Predicting community survival in early psychosis and schizophrenia populations after receiving intensive case management.
OBJECTIVE
The study was undertaken to assess whether social and living skills functioning predicted community survival between subjects with chronic schizophrenia and early episode psychosis after receiving assertive community-based case management.


METHODS
Forty-two chronic schizophrenia patients and 49 early psychosis subjects were measured on hospitalisation for up to 3 years after receiving equivalent community-based assertive case management. A Kaplan-Meier survival analysis was performed to compare community survival between the two groups. A Cox-regression analysis was used to investigate whether sex, age, social and occupational functioning measured by the social and occupational functional assessment score (SOFAS), living skills measured by the life skills profile score (LSP), and overall role functioning measured by the role functioning scale (RFS) predicted community survival. Subscales of the LSP were also analysed in a subsequent Cox-regression using the forward selection method.


RESULTS
Differences in rate of community survival were not statistically significant (using the log-rank Chi-squared test) between subjects with early psychosis and chronic schizophrenia; however, half of the early psychosis subjects survived past the 12-month period while only a third of the chronic schizophrenia subjects did so within the same time period. The life skill profile was a significant predictor of community survival with low scores on the subscale of non-turbulence (i.e. antisocial behaviour) contributing to poorer community survival.


CONCLUSIONS
The amount of antisocial behaviour displayed while receiving assertive community-based case management may be an important predictor of community survival among subjects with early psychosis and chronic schizophrenia. Treatment of such behaviour may improve community survival among these populations.
Preston
N J
NJ
Fremantle Hospital and Health Service, Western Australia, Australia. neil.preston@health.wa.gov.au
D000203:Activities of Daily Living / Q000523:psychology*; D000328:Adult; D019090:Case Management; D002908:Chronic Disease; D003156:Community Mental Health Services; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D010359:Patient Readmission / Q000706:statistics & numerical data; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000534:rehabilitation; D012050:Rehabilitation, Vocational; D012559:Schizophrenia / Q000534:rehabilitation*; D012565:Schizophrenic Psychology; D016019:Survival Analysis; D016896:Treatment Outcome