101
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Perrottelli A, Giordano GM, Brando F, Giuliani L, Mucci A. EEG-Based Measures in At-Risk Mental State and Early Stages of Schizophrenia: A Systematic Review. Front Psychiatry 2021; 12:653642. [PMID: 34017273 PMCID: PMC8129021 DOI: 10.3389/fpsyt.2021.653642] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 04/06/2021] [Indexed: 12/17/2022] Open
Abstract
Introduction: Electrophysiological (EEG) abnormalities in subjects with schizophrenia have been largely reported. In the last decades, research has shifted to the identification of electrophysiological alterations in the prodromal and early phases of the disorder, focusing on the prediction of clinical and functional outcome. The identification of neuronal aberrations in subjects with a first episode of psychosis (FEP) and in those at ultra high-risk (UHR) or clinical high-risk (CHR) to develop a psychosis is crucial to implement adequate interventions, reduce the rate of transition to psychosis, as well as the risk of irreversible functioning impairment. The aim of the review is to provide an up-to-date synthesis of the electrophysiological findings in the at-risk mental state and early stages of schizophrenia. Methods: A systematic review of English articles using Pubmed, Scopus, and PsychINFO was undertaken in July 2020. Additional studies were identified by hand-search. Electrophysiological studies that included at least one group of FEP or subjects at risk to develop psychosis, compared to healthy controls (HCs), were considered. The heterogeneity of the studies prevented a quantitative synthesis. Results: Out of 319 records screened, 133 studies were included in a final qualitative synthesis. Included studies were mainly carried out using frequency analysis, microstates and event-related potentials. The most common findings included an increase in delta and gamma power, an impairment in sensory gating assessed through P50 and N100 and a reduction of Mismatch Negativity and P300 amplitude in at-risk mental state and early stages of schizophrenia. Progressive changes in some of these electrophysiological measures were associated with transition to psychosis and disease course. Heterogeneous data have been reported for indices evaluating synchrony, connectivity, and evoked-responses in different frequency bands. Conclusions: Multiple EEG-indices were altered during at-risk mental state and early stages of schizophrenia, supporting the hypothesis that cerebral network dysfunctions appear already before the onset of the disorder. Some of these alterations demonstrated association with transition to psychosis or poor functional outcome. However, heterogeneity in subjects' inclusion criteria, clinical measures and electrophysiological methods prevents drawing solid conclusions. Large prospective studies are needed to consolidate findings concerning electrophysiological markers of clinical and functional outcome.
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Affiliation(s)
- Andrea Perrottelli
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | | | - Francesco Brando
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Luigi Giuliani
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Armida Mucci
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
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102
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Ewens B, Barnard-Towell A, Mortimer-Jones S, Kemp V, Cole A. Cochrane Corner Summary of Review Titled: "Peer Support for People with Schizophrenia or Other Serious Mental Illness". Issues Ment Health Nurs 2021; 42:106-108. [PMID: 33027603 DOI: 10.1080/01612840.2020.1822479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Beverley Ewens
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Amanda Barnard-Towell
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Sheila Mortimer-Jones
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Vivien Kemp
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Amanda Cole
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
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103
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Haguiara B, Koga G, Diniz E, Fonseca L, Higuchi CH, Kagan S, Lacerda A, Correll CU, Gadelha A. What is the Best Latent Structure of Negative Symptoms in Schizophrenia? A Systematic Review. SCHIZOPHRENIA BULLETIN OPEN 2021; 2:sgab013. [PMID: 34901862 PMCID: PMC8650068 DOI: 10.1093/schizbullopen/sgab013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Determining the best latent structure of negative symptoms in schizophrenia could benefit assessment tools, neurobiological research, and targeted interventions. However, no review systematically evaluated studies that assessed and validated latent models of negative symptoms. Objective To identify and evaluate existing latent structure models in the literature of negative symptoms and to determine the best model. Method Systematic search of MEDLINE, EMBASE, and Scopus on July 19, 2020, for confirmatory factor analysis models of negative symptoms in patients with schizophrenia. The available evidence was assessed through 2 sets of criteria: (1) study design quality—based on negative symptoms assessment and modeling strategy and (2) psychometric quality and model fit—based on fit indices and factor definition quality. Results In total, 22 studies (n = 17 086) from 9 countries were included. Studies differed greatly regarding symptom scales, setting, and sample size (range = 86–6889). Dimensional models included 2–6 factors (median = 4). Twelve studies evaluated competing models and adopted appropriate instruments to assess the latent structure of negative symptoms. The 5-factor and hierarchical models outperformed unitary, 2-factor, and 3-factor models on all direct comparisons, and most of the analyses derived from the Brief Negative Symptom Scale. Considering the quality criteria proposed, 5-factor and hierarchical models achieved excellent fit in just one study. Conclusions Our review points out that the 5-factor and hierarchical models represent the best latent structure of negative symptoms, but the immaturity of the relevant current literature may affect the robustness of this conclusion. Future studies should address current limitations regarding psychometric properties and also address biological and clinical validity to refine available models.
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Affiliation(s)
- Bernardo Haguiara
- Laboratory of Integrative Neurosciences, Department of Psychiatry, Escola Paulista de Medicina/Universidade Federal de São Paulo, SP, Brazil
| | - Gabriela Koga
- Laboratory of Integrative Neurosciences, Department of Psychiatry, Escola Paulista de Medicina/Universidade Federal de São Paulo, SP, Brazil
| | - Elton Diniz
- Laboratory of Integrative Neurosciences, Department of Psychiatry, Escola Paulista de Medicina/Universidade Federal de São Paulo, SP, Brazil
- Schizophrenia Program, Department of Psychiatry, Escola Paulista de Medicina/Universidade Federal de São Paulo, SP, Brazil
| | - Lais Fonseca
- Laboratory of Integrative Neurosciences, Department of Psychiatry, Escola Paulista de Medicina/Universidade Federal de São Paulo, SP, Brazil
- Schizophrenia Program, Department of Psychiatry, Escola Paulista de Medicina/Universidade Federal de São Paulo, SP, Brazil
| | - Cinthia H Higuchi
- Laboratory of Integrative Neurosciences, Department of Psychiatry, Escola Paulista de Medicina/Universidade Federal de São Paulo, SP, Brazil
| | - Simão Kagan
- Laboratory of Integrative Neurosciences, Department of Psychiatry, Escola Paulista de Medicina/Universidade Federal de São Paulo, SP, Brazil
| | - Acioly Lacerda
- Laboratory of Integrative Neurosciences, Department of Psychiatry, Escola Paulista de Medicina/Universidade Federal de São Paulo, SP, Brazil
- Schizophrenia Program, Department of Psychiatry, Escola Paulista de Medicina/Universidade Federal de São Paulo, SP, Brazil
| | - Christoph U Correll
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
- Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Ary Gadelha
- Laboratory of Integrative Neurosciences, Department of Psychiatry, Escola Paulista de Medicina/Universidade Federal de São Paulo, SP, Brazil
- Schizophrenia Program, Department of Psychiatry, Escola Paulista de Medicina/Universidade Federal de São Paulo, SP, Brazil
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104
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Recio-Barbero M, Segarra R, Zabala A, González-Fraile E, González-Pinto A, Ballesteros J. Cognitive Enhancers in Schizophrenia: A Systematic Review and Meta-Analysis of Alpha-7 Nicotinic Acetylcholine Receptor Agonists for Cognitive Deficits and Negative Symptoms. Front Psychiatry 2021; 12:631589. [PMID: 33889097 PMCID: PMC8055861 DOI: 10.3389/fpsyt.2021.631589] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 02/22/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Schizophrenia is a severe and enduring disease and is one of the leading causes of disability worldwide. Cognitive impairment is a core clinical symptom that plays a crucial role in functional outcomes and prognosis, thus making it a relevant treatment target. The aim of this study was to assess the efficacy of alpha-7 nicotinic acetylcholine receptor agonists (α7 nAChR) as adjunctive treatment to enhance cognition and ameliorate negative symptoms in patients with schizophrenia. Methods: A search strategy was developed for MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials up to May 2019. We included randomized controlled trials (RCTs) that compared antipsychotic treatment plus α7 nAChR agonists with antipsychotic treatment plus placebo and determined their effects on the main cognitive domains proposed by the MATRICS initiative and on negative symptoms. Two authors independently reviewed study eligibility and data extraction and assessed the risk of bias of the studies included. According to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework, we used a random-effects model and assessed the quality of the evidence. Results: Thirteen studies were included in the quantitative analysis. No differences were found in any of the cognitive domains assessed in four RCTs (n = 414). In contrast, nine RCTs (n = 978) presented a small effect in support of α7 nAChR agonists for negative symptoms [standardized mean difference -0.28, 95% CI (-0.56 to -0.00); P = 0.05], even though the confidence to support this evidence is low according to the GRADE system. Conclusions: Current evidence is too weak to consider α7 nAChR agonists as an effective add-on treatment to antipsychotics to enhance cognition and negative symptoms.
