Resilience and recovery style: a retrospective study on associations among personal resources, symptoms, neurocognition, quality of life and psychosocial functioning in psychotic patients

Genetic determinants of coping, resilience and self-esteem in schizophrenia suggest a primary role for social factors and hippocampal neurogenesis

Schizophrenia is a severe psychiatric disorder, associated with a reduction in life expectancy of 15-20 years. Available treatments are at least partially effective in most affected individuals, and personal resources such as resilience (successful adaptation despite adversity) and coping abilities (strategies used to deal with stressful or threatening situations), are important determinants of disease outcomes and long-term sustained recovery. Published findings support the existence of a genetic background underlying resilience and coping, with variable heritability estimates. However, genome-wide analyses concerning the genetic determinants of these personal resources, especially in the context of schizophrenia, are lacking. Here, we performed a genome-wide association study coupled with accessory analyses to investigate potential genetic determinants of resilience, coping and self-esteem in 490 schizophrenia patients. Results revealed a complex genetic background partly overlapping with that of neuroticism, worry and schizophrenia itself and support the importance of social aspects in shapingthese psychological constructs. Hippocampal neurogenesis and lipid metabolism appear to be potentially relevant biological underpinnings, and specific miRNAs such as miR-124 and miR-137 may warrant further studies as potential biomarkers. In conclusion, this study represents an important first step in the identification of genetic and biological correlates shaping resilience, coping resources and self-esteem in schizophrenia.

Main Biological Models of Resilience

Objective

Resilience is a complex process of adaptation to new conditions that would permit a positive outcome after adversities, traumas or other sources of stress. However, despite the growing interest in this topic, there is no universally accepted definition and no comprehensive bio-behavioural model. This systematic review aims to provide an overview of the main biological models that have been theorized to date, with a focus on new alternative theories to improve our understanding of the mechanisms underlying the development and strengthening of resilience, with potential implications for the prevention of some psychopathological disorders.

Method

This review was conducted according to PRISMA guidelines and includes 185 studies published in English in PubMed and Embase up to December 2023.

Results

Most studies use the stress-related model, which conceptualizes resilience as the absence of symptoms after the stressful event and mainly deal with the differences between stress-prone and resilient phenotypes in animals exposed to stress. However, the results of this search seem to suggest that resilience might be an independent construct with biological bases rooted in the stress system and the social brain, and widely sculptured by individual and environmental factors, especially early life events and affiliation.

Conclusions

This work contributes to ongoing efforts to understand the intricate mechanisms of resilience, while highlighting the potential of improving social relationships since our birth to promote coping strategies towards stress and traumas, and even a peaceful world.

Personal recovery in first-episode psychosis: Beyond clinical and functional recovery

BACKGROUND

The concept of personal recovery after psychotic illness focuses more on patients' social and existential needs compared to traditional outcome measures including clinical and functional recovery. This research aims to contribute to a broad framework on (personal) recovery and associated factors.

METHODS

Data from 203 persons with symptomatic remission of their first-episode psychosis from the ongoing HAMLETT study were analyzed. To determine the relative importance of several biological, clinical, psychological, and social factors in explaining personal recovery as measured by the Recovery Assessment Scale (RAS), partial Spearman correlations (controlling for clinical recovery (PANSS) and functional recovery (WHODAS 2.0)) and a bootstrapped multiple regression were performed. Indirect effects on personal recovery within these factors, clinical recovery, and functional recovery were explored using a regularized partial correlation network.

RESULTS

Of the factors that explained personal recovery beyond the effects of clinical and functional recovery, social support was the strongest predictor, followed by self-esteem, internalized stigma, and insecure attachment, collectively explaining 48.2 % of the variance. Anhedonia/apathy showed a trend towards a negative correlation. Age at onset, sex, early trauma/neglect, cognition, and being married/cohabiting did not significantly correlate with personal recovery. The network (n = 143) was consistent with these findings and indicated possible mediation pathways for early trauma/neglect, insecure attachment, cognition, and being married/cohabiting.

CONCLUSIONS

Personal recovery is an important addition to traditional measures of outcome after psychosis. Various quality of life indicators, such as self-esteem and social support, explain variance in personal recovery over clinical and functional recovery.

The Role of Vortioxetine in the Treatment of Depressive Symptoms in General Hospital Psychiatry: A Case-Series and PRISMA-Compliant Systematic Review of the Literature

Depressive symptoms are a customary finding in hospitalized patients, particularly those who are undergoing long hospitalizations, underwent major surgical procedures or suffer from high levels of multimorbidity and frailty. The patients included in this case series shared high degrees of frailty-complexity and were evaluated within the ordinary consultation and liaison psychiatry service of the University Hospital in Pisa, Italy, from September 2021 to June 2023. Patients were administered at least one follow-up evaluation after a week and before discharge. To relate this case series to the extant literature, a comprehensive systematic review of vortioxetine safety and efficacy was performed. None of the six patients included developed serious safety issues, but one patient complained of mild-to-moderate nausea for some days after the vortioxetine introduction. Five out of six patients exhibited at least a slight clinical benefit as measured by the clinical global impression scale. Of the 858 entries screened via Scopus and Medline/PubMed, a total of 134 papers were included in our review. The present case series provides preliminary evidence for vortioxetine's safety in this healthcare domain. The literature reviewed in this paper seems to endorse a promising safety profile and a very peculiar efficacy niche for vortioxetine in consultation and liaison psychiatry.

