on to show how it is tackled in OPUSV. The Aim of the Project: 1) To investigate whether or not it is possible to detect early schizophrenia and schizophrenia like psychosis by more co-operation with and more teaching of primary sector and local community. 2) To describe the prodromal phase as well as examine the duration of as yet untreated psychosis symptoms (VUP) in young patients with schizophrenia and schizophrenia like psychosis. 3) To describe whether or not VUP has an effect on the course of illness. 4) To describe whether or not an intensive psychological treatment would better the patient’s course of illness and its outcome. The History of the Project Schizophrenia runs through a number of stages: premorbid, prodromal, active psychosis and residual phases, as well as psychotic relapses. It has been established that there is a better course of illness for schizophrenics that have been treated with a combination of stress reductive psychosocial interventions and antipsychotic medicine. The additive effect of psychoeducational family therapy and social skills training has shown to be of the same size as the effect of neuroleptika on its own. That is when the effect is measured by the frequency of relapses (Bellack, 1985; Fallon et al. 1985; Leff et al. 1985; Tarrier et al. 1989; Hogarty et al. 1991; McFarlane, 1995). Examination of schizophrenic patients clearly shows that those experiencing short-term psychosis before the commencement of treatment are better off with respect to the duration of the illness and level of difficulty (Wyatt, 1991b). It is however not stated, whether these results can be attributed to the true effect of earlier treatment or if it can solely be applied to other prognostic propitious circumstances, for example, insight into the illness and the wish for co-operation in treatment. The Connection between VUP and prognosis is the foundation for the theories that say that untreated psychosis is toxic for the brain (Wyatt, 1991a). It is therefore, necessary to investigate the effect of early discovery of patient’s with schizophrenia and schizophrenia like psychosis, and to intensify the psychosocial intervention at an early stage of the illness. Schizophrenia often results into persistent flaws in the functional level and economically schizophrenia is one of the most expensive illnesses in the world. For the patient’s and for the patient’s family the illness is combined with extensive social and psychological costs. The terms on which schizophrenics have to cope have probably been worsened over the last decades, at least for a percentage of the group. Thus, the suicidal rate, among schizophrenics, has doubled, in the last couple of decades (Middellevetidsudvalget. Sundhedsministeriet, 1994), the percentage of psychotics among the homeless has increased radically (Brandt, 1987) as has the number of mentally ill criminals (Kramp, 1993). A great number of psychotic patients have, after the deinstitionalisation of the psychiatric treatment system, been given more freedom of choice to make decisions for themselves, in and about their lives. For a number of these patients the choices connected to this freedom are too difficult to manage. The single elements of societies concern for the ills that were formerly gathered in one total institution have been placed in a number of institutions. It is in these institutions that mentally ill patients may find it difficult to make entitled demands effective in a socially acceptable way. The notion of the psychosis team has been developed to see that such patients are not left behind because of their inability to control this co-ordination task (Stein and Test, 1980; Holloway, 1991; Burns and Santos, 1995; Kane and McGlashan, 1995; Santos et al. 1995; Vendsborg, 1992). In most of the models, a team of staff is allocated to the patient to make sure that there is continuity in the course of treatment. It is especially important in terms of assuring continuity between the hospitalisation and the socially based treatment as well as between the different parts of treatment plan. Emphasis is put on social skills training, control of anxiety, stress strains from the outside and on patients’ enrolment in activities that can help them become integrated into society, activities, for example either sport or education that can help develop a sense of self-worth. It is also an important part of the treatment plan for the patient to experience realistic job possibilities and job offers. Design Early detection is equally done in a part of Århus municipality (social district North), while the patient’s from Århus municipality (North and West); Randers and Silkeborg are randomised for strengthened psychosocial effort. The patient’s will be examined in the same way when entering the project, as they will be after 1 and 2 years. Page 2: Criteria for Admission |
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