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Affiliation(s)
| | - Rafael Segarra
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain.,Department of Psychiatry, Cruces University Hospital, Barakaldo, Spain.,Department of Neurosciences, University of the Basque Country (UPV/EHU), Leioa, Spain.,Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | - Arantzazu Zabala
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain.,Department of Neurosciences, University of the Basque Country (UPV/EHU), Leioa, Spain.,Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | | | - Ana González-Pinto
- Department of Neurosciences, University of the Basque Country (UPV/EHU), Leioa, Spain.,Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain.,Department of Psychiatry, Araba University Hospital, Vitoria-Gasteiz, Spain.,Bioaraba Health Research Institute, Vitoria-Gasteiz, Spain
| | - Javier Ballesteros
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain.,Department of Neurosciences, University of the Basque Country (UPV/EHU), Leioa, Spain.,Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
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105
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Giordano GM, Bucci P, Mucci A, Pezzella P, Galderisi S. Gender Differences in Clinical and Psychosocial Features Among Persons With Schizophrenia: A Mini Review. Front Psychiatry 2021; 12:789179. [PMID: 35002807 PMCID: PMC8727372 DOI: 10.3389/fpsyt.2021.789179] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 12/03/2021] [Indexed: 01/10/2023] Open
Abstract
An extensive literature regarding gender differences relevant to several aspects of schizophrenia is nowadays available. It includes some robust findings as well as some inconsistencies. In the present review, we summarize the literature on gender differences in schizophrenia relevant to clinical and social outcome as well as their determinants, focusing on clinical variables, while gender differences on biological factors which may have an impact on the outcome of the disorder were not included herewith. Consistent findings include, in male with respect to female patients, an earlier age of illness onset limited to early- and middle-onset schizophrenia, a worse premorbid functioning, a greater severity of negative symptoms, a lower severity of affective symptoms and a higher rate of comorbid alcohol/substance abuse. Discrepant findings have been reported on gender differences in positive symptoms and in social and non-social cognition, as well as in functional outcome and rates of recovery. In fact, despite the overall finding of a more severe clinical picture in males, this does not seem to translate into a worse outcome. From the recent literature emerges that, although some findings on gender differences in schizophrenia are consistent, there are still aspects of clinical and functional outcome which need clarification by means of further studies taking into account several methodological issues.
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Affiliation(s)
| | - Paola Bucci
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Armida Mucci
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Pasquale Pezzella
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Silvana Galderisi
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
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106
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Ebrahimi A, Poursharifi H, Dolatshahi B, Rezaee O, Hassanabadi HR, Naeem F. The Cognitive Model of Negative Symptoms in Schizophrenia: A Hierarchical Component Model With PLS-SEM. Front Psychiatry 2021; 12:707291. [PMID: 34366940 PMCID: PMC8339582 DOI: 10.3389/fpsyt.2021.707291] [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: 05/09/2021] [Accepted: 06/24/2021] [Indexed: 11/13/2022] Open
Abstract
The cognitive model of negative symptoms suggests that some dysfunctional beliefs mediate the relationship between neurocognitive deficits and negative symptoms and disability. This study tested the hypothesis that dysfunctional performance beliefs mediate neurocognitive deficits, negative symptoms, and disability. We used a hierarchal component model with 85 men patients diagnosed with chronic schizophrenia. Results showed a moderate to strong correlation between dysfunctional performance beliefs, neurocognitive deficits, negative symptoms, and disability. These results support the Hierarchal component model (HCM) of the cognitive model of negative symptoms. Our results indicated that the disability in schizophrenia is mediated through dysfunctional performance beliefs, neurocognitive deficits, and negative symptoms pathway. Further, dysfunctional performance beliefs have a crucial role in this pathway. Therefore, targeting this vicious cycle of dysfunctional beliefs can improve disability in patients with schizophrenia.
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Affiliation(s)
- Ali Ebrahimi
- Department of Clinical Psychology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Hamid Poursharifi
- Department of Clinical Psychology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Behrooz Dolatshahi
- Department of Clinical Psychology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Omid Rezaee
- Department of Psychiatry, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Hamid Reza Hassanabadi
- Department of Clinical Psychology, Faculty of Psychology and Educational Sciences, Kharazmi University, Tehran, Iran
| | - Farooq Naeem
- Department of Psychiatry, University of Toronto & Centre for Addiction and Mental Health, Toronto, ON, Canada
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107
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Marder SR, Meehan SR, Weiss C, Chen D, Hobart M, Hefting N. Effects of Brexpiprazole Across Symptom Domains in Patients With Schizophrenia: Post Hoc Analysis of Short- and Long-Term Studies. SCHIZOPHRENIA BULLETIN OPEN 2021; 2:sgab014. [PMID: 34901863 PMCID: PMC8650077 DOI: 10.1093/schizbullopen/sgab014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The successful treatment of schizophrenia entails improvement across a spectrum of symptoms. The aim of this post hoc analysis was to characterize the short- and long-term effects of brexpiprazole on Positive and Negative Syndrome Scale (PANSS) ‘Marder factors.’ Data were included from three 6-week, randomized, double-blind, placebo-controlled studies; a 52-week, randomized, double-blind, placebo-controlled maintenance treatment study; and two 52-week open-label extension (OLEx) studies—all in schizophrenia (DSM-IV-TR criteria). Patients receiving oral brexpiprazole were dosed at 2–4 mg/day (short-term studies) or 1–4 mg/day (long-term studies). At Week 6, least squares mean differences (LSMDs, with 95% confidence limits [CLs]) for brexpiprazole (n = 868) vs placebo (n = 517) were: Positive symptoms: −1.55 (−2.30, −0.80), P < .0001, Cohen’s d effect size (ES) = 0.27; Negative symptoms: −1.12 (−1.63, −0.61), P < .0001, ES = 0.29; Disorganized thought: −1.26 (−1.78, −0.74), P < .0001, ES = 0.32; Uncontrolled hostility/excitement: −0.76 (−1.15, −0.37), P = .0002, ES = 0.26; Anxiety/ depression: −0.56 (−0.91, −0.22), P = .0014, ES = 0.22. At last visit of the maintenance study, LSMDs (95% CLs) for brexpiprazole (n = 96) vs placebo (n = 104) were: Positive symptoms: −3.44 (−4.99, −1.89), P < .0001, ES = 0.62; Negative symptoms: −1.23 (−2.52, 0.07), P = .063, ES = 0.27; Disorganized thought: −1.69 (−2.81, −0.56), P = .0035, ES = 0.42; Uncontrolled hostility/excitement: −1.26 (−2.12, −0.39), P = .0046, ES = 0.41; Anxiety/depression: −0.72 (−1.47, 0.03), P = .061, ES = 0.27. In the OLEx studies, improvements were maintained over 58 (6 + 52) weeks of brexpiprazole treatment. In conclusion, these data suggest that brexpiprazole treats the continuum of schizophrenia symptoms, in the short- and long-term. Trial Registration: Data used in this post hoc analysis came from ClinicalTrials.gov identifiers: NCT01396421, NCT01393613, NCT01810380, NCT01668797, NCT01397786, NCT01810783.