A Systematic Review and Meta-Analysis of the Association Between Psychopathology and Social Functioning in Schizophrenia

BACKGROUND

Impaired social functioning is a major, but under-elucidated area of schizophrenia. It's typically understood as consequential to, eg, negative symptoms, but meta-analyses on the subject have not examined psychopathology in a broader perspective and there's severe heterogeneity in outcome measures. To enhance functional recovery from schizophrenia, a more comprehensive understanding of the nature of social functioning in schizophrenia is needed.

STUDY DESIGN

In this systematic review and meta-analysis, we searched PubMed, PsycInfo, and Ovid Embase for studies providing an association between psychopathology and social functioning. Meta-analyses of the regression and correlation coefficients were performed to explore associations between social functioning and psychopathology, as well as associations between their subdomains.

STUDY RESULTS

Thirty-six studies with a total of 4742 patients were included. Overall social functioning was associated with overall psychopathology (95% CI [-0.63; -0.37]), positive symptoms (95% CI [-0.39; -0.25]), negative symptoms (95% CI [-0.61; -0.42]), disorganized symptoms (95% CI [-0.54; -0.14]), depressive symptoms (95% CI [-0.33; -0.11]), and general psychopathology (95% CI [-0.60; -0.43]). There was significant heterogeneity in the results, with I2 ranging from 52% to 92%.

CONCLUSIONS

This is the first systematic review and meta-analysis to comprehensively examine associations between psychopathology and social functioning. The finding that all psychopathological subdomains seem to correlate with social functioning challenges the view that impaired social functioning in schizophrenia is mainly a result of negative symptoms. In line with classical psychopathological literature on schizophrenia, it may be more appropriate to consider impaired social functioning as a manifestation of the disorder itself.

Making meaning of trauma in psychosis

Background

Finding new meaning and identity in the aftermath of trauma has been identified as a key process of mental health recovery. However, research indicates that this meaning-making process is compromised in people with psychosis. Considering the high prevalence, yet under-treatment of trauma in people with psychosis, it is urgent to gain insight into how their meaning-making process can be supported.

Aim

To gain insight into how people with psychosis make meaning of trauma and identify barriers and facilitators in their meaning-making process.

Methods

Qualitative inquiry of N = 21 interviews transcripts from the Dutch Psychiatry Storybank. We included interviews of people who (a) lived through multiple psychotic episodes, and (b) spontaneously addressed traumatic experiences in a low-structured interview. Storyline analysis was performed to gain insight into the meaning-making of trauma within their self-stories. Psychosocial conceptualizations of narrative identity were used to inform the analysis. A data-validation session with four experts-by-experience was organized to check and improve the quality of our analysis.

Results

We identified four different story types: (1) Psychiatry as the wrong setting to find meaning; (2) The ongoing struggle to get trauma-therapy; (3) Exposure to trauma as a threat to a stable life, and (4) Disclosure as the key to resolving alienation. Each story type comprises a different plot, meaning of trauma withing the self-story, (lack of) integration and barriers and facilitators in the meaning-making process. Overall, barriers in the meaning-making process were mostly situated within mental healthcare and stigma-related. People felt particularly hindered by pessimistic ideas on their capacity to develop self-insight and cope with distress, resulting in limited treatment options. Their process of adaptive meaning-making often started with supportive, non-judgmental relationships with individuals or communities that offered them the safety to disclose trauma and motivated them to engage in a process of self-inquiry and growth.

Conclusion

The outcomes illuminate the social context of the meaning-making challenges that people with psychosis face and illustrate the devastating influence of stigma. Our outcomes offer guidance to remove barriers to adaptive meaning-making in people with psychosis, and can help clinicians to attune to differences in the meaning-making of trauma.

Clinical and psychological factors associated with resilience in patients with schizophrenia: data from the Italian network for research on psychoses using machine learning

BACKGROUND

Resilience is defined as the ability to modify thoughts to cope with stressful events. Patients with schizophrenia (SCZ) having higher resilience (HR) levels show less severe symptoms and better real-life functioning. However, the clinical factors contributing to determine resilience levels in patients remain unclear. Thus, based on psychological, historical, clinical and environmental variables, we built a supervised machine learning algorithm to classify patients with HR or lower resilience (LR).

METHODS

SCZ from the Italian Network for Research on Psychoses (N = 598 in the Discovery sample, N = 298 in the Validation sample) underwent historical, clinical, psychological, environmental and resilience assessments. A Support Vector Machine algorithm (based on 85 variables extracted from the above-mentioned assessments) was built in the Discovery sample, and replicated in the Validation sample, to classify between HR and LR patients, within a nested, Leave-Site-Out Cross-Validation framework. We then investigated whether algorithm decision scores were associated with the cognitive and clinical characteristics of patients.

