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Hofer A, Biedermann F, Kaufmann A, Kemmler G, Pfaffenberger NM, Yalcin-Siedentopf N. Self-esteem in stabilized individuals with chronic schizophrenia: association with residual symptoms and cognitive functioning. Eur Arch Psychiatry Clin Neurosci 2023; 273:1737-1746. [PMID: 36602648 PMCID: PMC10713693 DOI: 10.1007/s00406-022-01538-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 12/16/2022] [Indexed: 01/06/2023]
Abstract
Low self-esteem is regarded as a barrier to recovery from schizophrenia and the identification of factors affecting this psychological characteristic may help to implement effective therapeutic interventions. To this end, the present study aimed to assess whether residual symptoms of the disorder and performance on a comprehensive neuropsychological test battery might differently impact self-esteem among 70 stabilized outpatients with chronic schizophrenia from public outpatient mental health services. Self-esteem inter-correlated with the severity of overall symptomatology, affective and negative symptoms, with premorbid intelligence, and with performance in the domains of verbal learning and memory, visual memory, working memory, and verbal fluency. Residual affective symptoms, premorbid intelligence, and female sex predicted poorer self-esteem in multiple linear regression analysis. The findings of this study implicate that next to psychological interventions therapeutic strategies that specifically target affective symptoms of schizophrenia may have a beneficial impact on patients' self-esteem.
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Affiliation(s)
- Alex Hofer
- Division of Psychiatry I, Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria.
| | - Falko Biedermann
- Division of Psychiatry I, Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Alexandra Kaufmann
- Division of Psychiatry I, Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Georg Kemmler
- Division of Psychiatry I, Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Nicole M Pfaffenberger
- Division of Psychiatry I, Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Nursen Yalcin-Siedentopf
- Division of Psychiatry I, Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
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2
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Sun Y, Wang M, Yu H, Su H, Zhou Y. The relationship between self-esteem and mental disability in patients with schizophrenia: the mediating role of resilience and the moderating role of gender. PSYCHOL HEALTH MED 2023; 28:1985-1996. [PMID: 36101933 DOI: 10.1080/13548506.2022.2124294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 09/06/2022] [Indexed: 10/14/2022]
Abstract
This study aims to verify the mediating role of resilience between self-esteem and mental disability and to analyze the moderating role of gender in the relationship between resilience and mental disability in patients with schizophrenia. Patients with schizophrenia have been selected from Harbin Psychiatric (Baiyupao) Hospital and Daqing Third Hospital in Heilongjiang Province from January to December 2021. The study recruited a total of 220 patients with schizophrenia, including 120 males and 100 females to measure their self-esteem, resilience and mental disability. The results were as follows: Self-esteem and resilience are important protective factors that have a buffering effect on mental disability. The mediating effect of resilience on self-esteem and mental disability is stronger in males than in females. The results provide new ideas for delaying mental disability and for formulating intervention programs and applying them to clinical practice. The study indicates that psychiatric medical staff should not only treat the patients with schizophrenia psychotic symptoms but also improve their self-esteem and resilience through effective intervention to reduce the occurrence of mental disability.
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Affiliation(s)
- Yujing Sun
- Department of Nursing, Harbin Medical University Daqing Campus, Daqing, China
| | | | - Hong Yu
- Department of Nursing, Harbin Medical University Daqing Campus, Daqing, China
| | - Hong Su
- Department of Nursing, Harbin Medical University Daqing Campus, Daqing, China
| | - Yuqiu Zhou
- Department of Nursing, Harbin Medical University Daqing Campus, Daqing, China
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3
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Wood-Ross C, Tran T, Milanovic M, Jokic R, Milev R, Bowie CR. Neurocognition and Depressive Symptoms have Unique Pathways to Predicting Different Domains of Functioning in Major Depressive Disorder. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2023; 68:241-248. [PMID: 36411975 PMCID: PMC10037745 DOI: 10.1177/07067437221133375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Research has established the independent relationships between depressive symptoms to cognition and functioning in depression; however, little is known about the role of mediators in this relationship. We explored the role of neurocognitive abilities, depressive symptom severity, dysfunctional attitudes, and functional capacity in predicting two dimensions of daily functioning in individuals with major depressive disorder (MDD). METHODS One hundred and twenty-four participants (mean age = 46.26, SD = 12.27; 56% female) with a diagnosis of MDD were assessed on a standard neurocognitive battery, self-reported depressive symptoms, dysfunctional attitudes, and clinician-rated functional impairment. They completed a performance-based assessment of functional competence. RESULTS Confirmatory path analyses were used to model the independent and mediated effects of variables on two domains of functioning: social (relationships and social engagement) and productive (household and community activities). Cognition and depressive symptoms both predicted productive functioning, and dysfunctional attitudes mediated each of these relationships. Functional competence was a significant mediator in the relationship between neurocognition and productive functioning. Depressive symptoms and cognition were direct predictors of social functioning with no significant mediators. CONCLUSIONS There are divergent pathways to different dimensions of daily functioning in MDD. Measurement implications include the consideration of multiple levels of predicting productive activities and more direct relationships with social outcomes. Treatments that directly target depressive symptoms and cognition might not generalize to improvements in everyday functioning if additional pathways to functioning are not addressed.
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Affiliation(s)
| | - Tanya Tran
- Department of Psychology, Queen's University, Ontario, Canada
| | | | - Ruzica Jokic
- Department of Psychology, Queen's University, Ontario, Canada
- Centre for Neuroscience Studies, Queen's University, Ontario, Canada
| | - Roumen Milev
- Department of Psychology, Queen's University, Ontario, Canada
- Centre for Neuroscience Studies, Queen's University, Ontario, Canada
- Providence Care, Kingston, Ontario, Canada
| | - Christopher R Bowie
- Department of Psychology, Queen's University, Ontario, Canada
- Centre for Addictions and Mental Health, Ontario, Canada
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4
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Arneaud GJ, Kar A, Majumder S, Molodynski A, Lovett K, Kar S. Mental health disorders in English newspapers of India: A retrospective study. Int J Soc Psychiatry 2022; 69:646-652. [PMID: 36326007 DOI: 10.1177/00207640221132426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND In recent years there has been significant coverage of mental health in Indian newspapers; the media can play a significant role in perpetuating as well as reducing stigma towards people with mental illness. This paper analyses the content, context and type of newspaper coverage of various mental health disorders in English language newspapers in India between 2016 and 2021. METHODS A detailed analysis was performed on a sample of articles about mental illness in a range of English language Indian newspapers. RESULTS Depression was the most prevalent topic amongst the articles followed by anxiety, schizophrenia and bipolar disorder. Our study describes a wide range of use of mental health disorders in various newspapers. All diagnoses were generally described in a criminal context like homicide, sexual assault and other crimes. Over time newspaper coverage of mental illness has become less stigmatising. Further exploration of non-English medium newspapers is required to fully understand the extent of the role of print media in perpetuating unhelpful stereotypes of people with mental illness in India.
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Affiliation(s)
- Gervan J Arneaud
- Journey Behavioural Health Clinic, Port of Spain, Trinidad and Tobago
| | - Anindya Kar
- Advanced Neuropsychiatry Institute, Kolkata, India
| | - Sunrit Majumder
- Department of Internal Medicine, Burdwan Medical College & Hospital, India
| | - Andrew Molodynski
- Oxford Health NHS Foundation Trust, UK.,Department of Psychiatry, Oxford University, UK
| | - Kate Lovett
- Livewell Southwest, Cumberland Centre, Plymouth, UK.,Royal College of Psychiatrists, London, UK
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5
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Ebina K, Matsui M, Higuchi Y, Suzuki M. Premorbid intellectual ability in schizophrenia influence family appraisal related to cognitive impairments: a cross-sectional study on cognitive impairment and family assessments. BMC Psychiatry 2022; 22:227. [PMID: 35361170 PMCID: PMC8969239 DOI: 10.1186/s12888-022-03879-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 03/24/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Patients with schizophrenia are unaware of their cognitive impairments. Misperception of cognitive impairment is an important factor associated with real-world functional outcomes in patients with schizophrenia. The patient's family member plays a crucial role in detecting patients' cognitive impairments when the patients are unaware of their own cognitive impairments. Previous studies have reported that not only the patient's subjective rating, but also the patient's family members' rating of their cognitive impairment may not be precise. However, it is unclear why family ratings are inaccurate, and which factors impact family ratings. This study investigated whether family ratings differed significantly from the patients' subjective ratings of the patients' cognitive impairments and sought to determine the reason for the differences between the family ratings and the patients' neurocognitive performances. We investigated the relationship between patients' subjective ratings, family ratings for patients' cognitive impairments, neuropsychological performance, and other aspects, including premorbid IQ and clinical symptoms. METHOD We evaluated 44 patients with schizophrenia for cognitive function using neuropsychological tests; in addition, both the patients and their families rated the patients' cognitive impairments through questionnaires. We used the Mann-Whitney U test to examine whether the family ratings differed significantly from the patients' self-reported ratings of their cognitive impairment. We conducted multiple regression analysis and structural equation modeling to determine why the patients' subjective ratings and the family ratings were not definitively associated with the patients' neurocognitive performances. We performed multiple regression analysis with a stepwise method with neurocognitive performance, premorbid IQ, positive symptoms, and negative symptoms as independent variables and family ratings of patients' cognitive impairments as dependent variables. RESULTS We found that the family ratings differed significantly from the patients' subjective self-reported ratings of their cognitive impairments. Our results showed that the premorbid IQ of patients is the strongest predictor of family ratings. Furthermore, among the neurocognitive domains, only the processing speed of patients was associated with family ratings. CONCLUSIONS We found that the family ratings were not consistent with the patients' subjective self-reported ratings and the family ratings were most affected by the patients' premorbid intellectual abilities. These results suggest that the families' current assessments of the patients' current cognitive impairments were affected by the patients' premorbid intellectual ability rather than the patients' current neurocognitive performance. Patients' processing speed predicted family ratings; however, family members' ratings were not related to verbal learning/memory, executive function, and language of patients. Therefore, our findings highlight that patients' family ratings may differ from patients' subjective ratings, results of performance-based neuropsychological tests, and clinician ratings.