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Affiliation(s)
- Stephen R Marder
- Department of Psychiatry, Semel Institute for Neuroscience at UCLA and the VA VISN 22 Mental Illness Research, Education, and Clinical Center, Los Angeles, CA
| | | | - Catherine Weiss
- Otsuka Pharmaceutical Development & Commercialization Inc, Princeton, NJ
| | - Dalei Chen
- Otsuka Pharmaceutical Development & Commercialization Inc, Princeton, NJ
| | - Mary Hobart
- Otsuka Pharmaceutical Development & Commercialization Inc, Princeton, NJ
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108
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Jorratt P, Hoschl C, Ovsepian SV. Endogenous antagonists of N-methyl-d-aspartate receptor in schizophrenia. Alzheimers Dement 2020; 17:888-905. [PMID: 33336545 DOI: 10.1002/alz.12244] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 10/24/2020] [Indexed: 12/28/2022]
Abstract
Schizophrenia is a chronic neuropsychiatric brain disorder that has devastating personal impact and rising healthcare costs. Dysregulation of glutamatergic neurotransmission has been implicated in the pathobiology of the disease, attributed largely to the hypofunction of the N-methyl-d-aspartate (NMDA) receptor. Currently, there is a major gap in mechanistic analysis as to how endogenous modulators of the NMDA receptors contribute to the onset and progression of the disease. We present a systematic review of the neurobiology and the role of endogenous NMDA receptor antagonists in animal models of schizophrenia, and in patients. We discuss their neurochemical origin, release from neurons and glia with action mechanisms, and functional effects, which might contribute toward the impairment of neuronal processes underlying this complex pathological state. We consider clinical evidence suggesting dysregulations of endogenous NMDA receptor in schizophrenia, and highlight the pressing need in future studies and emerging directions, to restore the NMDA receptor functions for therapeutic benefits.
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Affiliation(s)
- Pascal Jorratt
- Department of Experimental Neurobiology, National Institute of Mental Health, Klecany, Czech Republic.,Department of Psychiatry and Medical Psychology, Third Faculty of Medicine, Charles University, Prague 10, Czech Republic
| | - Cyril Hoschl
- Department of Experimental Neurobiology, National Institute of Mental Health, Klecany, Czech Republic.,Department of Psychiatry and Medical Psychology, Third Faculty of Medicine, Charles University, Prague 10, Czech Republic
| | - Saak V Ovsepian
- Department of Experimental Neurobiology, National Institute of Mental Health, Klecany, Czech Republic.,Department of Psychiatry and Medical Psychology, Third Faculty of Medicine, Charles University, Prague 10, Czech Republic
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109
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Stogios N, Smith E, Asgariroozbehani R, Hamel L, Gdanski A, Selby P, Sockalingam S, Graff-Guerrero A, Taylor VH, Agarwal SM, Hahn MK. Exploring Patterns of Disturbed Eating in Psychosis: A Scoping Review. Nutrients 2020; 12:E3883. [PMID: 33353080 PMCID: PMC7768542 DOI: 10.3390/nu12123883] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 12/03/2020] [Accepted: 12/09/2020] [Indexed: 12/19/2022] Open
Abstract
Disturbed eating behaviours have been widely reported in psychotic disorders since the early 19th century. There is also evidence that antipsychotic (AP) treatment may induce binge eating or other related compulsive eating behaviours. It is therefore possible that abnormal eating patterns may contribute to the significant weight gain and other metabolic disturbances observed in patients with psychosis. In this scoping review, we aimed to explore the underlying psychopathological and neurobiological mechanisms of disrupted eating behaviours in psychosis spectrum disorders and the role of APs in this relationship. A systematic search identified 35 studies that met our eligibility criteria and were included in our qualitative synthesis. Synthesizing evidence from self-report questionnaires and food surveys, we found that patients with psychosis exhibit increased appetite and craving for fatty food, as well as increased caloric intake and snacking, which may be associated with increased disinhibition. Limited evidence from neuroimaging studies suggested that AP-naïve first episode patients exhibit similar neural processing of food to healthy controls, while chronic AP exposure may lead to decreased activity in satiety areas and increased activity in areas associated with reward anticipation. Overall, this review supports the notion that AP use can lead to disturbed eating patterns in patients, which may contribute to AP-induced weight gain. However, intrinsic illness-related effects on eating behaviors remain less well elucidated, and many confounding factors as well as variability in study designs limits interpretation of existing literature in this field and precludes firm conclusions from being made.
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Affiliation(s)
- Nicolette Stogios
- Centre for Addiction and Mental Health (CAMH), Toronto, ON M6J 1H3, Canada; (N.S.); (E.S.); (R.A.); (L.H.); (P.S.); (S.S.); (A.G.-G.); (S.M.A.)
- Institute of Medical Science (IMS), University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Emily Smith
- Centre for Addiction and Mental Health (CAMH), Toronto, ON M6J 1H3, Canada; (N.S.); (E.S.); (R.A.); (L.H.); (P.S.); (S.S.); (A.G.-G.); (S.M.A.)
- Institute of Medical Science (IMS), University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Roshanak Asgariroozbehani
- Centre for Addiction and Mental Health (CAMH), Toronto, ON M6J 1H3, Canada; (N.S.); (E.S.); (R.A.); (L.H.); (P.S.); (S.S.); (A.G.-G.); (S.M.A.)
- Institute of Medical Science (IMS), University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Laurie Hamel
- Centre for Addiction and Mental Health (CAMH), Toronto, ON M6J 1H3, Canada; (N.S.); (E.S.); (R.A.); (L.H.); (P.S.); (S.S.); (A.G.-G.); (S.M.A.)
| | - Alexander Gdanski
- Department of Human Biology, University of Toronto, Toronto, ON M5S 3J6, Canada;
| | - Peter Selby
- Centre for Addiction and Mental Health (CAMH), Toronto, ON M6J 1H3, Canada; (N.S.); (E.S.); (R.A.); (L.H.); (P.S.); (S.S.); (A.G.-G.); (S.M.A.)
