Neogi Rajarshi, Chakrabarti Subho, Grover Sandeep
Rajarshi Neogi, Subho Chakrabarti, Sandeep Grover, Department of Psychiatry, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India.
World J Psychiatry. 2016 Dec 22;6(4):431-441. doi: 10.5498/wjp.v6.i4.431.
To investigate health-care needs and their correlates among patients with remitted bipolar disorder (BD) compared to patients with remitted schizophrenia.
Outpatients with BD ( = 150) and schizophrenia ( = 75) meeting clearly defined remission criteria were included in the study along with their relatives. Diagnostic ascertainment was carried out using the Mini International Neuropsychiatric Interview. Demographic and clinical details were recorded using structured formats. Residual symptoms were assessed using standardized scales. Health-care needs were assessed on two separate scales. The principal instrument employed to assess health-care needs was the Camberwell Assessment of Need-Research version (CAN-R). To further evaluate health-care needs we felt that an additional instrument, which was more relevant for Indian patients and treatment-settings and designed to cover those areas of needs not specifically covered by the CAN-R was required. This instrument with a structure and scoring pattern similar to the CAN-R was used for additional evaluation of needs. Patients' level of functioning was assessed using the Global Assessment of Functioning Scale and their quality of life (QOL) using the World Health Organization Quality Of Life-BREF version in Hindi.
An average of 6-7 needs was reported by patients with BD as well as their relatives. Commonly reported needs were in the areas of economic and welfare needs, informational needs, social needs and the need for treatment. According to the CAN-R, both patients and relatives reported that more than 60% of the total needs were being met. However, over 90% of the needs covered by the additional evaluation were unmet according to patients and relatives. Needs in the areas of economic and welfare-benefits, information, company, daytime activities and physical health-care were largely unmet according to patients and relatives. Total, met and unmet needs were significantly higher for schizophrenia, but the most common types of needs were quite similar to BD. Relatives reported more needs than patients with certain differences in the types of needs reported. Level of patients' functioning was the principal correlate of greater total and unmet needs in both groups. Significant associations were also obtained with residual symptoms and QOL.
The presence of unmet needs in remitted patients with BD was an additional marker of the enduring psychosocial impairment characteristic of the remitted phase of BD.
与缓解期精神分裂症患者相比，调查缓解期双相情感障碍（BD）患者的医疗保健需求及其相关因素。
符合明确缓解标准的BD门诊患者（n = 150）和精神分裂症门诊患者（n = 75）及其亲属纳入本研究。使用迷你国际神经精神访谈进行诊断确定。使用结构化表格记录人口统计学和临床细节。使用标准化量表评估残留症状。在两个单独的量表上评估医疗保健需求。用于评估医疗保健需求的主要工具是坎伯韦尔需求评估研究版（CAN-R）。为了进一步评估医疗保健需求，我们认为需要一个额外的工具，该工具对印度患者和治疗环境更相关，并且旨在涵盖CAN-R未专门涵盖的那些需求领域。这个结构和评分模式与CAN-R相似的工具用于需求的额外评估。使用功能总体评估量表评估患者的功能水平，并使用印地语版世界卫生组织生活质量简表评估他们的生活质量（QOL）。
BD患者及其亲属平均报告了6 - 7项需求。常见报告的需求领域包括经济和福利需求、信息需求、社会需求和治疗需求。根据CAN-R，患者和亲属均报告超过60%的总需求得到满足。然而，根据患者和亲属的报告，额外评估涵盖的需求中超过90%未得到满足。根据患者和亲属的报告，经济和福利利益、信息、陪伴、日间活动和身体健康护理领域的需求在很大程度上未得到满足。精神分裂症患者的总需求、已满足需求和未满足需求显著更高，但最常见的需求类型与BD相当相似。亲属报告的需求比患者更多，在报告的需求类型上存在某些差异。患者的功能水平是两组中总需求和未满足需求增加的主要相关因素。还发现与残留症状和生活质量存在显著关联。
缓解期BD患者存在未满足的需求是BD缓解期持久心理社会损害特征的一个额外标志。
