STABILITY AND CHANGE IN NEEDS OF PATIENTS WITH SCHIZOPHRENIC DISORDERS - A 15 AND 17-YEAR FOLLOW-UP FROM FIRST ONSET OF PSYCHOSIS, AND A COMPARISON BETWEEN OBJECTIVE AND SUBJECTIVE ASSESSMENTS OF NEEDS FOR CARE

Need for care was studied in a Dutch incidence cohort of patients with schizophrenic disorders 15 and 17 years from first onset of psychosis . Long-term course of the disorders varied from complete remission and full community participation to chronic psychosis and longterm hospit al stay. Fifty patients were assessed twice with the Needs For Care As sessment Schedule (NFCAS, Brewin and Wing 1989); at the latter follow- up an assessment was also made using the Camberwell Assessment of Need (CAN, Phelan et al. 1995). The NFCAS is an investigator-or profession al-based instrument which provides an 'objective' assessment of needs. Need for care was recorded in 22 areas of clinical and social functio ning. Comparison of the two assessments over a 2-year period demonstra ted a high stability on the individual items (mean 88%, mostly concern ing the absence of a problem twice), but did not show the expected sta bility of need status among this group of patients with chronic disord ers. One in five patients (22%) had no needs at all on both occasions and 56% of the patients showed a change in needs. There was more negat ive than positive change: 28% suffered from new unmet needs at the 17- year follow-up, while only 12% had improved their status to no needs. About one-third (36%) had at least one unmet need, mostly regarding ps ychotic symptoms, dyskinesia or underactivity. The CAN provides a 'sub jective' assessment of needs according to the view of patients themsel ves. The problems patients reported most commonly were in the areas of day-time activities, social relationships and information on their co ndition and treatment, for all which they asked for more help than the y received. This patient-based instrument produces slightly higher num bers of problems and unmet needs, and a lower ratio between met and un met needs. There is an overall percentage of 21% of disagreement betwe en patient and investigator view regarding the unmet need status. Agre ement between the two instruments on the nature of the problems with u nmet needs was lacking altogether.