- Department of Family and Community Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada
| | - Sanjeev Sockalingam
- Centre for Addiction and Mental Health (CAMH), Toronto, ON M6J 1H3, Canada; (N.S.); (E.S.); (R.A.); (L.H.); (P.S.); (S.S.); (A.G.-G.); (S.M.A.)
- Institute of Medical Science (IMS), University of Toronto, Toronto, ON M5S 1A8, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada
- Bariatric Surgery Program, University Health Network, Toronto, ON M5T 2S8, Canada
| | - Ariel Graff-Guerrero
- Centre for Addiction and Mental Health (CAMH), Toronto, ON M6J 1H3, Canada; (N.S.); (E.S.); (R.A.); (L.H.); (P.S.); (S.S.); (A.G.-G.); (S.M.A.)
- Institute of Medical Science (IMS), University of Toronto, Toronto, ON M5S 1A8, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada
| | - Valerie H. Taylor
- Department of Psychiatry, University of Calgary, Calgary, AB T2N 1N4, Canada;
| | - Sri Mahavir Agarwal
- Centre for Addiction and Mental Health (CAMH), Toronto, ON M6J 1H3, Canada; (N.S.); (E.S.); (R.A.); (L.H.); (P.S.); (S.S.); (A.G.-G.); (S.M.A.)
- Institute of Medical Science (IMS), University of Toronto, Toronto, ON M5S 1A8, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada
| | - Margaret K. Hahn
- Centre for Addiction and Mental Health (CAMH), Toronto, ON M6J 1H3, Canada; (N.S.); (E.S.); (R.A.); (L.H.); (P.S.); (S.S.); (A.G.-G.); (S.M.A.)
- Institute of Medical Science (IMS), University of Toronto, Toronto, ON M5S 1A8, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada
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110
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Assessing Social Connectedness Among Persons with Schizophrenia: Psychometric Evaluation of the Perceived Social Connectedness Scale. J Behav Health Serv Res 2020; 47:113-125. [PMID: 30945109 DOI: 10.1007/s11414-019-09656-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The purpose of this study was a psychometric evaluation of the 4-item perceived social connectedness (PSC) scale. The study analyzed secondary data from a project that assessed physical, behavioral, and social health characteristics of adults with serious mental illness receiving integrated services at community mental health centers (CMHs). The current sample comprised those diagnosed with schizophrenia attending these CMHs (N = 146). Most participants were African-American males who receive disability benefits with Medicaid as health insurance. The sample self-reported low-to-moderate levels of social connectedness, daily functioning, and symptom severity. Factor analysis of the PSC scale revealed one dimension, accounting for 66% of total variance, with strong item loadings. Reliability coefficients indicated sufficient scale internal consistency. Construct validity was suggested via the PSC scale's directional, significant convergence with daily functioning and symptom severity. Implications include the application of the PSC scale for this socioeconomically disadvantaged population that customarily lacks meaningful social networks.
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Zhou C, Li Z. Modelling of self‐management in schizophrenia: The role of neurocognition, self‐efficacy and motivation. J Clin Nurs 2020; 29:3966-3976. [DOI: 10.1111/jocn.15407] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 05/29/2020] [Accepted: 06/27/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Chenxi Zhou
- School of Nursing Peking Union Medical College Beijing China
| | - Zheng Li
- School of Nursing Peking Union Medical College Beijing China
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112
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Barlati S, Minelli A, Ceraso A, Nibbio G, Carvalho Silva R, Deste G, Turrina C, Vita A. Social Cognition in a Research Domain Criteria Perspective: A Bridge Between Schizophrenia and Autism Spectra Disorders. Front Psychiatry 2020; 11:806. [PMID: 33005149 PMCID: PMC7485015 DOI: 10.3389/fpsyt.2020.00806] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 07/27/2020] [Indexed: 12/27/2022] Open
Abstract
Schizophrenia and autism spectra disorders are currently conceptualized as distinct clinical categories. However, the relationship between these two nosological entities has been revisited in recent years due to the evidence that they share some important clinical and neurobiological features, putting into question the nature and the extent of their commonalities and differences. In this respect, some core symptoms that are present in both disorders, such as social cognitive deficits, could be a primary target of investigation. This review briefly summarizes the commonalities and overlapping features between schizophrenia and autism spectra disorders in social cognitive functions, considering this construct in a Research Domain Criteria perspective. The clinical manifestation of deficits in social cognition are similar in schizophrenia spectrum disorders and autism spectrum disorders, and brain areas that appear to be altered in relation to these impairments are largely shared; however, the results of various studies suggest that, in some cases, the qualitative nature of these alterations may be different in the two spectra. Moreover, relevant differences could be present at the level of brain networks and connections. More research is required in this field, regarding molecular and genetic aspects of both spectra, to better define the neurobiological mechanisms involved in social cognition deficits, with the objective of developing specific and targeted treatments.
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Affiliation(s)
- Stefano Barlati
- Department of Clinical and Experimental Sciences, University of Brescia, and Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
- Genetics Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Alessandra Minelli
- Genetics Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Anna Ceraso
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Gabriele Nibbio
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Rosana Carvalho Silva
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Giacomo Deste
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Cesare Turrina
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Antonio Vita
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
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113
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Langova V, Vales K, Horka P, Horacek J. The Role of Zebrafish and Laboratory Rodents in Schizophrenia Research. Front Psychiatry 2020; 11:703. [PMID: 33101067 PMCID: PMC7500259 DOI: 10.3389/fpsyt.2020.00703] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 07/03/2020] [Indexed: 12/11/2022] Open
Abstract
Schizophrenia is a severe disorder characterized by positive, negative and cognitive symptoms, which are still not fully understood. The development of efficient antipsychotics requires animal models of a strong validity, therefore the aims of the article were to summarize the construct, face and predictive validity of schizophrenia models based on rodents and zebrafish, to compare the advantages and disadvantages of these models, and to propose future directions in schizophrenia modeling and indicate when it is reasonable to combine these models. The advantages of rodent models stem primarily from the high homology between rodent and human physiology, neurochemistry, brain morphology and circuitry. The advantages of zebrafish models stem in the high fecundity, fast development and transparency of the embryo. Disadvantages of both models originate in behavioral repertoires not allowing specific symptoms to be modeled, even when the models are combined. Especially modeling the verbal component of certain positive, negative and cognitive symptoms is currently impossible.
