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Since the appearance of the two previous editions of Mental Health Outcome Measures (first published by Springer Verlag in 1996, with a second edition published by the Royal College of Psychiatrists in 2001), there have been several intriguing developments in the field. First, an even wider range of important outcome domains are now measurable using well standardised instruments than were measurable before. Second, a greater emphasis upon positive outcomes has evolved (for example referring to the concept of recovery) among researchers, service users and clinicians. Third, the voice of the service user/consumer is now centre stage to a much greater extent than in earlier years. This third edition refers to these three core themes throughout its pages. Nevertheless, the fundamentals remain unchanged, namely:
• the scales used must have known and strong psychometric properties (Chapter 2)
• evidence (both qualitative and quantitative) needs to be ascertained from the most rigorously scientifically designed studies (Chapter 3), taking into account the complexity of the intervention (Campbell et al, 2000, 2007; Tansella et al, 2006)
• in many outcome studies, symptom and social domains (such as quality of life and employment) need to be assessed concurrently (Chapters 5, 8, 9, 11, 13, 14 and 16)
• scales need to be applicable and relevant to a wide of settings to allow valid international comparisons (Chapter 17)
• an inclusive approach to the whole range of mental disorders is required, so that people are included whose conditions have sometimes been excluded from care, such as personality disorders (Chapter 15).
At the same time, a clear trend is now identifiable not so much to look at mental disorders in terms of their producing chronicity, impairment and severe disability but instead to emphasise the hope of recovery (Chapter 4). Central to this view is the participation of service users in research (Chamberlin, 2005) and a more nuanced approach to potential collaboration between people disclosing experience of mental illness, and others, in the development and use of outcome measures (Sweeney et al, 2009).
Considerable variations in the incidence of psychosis have been observed across countries, in terms of age, gender, immigration status, urbanicity and socioeconomic deprivation.
To evaluate the incidence rate of first-episode psychosis in a large area of north-eastern Italy and the distribution of the above-mentioned risk factors in individuals with psychoses.
Epidemiologically based survey. Over a 3-year period individuals with psychosis on first contact with services were identified and diagnosed according to ICD-10 criteria.
In total, 558 individuals with first-episode psychosis were identified during 3 077 555 person-years at risk. The annual incidence rate per 100 000 was 18.1 for all psychoses, 14.3 for non-affective psychoses and 3.8 for affective psychoses. The rate for all psychoses was higher in young people aged 20–29 (incidence rate ratio (IRR) = 4.18, 95% CI 2.77–6.30), immigrants (IRR = 2.26, 95% CI 1.85–2.75) and those living in the most deprived areas (IRR = 2.09, 95% CI 1.54–2.85).
The incidence rate in our study area was lower than that found in other European and North American studies and provides new insights into the factors that may increase and/or decrease risk for developing psychosis.
The balanced care model proposes that a comprehensive mental health system needs to include both community-and hospital-based care. The model is based on a structured review of scientific evidence, and is also informed by the experience of experts active in mental health system change in many countries worldwide.
Hippocampal shrinkage is commonly reported in schizophrenia, but its role in the illness is still poorly understood. In particular, it is unclear how clinical and psychosocial variables relate to hippocampal volumes.
To investigate neuroanatomic differences in the hippocampus using three-dimensional (3D) computational image analysis.
We used high-resolution magnetic resonance imaging and surface-based modelling to map the 3D profile of hippocampal differences in adults with schizophrenia (n=67) and a healthy control group (n = 72). Manual tracings were used to create 3D parametric mesh models of the hippocampus. Regression models were used to relate diagnostic measures to maps of radial distance, and colour-coded maps were generated to show the profile of associations.
There was no detectable difference between the schizophrenia and control groups in hippocampal radial distance. In the schizophrenia group, however, bilateral shape deflation was associated with greater illness severity (length of illness, positive and negative symptoms) and with poorer social functioning (educational level, quality of life and health status), which survived Bonferroni correction.
Illness severity and poor social functioning may be associated with hippocampal deflation in schizophrenia. As a structural sign of poor outcome, imaging measures might help to identify a subgroup of patients who may need specific treatment to resist hippocampal shrinkage, such as cognitive rehabilitation or physical exercise.