RESULTS

The algorithm classified patients as HR or LR with a Balanced Accuracy of 74.5% (p < 0.0001) in the Discovery sample, and 80.2% in the Validation sample. Higher self-esteem, larger social network and use of adaptive coping strategies were the variables most frequently chosen by the algorithm to generate decisions. Correlations between algorithm decision scores, socio-cognitive abilities, and symptom severity were significant (pFDR < 0.05).

CONCLUSIONS

We identified an accurate, meaningful and generalizable clinical-psychological signature associated with resilience in SCZ. This study delivers relevant information regarding psychological and clinical factors that non-pharmacological interventions could target in schizophrenia.

The Impact of Covid-19 Pandemic on Mental Health Services: A Comparison Between First Psychiatric Consultations Before and After the Pandemic

Objective

A high rate of onset or exacerbation of several mental disorders has been observed during the COVID-19 pandemic. However, the risk contributing to mental distress during the pandemic remains unclear. The study aims to evaluate the risk of the onset of mental disorders by comparing the number of requests for the first psychiatric consultation before and after the COVID-19 pandemic at the psychiatric outpatient services of Varese, a small town in Northern Italy.

Method

This observational retrospective study aims to compare the requests for the first psychiatric consultation at the outpatient services of Varese during the 14-month period before COVID-19 pandemic (from 1st January 2019 to 28th February 2020) versus the 14-month period after the pandemic (from 1st March 2020 to 31st May 2021) extracted from the server SIPRL-Psicheweb database (Sistema Informativo della Psichiatria, Lombardy Region). For each patient, socio-demographic features and clinical data (psychiatric diagnosis, psychiatric comorbidities, previous psychiatric records, and previous hospitalization in the psychiatric ward) were collected.

Results

Three hundred ninety-five consultations were made during the pre-COVID period and 346 during the post-COVID period. No statistically significant difference was found between the number of first consultation requests in the two periods evaluated but a slight decrease in the total number during the pandemic period (395 vs 346; p=0.07) can be noticed. In the subjects of the pre-COVID group, a statistically significant association was detected with no previous psychiatric records ("absent") and with stressor-related disorders. In the post-COVID group, a statistically significant correlation between "present" previous records and anxiety-depressive disorders emerged.

Conclusions

It has been observed that anxiety-depressive disorders increased in the post-COVID-19 period compared to the pre-COVID-19, instead of stressor-related disorders. This might be because stressor-related disorders may be treated by general practitioners with no psychiatric interventions. Most of the first consultations during the period of the COVID-19 pandemic were for patients who already had contact with psychiatric services.The study shows an increasing request for care by more severe patients in the first phase of the SARS-CoV-2 pandemic. Further research is needed to investigate the long-term impact of the COVID-19 pandemic on emergency departments and hospital services.

Resilience and Quality of Life in People with Mental Illness: A Systematic Review and Meta-Analysis

Purpose

Resilience is viewed as an individual' positive adaptation and experiences of adversity. The maintenance and recovery of mental health in people with mental disorder is considered a sign of coping with adverse conditions. The purpose of the present meta-analysis was to examine the association between resilience and quality of life in individuals with mental disorders.

Methods

Studies were included if research reported measures of association with resilience, as assessed using self-reported resilience scale and quality of life. A systematic literature search was conducted in PubMed and PsycINFO.

Results

Eight studies involving a total of 1439 patients were included in the meta-analysis. Assuming a random-effects model, the weighted mean Pearson correlation between resilience and quality of life was r = 0.551 (95% confidence interval [0.370; 0.691], p < 0.001). This association was moderate, although the heterogeneity among individual effect sizes was substantial (I² = 93.35%).

Conclusion

Despite substantial heterogeneity across included studies, the findings suggest a strong association between resilience and quality of life in people with mental disorders. In clinical practice, the promotion of resilience is important to enhance the quality of life among people with mental illness.

Predictors of personal recovery for individuals with schizophrenia spectrum disorders living in the community

INTRODUCTION

Personal recovery is a complex construct frequently used as outcome measure in people with schizophrenia spectrum disorders. This study examined potential predictors of personal recovery using the two most common assessment tools for people with schizophrenia spectrum disorders living in the community: the Chinese version of the Questionnaire about the Process of Recovery and the Chinese version of the Recovery Assessment Scale.

METHODS

Ninety-one individuals (57 women) diagnosed with schizophrenia spectrum disorders participated in the study (mean age: 47.41 ± 9.41 years). All participants lived in the community and received community psychiatric services. The participants were evaluated via interviews, questionnaires and standardized assessments. Potential predictors included four domains: personal, disease-related, functional and social. Stepwise multiple linear regression was used to analyse the potential predictors of the recovery and recovery assessment scale.