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Affiliation(s)
- Veronika Langova
- Translational Neuroscience, National Institute of Mental Health, Prague, Czechia
- Third Faculty of Medicine, Charles University, Prague, Czechia
| | - Karel Vales
- Translational Neuroscience, National Institute of Mental Health, Prague, Czechia
| | - Petra Horka
- Institute for Environmental Studies, Faculty of Science, Charles University, Prague, Czechia
| | - Jiri Horacek
- Third Faculty of Medicine, Charles University, Prague, Czechia
- Brain Electrophysiology, National Institute of Mental Health, Prague, Czechia
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114
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EEG microstates as biomarker for psychosis in ultra-high-risk patients. Transl Psychiatry 2020; 10:300. [PMID: 32839449 PMCID: PMC7445239 DOI: 10.1038/s41398-020-00963-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 07/17/2020] [Accepted: 07/22/2020] [Indexed: 02/01/2023] Open
Abstract
Resting-state EEG microstates are brief (50-100 ms) periods, in which the spatial configuration of scalp global field power remains quasi-stable before rapidly shifting to another configuration. Changes in microstate parameters have been described in patients with psychotic disorders. These changes have also been observed in individuals with a clinical or genetic high risk, suggesting potential usefulness of EEG microstates as a biomarker for psychotic disorders. The present study aimed to investigate the potential of EEG microstates as biomarkers for psychotic disorders and future transition to psychosis in patients at ultra-high-risk (UHR). We used 19-channel clinical EEG recordings and orthogonal contrasts to compare temporal parameters of four normative microstate classes (A-D) between patients with first-episode psychosis (FEP; n = 29), UHR patients with (UHR-T; n = 20) and without (UHR-NT; n = 34) later transition to psychosis, and healthy controls (HC; n = 25). Microstate A was increased in patients (FEP & UHR-T & UHR-NT) compared to HC, suggesting an unspecific state biomarker of general psychopathology. Microstate B displayed a decrease in FEP compared to both UHR patient groups, and thus may represent a state biomarker specific to psychotic illness progression. Microstate D was significantly decreased in UHR-T compared to UHR-NT, suggesting its potential as a selective biomarker of future transition in UHR patients.
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115
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Teferra S. Initiating clozapine treatment service and characteristics of clozapine-treated patients in a general hospital in Addis Ababa, Ethiopia. S Afr J Psychiatr 2020; 26:1418. [PMID: 32670632 PMCID: PMC7343948 DOI: 10.4102/sajpsychiatry.v26i0.1418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 03/05/2020] [Indexed: 11/18/2022] Open
Abstract
Background At least one-third of patients with schizophrenia suffer from treatment-resistant schizophrenia needing treatment with clozapine. This is the first report on the experience of initiating clozapine service in Ethiopia. Aim The aim of this study was to report the experience of setting up clozapine service and describe characteristics of patients treated with clozapine. Setting This study was conducted in a general hospital in Addis Ababa, Ethiopia. Methods Descriptive summary of the clozapine treatment service and review of characteristics of patients treated with clozapine were conducted. Clinical Global Impression (CGI) Scale and Abnormal Involuntary Movement Scale (AIMS) score were used to measure outcome. Quantitative data were analysed using Statistical Package for the Social Sciences (SPSS) Version 24. Results It was possible to provide clozapine treatment in a general hospital using the national guideline. During the first year of initiation of the service, a total of 22 patients were treated. The majority were men (20/22, 90.9%) and in the age group of 30–44 years (11/22, 50%). Indications for clozapine were treatment-resistant schizophrenia (15/22, 68.2%) and tardive dyskinesia (7/22, 31.8%). The average dose of clozapine was 350 mg/day. Common side effects included sedation, constipation and excessive salivation. On CGI Scale, mean severity index score dropped from 5.18 at admission to 3.68 during discharge, and average AIMS score changed from 16.8 to 6.5. None of the patients developed agranulocytosis; however, three patients discontinued because of adverse effects. Conclusion Establishing clozapine treatment service was possible in a general hospital in Ethiopia where psychiatric service run by psychiatrists was available. Mechanisms should be in place to ensure adherence to the national guideline.
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Affiliation(s)
- Solomon Teferra
- Department of Psychiatry, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
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116
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Promoting Recovery in Mental Illness: The Perspectives of Patients, Caregivers, and Community Members in Dar es Salaam, Tanzania. PSYCHIATRY JOURNAL 2020; 2020:3607414. [PMID: 32566637 PMCID: PMC7298341 DOI: 10.1155/2020/3607414] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Accepted: 05/29/2020] [Indexed: 11/18/2022]
Abstract
Background Promoting mental health and care in the community setting leads to the recovery of patients with mental illness. Although recovery in mental health is a complex phenomenon, caregivers and community members have important roles to play in the recovery process for patients with mental illness. Little is documented on how recovery is promoted in the community setting. This study explored the experience of patients, caregivers, and community members on how recovery can be realized in a patient with severe mental illness in Dar es Salaam. Methods We conducted four focus group discussions (FGDs): two with caregivers and the other two with community members. Also, six in-depth interviews were held with patients with mental illness. Participants were purposively selected based on the type of information needed. Both FGD and in-depth interviews were digitally recorded and transcribed. Qualitative content analysis was used to analyze data. Findings. Four themes emerged from this study, which include promoting patients' participation in household activities, improving patients' support system, promoting patients' self-care management, and providing safety and protection among patients with mental illness. However, financial, psychological, and establishing care and support centers and professional supports emerged as subthemes from patients' support system. Conclusion Caregivers and community members are significant stakeholders for promoting recovery for people with mental illness. The current study reveals that patients' involvement in home activities, promoting self-care management, improving patients' support systems, and providing safety and protection are important factors that promote recovery for people with mental illness. Advocating mental health awareness for caregivers and community members will bridge the gap to enhance the recovery for people with mental illness. Further research is needed in this area to explore the health care providers' perspectives on the recovery process of mental illness in the hospital setting.
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Helldin L, Mohn C, Olsson AK, Hjärthag F. Neurocognitive variability in schizophrenia spectrum disorders: relationship to real-world functioning. Schizophr Res Cogn 2020; 20:100172. [PMID: 32090024 PMCID: PMC7026276 DOI: 10.1016/j.scog.2020.100172] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 01/31/2020] [Accepted: 02/04/2020] [Indexed: 12/31/2022]
Abstract
Neurocognitive variability exists within the schizophrenia spectrum disorder (SSD) population, with subgroups performing at the same level as healthy samples Here we study the relationship between different levels of neurocognitive responding and real-world functioning. The participants were 291 SSD patients and 302 healthy controls that were assessed with a comprehensive neurocognitive battery. In addition, the patients were assessed with the Specific Level of Functioning Scale (SLOF). The results showed that the mean neurocognitive test responses of the SSD group were significantly below that of the control group. However, there was considerable overlap between the cognitive scores of the two groups, with as many as 24% of the patients performing above the mean healthy score for some domains. Moreover, the patients with the highest level of neurocognitive functioning reached the highest levels of practical and work-related functioning outcome skills. There was no significant relationship between neurocognitive and social function skills. The large differences in cognitive performance and their associations with functional outcome within the patient group are rarely addressed in clinical practice, but indicate a clear need for individualized treatment of SSD. Early identification of cognitive risk factors for poor real-life functional outcome is necessary in order to alert the clinical and rehabilitation services about patients in need of extra care.