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Affiliation(s)
- Kota Ebina
- grid.9707.90000 0001 2308 3329Laboratory of Clinical Cognitive Neuroscience, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Mie Matsui
- Laboratory of Clinical Cognitive Neuroscience, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan. .,Laboratory of Clinical Cognitive Neuroscience, Institute of Liberal Arts and Science, Kanazawa University, Kanazawa, 920-1192, Japan.
| | - Yuko Higuchi
- grid.267346.20000 0001 2171 836XDepartment of Neuropsychiatry, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
| | - Michio Suzuki
- grid.267346.20000 0001 2171 836XDepartment of Neuropsychiatry, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
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6
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Dell'Osso L, Carpita B, Cremone IM, Gesi C, D'Ermo A, De Iorio G, Massimetti G, Aguglia E, Bucci P, Carpiniello B, Fagiolini A, Roncone R, Siracusano A, Vita A, Carmassi C, Maj M. Autism spectrum in patients with schizophrenia: correlations with real-life functioning, resilience, and coping styles. CNS Spectr 2021:1-11. [PMID: 33843551 DOI: 10.1017/s1092852921000353] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Previous researches highlighted among patients with schizophrenia spectrum disorders (SSD) a significant presence of autistic traits, which seem to influence clinical and functional outcomes. The aim of this study was to further deepen the investigation, evaluating how patients with SSD with or without autistic traits may differ with respect to levels of functioning, self-esteem, resilience, and coping profiles. METHODS As part of the add-on autism spectrum study of the Italian Network for Research on Psychoses, 164 outpatients with schizophrenia (SCZ) were recruited at eight Italian University psychiatric clinics. Subjects were grouped depending on the presence of significant autistic traits according to the Adult Autism Subthreshold Spectrum (AdAS Spectrum) instrument ("AT group" vs "No AT group"). Other instruments employed were: Autism Spectrum Quotient (AQ), Specific Levels of Functioning (SLOF), Self-Esteem Rating scale (SERS), Resilience Scale for Adults (RSA), and brief-COPE. RESULTS The "AT group" reported significantly higher scores than the "No AT group" on SLOF activities of community living but significantly lower scores on work skills subscale. The same group scored significantly lower also on SERS total score and RSA perception of the self subscale. Higher scores were reported on COPE self-blame, use of emotional support and humor domains in the AT group. Several correlations were found between specific dimensions of the instruments. CONCLUSION Our findings suggest the presence of specific patterns of functioning, resilience, and coping abilities among SSD patients with autistic traits.
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Affiliation(s)
- Liliana Dell'Osso
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Barbara Carpita
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Ivan Mirko Cremone
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Camilla Gesi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Arcangelo D'Ermo
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giovanni De Iorio
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Gabriele Massimetti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Eugenio Aguglia
- Department of Clinical and Molecular Biomedicine, Psychiatry Unit, University of Catania, Catania, Italy
| | - Paola Bucci
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Bernardo Carpiniello
- Section of Psychiatry, Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy
| | - Andrea Fagiolini
- Department of Molecular Medicine and Clinical Department of Mental Health, University of Siena, Siena, Italy
| | - Rita Roncone
- Unit of Psychiatry, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Alberto Siracusano
- Department of Systems Medicine, Psychiatry and Clinical Psychology Unit, Tor Vergata University of Rome, Rome, Italy
| | - Antonio Vita
- Psychiatric Unit, School of Medicine, University of Brescia, Brescia, Italy
- Department of Mental Health, Spedali Civili Hospital, Brescia, Italy
| | - Claudia Carmassi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Mario Maj
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
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7
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Tan EJ, Rossell SL, Lee SJ. Impaired meaning-based cognitive skills are specifically associated with poorer subjective quality of life in schizophrenia. ACTA ACUST UNITED AC 2020. [DOI: 10.1016/j.pmip.2020.100062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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8
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González-Blanch C, Medrano LA, Bendall S, D'Alfonso S, Cagliarini D, McEnery C, O'Sullivan S, Valentine L, Gleeson JF, Alvarez-Jimenez M. The role of social relatedness and self-beliefs in social functioning in first-episode psychosis: Are we overestimating the contribution of illness-related factors? Eur Psychiatry 2020; 63:e92. [PMID: 33032679 PMCID: PMC7681152 DOI: 10.1192/j.eurpsy.2020.90] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Objective Numerous research studies have demonstrated an association between higher symptom severity and cognitive impairment with poorer social functioning in first-episode psychosis (FEP). By contrast, the influence of subjective experiences, such as social relatedness and self-beliefs, has received less attention. Consequently, a cohesive understanding of how these variables interact to influence social functioning is lacking. Method We used structural equation modeling to examine the direct and indirect relationships among neurocognition (processing speed) and social cognition, symptoms, and social relatedness (perceived social support and loneliness) and self-beliefs (self-efficacy and self-esteem) in 170 individuals with FEP. Results The final model yielded an acceptable model fit (χ2 = 45.48, comparative fit index = 0.96; goodness of fit index = 0.94; Tucker–Lewis index = 0.94; root mean square error of approximation = 0.06) and explained 45% of social functioning. Negative symptoms, social relatedness, and self-beliefs exerted a direct effect on social functioning. Social relatedness partially mediated the impact of social cognition and negative symptoms on social functioning. Self-beliefs also mediated the relationship between social relatedness and social functioning. Conclusions The observed associations highlight the potential value of targeting social relatedness and self-beliefs to improve functional outcomes in FEP. Explanatory models of social functioning in FEP not accounting for social relatedness and self-beliefs might be overestimating the effect of the illness-related factors.
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Affiliation(s)
- César González-Blanch
- Mental Health Centre, University Hospital Marqués de Valdecilla - IDIVAL, Santander, Spain
| | - Leonardo A Medrano
- Faculty of Psychology, Pontificia Universidad Católica Madre y Maestra, Santiago de los Caballeros, Dominican Republic
| | - Sarah Bendall
- Orygen, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Simon D'Alfonso
- Orygen, Melbourne, Victoria, Australia.,School of Computing and Information Systems, University of Melbourne, Parkville, Victoria, Australia
| | - Daniela Cagliarini
- Orygen, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Carla McEnery
- Orygen, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Shaunagh O'Sullivan
- Orygen, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Lee Valentine
- Orygen, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - John F Gleeson
- Healthy Brain and Mind Research Centre and School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Victoria, Australia
| | - Mario Alvarez-Jimenez
- Orygen, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
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9
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Demirkol ME, Tamam L, Namlı Z, Uğur K, Karaytuğ MO. The Mediating Effect of Depression and Disability in the Relationship Between Schizophreniaand Self-Esteem. Psychiatr Q 2020; 91:363-378. [PMID: 31912456 DOI: 10.1007/s11126-019-09706-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Depressive symptoms, in addition to positive and negative symptoms, are commonly observed in the course of schizophrenia. These symptoms may cause disability and reduced self-esteem. Disability and lower self-esteem may disrupt the quality of life and lead to social isolation. Demonstrating the relationships among these concepts and correcting possible disturbances may help to augment treatment compliance and improve the prognosis. In this study, the Calgary Depression Scale for Schizophrenia (CDSS), the Positive and Negative Syndrome Scale for Schizophrenia (PANSS), the World Health Organization Disability Assessment Schedule 2.0 (WHODAS), and the Rosenberg Self Esteem Scale (RSES) were applied along with a sociodemographic data form to 146 patients with schizophrenia. Path analyses were used to demonstrate the direct effect of schizophrenia severity on self-esteem and its indirect effect through disability and depression, the mediating effect of depression in the relationship between schizophrenia severity and disability, and the mediator effect of disability in the bidirectional relationship between self-esteem and depression. Statistically significant results were obtained. In multivariate regression analysis, significant effects on disability were demonstrated for PANSS General Psychopathology subscale, CDSS, and RSES. These data suggest that attention should be focused on concepts such as depression, disability, and self-esteem in schizophrenia patients.
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Affiliation(s)
- Mehmet Emin Demirkol
- Department of Psychiatry, Çukurova University Medical School, Psikiyatri Anabilim Dalı, Çukurova Üniversitesi Tıp Fakültesi Balcalı Hastanesi 01330 Sarıçam, Adana, Turkey
| | - Lut Tamam
- Department of Psychiatry, Çukurova University Medical School, Psikiyatri Anabilim Dalı, Çukurova Üniversitesi Tıp Fakültesi Balcalı Hastanesi 01330 Sarıçam, Adana, Turkey.
| | - Zeynep Namlı
- Department of Psychiatry, Şanlıurfa Mehmet Akif Inan State Hospital, Şanlıurfa, Turkey
| | - Kerim Uğur
- Department of Psychiatry, Malatya Training and Research Hospital, Malatya, Turkey
| | - Mahmut Onur Karaytuğ
- Department of Psychiatry, Dr Ekrem Tok Hospital for Mental and Nervous Disesase, Adana, Turkey
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10
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Hofer A, Baumgartner S, Edlinger M, Hummer M, Kemmler G, Rettenbacher MA, Schweigkofler H, Schwitzer J, Fleischhacker WW. Patient outcomes in schizophrenia I: correlates with sociodemographic variables, psychopathology, and side effects. Eur Psychiatry 2020; 20:386-94. [PMID: 16171653 DOI: 10.1016/j.eurpsy.2005.02.005] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2004] [Accepted: 02/02/2005] [Indexed: 10/25/2022] Open
Abstract
AbstractObjectiveThe present cross-sectional study examined the relationships of psychopathology, side effects, and sociodemographic factors with treatment outcomes in terms of patients' quality of life (QOL), functioning, and needs for care.MethodSixty outpatients with chronic schizophrenia who had been treated with either clozapine or olanzapine for at least 6 months were investigated.ResultsMost psychopathological symptoms as well as psychic side effects, weight gain, and female sex were associated with lower QOL, while cognitive symptoms correlated with better QOL. Female sex, cognitive symptoms, and parkinsonism negatively influenced occupational functioning, and negative symptoms determined a lesser likelihood of living independently. Age, education, depression/anxiety, negative symptoms, and psychic side effects were predictors of patients' needs for care.ConclusionOur results highlight the complex nature of patient outcomes in schizophrenia. They reemphasize the need of targeting effectiveness, i.e. both symptomatic improvement as well as drug safety, in such patients.
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Affiliation(s)
- Alex Hofer
- Department of Biological Psychiatry, Innsbruck Medical University, Anichstrasse 35, A-6020 Innsbruck, Austria.
