The Opus Project: ....continued            Return to Forum
Clinical treatment and research in Copenhagen, Denmark

Organisational Issues for Establishing the OPUS Project in HS
Among the approximately 560.00 inhabitants, in the admission area, there will be approximately 140 first time patients with a F2 diagnosis, during the 1^st year. It is understood that each practitioner in the OPUS project can handle the outpatient treatment of 10-15 patients.

Two teams started in the HS admittance area, in the first two months of 1998, with the aim of securing the success of the OPUS project. The teams consist of employees in HS and Copenhagen Municipal Council’s department of Societal affairs.

One team cover Bispebjerg Hospital and Frederiksberg Municipal Council. This team is based at the Community Mental Health Centre on Møntmestervej. The second team covers the rest of HS and is based at the Community Mental Health Centre, in Vesterbro.

The patients can be referred to OPUS from the psychiatric wards in HS, from the Community Mental Health Centres and from the GP, via the Community Mental Health centre. The two teams will establish a repeated visiting round, in which the goal is to ensure that departments and centres are aware of the project and answer questions which may facilitate a possible transfer of a patient. In each Community Mental Health Centre it should be the physician, who is responsible for the transfer. The project offers teaching to all the psychiatric wards in HS and offers to be present at staff meetings, especially in the psychiatric admission ward. Admitted patients will be evaluated by the project PhD students within 72 hours after the OPUS project has been contacted. At this first contact the interview is a diagnostic one (SCAN 2.0), to see if the patient can fulfil the necessary requirements. Evaluation of the relevancy for the transfer of patients to OPUS is done by personal contact. After the admission the randomisation treatment starts.

Every third month, from the time of admission and beyond the patient’s clinical stage and treatment is evaluated and recorded. With the focus on establishing a psychopathological evaluation of patients in and out of the project and control group, a research group will be established consisting of the two PhD students with the project as well as the PhD students allocated to ward U7 at Sct. Hans Hospital. They will be responsible for evaluations every 3^rd month and they will use the Schedule for Assessment of Negative Symptoms (SANS) and Schedule for Assessment of Positive Symptoms (SAPS) concerned with the estimation of time for remission and degree of remission. They will also document the kind of treatment the patient has received. The more thorough evaluation will be undertaken after 1 and 2 years, and will be carried out by the two allocated PhD students alone.

The National Schizophrenia project (DNS) started locally on 01.10.1997, with the aim of researching the effect of supportive analytical psychotherapy as supplement to the rest of the treatment. The data from OPUS is anonymous, according to usual standards.

Responsible for the local project is: Ralf Hemmingsen, Merete Nordentoft and Per Vendsborg.

Description of the OPUS project at DC-Vesterbro
The OPUS project on Vesterbro (OPUSV), started on April 1^st 1998 and by December 23^rd 1999, it had 35 patients and is capable of taking 60. The patients were continuously admitted to the project up on till December 31^st 2000. The whole project is expected to last 5 years. The team consists of:

- 1 Psychiatrist
- 1 Mental Health Nurse
- 1 Psychologist
- 1 Social Advisor
- 1 Occupational Therapist

OPUSV admitted persons between 18 and 45, with first time psychotic outbreak or patients that had not yet been sufficiently treated. The patient could not have been treated with neuroleptica for more than 3 months and had to be in the schizophrenic spectre (including the patients with schizophrenia like symptoms).

If the patient was found adequate for the project and accepted it, there was a draw, in which the patient was either transferred to the project or to the standard treatment. If the patient’s psychological condition warranted hospitalisation and the patient had accepted it, he or she was transferred to U7 at Sct. Hans Hospital (SHH). This ward is part of the OPUS project..

The Treatment consists of 4 components:

- Case Manager (CM)
- Multi-Family group
- Medical treatment
- Social Skills training (SFT)

The Personal Contact Practitioner (CM):

- Offers contact to the patient at least once a week.
- Tries, together with the patient, to find the root of problems and helps the patient to take control of the patients life.
- If the patient is admitted, the CM upholds the contact.