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Affiliation(s)
- Lars Helldin
- Department of Psychiatry, NU Health-Care Hospital, Region Västra Götaland, Sweden
- Department of Psychology, Karlstad University, Sweden
| | - Christine Mohn
- NORMENT, Institute of Clinical Medicine, University of Oslo, Norway
| | - Anna-Karin Olsson
- Department of Psychiatry, NU Health-Care Hospital, Region Västra Götaland, Sweden
- Department of Psychology, Karlstad University, Sweden
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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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The overall and sex- and age-group specific incidence rates of cancer in people with schizophrenia: a population-based cohort study. Epidemiol Psychiatr Sci 2020; 29:e132. [PMID: 32460950 PMCID: PMC7264860 DOI: 10.1017/s204579602000044x] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
AIMS Decades of research show that people with schizophrenia have an increased risk of death from cancer; however, the relationship between schizophrenia and cancer incidence remains less clear. This population-based study investigates the incidence of seven common types of cancer among people with a hospital diagnosis of schizophrenia and accounting for the effects of age, sex and calendar time. METHODS This population-based study used 1990-2013 data from three nationwide Swedish registries to calculate the incidence (in total, by age group and by sex) of any cancer and of lung, oesophageal, pancreatic, stomach, colon, (in men) prostate and (in women) breast cancer in 111 306 people with a hospital diagnosis of schizophrenia. The incidence in people with diagnosed schizophrenia was compared with the incidence in the general population. Risk estimates accounted for the effects of calendar time. RESULTS In 1 424 829 person-years of follow-up, schizophrenia did not confer an overall higher cancer risk (IRR 1.02, 95% CI 0.91-1.13) but was associated with a higher risk for female breast (IRR 1.19, 95% CI 1.12-1.26), lung (IRR 1.42, 95% CI 1.28-1.58), oesophageal (IRR 1.25, 95% CI 1.07-1.46) and pancreatic (IRR 1.10, 95% CI 1.01-1.21) and a lower risk of prostate (IRR 0.66, 95% CI 0.55-0.79) cancer. Some age- and sex-specific differences in risk were observed. CONCLUSIONS People with schizophrenia do not have a higher overall incidence of cancer than people in the general population. However, there are significant differences in the risk of specific cancer types overall and by sex calling for efforts to develop disease-specific prevention programmes. In people with schizophrenia, higher risk generally occurs in those <75 years.
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Nibbio G, Barlati S, Cacciani P, Corsini P, Mosca A, Ceraso A, Deste G, Vita A. Evidence-Based Integrated Intervention in Patients with Schizophrenia: A Pilot Study of Feasibility and Effectiveness in a Real-World Rehabilitation Setting. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E3352. [PMID: 32408561 PMCID: PMC7277196 DOI: 10.3390/ijerph17103352] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 04/21/2020] [Accepted: 04/22/2020] [Indexed: 12/02/2022]
Abstract
Impairment in real-world functioning remains one of the most problematic challenges that people with schizophrenia have to face. Various psychosocial interventions have proven to be effective in promoting recovery and improving functioning in schizophrenia; however, their implementation and their effectiveness in routine rehabilitation practice are still objects of study. The present pilot study aimed to assess the feasibility and effectiveness on clinical and real-world outcomes of an integrated treatment protocol composed of stable pharmacological treatment, computer-assisted cognitive remediation and social skills training provided in a rehabilitation center. Predictors of functional improvement were also assessed. Seventy-two patients diagnosed with schizophrenia participated in the study. A significant (p < 0.001) improvement in positive, negative and total symptoms, as well as in global clinical severity and real-world functioning outcomes was observed, with a large effect size in positive and total symptoms, global clinical severity and real-world functioning, and a moderate effect size on negative symptoms. Improvement in total symptoms (p < 0.001) and in global clinical severity (p = 0.007) emerged as individual predictors of functional improvement. These findings, although preliminary, suggest that an integrated, evidence-based treatment program is feasible and effective in a real-world rehabilitation context, and that similar interventions should be further implemented in everyday clinical practice.
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Affiliation(s)
- Gabriele Nibbio
- Department of Clinical and Experimental Sciences, University of Brescia, 25133 Brescia, Italy; (G.N.); (A.C.); (A.V.)
| | - Stefano Barlati
- Department of Clinical and Experimental Sciences, University of Brescia, 25133 Brescia, Italy; (G.N.); (A.C.); (A.V.)
- Department of Mental Health and Addiction Services, ASST Spedali Civili, 25133 Brescia, Italy; (P.C.); (P.C.); (A.M.); (G.D.)
| | - Paolo Cacciani
- Department of Mental Health and Addiction Services, ASST Spedali Civili, 25133 Brescia, Italy; (P.C.); (P.C.); (A.M.); (G.D.)
| | - Paola Corsini
- Department of Mental Health and Addiction Services, ASST Spedali Civili, 25133 Brescia, Italy; (P.C.); (P.C.); (A.M.); (G.D.)
| | - Alessandra Mosca
- Department of Mental Health and Addiction Services, ASST Spedali Civili, 25133 Brescia, Italy; (P.C.); (P.C.); (A.M.); (G.D.)
| | - Anna Ceraso
- Department of Clinical and Experimental Sciences, University of Brescia, 25133 Brescia, Italy; (G.N.); (A.C.); (A.V.)
| | - Giacomo Deste
- Department of Mental Health and Addiction Services, ASST Spedali Civili, 25133 Brescia, Italy; (P.C.); (P.C.); (A.M.); (G.D.)
| | - Antonio Vita
- Department of Clinical and Experimental Sciences, University of Brescia, 25133 Brescia, Italy; (G.N.); (A.C.); (A.V.)
- Department of Mental Health and Addiction Services, ASST Spedali Civili, 25133 Brescia, Italy; (P.C.); (P.C.); (A.M.); (G.D.)
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Dubreucq J, Gabayet F, Ycart B, Faraldo M, Melis F, Lucas T, Arnaud B, Bacconnier M, Bakri M, Cambier G, Carmona F, Chereau I, Challe T, Morel S, Pires S, Roussel C, Lamy P, Legrand G, Pages E, Pommier R, Rey R, Souchet Y, Llorca PM, Massoubre C. Improving social function with real-world social-cognitive remediation in schizophrenia: Results from the RemedRugby quasi-experimental trial. Eur Psychiatry 2020; 63:e41. [PMID: 32349835 PMCID: PMC7355162 DOI: 10.1192/j.eurpsy.2020.42] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background. Functional capacity (FC) has been identified as a key outcome to improve real-world functioning in schizophrenia. FC is influenced by cognitive impairments, negative symptoms, self-stigma and reduced physical activity (PA). Psychosocial interventions targeting FC are still under-developed. Methods. we conducted a quasi-experimental study evaluating the effects of an exercise-enriched integrated social cognitive remediation (SCR) intervention (RemedRugby [RR]) compared with an active control group practicing Touch Rugby (TR). To our knowledge, this is the first trial to date evaluating the effectiveness of such a program provided in a real-life environment. Results. Eighty-seven people with schizophrenia were included and allocated to either the RR group (n = 57) or the TR group (n = 30) according to the routine clinical practice of the recruiting center. Outcomes were evaluated at baseline and post-treatment in both groups and after 6 months of follow-up in the RR group using standardized scales for symptom severity, social functioning, self-stigma, and a large cognitive battery. After treatment we observed moderate to large improvements in social function (Personal and Social Performance Scale [PSP], p < 0.001, d = 1.255), symptom severity (Positive and Negative Syndrome Scale [PANSS] negative, p < 0.001, d = 0.827; PANSS GP, p < 0.001, d = 0.991; PANSS positive, p = 0.009, d = 0.594), verbal abstraction (p = 0.008, d = 0.554), aggression bias (p = 0.008, d = 0.627), and self-stigma (stereotype endorsement, p = 0.019, d = 0.495; discrimination experiences, p = 0.047; d = 0.389) that were specific to the RR group and were not observed in participants playing only TR. Effects were persistent over time and even larger between post-treatment and follow-up. Conclusions. Exercise-enriched integrated SCR appears promising to improve real-life functioning in schizophrenia. Future research should investigate the potential effects of this intervention on neuroplasticity and physical fitness.