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11
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Setlaba NNC, Mosotho NL, Joubert G. Demographic, clinical and social characteristics of forensic patients diagnosed with schizophrenia at the Free State Psychiatric Complex, Bloemfontein, South Africa. PSYCHIATRY, PSYCHOLOGY, AND LAW : AN INTERDISCIPLINARY JOURNAL OF THE AUSTRALIAN AND NEW ZEALAND ASSOCIATION OF PSYCHIATRY, PSYCHOLOGY AND LAW 2020; 27:192-201. [PMID: 32944121 PMCID: PMC7476627 DOI: 10.1080/13218719.2019.1618751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Schizophrenia, prevalent in forensic mental health settings, is chronic and devastating, with a generally unfavourable course and prognosis. The aim of this study was to determine the demographic, clinical and social characteristics of forensic patients diagnosed with schizophrenia at the Free State Psychiatric Complex. A data collection form was used to gather information from the clinical records of patients diagnosed with schizophrenia between 1 January 2011 and 31 December 2015. The majority of the 110 participants were young male adults aged between 18 and 35 years with a low educational level. Cognitive impairment and positive symptoms were the most prominent clinical features. Aggressive and violent behaviour was notably prevalent. The majority of our sample had committed crimes against humans, while fewer had committed other types of crimes. It was concluded that causal factors included young adulthood, male gender, substance abuse, a poor social support system and lower educational level.
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Affiliation(s)
| | | | - Gina Joubert
- Department of Biostatistics, University of the Free State, Bloemfontein, South Africa
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12
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Kurtz MM, Gopal S, John S, Thara R. Objective psychosocial function vs. subjective quality-of-life in schizophrenia within 5-years after diagnosis: A study from southern India. Psychiatry Res 2019; 272:419-424. [PMID: 30611958 DOI: 10.1016/j.psychres.2018.12.149] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 12/28/2018] [Accepted: 12/28/2018] [Indexed: 10/27/2022]
Abstract
There is increasing interest from treaters and patients alike in subjective quality-of-life (sQOL) and objective psychosocial function as indices of treatment outcome in studies of schizophrenia. With the emergence of evidence-based treatment protocols (e.g., NIMH-funded Recovery after Initial Schizophrenia Episode Initiative) these outcomes are of particular significance in treatment studies of samples early in the course of their illness. Few studies have investigated demographic, clinical and cognitive factors associated with sQOL in samples early in the course of their illness and compared these factors to objective measures. We administered measures of sQOL or satisfaction with life, and objective psychosocial function to 59 people with schizophrenia within 5-years of diagnosis, along with standardized measures of symptoms and cognition. Results revealed that symptoms, rather than cognitive or demographic variables, were the best independent predictors of both subjective QOL and objective functioning. Positive symptoms were independent predictors of sQOL, while positive and negative symptoms were independent predictors of objective psychosocial status. Depression and cognition were also linked to sQOL. These findings point to the importance of attending to residual positive symptoms early in the treatment of schizophrenia as a means of possibly enhancing both subjective and objective outcome in early course schizophrenia.
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Affiliation(s)
- Matthew M Kurtz
- Department of Psychology and Program in Neuroscience and Behavior, Wesleyan University, Middletown, CT, USA.
| | | | - Sujit John
- Schizophrenia Research Foundation, Chennai, Tamil Nadu, India
| | - R Thara
- Schizophrenia Research Foundation, Chennai, Tamil Nadu, India
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13
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Predicting Predischarge Anhedonia Among Inpatients With Schizophrenia and Schizoaffective Disorders: A Large-scale Analysis. J Nerv Ment Dis 2019; 207:12-21. [PMID: 30575703 DOI: 10.1097/nmd.0000000000000923] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
This study sought to evaluate predischarge anhedonia level and its predictors in 125 inpatients with schizophrenia and schizoaffective disorders. Consecutively admitted inpatients were assessed before discharge from the hospital using the Specific Loss of Interest and Pleasure Scale (SLIPS) and a battery of measures for clinical and psychosocial variables. When symptoms, distress, and social anhedonia scores were controlled, the SLIPS score inversely correlated with self-constructs, social support, quality of life, recovery, and unmet needs. Using two cutoff points of the data set of SLIPS, we identified three groups: 19 (15.2%) patients reported "no loss of pleasure"; 46 (36.8%), "some loss of pleasure"; and 60 (48.0%), "marked diminishment of pleasure." The SLIPS score is predicted by sensitivity, unmet needs, deficient interpersonal pleasure, poor quality of life, and friend support. The study underlines the importance of assessing anhedonia and related psychosocial factors in patients with serious mental illness.
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Association of lifestyle-related factors and psychological factors on quality of life in people with schizophrenia. Psychiatry Res 2018; 267:382-393. [PMID: 29960260 DOI: 10.1016/j.psychres.2018.06.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 06/09/2018] [Accepted: 06/10/2018] [Indexed: 02/07/2023]
Abstract
In people with schizophrenia several factors are associated with poor quality of life (QoL), namely, lifestyle-related factors and psychological factors. However, there has been little research on the impact of these factors on QoL. Therefore, the relation between lifestyle-related factors, psychological factors, and QoL in people with schizophrenia was assessed. A cross-sectional study was conducted among 115 patients (25% women, 50% inpatients). QoL was measured by World Health Organisation Quality of Life- Brief Version. Lifestyle-related factors were assessed, namely physical activity (International Physical Activity Questionnaire- Short Form), sleep quality (Pittsburgh Sleep Quality Index) and dietary intake (Mediterranean Diet score). Psychological factors such as self-esteem (Rosenberg Self-Esteem Scale) and autonomous motivation (Behavioural Regulation Questionnaire- version 3) were also measured. Regression analyses were performed to identify significant predictors of QoL. Results showed that self-esteem predicted better global, physical, psychological and environmental QoL. Physical activity predicted better global and physical QoL, while sedentary time predicted poor social and environmental QoL. Identifying predictors of QoL has implication for the effective design and delivery of lifestyles interventions, including physical activity, dietary education and smoking cessation in people with schizophrenia. Adopting healthy lifestyles may lead to improved physical health, psychological well-being and QoL in this population.
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Allott K, Fraguas D, Bartholomeusz CF, Díaz-Caneja CM, Wannan C, Parrish EM, Amminger GP, Pantelis C, Arango C, McGorry PD, Rapado-Castro M. Duration of untreated psychosis and neurocognitive functioning in first-episode psychosis: a systematic review and meta-analysis. Psychol Med 2018; 48:1592-1607. [PMID: 29173201 DOI: 10.1017/s0033291717003002] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Previous reviews suggest there is minimal evidence for an association between duration of untreated psychosis (DUP) and neurocognition. This is based on tallied findings of studies with small samples and neurocognition viewed as a single construct. We aimed to conduct a systematic review and meta-analysis examining the association between DUP and individual neurocognitive domains and tests in first-episode psychosis (FEP). METHOD MOOSE and PRISMA guidelines were followed. Forty-three studies involving 4647 FEP patients were included. For studies providing correlations between DUP and neurocognition, 12 separate meta-analyses were performed based on neurocognitive domains/indices. The influence of demographic/clinical variables was tested using weighted linear meta-regression analyses. RESULTS The relationship between DUP and most neurocognitive domains/indices was not significant. Longer DUP was associated with a larger cognitive deterioration index, i.e. current minus premorbid intellectual functioning (N = 4; mean ES -0.213, 95% confidence interval (CI) (-0.344 to -0.074), p = 0.003). Findings were homogeneous, with no evidence of publication bias or significant influence from moderators. For studies providing mean and standard deviations for neurocognitive measures and DUP, 20 meta-regressions were performed on individual neurocognitive tests. One significant finding emerged showing that longer DUP was associated with fewer Wisconsin Card Sorting Test-perseverative errors (mean ES -0.031, 95% CI (-0.048 to -0.013), p < 0.001). Exploratory meta-regressions in studies with mean DUP <360 days showed longer DUP was significantly associated with poorer performance on Trail Making Test A and B and higher Full-Scale IQ. CONCLUSION There may not be a generalised association between DUP and neurocognition, however, specific cognitive functions may be associated with longer DUP or delayed help-seeking.
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Affiliation(s)
- K Allott
- Orygen,The National Centre of Excellence in Youth Mental Health,Parkville,Australia
| | - D Fraguas
- Department of Child and Adolescent Psychiatry,Hospital General Universitario Gregorio Marañón, CIBERSAM, IiSGM,School of Medicine,Universidad Complutense de Madrid,Madrid,Spain
| | - C F Bartholomeusz
- Orygen,The National Centre of Excellence in Youth Mental Health,Parkville,Australia
| | - C M Díaz-Caneja
- Department of Child and Adolescent Psychiatry,Hospital General Universitario Gregorio Marañón, CIBERSAM, IiSGM,School of Medicine,Universidad Complutense de Madrid,Madrid,Spain
| | - C Wannan
- Department of Psychiatry,Melbourne Neuropsychiatry Centre,The University of Melbourne and Melbourne Health,Parkville,Australia
| | - E M Parrish
- Orygen,The National Centre of Excellence in Youth Mental Health,Parkville,Australia
| | - G P Amminger
- Orygen,The National Centre of Excellence in Youth Mental Health,Parkville,Australia
| | - C Pantelis
- Department of Psychiatry,Melbourne Neuropsychiatry Centre,The University of Melbourne and Melbourne Health,Parkville,Australia
| | - C Arango
- Department of Child and Adolescent Psychiatry,Hospital General Universitario Gregorio Marañón, CIBERSAM, IiSGM,School of Medicine,Universidad Complutense de Madrid,Madrid,Spain
| | - P D McGorry
- Orygen,The National Centre of Excellence in Youth Mental Health,Parkville,Australia
| | - M Rapado-Castro
- Department of Child and Adolescent Psychiatry,Hospital General Universitario Gregorio Marañón, CIBERSAM, IiSGM,School of Medicine,Universidad Complutense de Madrid,Madrid,Spain
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DeRosse P, Nitzburg GC, Blair M, Malhotra AK. Dimensional symptom severity and global cognitive function predict subjective quality of life in patients with schizophrenia and healthy adults. Schizophr Res 2018; 195:385-390. [PMID: 29056491 PMCID: PMC5908765 DOI: 10.1016/j.schres.2017.10.018] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 08/23/2017] [Accepted: 10/09/2017] [Indexed: 11/28/2022]
Abstract
Over the last several decades Quality of Life (QoL) has become increasingly important as an indicator of treatment outcomes; particularly in schizophrenia spectrum disorders because of its close association with functional disability. Numerous studies seeking to elucidate the factors that contribute to QoL in this population have implicated both symptom severity and cognition in determining QoL but the findings have been mixed. The critical factors that appear to impede the lack of consensus in the extant literature examining determinants of QoL include the heterogeneity of the samples and measures examined as well as medication effects across different studies. Thus, the present study sought to address some of these issues by examining the relationship between subjective QoL and both symptom severity and cognitive function in a relatively homogeneous patient sample of patients and a community control sample assessed for dimensional symptom severity. Our results suggest that both global cognitive function and psychiatric symptoms have a significant impact on the subjective QoL of both people with schizophrenia spectrum disorders and psychiatrically healthy adults. Specifically, we found that a global index of cognition as well as self-reported avolitional and depressive symptoms were significantly predictive of QoL in both samples. These findings highlight the importance of addressing cognitive, depressive and avolitional symptoms in the treatment of patients with schizophrenia spectrum disorders and suggest that improvements in these domains may have a meaningful impact on their overall QoL.
