The Impact of the Covid-19 Pandemic on Schizophrenia Patients Registered With the Community Mental Health Center

Study Overview
=================
Brief Summary
-----------------
This study aimed to examine the effect of the Covid-19 pandemic on schizophrenia patients registered to the Community Mental Health Center (CMHC) in terms of depression, suicide risk, and tendency to violence.

Detailed Description
-----------------
The study was conducted on patients registered to the Ministry of Health Kartal Dr. Lütfi Kırdar City Hospital Adatepe Community Mental Health Center and was followed up regularly. It was carried out on 108 individuals who met the diagnosis of schizophrenia according to the DSM-V (American Psychiatric Association 2013) and met the inclusion criteria. Individuals who were respectively classified as hospitalized group (HG) during the Covid-19 pandemic period (n=39), non-hospitalized with emergency care group (NHECG) without hospitalization (n=37), and non-hospitalized with non-emergency care group (NHNECG) (n=32). Individuals who had been diagnosed with schizophrenia for at least two years, were not in the active phase of the disease, did not have organic mental disorders, did not have any other psychiatric diseases were included in the study. In the study, the Socio-Demographic Questionnaire, the Calgary Depression Scale in Schizophrenia (CDSS), the Buss-perry Aggression Questionnaire (BPAQ), and the Suicide Probability Scale (SPS) were used.

Official Title
-----------------
The Impact of the Covid-19 Pandemic on Schizophrenia Patients Registered With the Community Mental Health Center

Conditions
-----------------
Schizophrenia

Intervention / Treatment
-----------------
* Other: Hospitalized
* Other: Non-hospitalized with emergency care
* Other: Non-hospitalized and non-emergency care


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: between the ages of 18-65, receiving service from Kartal Dr. Lütfi Kırdar City Hospital Adatepe CMHC, having been diagnosed with schizophrenia for at least two years, not being in the active phase of the disease, not having an organic mental disorder, not having an additional psychiatric illness, and being literate Exclusion Criteria: Individuals with cognitive and physical dysfunction, mental retardation, different psychiatric diseases that would prevent interview or testing, and those who did not consent to participate in the study

Ages Eligible for Study
-----------------
Minimum Age: 18 Years
Maximum Age: 65 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Hospitalized group<br>Hospitalized patient (HP) stayed in hospital during the Covid-19 pandemic period | Other: Non-hospitalized with emergency care<br>* It is adapted from the Buss-Durkee Hostility Inventory by Buss and Perry (1992), the scale consists of 29 items and five-point Likert types. The scale is physical and verbal aggression, hostility, and anger. Questions 9 and 16 on the scale are reverse scored. The score value on the scale varies in direct proportion to the aggression, that is, the higher the score, the higher the aggression. The Cronbach Alpha internal consistency coefficients of the original version of the scale is defined as; 0.89 for physical aggression, 0.85 for physical aggression, 0.72 for verbal aggression, 0.77 for hostility, 0.83 for anger subscale.<br>Other: Non-hospitalized and non-emergency care<br>* Developed by Cull and Gill (1989), it evaluates the probability of suicide in adolescents and adults. The Turkish validity and reliability of the scale were performed by Atlı et al (2009). The scale consists of 36 items and is answered as a four-point Likert-type scale as never or rarely, sometimes, often and often or always.<br>|
| Non-hospitalized with Emergency care<br>Emergency care plan made but no hospitalization was included to this study during the Covid-19 pandemic period | Other: Hospitalized<br>* It was developed by Addington et al. (1994) to measure the presence of depression and the severity of depressive symptoms in patients with schizophrenia. The scale consists of 9 items to assess depression and is answered with a four-point Likert scale. The validity and reliability of the scale in schizophrenia patients in the Turkish population was determined by Oksay et al. by (2000). In the reliability study, the Cronbach's alpha coefficient was found to be 0.88. The cut-off point of the scale was stated as 11.<br>Other: Non-hospitalized and non-emergency care<br>* Developed by Cull and Gill (1989), it evaluates the probability of suicide in adolescents and adults. The Turkish validity and reliability of the scale were performed by Atlı et al (2009). The scale consists of 36 items and is answered as a four-point Likert-type scale as never or rarely, sometimes, often and often or always.<br>|
| Non-hospitalized and non-emergency care<br>Patients who neither apply to the emergency department nor are hospitalized was included to this study during the Covid-19 pandemic period | Other: Hospitalized<br>* It was developed by Addington et al. (1994) to measure the presence of depression and the severity of depressive symptoms in patients with schizophrenia. The scale consists of 9 items to assess depression and is answered with a four-point Likert scale. The validity and reliability of the scale in schizophrenia patients in the Turkish population was determined by Oksay et al. by (2000). In the reliability study, the Cronbach's alpha coefficient was found to be 0.88. The cut-off point of the scale was stated as 11.<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Calgary Depression Scale in Schizophrenia | It was developed by Addington et al. (1994) to measure the presence of depression and the severity of depressive symptoms in patients with schizophrenia. 19 The scale consists of 9 items to assess depression and is answered with a four-point Likert scale.The validity and reliability of the scale in schizophrenia patients in the Turkish population was determined by Oksay et al. by (2000). In the reliability study, the Cronbach&#39;s alpha coefficient was found to be 0.88. The cut-off point of the scale was stated as 11. | 6 months | 
| Buss-perry Aggression Questionnaire | It is adapted from the Buss-Durkee Hostility Inventory by Buss and Perry (1992), the scale consists of 29 items and five-point Likert types. 21 The scale is physical and verbal aggression, hostility, and anger. Questions 9 and 16 on the scale are reverse scored. The score value on the scale varies in direct proportion to the aggression, that is, the higher the score, the higher the aggression. The Cronbach Alpha internal consistency coefficients of the original version of the scale is defined as; 0.89 for physical aggression, 0.85 for physical aggression, 0.72 for verbal aggression, 0.77 for hostility, 0.83 for anger subscale. | 6 months | 
| Suicide Probability Scale | Developed by Cull and Gill (1989), it evaluates the probability of suicide in adolescents and adults. The Turkish validity and reliability of the scale were performed by Atlı et al (2009). The scale consists of 36 items and is answered as a four-point Likert-type scale as never or rarely, sometimes, often and often or always. | 6 months |