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Affiliation(s)
- Julien Dubreucq
- Centre de Neurosciences Cognitive, UMR 5229, CNRS and Université Lyon 1, Lyon, France.,Centre Référent de Réhabilitation Psychosociale et de Remédiation cognitive (C3R), Centre Hospitalier Alpes Isère, Grenoble, France.,Fondation FondaMental, Créteil, France.,Réseau Handicap Psychique, Grenoble, France
| | - Franck Gabayet
- Centre Référent de Réhabilitation Psychosociale et de Remédiation cognitive (C3R), Centre Hospitalier Alpes Isère, Grenoble, France.,Fondation FondaMental, Créteil, France
| | - Bernard Ycart
- Laboratoire Jean Kuntzmann, CNRS UMR 5224, Université Grenoble-Alpes, Grenoble, France
| | - Megane Faraldo
- Centre Référent de Réhabilitation Psychosociale et de Remédiation cognitive (C3R), Centre Hospitalier Alpes Isère, Grenoble, France.,Fondation FondaMental, Créteil, France
| | - Fanny Melis
- Centre Référent de Réhabilitation Psychosociale et de Remédiation cognitive (C3R), Centre Hospitalier Alpes Isère, Grenoble, France
| | - Thierry Lucas
- Centre Référent de Réhabilitation Psychosociale et de Remédiation cognitive (C3R), Centre Hospitalier Alpes Isère, Grenoble, France
| | - Benjamin Arnaud
- Centre Hospitalier Sainte Marie de Clermont Ferrand, 33 rue Gabriel Péri, CS 9912, Clermont-Ferrand Cedex 1 63037, France
| | - Mickael Bacconnier
- Centre Médical La Teppe, 25 Avenue de la Bouterne, CS 9721, Tain-l'Hermitage Cedex 26602, France.,Centre de Réhabilitation Psychosociale et de Remédiation Cognitive (C2R), CH Drôme Vivarais, Montéléger, France
| | - Motassem Bakri
- Centre de Réhabilitation Psychosociale et de Remédiation Cognitive (C2R), CH Drôme Vivarais, Montéléger, France
| | - Gentiane Cambier
- Centre Hospitalier de la Savoie, 89 avenue de Bassens, Bassens73000, France
| | | | - Isabelle Chereau
- Fondation FondaMental, Créteil, France.,CMP B, CHU, EA 7280 Faculté de Médecine, Université d'Auvergne, BP 69, Clermont-Ferrand Cedex 1 63003, France
| | - Titaua Challe
- Centre Départemental de Réhabilitation Psychosociale des Glières, 219 Chemin des Bois des Fornets, La Roche sur Foron 74800, France
| | - Sophie Morel
- Centre de Réhabilitation Psychosociale et de Remédiation Cognitive (C2R), CH Drôme Vivarais, Montéléger, France
| | - Sylvie Pires
- Fondation FondaMental, Créteil, France.,CMP B, CHU, EA 7280 Faculté de Médecine, Université d'Auvergne, BP 69, Clermont-Ferrand Cedex 1 63003, France
| | - Celine Roussel
- Centre Départemental de Réhabilitation Psychosociale des Glières, 219 Chemin des Bois des Fornets, La Roche sur Foron 74800, France
| | - Philippe Lamy
- REHALise, CHU de Saint-Etienne, Saint-Etienne, France
| | - Guillaume Legrand
- Centre Hospitalier Sainte Marie de Clermont Ferrand, 33 rue Gabriel Péri, CS 9912, Clermont-Ferrand Cedex 1 63037, France
| | - Emmanuelle Pages
- Centre Hospitalier de la Savoie, 89 avenue de Bassens, Bassens73000, France
| | | | - Romain Rey
- Fondation FondaMental, Créteil, France.,Université Claude Bernard Lyon 1/Centre Hospitalier Le Vinatier Pole Est BP 300 39, 95 bd Pinel, Bron Cedex69678, France
| | - Yohan Souchet
- Fondation FondaMental, Créteil, France.,Université Claude Bernard Lyon 1/Centre Hospitalier Le Vinatier Pole Est BP 300 39, 95 bd Pinel, Bron Cedex69678, France
| | - Pierre-Michel Llorca
- Fondation FondaMental, Créteil, France.,CMP B, CHU, EA 7280 Faculté de Médecine, Université d'Auvergne, BP 69, Clermont-Ferrand Cedex 1 63003, France
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Predictive factors of functional capacity and real-world functioning in patients with schizophrenia. Eur Psychiatry 2020; 30:622-7. [DOI: 10.1016/j.eurpsy.2014.12.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 12/08/2014] [Accepted: 12/22/2014] [Indexed: 11/27/2022] Open
Abstract
AbstractPurposeThis study was performed to identify the predictive factors of functional capacity assessed by the Spanish University of California Performance Skills Assessment (Sp-UPSA) and real-world functioning assessed by the Spanish Personal and Social Performance scale (PSP) in outpatients with schizophrenia.MethodsNaturalistic, 6-month follow-up, multicentre, validation study. Here, we report data on 139 patients with schizophrenia at their baseline visit. Assessment: Positive and Negative Syndrome Scale (PANSS), Clinical Global Impression-Severity (CGI-S), Sp-UPSA and PSP. Statistics: Pearson's correlation coefficient (r) was used to determine the relationships between variables, and multivariable stepwise linear regression analyses to identify predictive variables of Sp-UPSA and PSP total scores.ResultsFunctional capacity: scores on the PSP and PANSS-GP entered first and second at P < 0.0001 and accounted for 21% of variance (R2 = 0.208, model df = 2, F = 15.724, P < 0.0001). Real-world functioning: scores on the CGI-S (B = −5.406), PANSS-N (B = −0.657) and Sp-UPSA (B = 0.230) entered first, second and third, and accounted for 51% of variance (model df = 3, F = 37.741, P < 0.0001).ConclusionIn patients with schizophrenia, functional capacity and real-world functioning are two related but different constructs. Each one predicts the other along with other factors; general psychopathology for functional capacity, and severity of the illness and negative symptoms for real-world functioning. These findings have important clinical implications: (1) both types of functioning should be assessed in patients with schizophrenia and (2) strategies for improving them should be different.
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Rao RN, Chanda K. An assessment study of known pyrazolopyrimidines: Chemical methodology and cellular activity. Bioorg Chem 2020; 99:103801. [PMID: 32278206 DOI: 10.1016/j.bioorg.2020.103801] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 03/22/2020] [Accepted: 03/24/2020] [Indexed: 10/24/2022]
Abstract
Heterocyclic compounds with nitrogen atom play a key role in the normal life cycle of a cell. Pyrazolopyrimidine is a privileged class of nitrogen containing fused heterocyclic compound contributing to a major portion of all lead molecules in medicinal chemistry. The thumbprint of pyrazolopyrimidine as a pharmacophore is always noticeable due to its analogy with the adenine base in DNA. Pyrazolopyrimidines are divided into five types [I, II, III, IV, V] based on the mechanism of action on the specific target conferring a wide scope of research which has accelerated the interest of researchers to investigate its biological profile. In 1956, the anti-cancer activity of pyrazolopyrimidine was evaluated for the first time with appreciable results. Since then, medicinal chemists centered their work on various methods of synthesis and evaluating the biological profile of pyrazolopyrimidine isomers. This report consists of novel methodologies followed to synthesize pyrazolopyrimidine isomers along with a note on their biological significance. To the best of our knowledge, this review article will be first of its kind to encompass different synthetic procedures along with anti-cancer, kinase inhibition, phosphodiesterase inhibition and receptor blocking activity of pyrazolopyrimidine moieties. IC50 values of potent compounds are added wherever necessary to understand the suitability of pyrazolopyrimidine skeletons for a specific biological activity.