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Affiliation(s)
- Pamela DeRosse
- Hofstra-Northwell School of Medicine, Department of Psychiatry, Hempstead, NY, USA; Center for Psychiatric Neuroscience, The Feinstein Institute for Medical Research, Manhasset, NY, USA; Division of Psychiatry Research, The Zucker Hillside Hospital, Division of Northwell Health, Glen Oaks, NY, USA.
| | - George C. Nitzburg
- Center for Psychiatric Neuroscience, The Feinstein Institute for Medical Research, Manhasset, NY, USA,Division of Psychiatry Research, The Zucker Hillside Hospital, Division of Northwell Health, Glen Oaks, NY, USA,Teachers College, Columbia University, New York, NY, USA
| | - Melanie Blair
- Center for Psychiatric Neuroscience, The Feinstein Institute for Medical Research, Manhasset, NY, USA,Division of Psychiatry Research, The Zucker Hillside Hospital, Division of Northwell Health, Glen Oaks, NY, USA,Graduate Center, City University of New York, New York, NY, USA
| | - Anil K. Malhotra
- Hofstra-Northwell School of Medicine, Department of Psychiatry, Hempstead, NY, USA,Center for Psychiatric Neuroscience, The Feinstein Institute for Medical Research, Manhasset, NY, USA,Division of Psychiatry Research, The Zucker Hillside Hospital, Division of Northwell Health, Glen Oaks, NY, USA
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Färdig R, Fredriksson A, Lewander T, Melin L, Mueser KT. Neurocognitive functioning and outcome of the Illness Management and Recovery Program for clients with schizophrenia and schizoaffective disorder. Nord J Psychiatry 2016; 70:430-5. [PMID: 26936087 DOI: 10.3109/08039488.2016.1146797] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The relationship between psychosocial programming and neurocognition has been established in previous research, but has not been explored in the context of the Illness Management and Recovery Program (IMR). This study examined associations between neurocognition and illness self-management skills acquisition, based on two previous trials of IMR. Neurocognitive functioning was assessed at baseline and post-treatment in 53 participants with schizophrenia or schizoaffective disorder who completed the IMR. Illness self-management was measured by the client and clinician versions of the Illness Management and Recovery Scale. Statistical analyses investigated improvements in neurocognitive functioning and possible association between illness self-management skills acquisition and neurocognitive functioning. Speed of processing as measured by the Trail Making Test A, was related to client-reported acquisition of illness self-management skills, before and after controlling for psychiatric symptoms and medication, but did not predict improvement in clinician ratings of client illness self-management skills. However, when controlling for client session attendance rates, the association between speed of processing and client-reported illness self-management skills acquisition ceased to be statistically significant, which suggests that compromised neurocognitive functioning does not reduce response to training in illness self-management in itself. The association between the frequency of attended IMR sessions and outcome of the IMR seems to decrease the negative impact of compromised neurocognition on illness self-management skills acquisition. Also, clients with slower speed of processing may experience less benefit from the IMR and may attend fewer sessions.
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Affiliation(s)
- Rickard Färdig
- a Department of Neuroscience and Psychiatry , Uppsala University Hospital , Uppsala , Sweden ;,d Akershus University Hospital, Division of Mental Health Services , Lørenskog , Norway
| | - Anders Fredriksson
- a Department of Neuroscience and Psychiatry , Uppsala University Hospital , Uppsala , Sweden
| | - Tommy Lewander
- a Department of Neuroscience and Psychiatry , Uppsala University Hospital , Uppsala , Sweden
| | - Lennart Melin
- b Department of Psychology , Uppsala University , Uppsala , Sweden
| | - Kim T Mueser
- c Center for Psychiatric Rehabilitation, Departments of Occupational Therapy, Psychology, and Psychiatry , Boston University , Boston , Massachusetts , USA
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Calibration and cross-validation of MCCB and CogState in schizophrenia. Psychopharmacology (Berl) 2015; 232:3873-82. [PMID: 26018529 DOI: 10.1007/s00213-015-3960-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 05/05/2015] [Indexed: 10/23/2022]
Abstract
RATIONALE Cognitive impairment associated with schizophrenia is a key predictor of functional outcomes. The FDA-accepted MATRICS Consensus Cognitive Battery (MCCB) is held to be the gold standard measure but there are concerns about its ease of administration, reliance on language causing problems with translation and possible practice effects. The CogState Schizophrenia Battery (SB) is suggested as a non-language-based alternative but there is no substantial, independent comparison. OBJECTIVES The objective of this study was to assess the reliability and validity of these two assessment batteries. METHODS One hundred forty-three participants with DSM-IV schizophrenia and schizoaffective disorder were recruited into three similar studies. Each study administered MCCB and SB tests on consecutive days (baseline 1 and 2) and follow-up 3-4 weeks later. RESULTS Batteries' test-retest reliability was similar: SB composites correlated r = 0.66-0.78 between baselines, MCCB domains r = 0.69-0.90. Baseline 2 and follow-up SB composites correlated r = 0.65-0.80 and MCCB domains r = 0.62-0.87. MCCB tasks' practice effects (Glass' ∆ = 0.02-0.46) exceeded SB's (Glass' ∆ = 0.02-0.34). While the batteries' total scores correlated strongly (r = 0.79-0.82), apparently equivalent cognitive domains on each battery (e.g. psychomotor-attention) correlated r = 0.22-0.60, indicating substantial differences between some supposed counterparts. CONCLUSIONS Clinical trials using either battery would benefit from initial practice sessions to ameliorate practice effects but the SB may be more suitable to measure change in the absence of repeated baselines. The MCCB domains' better correlations with social skills performance suggest that it may have an advantage for measuring cognition in relation to functional outcome.
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Siu CO, Harvey PD, Agid O, Waye M, Brambilla C, Choi WK, Remington G. Insight and subjective measures of quality of life in chronic schizophrenia. SCHIZOPHRENIA RESEARCH-COGNITION 2015; 2:127-132. [PMID: 26973810 PMCID: PMC4788499 DOI: 10.1016/j.scog.2015.05.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Lack of insight is a well-established phenomenon in schizophrenia, and has been associated with reduced rater-assessed functional performance but increased self-reported well-being in previous studies. The objective of this study was to examine factors that might influence insight (as assessed by the Insight and Treatment Attitudes Questionnaire [ITAQ] or PANSS item G12) and subjective quality-of-life (as assessed by Lehman QoL Interview [LQOLI]), using the large National Institute of Mental Health Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) dataset. Uncooperativeness was assessed by PANSS item G8 (“Uncooperativeness”). In the analysis, we found significant moderating effects for insight on the relationships of subjective life satisfaction assessment to symptom severity (as assessed by CGI-S score), objective everyday functioning (as assessed by rater-administered Heinrichs–Carpenter Quality of Life scale), clinically rated uncooperativeness (as assessed by PANSS G8), and discontinuation of treatment for all causes (all P < 0.05 for statistical interaction between insight and subject QoL). Patients with chronic schizophrenia who reported being "pleased" or "delighted" on LQOLI were found to have significantly lower neurocognitive reasoning performance and poorer insight (ITAQ total score). Our findings underscore the importance of reducing cognitive and insight impairments for both treatment compliance and improved functional outcomes.
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Affiliation(s)
| | - Philip D Harvey
- University of Miami Miller School of Medicine, Miami, FL, USA; Research Service, Bruce W. Carter VA Medical Center, Miami, FL, USA
| | - Ofer Agid
- Center for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Mary Waye
- Chinese University of Hong Kong, Shatin, N.T., Hong Kong
| | - Carla Brambilla
- Applied Mathematics and Information Technologies Institute, National Research Council, Milan, Italy
| | | | - Gary Remington
- Center for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, Canada
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Revicki DA, Kleinman L, Cella D. A history of health-related quality of life outcomes in psychiatry. DIALOGUES IN CLINICAL NEUROSCIENCE 2015. [PMID: 25152652 PMCID: PMC4140507 DOI: 10.31887/dcns.2014.16.2/drevicki] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Health-related quality of life (HRQoL) is a multidimensional concept that includes subjective reports of symptoms, side effects, functioning in multiple life domains, and general perceptions of life satisfaction and quality. Rather than estimating it from external observations, interview, or clinical assessment, it is best measured by direct query. Due to a perception that respondents may not be reliable or credible, there has been some reluctance to use self-report outcomes in psychiatry. More recently, and increasingly, HRQoL assessment through direct patient query has become common when evaluating a range of psychiatric, psychological, and social therapies. With few exceptions, psychiatric patients are credible and reliable reporters of this information. This article summarizes studies that highlight the development, validation, and application of HRQoL measures in psychiatry. Thoughtful application of these tools in psychiatric research can provide a much-needed patient perspective in the future of comparative effectiveness research, patient-centered outcomes research, and clinical care.