RESULTS

Resilience and social support were the only significant predictors of the Chinese versions of the Questionnaire about the Process of Recovery and Chinese version of the Recovery Assessment Scale. The primary predictor of the Chinese version of the Questionnaire about the Process of Recovery was social support from family and institutional staff. Conversely, resilience was the major predictor of the Chinese version of the Recovery Assessment Scale.

DISCUSSION

For people with schizophrenia spectrum disorders living in the community, social support and resilience significantly predicted personal recovery. Age, educational level, disease-related and functional factors were not significant predictors of personal recovery. Therefore, it is important to develop successful personal recovery-oriented practices that enhance resilience and promote social support.

Neurocognitive correlates of the varied domains of outcomes at 20 year follow-up of first-episode psychosis

Little is known about long-term outcomes of the first episode of psychosis (FEP) other than in the symptomatic domain. We hypothesised that cognitive impairment is associated with poorer multi-domain outcomes at a long-term follow-up of FEP patients. We followed-up 172 FEP patients for a mean of 20.3 years. Ten outcome dimensions were assessed (symptomatic, functional and personal recovery, social disadvantage, physical health, suicide attempts, number of episodes, current drug use, chlorpromazine equivalent doses (CPZ), and schizophrenia/schizoaffective disorder final diagnosis). Cognition was assessed at follow-up. Processing speed and verbal memory deficits showed significant associations with poor outcomes on symptomatic, social functioning, social disadvantage, higher number of episodes, and higher CPZ. Significant associations were found between visual memory impairments were significantly associated with low symptomatic and functional recovery, between attentional deficits and a final diagnosis of schizophrenia/schizoaffective disorder, and between social cognition deficits and poor personal recovery.Lower cognitive global scores were significantly associated with all outcome dimensions except for drug abuse and physical status. Using multiple outcome dimensions allowed for the inclusion of the patients' perspective and other commonly neglected outcome measures. Taken together, cognitive impairment in FEP patients is strongly related to poor performance on several outcome dimensions beyond symptomatic remission.

The associations of cannabis and methamphetamine use with cognitive performance over the first 2 years of treatment in schizophrenia spectrum disorders

AIM

Cognitive deficits are a core feature of schizophrenia, and comorbid substance use may be a contributory factor. Methamphetamine use has been associated with cognitive impairment in schizophrenia, while associations with cannabis use are less clear-cut. This study aimed to investigate the associations of cannabis and methamphetamine use with cognitive performance in first-episode schizophrenia spectrum disorders over the first 2 years of treatment.

METHODS

This was a longitudinal cohort study in 81 patients treated with flupenthixol decanoate according to a standardized protocol over 24 months. Cognitive performance was assessed with the Measurement and Treatment Research to Improve Cognition in Schizophrenia Cognitive Consensus Battery at four time points, and urine testing for cannabis and methamphetamine was conducted at six time points. We used linear mixed-effect models for repeated measures to assess visit-wise changes in composite cognitive scores in patients (n = 91) compared to matched controls without psychiatric or medical disorders (n = 100). Linear regression models were constructed to examine pre-treatment and end-point effects in patients.

RESULTS

Compared to controls, patients exhibited greater cognitive impairments at baseline, which improved with treatment, but remained significantly lower throughout. The number of positive methamphetamine, but not cannabis, tests predicted less cognitive improvement in patients.

CONCLUSIONS

Our findings suggest a negative association between methamphetamine and cognition, but not cannabis.

Resilience and its inter-relationship with symptomatology, illness course, psychosocial functioning, and mediational roles in schizophrenia: A systematic review

BACKGROUND

Schizophrenia is a major psychiatric disorder which poses substantial illness burden on affected individuals. In view of the need to better understand the growing literature on resilience (adaptation in the face of adversity) and its clinical correlates to inform and optimize clinical management in schizophrenia, we sought to summarize the extant literature which examined the inter-relationships between resilience and demographic features, phenomenology, illness course, psychosocial functioning, and its mediational role among relevant factors.

METHODS

A systematic review was conducted on published empirical studies examining the topic of resilience and clinical correlates within schizophrenia spectrum conditions up until December 2020.

RESULTS

Higher level of resilience was associated with lower severity of specific symptomatology including positive, negative, depressive symptoms, suicidal ideation, cognitive deficits, and better insight. Moreover, higher resilience was significantly associated with different aspects of illness course (such as shorter duration of untreated psychosis, longer duration of illness, improved symptom remission and recovery), internal factors (such as lower stigma, better self-esteem), and psychosocial functioning (better overall, real-life, social and interpersonal functioning, better quality of life). Resilience also acts as a mediator in pathways leading to depression, functioning, and quality of life within schizophrenia spectrum conditions.

DISCUSSION

Viewed within the context of various resiliency models (compensatory, challenge, protective factor models), suggestions were made to enhance resilience and balance risk versus protective factors in order to improve disease management. Future research should seek to better elucidate associated biomarkers, inter-relationships with carer resilience, and evaluate the efficacy of suitable resilience-targeted interventions in schizophrenia.