Multi-Family group:

- Seeks to create a quick contact to the patient’s family.
- It starts with a ½ day lesson day for the patients and 1 whole day of lessons to the family.
- The first 3 sessions, with the family are related to the subject and without the patient’s participation.
- For the next 1½-years the families meet, in a mixed group, every second week, for 90 minutes.
- In these sessions, the focus is on problem solving models and training in problem solving, as well as trying the solutions set up.

Medical Treatment:

- Anti psychotic medicine is preferred (Risperdal and Zyprexa).
- The smallest doses necessary are preferred.

Social Skills Training (SFT):

- Is offered by need.
- It will be evaluated whether or not the patient needs individual or group treatment.
- The group treatment lasts a year and shifts between 1 and 2 days a week.
- There are 6-8 patients in each group, and 2 trainers (therapists).
- Every SFT group treatment is divided into 5 modules. These modules contain teaching and training in:

         Medicine.
         Symptom Control.
         Discourse Therapy.
         Conflict Solving.
         Problem Solving.

Methods

         Homework.
         Role games and video recording.
         Group Dynamics.

All OPUSV team members are Case Managers and group therapists, either in a Multiple-Family group or/and Social Skills training (SFT). They are supervised on the SFT groups, by a specially trained psychologist (Irene Öesterich), once a month. In the Multiple-Family groups they are also supervised every second week by a psychiatrist. Furthermore, they are twice a year given lectures, by McFarlane and have two tutorial days a year, with Anne Fjeld (Norway).

Half way results
In December 1999, after the project had been running for nearly 2 years, it was the contention of OPUSV that patients provided with the OPUS project treatment continued maintained more clinical contact than patients who received the standard treatment.

In the first 2½ years more than 500 project participants were included and an even larger number have been interviewed. It means that 250 project participants are either receiving, or have received, treatment by the OPUS project either in Copenhagen or in Århus, half in each centre. Another 250 are receiving standard treatment.

Sample Data (concerning the first 500 project participants):

Men/women             61/39 %

Average age             27 year

Average length of psychosis  25 month

Misuse of alcohol or drugs    26 %

Live on their own          58 %

Work income             13 %

Results after the first year of treatment
The results of the scientific research investigation reported here are based on interviews of patients one year after they where included in the project. The results shows that the patients admitted to the OPUS-team treatment performed better in a number of areas compared to those patients admitted to the standard treatment. Those areas are:

1. Reduction of psychotic symptoms such as hallucinations and delusions. (Hallucinations - OPUS treatment 66%, standard treatment 56%. Delusions - OPUS treatment 71%, standard treatment 66%).

2. Reduction of negative symptoms such as low engagement and initiative. (Engagement -OPUS treatment 52%, standard treatment 27%. Initiative - OPUS treatment 46%, standard treatment 36%).

3. Compliance with psychosocial intervention and medical treatment. (Full compliance with medical treatment - OPUS treatment 60%, standard treatment 42%. Compliance with psychosocial intervention treatment - OPUS treatment 76%, standard treatment 45%).

4. Satisfaction with the treatment. (Very satisfied - OPUS treatment 32%, standard treatment 20%. Over all satisfaction - OPUS treatment 83%, standard treatment 74%).

5. Satisfaction amongst family and relatives. (60% of the families and relatives are satisfied with the OPUS treatment and 26% of the families and relatives are satisfied with the standard treatment).

6. Families and relatives engagement in the treatment measured by participation in follow up interviews. (OPUS treatment 59%, standard treatment 40 %)

The patients connected to the OPUS treatment had a significant reduction in hallucinations, delusions and negative symptoms such as low engagement and initiative than the patients connected to standard treatment. Those symptoms have a major impact on the patient’s social competence.Regarding both OPUS treatment and standard treatment it showed that the families and relatives developed more knowledge about schizophrenia and subjectively they felt better. There was no significance between the two types of treatment but a lager group of family and relatives were involved in the OPUS treatment.

References and Bibliography

Return to the Top • Return to What’s New

Copyright© 2000 International Society of
Psychiatric-Mental Health Nurses
All rights reserved.
Developed and hosted by ProAccess, Inc.
Questions and comments to webmaster@proaccess.net