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Affiliation(s)
| | | | - David Cella
- Department of Medical Social Sciences, Northwestern University, Chicago, Illinois, USA
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21
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The impact of neuropsychological functioning and coping style on perceived stress in individuals with first-episode psychosis and healthy controls. Psychiatry Res 2015; 226:128-35. [PMID: 25618467 DOI: 10.1016/j.psychres.2014.12.032] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 08/22/2014] [Accepted: 12/21/2014] [Indexed: 11/22/2022]
Abstract
Stress is implicated in the development and course of psychotic illness, but the factors that influence stress levels are not well understood. The aim of this study was to examine the impact of neuropsychological functioning and coping styles on perceived stress in people with first-episode psychosis (FEP) and healthy controls (HC). Thirty-four minimally treated FEP patients from the Early Psychosis Prevention and Intervention Centre, Melbourne, Australia, and 26 HC participants from a similar demographic area participated in the study. Participants completed a comprehensive neuropsychological test battery as well as the Coping Inventory for Stressful Situations (task-, emotion- and avoidance-focussed coping styles) and Perceived Stress Scale (PSS). Linear regressions were used to determine the contribution of neuropsychological functioning and coping style to perceived stress in the two groups. In the FEP group, higher levels of emotion-focussed and lower levels of task-focussed coping were associated with elevated stress. Higher premorbid IQ and working memory were also associated with higher subjective stress. In the HC group, higher levels of emotion-focussed coping, and contrary to the FEP group, lower premorbid IQ, working memory and executive functioning, were associated with increased stress. Lower intellectual functioning may provide some protection against perceived stress in FEP.
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Prouteau A, Atzeni T, Tastet H, Bergua V, Destaillats JM, Verdoux H. Neurocognitive insight and executive functioning in schizophrenia. Cogn Neuropsychiatry 2015; 20:64-71. [PMID: 25359274 DOI: 10.1080/13546805.2014.973486] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION This study explored whether integrity of executive functioning is required for good neurocognitive insight (NI) in subjects with schizophrenia. METHODS NI was measured by subtracting executive difficulties (errors in the Modified Card Sorting Task) from executive cognitive complaints (Subjective Scale to Investigate Cognition in Schizophrenia) in 40 outpatients with schizophrenia and 42 normal controls. The schizophrenia sample was a priori divided into two subgroups on the basis of executive level. Multivariate analyses were conducted to compare groups and to control for potential confounding factors. RESULTS Only the schizophrenia dysexecutive subgroup had a poorer NI compared to normal controls. Group differences remained significant after adjustment for potential confounding factors (education, depression, anxiety and self-esteem). CONCLUSION These results provide support for the hypothesis that executive dysfunctioning is a limiting factor for NI, independently from depressive and anxiety symptoms.
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Affiliation(s)
- Antoinette Prouteau
- a "Psychologie, Santé et Qualité de vie" , Univ Bordeaux , EA 4139, F-33000 , Bordeaux , France
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Hacioglu Yildirim M, Alantar Z, Yildirim EA. The relationship between working status and symptoms, quality of life and self-esteem in patients with schizophrenia in Turkey. Int J Soc Psychiatry 2014; 60:646-55. [PMID: 24319053 DOI: 10.1177/0020764013511791] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Schizophrenia is a severe mental disorder with substantial socioeconomic burden associated with poorer psychosocial functioning during the course of illness. In schizophrenia patients, multiple factors play a role in occupational functioning. AIM It was aimed to investigate the relationship between different working conditions and quality of life and self-esteem on patients with schizophrenia in Turkey. METHODS A total of 100 patients diagnosed as schizophrenic were divided into three groups: competitive working, supported working and unemployed. RESULTS The groups did not differ significantly with regard to psychotic symptoms, self-esteem and illness history. Working was associated with higher scores on quality of life subscales especially in supported working group, whereas unemployed patients had more depressive symptoms and autonomic drug side effects. CONCLUSION Structured working programs which may improve social life of patients with schizophrenia in many aspects is warranted in Turkey.
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Affiliation(s)
- Munevver Hacioglu Yildirim
- Department of Psychiatry, Psychotic Disorders Inpatient Clinic, Bakirkoy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey
| | - Zeynep Alantar
- Department of Psychiatry, Psychotic Disorders Inpatient Clinic, Bakirkoy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey
| | - Ejder A Yildirim
- Department of Psychiatry, Psychotherapy Outpatient Clinic, Bakirkoy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey
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Patrick RE, Rastogi A, Christensen BK. Effortful versus automatic emotional processing in schizophrenia: Insights from a face-vignette task. Cogn Emot 2014; 29:767-83. [DOI: 10.1080/02699931.2014.935297] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Wang CS, Wu JYW, Chang WC, Chuang SP. Cognitive functioning correlates of self-esteem and health locus of control in schizophrenia. Neuropsychiatr Dis Treat 2013; 9:1647-54. [PMID: 24194641 PMCID: PMC3814929 DOI: 10.2147/ndt.s51682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
AIM The study aimed to investigate the relationship among sociodemographic factors, neurocognitive factors, self-esteem, and health locus of control in patients diagnosed with schizophrenia. We examined the self-esteem, internal health locus of control, and external health locus of control through sociodemographic and neurocognitive factors. METHODS Forty-six schizophrenic patients and 31 healthy residents from the community or hospital were recruited as the control group. All subjects participated in the self-esteem questionnaire, health locus of control questionnaire, and a series of neuropychological measures. RESULTS Multiple regression analysis revealed that inhibition of attention and external health locus of control were predictors for self-esteem (r=-0.30, P<0.05; r=0.41, P<0.01); inhibition of attention and external health locus of control were contributors for internal health locus of control (r=-0.43, P<0.01; r=0.61, P<0.001); and education was related to external health locus of control (r=-0.31, P<0.05). CONCLUSION The current study integrated background characteristics and cognitive function to better understand the impact of self-esteem and health locus of control in schizophrenia. The findings indicated that inhibition of attention, external health locus of control, and education contributed to self-esteem, internal health locus of control and external health locus of control. However, the overall predicted variance accounted for by these predictors was small; thus, further research is necessary to examine imperative variables related with self-esteem and health locus of control in schizophrenia.
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Affiliation(s)
- Chien-Shu Wang
- Department of Psychiatry, Zuoying Branch of Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan
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Kurtz MM, Bronfeld M, Rose J. Cognitive and social cognitive predictors of change in objective versus subjective quality-of-life in rehabilitation for schizophrenia. Psychiatry Res 2012; 200:102-7. [PMID: 22769048 PMCID: PMC3475729 DOI: 10.1016/j.psychres.2012.06.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2012] [Revised: 06/11/2012] [Accepted: 06/15/2012] [Indexed: 11/19/2022]
Abstract
A small but growing body of work has studied the role of cognitive skills in predicting response to integrated programs of rehabilitation in schizophrenia. No studies however, have directly compared the roles and interrelationships of cognition, social cognition and other disease factors in predicting improvements in the separate domains of objective quality-of-life (QOL) and subjective satisfaction with life (SWL) in response to rehabilitation in schizophrenia. Forty-four outpatients with schizophrenia were administered measures of cognition, social cognition, and symptoms at entry to a psychosocial and cognitive rehabilitation program. Change in objective QOL and subjective SWL before and after treatment were measured as outcome variables. Cognitive measures of verbal memory and social cognitive measures of facial affect recognition were linked to improvements in objective QOL, while verbal memory and crystallized verbal skill was linked to improvements in SWL. Facial affect recognition partially mediated the relationship between verbal memory and improvements in objective QOL. The implications of these findings for understanding interrelationships between cognition and social cognition and their role in predicting change in different domains of outcome as a function of behavioral treatment are discussed.
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Affiliation(s)
- Matthew M Kurtz
- Department of Psychology, Quantitative Analysis Center and Program in Neuroscience and Behavior, Wesleyan University, Middletown, CT 06459, USA.
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Kurtz MM. Cognitive remediation for schizophrenia: current status, biological correlates and predictors of response. Expert Rev Neurother 2012; 12:813-21. [PMID: 22853789 DOI: 10.1586/ern.12.71] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Cognitive remediation (CR) is an increasingly studied behavioral intervention for improving illness-linked cognitive deficits in schizophrenia, with considerable promise for improving the disease outcome when offered in concert with other therapies. We present findings from a comprehensive, critical review of the extant literature on CR for schizophrenia. Conclusions from six meta-analyses presented to date are summarized, and existing CR interventions are categorized into three major classes: restorative, strategy-based and hybrid approaches. The crucial elements and empirical support for each class are presented. Studies of predictors of treatment response suggest that attention, motivation and clinician expertise, along with the measures of 'brain reserve', are key features of a positive treatment response. Lastly, findings from studies of neuroimaging indicate that CR is accompanied by structural and functional neural changes in key frontal and temporal brain regions.
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Affiliation(s)
- Matthew M Kurtz
- Department of Psychology and Program in Neuroscience and Behavior, Wesleyan University, Judd Hall, 207 High Street, Middletown, CT 06459, USA.
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Reininghaus U, Priebe S. Measuring patient-reported outcomes in psychosis: conceptual and methodological review. Br J Psychiatry 2012; 201:262-7. [PMID: 23028084 DOI: 10.1192/bjp.bp.111.107615] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND There are calls to use patient-reported outcomes (PROs) routinely across mental health services. However, the use of PROs in patients with psychosis has been questioned. AIMS To examine the concepts and measures of four widely used PROs: treatment satisfaction, subjective quality of life, needs for care and the quality of the therapeutic relationship. METHOD We conducted a literature search of academic databases on concepts, characteristics and psychometric properties of the four PROs in patients with psychosis. RESULTS Although numerous concepts and measures have been published, evidence on the methodological quality of existing PROs is limited. Measures designed to assess distinct PROs showed a considerable conceptual, operational and empirical overlap, and some of them also included specific aspects. The impact of symptoms and cognitive deficits appears unlikely to be of clinical significance. CONCLUSIONS The popularity of PROs has not been matched with progress in their conceptualisation and measurement. Based on current evidence, some recommendations can be made. Distinct and short measures with clinical relevance and sufficient psychometric properties should be preferred. Future research should optimise the validity and measurement precision of PROs, while reducing assessment burden.
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Bechi M, Riccaboni R, Ali S, Fresi F, Buonocore M, Bosia M, Cocchi F, Smeraldi E, Cavallaro R. Theory of mind and emotion processing training for patients with schizophrenia: preliminary findings. Psychiatry Res 2012; 198:371-7. [PMID: 22425473 DOI: 10.1016/j.psychres.2012.02.004] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Revised: 02/02/2012] [Accepted: 02/06/2012] [Indexed: 02/07/2023]
Abstract
Impairments in social cognition are critical predictors of social functioning in patients with schizophrenia. Emotion processing (EP) and theory of mind (ToM) are hypothesized to influence real-world behavior more directly than basic cognition and represent important targets of intervention. The use of video scenes depicting human interactions could constitute an appropriate tool to enhance understanding of the characters' behavior and stimulate inferences on mental states. The aim of our pilot study was to evaluate longitudinally, with a controlled trial, the feasibility and the efficacy of a single-paradigm emotion recognition and ToM training designed for outpatients affected by schizophrenia, with the goal to create an ecological treatment, overcoming artificial laboratory biases, by the use of specific videotaped material. Fifty-two outpatients were randomly assigned to an EP and ToM video-based training (n=27) or to a standard social cognitive rehabilitation treatment (n=24). They were assessed before and after 12 weeks of intervention and compared to a time-matched control group (n=24). Our results show a statistically significant improvement in ToM abilities, confirming the hypothesis of the enhancing potential of social cognitive interventions, but no changes with respect to EP; despite the need for a deeper examination, these data support further development of this treatment approach.