Assessing Mental Pain as a Predictive Factor of Suicide Risk in a Clinical Sample of Patients with Psychiatric Disorders

According to contemporary suicidology, mental pain represents one of the main suicide risk factors, along with more traditional constructs such as depression, anxiety and hopelessness. This work aims to investigate the relationship between the levels of mental pain and the risk to carry out suicide or suicide attempt in the short term in order to understand if a measurement of mental pain can be used as a screening tool for prevention. For this purpose, 105 outpatients with psychiatric diagnosis were recruited at the university hospital of Varese during a check-up visit and were assessed by using psychometric scales of mental pain levels, hopelessness, anxiety and depression. Clinical and sociodemographic variables of the sample were also collected. A period of 18 months following the recruitment was observed to evaluate any suicides or attempted suicides. Subjects numbering 11 out of 105 committed an attempted suicide. From statistical analyses, high values of the Beck Depression Inventory (BDI-II), Mental Pain Questionnaire (OMMP) and Hamilton Rating Scale for Depression (HAM-D) scales showed a significant association with the risk of carrying out a suicide attempt and, among these, OMMP and BDI-II showed characteristics of good applicability and predictivity proving suitable to be used as potential tools for screening and primary prevention of suicidal behavior.

Psychosis-like experiences and resilience: A systematic and critical review of the literature

Resilience research has documented the ability to cope with traumatic and stressful situations and/or retain functioning given certain risk factors in the context of psychosis. In this study, we conducted the first systematic review of the literature on psychosis-like experiences (PLEs) and resilience. Fifteen articles (from 11 unique study samples) from 10 countries were included in this systematic review, with a total of 11,937 unique study participants. Inclusion criteria were broad, capturing a wide range of individuals with PLEs who have not yet experienced threshold psychosis, such as individuals in the general population with elevated self-reports of PLEs, as well as clinical groups diagnosed by clinician interviews (i.e., clinical- or ultra-high-risk for psychosis [CHR or UHR]). For this review, studies needed to include research aims and empirical research related to resilience, and use an established or author-defined measure of psychological and/or social resilience. Data reporting quality was assessed with the Strengthening the Reporting of Observational Studies in Epidemiology and place of residence, race/ethnicity/culture/language, occupation, gender/sex, religion, education, socioeconomic status, social capital (PROGRESS) guidelines. Study aims and measurement of key variables varied widely, and all studies were cross-sectional. In 73% of the studies, resilience was inversely associated with PLEs or psychosis risk status (e.g., CHR or UHR). Results related to specific resilience subscales were mixed. Author-defined resilience was typically related to internal/psychological resources. Future research, particularly longitudinal research involving multidimensional measurement of resilience (e.g., internal and external factors), along with well-defined theoretical models, are necessary before drawing firm conclusions on resilience and PLEs. We propose a dynamic, multifaceted, developmentally appropriate, and culturally sensitive model of resilience for future research. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The Complex Interplay Between Physical Activity and Recovery Styles in Patients With Severe Mental Disorders in a Real-World Multicentric Study

Compared with the general population, people with severe mental disorders have significantly worse physical health and a higher mortality rate, which is partially due to the adoption of unhealthy lifestyle behaviors, such as heavy smoking, use of alcohol or illicit drugs, unbalanced diet, and physical inactivity. These unhealthy behaviors may also play a significant role in the personal and functional recovery of patients with severe mental disorders, although this relationship has been rarely investigated in methodologically robust studies. In this paper, we aim to: a) describe the levels of physical activity and recovery style in a sample of patients with severe mental disorders; b) identify the clinical, social, and illness-related factors that predict the likelihood of patients performing physical activity. The global sample consists of 401 patients, with a main psychiatric diagnosis of bipolar disorder (43.4%, N = 174), psychosis spectrum disorder (29.7%; N = 119), or major depression (26.9%; N = 118). 29.4% (N = 119) of patients reported performing physical activity regularly, most frequently walking (52.1%, N = 62), going to the gym (21.8%, N = 26), and running (10.9%, N = 13). Only 15 patients (3.7%) performed at least 75 min of vigorous physical activity per week. 46.8% of patients adopted sealing over as a recovery style and 37.9% used a mixed style toward integration. Recovery style is influenced by gender (p < 0.05) and age (p < 0.05). The probability to practice regular physical activity is higher in patients with metabolic syndrome (Odds Ratio - OR: 2.1; Confidence Interval - CI 95%: 1.2-3.5; p < 0.050), and significantly lower in those with higher levels of anxiety/depressive symptoms (OR: 0.877; CI 95%: 0.771-0.998; p < 0.01). Globally, patients with severe mental disorders report low levels of physical activities, which are associated with poor recovery styles. Psychoeducational interventions aimed at increasing patients' motivation to adopt healthy lifestyle behaviors and modifying recovery styles may improve the physical health of people with severe mental disorders thus reducing the mortality rates.

Relationship between clinical outcomes measures and personal and social performance functioning in a prospective, interventional study in schizophrenia

OBJECTIVES

To explore clinical and demographic characteristics impacting patient functioning by determining extent of overlap in factors driving change in Personal and Social Performance (PSP) and other clinical outcomes.

