1. GLOBAL FUNCTIONING OF PATIENTS WITH DIFFERENT DIAGNOSES
Aleš Logar, Peter Pregelj
University Psychiatric Clinic Ljubljana
GLOBAL FUNCTIONING OF PATIENTS WITH DIFFERENT DIAGNOSES

2. Psychiatric emergency unit (PEU)
established at Outpatient Psychiatry Centre of University Psychiatric Clinic Ljubljana in 2004
outpatient unit, operating during working hours (8:00 AM – 16:00 PM Monday till Friday)
a psychiatric nurse and a psychiatrist
patiets may arrive through their own request or a referral from another doctor (GP or other specialities)
after examination and initial treatment patients are referred to further out- or inpatient treatment
at presentation evaluated patients with Clinical Global Ipressions scale (CGI) and Global Assessment Scale (GAS)

3. Clinical Global Impressions Scale (CGI)
developed for use in NIMH-sponsored clinical trials to provide a brief assessment of the clinician's view of the patient's global functioning prior to and after initiating a study medication
two components:
CGI-Severity component
CGI-Improvement component

4. Clinical Global Impressions Scale (CGI)
seven-point scale:
1=normal, not at all ill,
2=borderline mentaly ill,
3=mildly ill,
4=moderately ill,
5=markedly ill,
6=severely ill,
7=among the most extremely ill patients

5. Global Assessment Scale (GAS)
a single rating scale for evaluating the overall functioning of a subject from psychological or psychiatric sickness to health
designed for the use of clinicians, the data can be collected from patients, reliable informant, or a case record
scale values range from 1, which represents the hypothetically sickest individual, to 100, the hypothetically healthiest

6. Global Assessment Scale (GAS)
divided into ten equal intervals: 1 to 10, 11 to 20, and so on to 81 to 90 and 91 to 100
doing very well
81-90 doing well
71-80 doing all right, minor impairment
61-70 some problems in one area only
51-60 some noticable problems in more than one area
41-50 obvious problems, moderate imapirment or severe in one area
31-40 serious problems, major impairment in several areas and unable to function in one area
21-30 severe porblems, unable to function in almost all situations
11-20 very severely impaired, considerable supervision is required for safety
1-10 extremely imapaired, constant supervision is required for safety
0 means not enough data

7. Global Assessment Scale (GAS)
Global Assessment of Functioning Scale (GAF) was later developed from GAS
GAF was in introduced as a 5th axis of 5 axis classification system developed for the 3rd edition of The Diagnostic and Statistical Manual of Mental Disorders (DSM III)
5th axis renounced with DSM V in 2015).

8. Hypothesis
global functioning of patients examined and treated at PEU was different in different diagnostic groups

9. Methods: diagnostic groups of patients from ICD 10:
F organic, incl. symptomatic, mental disorders
F disorders due to psychoactive substance use
F schizophrenia, scizotypal and delusional disorders
F mood (affective) disorders
F neurotic, stress related and somatophorm disorders
F with onset usually in childhood and adolescence
data from medical documentation about patient's age, gender, diagnoses and her/his overall functioning that was gathered at presentation in PEU

10. 735 patients evaluated with Clinical Global Impressions-Severity scale (CGI)
618 patients evaluated with Global Assessment Scale (GAS)
global functioning of patients compared according to diagnostic groups (F00-09, F10- 19, F20-29, F30-39, F40-49, F90-99)
patients assigned to different diagnostic groups according to their main clinical diagnosis, comorbidities were diagnosed but not taken in account statistically

11. Results majority: fewest: similar numbers
neurotic, stress-related and somatoform disorders
mood disorders
fewest:
organic, including simptomatic, mental disorders
similar numbers
mental and behavioral disorders due to psychoactive substance use
schizophrenia, schizotypal and delusional disorders
behavioural and emotional disorders with onset usually occuring in childhood and adolescence and unspecified mental disorder

12. CGI N
GAS
F 00-09 41 37
F 10-19 87 73
F 20-29 61
F 30-39
202
156
F 40-49
266
225
F 90-99 66
735
618

13. Heaviest impairment of global functioning:
schizophrenia, schizotypal and delusional disorders (CGI=5,05, GAS=47,57)
organic, including simptomatic, mental disorders (CGI=3,98, GAS=49,03)
Less affected:
mood disorders (CGI=3,80, GAS=58,70)
mental and behavioral disorders due to psychoactive substance use (CGI=3,39, GAS=62,18)

14. Best functioning:
neurotic, stress-related and somatoform disorders (CGI=3,06, GAS=67,26)
behavioural and emotional disorders with onset usually occuring in childhood and adolescence and unspecified mental disorder (CGI=2,79, GAS=70,02)
Average score:
CGI=3, – mildly and 4 – moderately ill
GAS=61, – some problems in one area only ( – some noticable problems in more than one area)

15. CGI p=0,05: p=0,05: p=0,05: p=0,05: p=0.05: p=0.05:
F F F F F F00-09
F F F F F20-29
F F F F F30-39
F40-49
F90-99

16. GAS
P=0, p=0, p=0, p=0, p=0, p=0,05
F F F F F F00-09
F F F F F F20-29
F F F F F30-39
F F F90-99

17. Conclusions
data confirms that global funcioning is associated with type of mental disorder
impairment of global functioning is the heaviest in schizophrenia and organic disorders
global functioning of patients with neurotic, stress-relating disorders and behavioral and emotional disorders is least affected
possibly useful in work capacity evaluation