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Affiliation(s)
- Margherita Bechi
- Department of Clinical Neurosciences, San Raffaele Universitary Scientific Institute Hospital, Vita-Salute San Raffaele University, Milano, Italy.
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Edmondson M, Pahwa R, Lee KK, Hoe M, Brekke JS. A dual change model of life satisfaction and functioning for individuals with schizophrenia. Schizophr Res 2012; 139:110-5. [PMID: 22591780 PMCID: PMC3608427 DOI: 10.1016/j.schres.2012.04.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Revised: 04/18/2012] [Accepted: 04/20/2012] [Indexed: 11/27/2022]
Abstract
Despite the notion that increases in functioning should be associated with increases in life satisfaction in schizophrenia, research has often found no association between the two. Dual change models of global and domain-specific life satisfaction and functioning were examined in 145 individuals with schizophrenia receiving community-based services over 12 months. Functioning and satisfaction were measured using the Role Functioning Scale and Satisfaction with Life Scale. Data were analyzed using latent growth curve modeling. Improvement in global life satisfaction was associated with improvement in overall functioning over time. Satisfaction with living situation also improved as independent functioning improved. Work satisfaction did not improve as work functioning improved. Although social functioning improved, satisfaction with social relationships did not. The link between overall functioning and global life satisfaction provides support for a recovery-based orientation to community based psychosocial rehabilitation services. When examining sub-domains, the link between outcomes and subjective experience suggests a more complex picture than previously found. These findings are crucial to interventions and programs aimed at improving functioning and the subjective experiences of consumers recovering from mental illness. Interventions that show improvements in functional outcomes can assume that they will show concurrent improvements in global life satisfaction as well and in satisfaction with independent living. Interventions geared toward improving social functioning will need to consider the complexity of social relationships and how they affect satisfaction associated with personal relationships. Interventions geared towards improving work functioning will need to consider how the quality and level of work affect satisfaction with employment.
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Affiliation(s)
- Melissa Edmondson
- University of Southern California, School of Social Work, 669 W. 34th St., Los Angeles, CA 90089-0411, United States.
| | - Rohini Pahwa
- University of Southern California, School of Social Work, 669 W. 34th St., Los Angeles, CA 90089-0411, United States
| | - Karen Kyeunghae Lee
- University of Kansas, School of Social Welfare, 1545 Lilac Lane, Lawrence, KS 66045-3129, United States
| | - Maanse Hoe
- Keimyung University, College of Social Science, Department of Social Welfare, 2800 Dalgubeoldaero, Dalseo-Gu, Daegu 704-701, South Korea
| | - John S. Brekke
- University of Southern California, School of Social Work, 669 W. 34th St., Los Angeles, CA 90089-0411, United States
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Quality of life among Egyptian patients with schizophrenia disorder, impact of psychopathology. MIDDLE EAST CURRENT PSYCHIATRY 2012. [DOI: 10.1097/01.xme.0000415298.98046.43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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32
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Understanding the executive functioning heterogeneity in schizophrenia. Brain Cogn 2012; 79:60-9. [DOI: 10.1016/j.bandc.2012.01.008] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Accepted: 01/09/2012] [Indexed: 11/21/2022]
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Maat A, Fett AK, Derks E. Social cognition and quality of life in schizophrenia. Schizophr Res 2012; 137:212-8. [PMID: 22406280 DOI: 10.1016/j.schres.2012.02.017] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Revised: 01/31/2012] [Accepted: 02/14/2012] [Indexed: 12/14/2022]
Abstract
Schizophrenia is associated with poor quality of life (QOL). Whereas the effects of neurocognitive deficits and psychopathology on QOL of schizophrenia patients have recently been elucidated, little is known about social cognitive deficits in this regard. This study investigated the influence of social cognition on QOL in schizophrenia. A sample of 1032 patients, 1011 of their siblings, and 552 healthy controls was recruited from the Dutch Genetic Risk and Outcome in Psychosis (GROUP) study. Participants completed a battery of cognitive tests, including social cognitive tests on theory of mind and emotion perception. To assess QOL the World Health Organization QOL Assessment-BREF (WHOQOL-BREF) was used. Schizophrenia symptoms were assessed with the Positive and Negative Syndrome Scale (PANSS). Social cognitive performance was significantly worse in patients compared to siblings and healthy controls. Patients had the poorest QOL, while QOL in healthy controls was better than in siblings. Theory of mind but not emotion perception or neurocognition was associated with QOL in patients, whereas neurocognition was the only significant predictor of QOL in siblings and healthy controls. There was a significant interaction between theory of mind and symptom severity with respect to QOL. Our study indicates that social cognition is associated with QOL in schizophrenia. Theory of mind rather than emotion perception is associated with QOL, and this association is moderated by schizophrenia symptoms. In particular, patients with relatively unimpaired theory of mind and more severe schizophrenia symptoms have poor QOL and could therefore benefit from therapeutic intervention.
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Affiliation(s)
- Arija Maat
- Department of Psychiatry, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands
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Davis L, Kurzban S, Brekke J. Self-esteem as a mediator of the relationship between role functioning and symptoms for individuals with severe mental illness: a prospective analysis of Modified Labeling theory. Schizophr Res 2012; 137:185-9. [PMID: 22377104 DOI: 10.1016/j.schres.2012.02.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2011] [Revised: 02/01/2012] [Accepted: 02/03/2012] [Indexed: 11/24/2022]
Abstract
BACKGROUND Despite a growing body of evidence supporting the efficacy of psychosocial rehabilitation for individuals with severe mental illness (SMI), a large proportion of these individuals remain unable to maintain basic social roles such as employee, parent, or spouse. This study investigated whether changes in role functioning over time impact symptom severity indirectly through the mechanism of changes in self-esteem as posited by Modified Labeling theory. METHODS The study sample was composed of 148 individuals diagnosed with schizophrenia, schizoaffective disorder, bipolar disorder with psychotic features, and major depression with psychotic features who elected to participate in community-based psychosocial rehabilitation services. Measures of role functioning, self-esteem, and psychiatric symptoms were gathered at baseline and six months through a combination of structured clinical interviews and self-report surveys. RESULTS SEM results at baseline provided support for a model in which self-esteem fully mediated the relationship between role functioning and psychiatric symptoms. The final model explained 20% of the variance in psychiatric symptoms. Analyses at six months post-baseline (time 2) indicate that changes in self-esteem fully mediated the relationship between changes in role functioning and changes in psychiatric symptoms. The final change model explained 23% of the variance in changes in psychiatric symptoms. CONCLUSION Results provide empirical support for the principles underlying Modified Labeling theory. Implications include the need for interventions that focus on social participation as a means of improving self-esteem, thereby decreasing symptom exacerbation and future relapse for people with SMI.
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Affiliation(s)
- Lisa Davis
- University of Southern California, School of Social Work, USA.
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35
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Davis L, Kurzban S. Mindfulness-Based Treatment for People With Severe Mental Illness: A Literature Review. AMERICAN JOURNAL OF PSYCHIATRIC REHABILITATION 2012. [DOI: 10.1080/15487768.2012.679578] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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36
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Tolman AW, Kurtz MM. Neurocognitive predictors of objective and subjective quality of life in individuals with schizophrenia: a meta-analytic investigation. Schizophr Bull 2012; 38:304-15. [PMID: 20624752 PMCID: PMC3283161 DOI: 10.1093/schbul/sbq077] [Citation(s) in RCA: 132] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Quality of life (QOL) has been recognized as a crucial domain of outcome in schizophrenia treatment, and yet its determinants are not well understood. Recent meta-analyses suggest that symptoms have only a modest relationship to QOL (Eack SM, Newhill CE. Psychiatric symptoms and quality of life in schizophrenia: a meta-analysis. Schizophr Bull. 2007;33:1225-1237). Individuals with schizophrenia show 1-2 SD deficits on measures of elementary neurocognition, and links between these deficits and objective measures of community functioning (eg, employment and independent living) are well established. While objective measures of community functioning and measures of QOL would appear to be closely related, studies investigating the ability of neurocognitive variables to predict QOL in individuals with schizophrenia have yielded conflicting results. One potential explanation for opposing findings in the schizophrenia literature is the interchangeable use of objective and subjective indices of QOL. This study used quantitative methods of meta-analysis to clarify the relationship between neurocognitive determinants of objective QOL (ie, observable, clinician-rated) and subjective QOL (ie, patient satisfaction) separately in individuals with schizophrenia. A total of 20 studies (10 objective and 10 subjective) consisting of 1615 clients were aggregated from relevant databases. Weighted effect size analysis revealed that there were small-moderate relationships (d ≤ 0.55) between crystallized verbal ability, working memory verbal list learning, processing speed, and executive function and objective indices of QOL. In contrast, results revealed either nonsignificant or inverse relationships for the vast majority of neurocognitive measures and measures of subjective QOL. Moderating variables and implications for future research and treatment development are discussed.
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Affiliation(s)
| | - Matthew M. Kurtz
- To whom correspondence should be addressed; tel: 860-685-2072, fax: 860-685-2761, e-mail:
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37
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How family factors impact psychosocial functioning for African American consumers with schizophrenia. Community Ment Health J 2012; 48:45-55. [PMID: 21170737 PMCID: PMC8395533 DOI: 10.1007/s10597-010-9365-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2010] [Accepted: 11/15/2010] [Indexed: 10/18/2022]
Abstract
There is a critical need to test how family contextual factors impact outpatient consumer functioning in schizophrenia. This is the first study of two companion studies reported here that tests family factors' influence on consumer functioning. Ninety-three low income inner-city African American consumer-family dyads were tested to see the possible impact of family factors, based on the EE and family caregiver burden literatures, on consumer psychosocial functioning (work, social, and independent living). The results supported a model wherein greater amounts of family contact had a significant relationship with better consumer psychosocial functioning. Additionally, family dysfunction had a direct negative relationship to consumer psychosocial functioning while family pressures and resources had an indirect negative relationship to consumer psychosocial functioning. Results are in marked contrast to what impacted consumer clinical functioning for the same sample. The findings appear to confirm that family factors differently impact the domains of clinical and psychosocial functioning. These findings are new for understanding the contextual factors that impact consumer functioning, especially psychosocial functioning.