METHODS

Post-hoc analysis from a single-arm trial of paliperidone extended release in adult patients with nonacute symptomatic schizophrenia. Psychosocial functioning measures: PSP, Clinical Global Impression-Severity (CGI-S), Positive and Negative Syndrome Scale (PANSS), Short-Form 36 (SF-36), treatment satisfaction, sleep quality/daytime drowsiness, and Extrapyramidal Symptoms Rating Scale.

RESULTS

Highest correlations with PSP total score change included PANSS total score change (Spearman's r = 0.607), PANSS general psychopathology change (r = 0.579), and CGI-S change (r = 0.569). A PSP score change of -32 predicted 90% probability of deterioration in CGI-S (score change of ≥1). The power of PSP change to predict PANSS total score change was lower. Linear stepwise regression demonstrated independent relationships for PSP change and: PANSS total change; CGI-S change; SF-36 Mental Component change; treatment satisfaction at endpoint; PSP at baseline; previous psychiatric hospitalizations. R ² = 0.55 meant that 45% of PSP variation could not be explained by other clinical outcome measures.

CONCLUSIONS

Psychosocial functioning improvement is important in schizophrenia. PSP may be valuable for assessing functioning; it encompasses psychosocial and clinical factors not measured by other established assessments.

Global health-related quality of life in schizophrenia: systematic review and meta-analysis

BACKGROUND AND AIM

Signs and symptoms of schizophrenia may have serious impacts on patients' quality of life leading to concern about different aspects of their lives. This study presents a systematic review and meta-analysis of the studies examining the quality of life among patients with schizophrenia and its relationship with patients' characteristics.

MATERIALS AND METHODS

A total of 40 studies were extracted from searching of relevant databases published between 2000 and 2020. Descriptive data and correlation coefficients between patient's characteristics and quality of life were extracted and the results were reported according to Preferred Reporting Items for Systematic Reviews and Meta-analyses standards and meta-analysis of pooled studies.

RESULTS

In total, 8363 patients with schizophrenia participated in 40 studies which used Schizophrenia Quality of Life Scale revision 4. The total score of quality of life (QOL) in the study subjects was reported to be 40.66. Weighted effect size analyses revealed a significant relationship between QOL and variables including patients' age and duration of the disease. Furthermore, the highest (the worst) score of QOL in schizophrenia patients was observed in Europe 47.04 (95% CI 41.26 to 52.82) and the Euro region 47.05 (95% CI 41.18 to 52.92).

CONCLUSION

Overall, the QOL among patients with schizophrenia was in a good status, which could be improved through considering different life aspects of people living in various contexts. In fact, clarifying the determinants of QOL would be a key step in the provision of future treatment efforts.

Personal Recovery in People With a Psychotic Disorder: A Systematic Review and Meta-Analysis of Associated Factors

Background: Personal recovery (PR) is a subjective, multidimensional concept, and quantitative research using PR as an outcome is rapidly increasing. This systematic review is intended to support the design of interventions that contribute to PR in psychotic disorders, by providing an overview of associated factors and their weighted importance to PR: clinical factors, social factors, and socio-demographic characteristics are included, and factors related to the concept of PR (organized into CHIME dimensions). Methods: A systematic literature search was conducted from inception to March 2020. Quantitative studies that had used a validated questionnaire assessing the concept of PR were included. Mean effect sizes for the relationship between PR-scale total scores and related factors were calculated using meta-analyses. Sources of heterogeneity were examined using meta-regression tests. Results: Forty-six studies, that used (a total of) eight PR measures, showed that in clinical factors, affective symptoms had a medium negative association with PR-scale total scores (r = -0.44, 95%CI -0.50 to -0.37), while positive, negative and general symptoms had small negative correlations. No association was found with neuro-cognition. Social factors (support, work and housing, and functioning) showed small positive correlations. Gender and age differences had barely been researched. Large associations were found for PR-scale total scores with the CHIME dimensions hope (r = 0.56, 95%CI 0.48-0.63), meaning in life (r = 0.48, 95%CI 0.38-0.58) and empowerment (r = 0.53, 95%CI 0.42-0.63); while medium associations were found with connectedness (r = 0.34, 95%CI 0.43-0.65) and identity (r = 0.43, 95%CI 0.35-0.50). Levels of heterogeneity were high, sources included: the variety of PR measures, variations in sample characteristics, publication bias, variations in outcome measures, and cultural differences. Discussion: Most interventions in mental healthcare aim to reduce symptoms and improve functioning. With regard to stimulating PR, these interventions may benefit from also focusing on enhancing hope, empowerment, and meaning in life. The strength of these findings is limited by the challenges of comparing separate CHIME dimensions with questionnaires assessing the concept of PR, and by the high levels of heterogeneity observed. Future research should focus on the interaction between elements of PR and clinical and social factors over time.

