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BACKGROUND: In the era of deinstitutionalization, increasing numbers of schizophrenia patients reside and receive rehabilitational treatment within the framework of community hostels. The quality of staff-patient relationships is a crucial determinant of the rehabilitational process outcome. METHOD: This study examined the characteristics of 56 schizophrenia hostel residents, measured the degree of staff criticism and rejection expressed towards these patients and assessed the contribution of residents and staff characteristics to the induction of staff rejection. Measures included assessments of patients' symptoms using the Positive and Negative Syndrome Scale (PANSS), staff attitudes using the Patient Rejection Scale (PRS), and patients' living skills using the Independent Living Skills Survey (ILSS). RESULTS: Young, relatively inexperienced instructors represented 60% of the hostels staff. Residents' symptoms and staff rejection levels were overall low. However, significantly increased rejection was expressed towards patients who were more symptomatic, as measured by PANSS total and positive symptoms scores and had diminished job-related and health care living skills. Staff older age and longer professional experience were correlated with higher rejection scores. LIMITATIONS: Relatively small sample size and catchment area. CONCLUSIONS: These findings highlight the need for a better definition and understanding of schizophrenia residents selection criteria and treatment goals in community hostels. Moreover, they suggest that improvements in this area should be coupled with the provision of specialized staff training aiming at the achievement of more flexible staff attitudes. Within this framework, the PRS may serve as a practical, cost-effective tool for monitoring crucial aspects of staff-patients relationships.

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The use of atypical antipsychotic agents is associated with the induction of both an indolent progression to insulin-resistant diabetes and an idiosyncratic beta-cell toxicity presenting as diabetic ketoacidosis, both of which are usually reversible or improved subsequent to cessation of treatment. The underlying mechanisms are unclear at present. Nonetheless, in light of the now numerous reports on the adverse metabolic effects of these drugs, the Consensus Development Conference which met in November 2003 recommends that metabolic risks be considered when starting atypical antipsychotic drugs. Their operative checklist includes baseline screening of candidates for antipsychotic treatment, which includes personal/family history of diabetes, weight, waist circumference, blood pressure, fasting plasma glucose and fasting lipid profile, and then follow-up of these parameters. Furthermore, the health professionals, patients, family and caregivers should be aware of the signs and symptoms of diabetes, especially when acute decompensation occurs which is commensurate with diabetic ketoacidosis. We wish, through this short report, to raise the awareness of physicians treating psychiatric patients to the possibility of new-onset diabetes during therapy with atypical antipsychotic drugs and to emphasize the necessity for increased vigilance and close metabolic follow-up of these patients. Moreover, the choice of the best antipsychotic treatment for each patient should take into consideration the diabetogenic effect of the different treatment options as well the other side effects.

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BACKGROUND: This study examined whether transition from hospital to hostel improves patients' quality of life (QOL). METHOD: In a longitudinal prospective study comparing the QOL of 16 patients who moved to a hostel with that of 20 who remained hospitalized, we posited that the former would exhibit improved QOL. We also assessed the reliability of psychiatric patients' reports by comparing them with staff reports. RESULTS: No changes were reported in the QOL of hospitalized patients, whereas those who moved to the hostel exhibited significant improvement in all aspects of life, as reflected in the World Health Organizations Quality of Life measure (WHOQOL-BREF), reports by patients and staff and subjective (but not objective) indicators in the TL30s questionnaire. Patients' reports reflect a higher QOL improvement than staff reports but both display similar trends regarding changes in QOL. CONCLUSIONS: It was concluded that the move from the hospital to the hostel improved the QOL of the patients.

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A.L., a 42-yr-old man has been in treatment at our out- patient clinic since 1992 suffering from psychotic manifestations following a second severe closed-head injury. The patient had his first contact with a psychiatrist 3 yr after his first severe head injury in 1962 (when 10 yr old). During his first hospitalization (in 1994) he presented with signs of affective flattening and behavioural problems and indications of borderline intellectual functioning or mild mental retardation. The patient underwent several surgical interventions. The early inter-operative period was complicated by behavioural problems and a lack of motivation. At that time his intellectual tests (WAIS) showed a decline of results to a level of 60-80 in verbal tests, with a significant decrease in performance results. However, after further surgery, his intellectual condition improved enabling him to complete a secondary-school education, get married and start work as an industrial worker. From that time onwards he had no contact with psychiatrists, nor did he receive any medication treatment.