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Abstract
Cognitive functioning is moderately to severely impaired in patients with schizophrenia. This impairment is the prime driver of the significant disabilities in occupational, social, and economic functioning in patients with schizophrenia and an important treatment target. The profile of deficits in schizophrenia includes many of the most important aspects of human cognition: attention, memory, reasoning, and processing speed. While various efforts are under way to identify specific aspects of neurocognition that may lie closest to the neurobiological etiology and pathophysiology of the illness, and may provide relevant convergence with animal models of cognition, standard neuropsychological measures continue to demonstrate the greatest sensitivity to functionally relevant cognitive impairment.The effects of antipsychotic medications on cognition in schizophrenia and first-episode psychosis appear to be minimal. Important work on the effects of add-on pharmacologic treatments is ongoing. Very few of the studies completed to date have had sufficient statistical power to generate firm conclusions; recent studies examining novel add-on treatments have produced some encouraging findings. Cognitive remediation programs have generated considerable interest as these methods are far less costly than pharmacologic treatment and are likely to be safer. A growing consensus suggests that these interventions produce modest gains for patients with schizophrenia, but the efficacy of the various methods used has not been empirically investigated.
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Roe D, Mashiach-Eizenberg M, Lysaker PH. The relation between objective and subjective domains of recovery among persons with schizophrenia-related disorders. Schizophr Res 2011; 131:133-8. [PMID: 21669512 DOI: 10.1016/j.schres.2011.05.023] [Citation(s) in RCA: 138] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Revised: 05/19/2011] [Accepted: 05/23/2011] [Indexed: 01/25/2023]
Abstract
In recent years, growing emphasis has been placed on the vision of recovery, which is broadly organized into two types: clinical objective versus personal subjective. The purpose of the present study was to investigate the relation between objective clinical recovery as defined by symptom severity and level of functioning, and subjective personal recovery as defined by quality of life, domains of personal confidence and hope, willingness to ask for help, reliance on others and no domination by symptoms. One hundred and fifty-nine persons diagnosed with schizophrenia or schizoaffective disorder completed measures of recovery, quality of life, perceived social support and emotional loneliness. Clinicians used the Modified Brief Psychiatric Rating Scale and the Global Assessment Functioning Scale to assess the severity of symptoms and level of functioning. Results revealed no direct correlation between total score of observer ratings of symptoms and total score of subjective self-report of being in recovery. The relationship between total score of symptoms and total score of subjective self-report of recovery was moderated by the age of onset. Magnitude of the self-report of subjective recovery was related to higher levels of reported social support and lower levels of reported loneliness. Finally, analyses suggested that the impact of social support and loneliness upon self-reported recovery was mediated by quality of life. Taken together, results are consistent with literature suggesting that clinical objective recovery is not synonymous with personal subjective recovery yet can be conceptualized as complementary.
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Affiliation(s)
- David Roe
- Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel.
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Plath N, Lerdrup L, Larsen PH, Redrobe JP. Can small molecules provide truly effective enhancement of cognition? Current achievements and future directions. Expert Opin Investig Drugs 2011; 20:795-811. [PMID: 21510828 DOI: 10.1517/13543784.2011.574612] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION The prevalence of age-related diseases that implicate a deterioration of cognitive abilities is increasing. Moreover, cognitive decline occurs in numerous CNS disorders affecting patients at younger ages as well, resulting in reduced functional ability and quality of life. Despite the existence of few medications treating cognition, the need for efficacious treatment options to alleviate, halt or even prevent cognitive decline is generally unmet to date. Consequently, extensive research efforts are undertaken to identify medications that can effectively enhance cognition. AREAS COVERED This review covers ongoing clinical trials for cognition and reflects on efforts undertaken to increase the success rates of procognitive drug treatment. The review discusses ways to optimize the drug development process for cognition enhancing agents at the preclinical to clinical interface and provides concrete examples. EXPERT OPINION The existing efficacy readouts addressing cognition in preclinical research offer little translational validity to the clinical situation. In order to identify truly efficacious drug candidates, biomarkers need to be developed that directly address conserved mechanisms underlying cognitive performances. To this end, technologies such as neuroimaging or electroencephalography constitute promising entry points for identifying both the cognitive domain and the patient population most responsive to drug treatment.
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Affiliation(s)
- Niels Plath
- Synaptic Transmission, H. Lundbeck A/S, Ottiliavej 9, 2500 Valby, Denmark.
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41
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Kurtz MM, Tolman A. Neurocognition, insight into illness and subjective quality-of-life in schizophrenia: what is their relationship? Schizophr Res 2011; 127:157-62. [PMID: 21211943 PMCID: PMC3051009 DOI: 10.1016/j.schres.2010.12.004] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2010] [Revised: 12/01/2010] [Accepted: 12/06/2010] [Indexed: 11/16/2022]
Abstract
Subjective quality-of-life (SQOL) has been recognized as a crucial domain of outcome in schizophrenia treatment, and yet its determinants are not well understood. In a recent meta-analytic investigation of 10 studies of neurocognition and SQOL in schizophrenia (Tolman and Kurtz, Scz Bull, 2010) measures of crystallized verbal ability and processing speed were moderately negatively correlated with SQOL. One potential explanation for inverse relationships between measures of elementary neurocognition and SQOL is that higher levels of cognition may serve as a proxy for better insight into the illness, and better consequent recognition of illness-related functional impairment. This study sought to determine whether: (1) symptoms, neurocognitive variables, and insight into illness influence SQOL; and, (2) whether insight mediated or moderated a relationship between elementary neurocognitive function and SQOL. Seventy-one stabilized clients with schizophrenia or schizoaffective disorder were administered a neuropsychological test battery, symptom and subjective quality-of-life measures. Elementary neuropsychological measures of crystallized verbal ability, attention and working memory, and problem-solving were all inversely related to SQOL. Insight into illness and depression severity, but not positive and negative symptoms, was also inversely related to SQOL. Insight was not found to mediate or moderate any of the relationships between elementary neurocognition and SQOL. Taken together, these findings suggest that neurocognition and insight into illness have inverse relationships to SQOL and that elementary neurocognition does not influence SQOL through its link with illness insight.
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Affiliation(s)
- Matthew M. Kurtz
- To whom correspondence should be addressed: Department of Psychology, Wesleyan University, Judd Hall, 207 High Street, Middletown, CT. 06549; fax: 860-685-2761;
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Sawamura J, Morishita S, Ishigooka J. Is there a linear relationship between the Brief Psychiatric Rating Scale and the Clinical Global Impression-Schizophrenia scale? A retrospective analysis. BMC Psychiatry 2010; 10:105. [PMID: 21134296 PMCID: PMC3016312 DOI: 10.1186/1471-244x-10-105] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2010] [Accepted: 12/07/2010] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Although the Brief Psychiatric Rating Scale (BPRS) is widely used for evaluating patients with schizophrenia, it has limited value in estimating the clinical weight of individual symptoms. The aim of this study was 4-fold: 1) to investigate the relationship of the BPRS to the Clinical Global Impression-Schizophrenia Scale (CGI-SCH), 2) to express this relationship in mathematical form, 3) to seek significant symptoms, and 4) to consider a possible modified BPRS subscale. METHODS We evaluated 150 schizophrenia patients using the BPRS and the CGI-SCH, then examined the scatter plot distribution of the two scales and expressed it in a mathematical equation. Next, backward stepwise regression was performed to select BPRS items that were highly associated with the CGI-SCH. Multivariate regression was conducted to allocate marks to individual items, proportional to their respective magnitude. We assessed the influence of modifications to the BPRS in terms of Pearson's r correlation coefficient and r-squared to evaluate the relationship between the two scales. Utilizing symptom weighting, we assumed a possible BPRS subscale. RESULTS By plotting the scores for the two scales, a logarithmic curve was obtained. By performing a logarithmic transformation of the BPRS total score, the curve was modified to a linear distribution, described by [CGI-SCH] = 7.1497 × log10[18-item BPRS] - 6.7705 (p < 0.001). Pearson's r for the relationship between the scales was 0.7926 and r-squared was 0.7560 (both p < 0.001). Applying backward stepwise regression using small sets of items, eight symptoms were positively correlated with the CGI-SCH (p < 0.005) and the subset gave Pearson's r of 0.8185 and r-squared of 0.7198. Further selection at the multivariate regression yielded Pearson's r of 0.8315 and r-squared of 0.7036. Then, modification of point allocation provided Pearson's r of 0.8339 and r-squared of 0.7036 (all these p < 0.001). A possible modified BPRS subscale, "the modified seven-item BPRS", was designed. CONCLUSIONS Limited within our data, a logarithmic relationship was assumed between the two scales, and not only individual items of the BPRS but also their weightings were considered important for a linear relationship and improvement of the BPRS for evaluating schizophrenia.
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Affiliation(s)
- Jitsuki Sawamura
- Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan.
| | - Shigeru Morishita
- Depression Prevention Medical Center, Kyoto Jujo Rehabilitation Hospital, Kyoto, Japan
| | - Jun Ishigooka
- Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan
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Wittorf A, Wiedemann G, Buchkremer G, Klingberg S. Quality and correlates of specific self-esteem at the beginning stabilisation phase of schizophrenia. Psychiatry Res 2010; 179:130-8. [PMID: 20483167 DOI: 10.1016/j.psychres.2009.03.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2008] [Revised: 02/19/2009] [Accepted: 03/19/2009] [Indexed: 11/30/2022]
Abstract
In view of the potential importance of self-esteem in schizophrenia, there is a considerable lack of knowledge about the characteristics of specific self-esteem. The literature suggests that the experience of the self might be particularly destabilised in the transition phase between acute and remission points of the illness. Thus, the present study aims at examining the quality and correlates of different self-concepts at the beginning stabilisation phase of schizophrenia. In this study, 135 patients with schizophrenia were assessed 3 weeks after admission to inpatient treatment. Four central self-concepts were measured by the Frankfurt Self-Concept Scales (FSKN; Deusinger, I.M., 1986, Die Frankfurter Selbstkonzeptskalen (FSKN), Göttingen, Hogrefe). Clinical psychopathologic, neuropsychological and sociodemographic factors were analysed in two-step exploratory correlation and regression analyses to determine their relative contribution to self-concepts. The median of the four self-concepts ranged between -0.9 and -1.4 standard deviations below normative level. The relationship between negative symptoms and self-concepts was consistently significant, even when the contribution of depression was partialed out. In the multivariate analyses, these two symptom clusters explained up to 39% of the variances in our patients' self-evaluation. Neuropsychological dysfunctions were of relatively subordinate relevance for the patients' self-concepts. Thus, our results suggest that specific self-esteem at the point of beginning stabilisation of schizophrenia is significantly confounded not only by depression but also by negative symptoms.