Factors Related to the Length of Stay for Patients With Schizophrenia: A Retrospective Study

BACKGROUND

The length of stay (LOS) of patients with schizophrenia has been a wide concern of researchers. Reasonable management of the LOS to achieve a balance between quality of treatment and efficient medical source allocation has become a significant issue in clinical work in psychiatry. Figuring out the factors related to the LOS of schizophrenia patients can help optimize its management by the hospital.

METHOD

The essential information of patients was obtained from the electronic medical record system. The variables were divided into the following kinds: demographic, clinical, and biochemical. Univariate analysis and multivariate analysis were conducted to find the potential factors related to the LOS of schizophrenia patients. Receiver operating characteristic analyses were conducted to evaluate the accuracy of judging the LOS of the regression model.

RESULT

A total of 1,160 patients with schizophrenia were enrolled in our research. Our results demonstrated that the status of unmarried (single, separated, divorced, or widowed) and the abnormality of thyroid-stimulating hormone (TSH) were risk factors for the longer LOS of schizophrenia patients. The area under the curve was 0.576, which meant that the regression model had a certain predictive value.

CONCLUSION

To our knowledge, this research is the first study to analyze the effect of various factors, including the biochemical index, on the LOS of a single type of mental disorder. Marital status and TSH were proven to be related to the LOS of schizophrenia patients. The results of this study provided reference factors of LOS for clinical psychiatry, which will be helpful to the management of hospitalization and in optimizing the allocation of medical sources.

Resilience, Cardiological Outcome, and Their Correlations With Anxious-Depressive Symptoms and Quality of Life in Patients With an Implantable Cardioverter Defibrillator

Background: Resilience is proven as a protective factor against the development of psychiatric disorders, and it has gained clinical relevance in the development and progression of cardiovascular pathology. The authors performed a longitudinal study on patients with implantable cardioverter defibrillator (ICD) with the primary aim to highlight the possible existence of a correlation between individual resilience capacity, depressive and anxiety symptoms, and quality of life in terms of outcomes. The secondary aim was to analyze the differences between patients with major cardiac events in the follow-up and patients without cardiac events with respect to the previous variables. Materials and Methods: A total of 80 patients enrolled in the Cardiology Unit were evaluated at T₀ and during the follow-up through the following scales: the 14-item Resilience Scale (RS-14), the Hospital Anxiety and Depression Scale (HADS), and the World Health Organization Quality of Life-Brief Version (WHOQOL-Bref). Results: A significant linear correlation between resilience and all the areas of quality of life at T₀, T₁, and T₂ emerged. A negative correlation between resilience and anxiety and depressive symptoms emerged, as well as between depression and anxiety and quality of life. Patients with cardiac events during the follow up have shown a worse quality of life and the onset of anxiety-depressive symptoms over time, without changes to the resilience scores. Patients without cardiac events showed an increasing trend in resilience scores. Discussion: Given the speed and simplicity of use of the RS-14 scale, it seems promising to further investigate the real clinical usefulness of this instrument in the cardiology field.

The association between resilience and psychosocial functioning in schizophrenia: A systematic review and meta-analysis

The exploration of resilience in schizophrenia is recent and poorly understood. Literature suggests that exploration of the construct will help with the understanding of not only risk but also protective factors in individuals living with psychosis. We performed a systematic review and meta-analysis with the primary aim of synthesizing the evidence of an existing relationship between resilience and schizophrenia-spectrum disorders (SSD). We searched electronic databases for relevant articles that evaluated resilience and psychosocial functioning in participants with schizophrenia-spectrum disorders. Sixteen studies were deemed eligible for review. We also conducted a random-effects meta-analysis to explore resilience levels of study participants. Our findings highlight lower levels of resilience in SSD cohorts and poorer psychosocial functioning among those with low levels of resilience. Evidence also suggests that the presence of resilience in individuals with schizophrenia-spectrum disorders is associated with improved psychosocial functioning.

Distress and Resilience in the Days of COVID-19: Comparing Two Ethnicities

The COVID-19 pandemic is an ongoing epidemic of coronavirus disease, caused by severe acute respiratory syndrome, which has spread recently worldwide. Efforts to prevent the virus from spreading include travel restrictions, lockdowns as well as national or regional quarantines throughout the international community. The major negative psychological outcome of the COVID-19 pandemic is the anxiety caused by it. The aim of the present study was to examine the level of concern and the contributions of modes of resilience, well-being and demographic attributes towards decreasing or enhancing anxiety and depression among two samples: Israeli Jews (majority group) and Israeli Arabs (minority group). These random samples included 605 Jews and 156 Arabs who participated in an internet survey. A previous study, which has been conducted in the context of terror attacks, has shown that compared to Israeli Jews, Israeli Arabs expressed a higher level of fear of war and lower levels of resilience supporting personality attributes. The results of the current study indicated a similar pattern that emerged in the context of the COVID-19 pandemic: the Israeli Arabs reported a higher level of distress and a lower level of resilience and well-being.

Methamphetamine-associated psychosis: links to drug use characteristics and similarity to primary psychosis

Objectives: Despite the prevalence of methamphetamine-associated psychosis, how characteristics of drug use affect the severity and clinical course, and its optimal treatments have not been established. We addressed these questions, assessing clinical features of methamphetamine-associated psychosis, and compared it with primary psychosis.Methods: Hospitalised patients with methamphetamine-associated (n = 70) or primary schizophrenic psychosis (n = 70) were matched on sex, age and duration of psychosis. Association of drug use variables (age at initiation, duration of methamphetamine use) with the Brief Psychiatric Rating Scale (BPRS) scores and psychosis duration were examined for patients with methamphetamine-associated psychosis, and the groups were compared on the BPRS scores.Results: Methamphetamine use initiation age correlated negatively with the BPRS total score and the Activation subscale score; methamphetamine use duration correlated positively with psychosis duration. Methamphetamine-associated psychosis group scored lower on the Hostility-Suspiciousness and Anergia subscales of the BPRS (adjusted p values < .05).Conclusions: Association of early initiation of methamphetamine with psychosis severity may suggest a lasting effect on brain development. Correlation of drug use and psychosis durations may suggest a cumulative effect of methamphetamine exposure. Less severe paranoia and negative symptoms in the methamphetamine-using group could implicate better social functioning of these patients. Further mechanistic studies are warranted.Key pointsEarly initiation of methamphetamine use is associated with psychosis severity.Methamphetamine use duration associates with psychosis duration.Methamphetamine-associated and primary schizophrenic psychoses were similar in symptoms.Methamphetamine psychosis patients were less severe in paranoia and negative symptoms.

Self-care research: Where are we now? Where are we going?

BACKGROUND AND OBJECTIVE

The beneficial effects of self-care include improved well-being and lower morbidity, mortality, and healthcare costs. In this article we address the current state of self-care research and propose an agenda for future research based on the inaugural conference of the International Center for Self-Care Research held in Rome, Italy in June 2019. The vision of this Center is a world where self-care is prioritized by individuals, families, and communities and is the first line of approach in every health care encounter. The mission of the Center is to lead the self-care research endeavor, improving conceptual clarity and promoting interdisciplinary work informed by a shared vision addressing knowledge gaps. A focused research agenda can deepen our theoretical understanding of self-care and the mechanisms underlying self-care, which can contribute to the development of effective interventions that improve outcomes.

METHODS

During conference discussions, we identified seven major reasons why self-care is challenging, which can be grouped into the general categories of behavior change and illness related factors. We identified six specific knowledge gaps that, if addressed, may help to address these challenges: the influence of habit formation on behavior change, resilience in the face of stressful life events that interfere with self-care, the influence of culture on self-care behavioral choices, the difficulty performing self-care with multiple chronic conditions, self-care in persons with severe mental illness, and the influence of others (care partners, family, peer supporters, and healthcare professionals) on self-care.

PLANS TO ACHIEVE RESULTS

To achieve the vision and mission of the Center, we will lead a collaborative program of research that addresses self-care knowledge gaps and improves outcomes, create a supportive international network for knowledge transfer and support of innovations in self-care research, and support and train others in self-care research. Beyond these specific short-term goals, important policy implications of this work are discussed.

Positive Coping and Resilience as Mediators Between Negative Symptoms and Disability Among Patients With Schizophrenia

Objective: This study proposes a schizophrenia disability model to describe the associations between negative symptoms and disability to test the possible mediating roles of positive coping and resilience and to compare the relative weights of the indirect effects of these two mediators in an integrated whole. Methods: A total of 407 hospitalized Han Chinese patients diagnosed with stable schizophrenia or schizoaffective disorder were included. Patients were evaluated using the following scales: the Simplified Coping Style Questionnaire (SCQ) for positive coping, the Connor-Davidson Resilience Scale (CD-RISC) for resilience, the Positive and Negative Syndrome Scale (PANSS) for negative symptoms, and the World Health Organization Disability Assessment Schedule, Version II (WHO-DAS II) for the severity of disability. The schizophrenia disability distal mediation model was constructed using the structural modeling (SEM) approach. Bootstrapping procedures and the PRODCLIN program were used to examine the mediating roles of positive coping and resilience. Results: The schizophrenia disability model was well-fitted to the observed data. Positive coping and resilience together with negative symptoms explained 66% of the variance in disability. Positive coping and resilience partly mediated the negative symptoms-disability relationship. The bootstrapped unstandardized indirect effect was 0.319, and the direct effect was 0.224. Positive coping also has a significant positive effect on resilience. In addition, the ratio of the specific indirect effect of positive coping to the total indirect effect (48%) is higher than that of resilience (30%). Conclusion: Positive coping and resilience are two key causal mediators of the negative symptoms-disability relationship. Positive coping and resilience are important personal resources for patients with schizophrenia. We found that the indirect effect of positive coping was relatively more important than that of resilience. This result suggests that personalized treatments aimed at resilience and positive coping can effectively buffer the impact of negative symptoms for patients with schizophrenia and promote rehabilitation.