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Affiliation(s)
- Andreas Wittorf
- Department of Psychiatry and Psychotherapy, University of Tuebingen, 72076 Tuebingen, Germany.
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Fett AKJ, Viechtbauer W, Dominguez MDG, Penn DL, van Os J, Krabbendam L. The relationship between neurocognition and social cognition with functional outcomes in schizophrenia: a meta-analysis. Neurosci Biobehav Rev 2010; 35:573-88. [PMID: 20620163 DOI: 10.1016/j.neubiorev.2010.07.001] [Citation(s) in RCA: 1217] [Impact Index Per Article: 86.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2010] [Revised: 06/30/2010] [Accepted: 07/01/2010] [Indexed: 11/28/2022]
Abstract
The current systematic review and meta-analysis provides an extended and comprehensive overview of the associations between neurocognitive and social cognitive functioning and different types of functional outcome. Literature searches were conducted in MEDLINE and PsycINFO and reference lists from identified articles to retrieve relevant studies on cross-sectional associations between neurocognition, social cognition and functional outcome in individuals with non-affective psychosis. Of 285 studies identified, 52 studies comprising 2692 subjects met all inclusion criteria. Pearson correlations between cognition and outcome, demographic data, sample sizes and potential moderator variables were extracted. Forty-eight independent meta-analyses, on associations between 12 a priori identified neurocognitive and social cognitive domains and 4 domains of functional outcome yielded a number of 25 significant mean correlations. Overall, social cognition was more strongly associated with community functioning than neurocognition, with the strongest associations being between theory of mind and functional outcomes. However, as three-quarters of variance in outcome were left unexplained, cognitive remediation approaches need to be combined with therapies targeting other factors impacting on outcome.
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Affiliation(s)
- Anne-Kathrin J Fett
- Department of Psychiatry and Neuropsychology, School of Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
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Ritsner M, Kurs R. Quality of life outcomes in mental illness: schizophrenia, mood and anxiety disorders. Expert Rev Pharmacoecon Outcomes Res 2010; 3:189-99. [PMID: 19807366 DOI: 10.1586/14737167.3.2.189] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Although health-related quality of life is an amorphous and heterogeneous concept, it has become an important outcome measure in the treatment of psychiatric disorders. This review illustrates the negative effects of distress/clinical factors (psychological distress, anxiety, depressive and negative symptoms) on quality of life of psychiatric patients. Contradictory findings have been reported regarding the relationship of positive symptoms, cognitive deficits and insight with quality of life scores among schizophrenia patients. Increasing evidence suggests that psychosocial or stress process related rather than clinical factors more accurately predict quality of life. The authors suggest that the impact of distress/clinical factors on subjective quality of life of mentally disordered patients is experienced through psychosocial factors. Limitations in current knowledge in this area are identified and suggestions for future research are provided.
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Affiliation(s)
- Michael Ritsner
- Acute Psychiatric Ward and Research Unit, Sha'ar Menashe Mental Health Center, Mobile Post Hefer 38814, Hadera, Israel.
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46
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Woon PS, Chia MY, Chan WY, Sim K. Neurocognitive, clinical and functional correlates of subjective quality of life in Asian outpatients with schizophrenia. Prog Neuropsychopharmacol Biol Psychiatry 2010; 34:463-8. [PMID: 20109511 DOI: 10.1016/j.pnpbp.2010.01.014] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2009] [Revised: 01/20/2010] [Accepted: 01/20/2010] [Indexed: 11/25/2022]
Abstract
Quality of life (QOL) impairment is evident in patients with schizophrenia and is increasingly recognised as an important evaluation criterion of treatment outcome. Hence, this study aimed to identify the neurocognitive, clinical and functional parameters associated with subjective QOL in patients with schizophrenia within an Asian context, and specifically in an outpatient setting. This study was conducted on 83 outpatients with DSM-IV diagnosis of schizophrenia, and 47 age- and gender-matched healthy controls. All participants were administered with the World Health Organisation Quality of Life Assessment-Brief Form (WHOQOL-BREF) and Brief Assessment of Cognition in Schizophrenia (BACS), to measure quality of life and cognitive function respectively. Patients were also assessed for severity of psychopathology, as well as level of psychosocial functioning, using the Positive and Negative Syndrome Scale (PANSS) and Global Assessment of Functioning (GAF) rating scales respectively. Specific psychopathology (greater severity of PANSS negative symptoms, general psychopathology subscale scores), cognitive deficits (working and verbal memories), and lower GAF scores were correlated with poorer QOL in patients. Multivariate analyses revealed that younger age, being single and lower level of psychosocial functioning were associated with poorer QOL but level of psychosocial functioning did not appear to mediate the effects of symptoms and neurocognitive deficits on QOL. Overall, this study highlighted the need for clinicians to pay more attention to these clinical, neurocognitive and functional parameters and their integrative relationships with QOL in order to optimise the treatment outcomes of patients with schizophrenia.
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Affiliation(s)
- Puay San Woon
- Research Division, Institute of Mental Health/Woodbridge Hospital, Singapore
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Grant PM, Beck AT. Defeatist beliefs as a mediator of cognitive impairment, negative symptoms, and functioning in schizophrenia. Schizophr Bull 2009; 35:798-806. [PMID: 18308717 PMCID: PMC2696369 DOI: 10.1093/schbul/sbn008] [Citation(s) in RCA: 246] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Poor social and vocational outcomes have long been observed in schizophrenia. Two of the most consistent predictors are negative symptoms and cognitive impairment. We investigate the hypothesis that cognitive content--defeatist beliefs regarding performance--provides a link between cognitive impairment, negative symptoms, and poor functioning in schizophrenia. A total of 77 individuals (55 patients diagnosed with schizophrenia or schizoaffective disorder and 22 healthy controls) participated in a cross-sectional study of psychopathology. Tests of memory, abstraction, attention, and processing speed, as well as current psychopathology, functioning, and endorsement of defeatist beliefs, were employed. Greater neurocognitive impairment was associated with elevated defeatist belief endorsement, higher negative symptom levels, and worse social and vocational functioning. Notably, statistical modeling indicated that defeatist belief endorsements were mediators in the relationship between cognitive impairment and both negative symptoms and functioning. These effects were independent of depression and positive symptom levels. The results add to the emerging biopsychosocial understanding of negative symptoms and introduce defeatist beliefs as a new psychotherapeutic target.
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Affiliation(s)
- Paul M Grant
- School of Medicine, University of Pennsylvania, 3535 Market Street, Room 2032, Philadelphia, PA 19104, USA.
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The relationships among perceived criticism, family contact, and consumer clinical and psychosocial functioning for African-American consumers with schizophrenia. Community Ment Health J 2009; 45:106-16. [PMID: 18841474 DOI: 10.1007/s10597-008-9165-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2008] [Accepted: 09/19/2008] [Indexed: 10/21/2022]
Abstract
This study examined whether Perceived Criticism (PC) was related to community functioning in a sample of African-American consumers with schizophrenia. The study tested assumptions from the Expressed Emotion literature that were based primarily on samples of white consumers. The study found that PC affected psychiatric symptomatology but not psychosocial functioning. Greater family contact was strongly related to better psychosocial functioning. Findings suggested that the nature and impact of contact between consumer and family for this sample of African-Americans appears different from what has been found in white, middle-class samples.
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Jabben N, van Os J, Burns T, Creed F, Tattan T, Green J, Tyrer P, Murray R, Krabbendam L. Is processing speed predictive of functional outcome in psychosis? Soc Psychiatry Psychiatr Epidemiol 2008; 43:437-44. [PMID: 18305883 DOI: 10.1007/s00127-008-0328-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2007] [Accepted: 02/08/2008] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate the contribution of processing speed in the prediction of various domains of outcome in psychosis. METHOD Data were drawn from the UK700 Case Management Trial of 708 patients with chronic psychotic illness. Regression analyses were applied to investigate cross-sectional and longitudinal associations between processing speed at baseline and measures of service use, social outcome and subjective outcome, taking into account current psychopathology and adjusting for baseline values of the outcome measure. RESULTS Cross-sectionally, processing speed was associated with all three domains of outcome, although only associations in the social and subjective outcome domain remained significant after controlling for psychopathology and the effects differed between and within domains of outcome. Prospectively, only the subjective outcome measure of number of met and unmet needs (CAN) was weakly associated with baseline neurocognitive performance after adjustment for baseline needs. Other associations disappeared after adjustment for the baseline measure of outcome and/or baseline psychopathology. CONCLUSION The finding of weak cross-sectional associations in the absence of specific and unconfounded longitudinal associations suggests that processing speed is an independent dimension of disease severity rather than a causal factor impacting on social outcome. Nevertheless, longitudinal change in patient reported needs may be weakly sensitive to baseline cognitive impairment.
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Affiliation(s)
- Nienke Jabben
- Department of Psychiatry and Neuropsychology, Maastricht University, P.O. BOX 616 (VIJV), 6200 MD, Maastricht, The Netherlands
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Lecomte Y, Stip E, Caron J, Renaud S. [An exploratory study of adaptation of people with schizophrenia]. SANTE MENTALE AU QUEBEC 2008; 32:137-58. [PMID: 18253665 DOI: 10.7202/016513ar] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This exploratory study examines relations between socio-demographic, social, psychological, cognitive, variables and stressors, coping strategies and adaptation of individuals with schizophrenia. The study's design is correlational with two repeated measures (cross-sectional) with 153 subjects at a six-month interval. The variables of the model explain 49,3 % of adaptation at time 1, and 54,6 % of adaptation at time 2. Data show that five predictors are simultaneously significant at both times : work, social integration, long term memory, positive and negative symptoms. At time 2, variables of self-esteem and "changing the situation" are also significant.
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