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Affiliation(s)
- R Nishanth Rao
- Department of Chemistry, School of Advanced Sciences, Vellore Institute of Technology, Vellore 632014, India
| | - Kaushik Chanda
- Department of Chemistry, School of Advanced Sciences, Vellore Institute of Technology, Vellore 632014, India
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Gerritsen C, Maheandiran M, Lepock J, Ahmed S, Kiang M, Bagby RM, Mizrahi R. Negative symptoms in the clinical high-risk state for psychosis: Connection with cognition and primacy in impacting functioning. Early Interv Psychiatry 2020; 14:188-195. [PMID: 31264790 DOI: 10.1111/eip.12843] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 05/30/2019] [Accepted: 06/09/2019] [Indexed: 12/14/2022]
Abstract
AIM In the clinical high-risk (CHR) state for psychosis, both negative symptoms and lower cognitive function have been associated with poorer daily functioning. Recent evidence suggests that negative symptoms share overlapping variability with cognition and may partially mediate the relationship between cognition and functioning. However, the nature of this overlap is unknown, and the reverse mediation model remains untested leaving the precise nature of these associations unclear. METHODS In order to clarify these relationships, a sample of community-dwelling youth meeting CHR criteria was collected from a specialty CHR clinic (n = 91, mean age = 21, 63% male). Bootstrapping methods were then applied in a mediation analysis to test both negative symptoms and cognition as independent variables and mediating variables predicting social and role functioning in CHR individuals. Canonical correlation analysis was used to characterize the overlapping variability between negative symptoms and cognition. RESULTS Support for a primary role of negative symptoms in predicting functioning and cognition was observed. Canonical correlation revealed a single dimension of overlap between the two symptom types (r = .62), represented by a strong correlation between negative symptoms in general and tasks involving verbal working memory, vigilance and social cognition specifically. A single cognitive factor composed primarily of these tasks was found to predict role functioning (adjusted R 2 = .04). CONCLUSIONS The results highlight the importance of considering specific cognitive mechanisms overlapping with negative symptoms in research and rehabilitative practice in CHR populations, as well as the primary importance of targeting negative symptoms.
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Affiliation(s)
- Cory Gerritsen
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | | | - Jenny Lepock
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Sarah Ahmed
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Michael Kiang
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Robert Michael Bagby
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Romina Mizrahi
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
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125
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Galderisi S, Riva MA, Girardi P, Amore M, Carpiniello B, Aguglia E, Fagiolini A, Mucci A, Vita A. Schizophrenia and "unmet needs": From diagnosis to care in Italy. Eur Psychiatry 2020; 63:e26. [PMID: 32167448 PMCID: PMC7315886 DOI: 10.1192/j.eurpsy.2019.8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background. Schizophrenia is a leading cause of disability. People living with schizophrenia (PLWS) present unemployment, social isolation, excess mortality and morbidity, and poor quality of life. Early recognition and appropriate treatment reduce the risk of chronicity and comorbidity. Personalization and integration of pharmacological and psychosocial interventions, as well as accurate identification and management of psychiatric and somatic comorbidities, can significantly improve mental and physical health of PLWS, promoting recovery. Methods. A three-step Delphi approach was used to explore consensus on the essential components of early recognition and intervention, personalization, and integration of care to improve schizophrenia outcome, and on barriers and challenges to close treatment gaps. The consensus involved 8 Italian experts of schizophrenia, 100 psychiatrists from academic and nonacademic settings, including representatives of Italian Society of Psychiatry, and 65 trainees in psychiatry. Results. A strong consensus (from mostly agree to totally agree) emerged on the importance of early diagnosis (97%), standardized assessments (91%), correct management of somatic and psychiatric comorbidities (99%), and personalization and integration of care (94%). Lack of time, human resources, and training were identified as the main barriers and challenges to the translation of knowledge into clinical practice. Conclusions. The results of this Delphi study demonstrated a strong consensus on main components of schizophrenia care, as well as on unmet needs to promote best practice and gaps between knowledge and clinical practice. The involvement of a large group of professionals and trainees in this in-depth consensus process might contribute to raise awareness and stimulate innovative strategies to improve the outcome of PLWS.
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Affiliation(s)
- Silvana Galderisi
- Department of Psychiatry, University of Campania "Luigi Vanvitelli,"Naples, Italy
| | - Marco A Riva
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - Paolo Girardi
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Mario Amore
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal, and Child Health (DINOGMI), Section of Psychiatry, University of Genova, Genova, Italy
| | - Bernardo Carpiniello
- Department of Public Health, Clinical and Molecular Medicine-Psychiatric Unit, University of Cagliari, Cagliari, Italy
| | - Eugenio Aguglia
- Department of Clinical and Molecular Biomedicine, Psychiatry Unit, University of Catania, Catania, Italy
| | - Andrea Fagiolini
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Armida Mucci
- Department of Psychiatry, University of Campania "Luigi Vanvitelli,"Naples, Italy
| | - Antonio Vita
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,Department of Mental Health, Spedali Civili Hospital, Brescia, Italy
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126
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Galderisi S, Rucci P, Mucci A, Rossi A, Rocca P, Bertolino A, Aguglia E, Amore M, Bellomo A, Bozzatello P, Bucci P, Carpiniello B, Collantoni E, Cuomo A, Dell'Osso L, Di Fabio F, di Giannantonio M, Gibertoni D, Giordano GM, Marchesi C, Monteleone P, Oldani L, Pompili M, Roncone R, Rossi R, Siracusano A, Vita A, Zeppegno P, Maj M. The interplay among psychopathology, personal resources, context-related factors and real-life functioning in schizophrenia: stability in relationships after 4 years and differences in network structure between recovered and non-recovered patients. World Psychiatry 2020; 19:81-91. [PMID: 31922687 PMCID: PMC6953544 DOI: 10.1002/wps.20700] [Citation(s) in RCA: 93] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Improving real-life functioning is the main goal of the most advanced integrated treatment programs in people with schizophrenia. The Italian Network for Research on Psychoses previously explored, by using network analysis, the interplay among illness-related variables, personal resources, context-related factors and real-life functioning in a large sample of patients with schizophrenia. The same research network has now completed a 4-year follow-up of the original sample. In the present study, we used network analysis to test whether the pattern of relationships among all variables investigated at baseline was similar at follow-up. In addition, we compared the network structure of patients who were classified as recovered at follow-up versus those who did not recover. Six hundred eighteen subjects recruited at baseline could be assessed in the follow-up study. The network structure did not change significantly from baseline to follow-up, and the overall strength of the connections among variables increased slightly, but not significantly. Functional capacity and everyday life skills had a high betweenness and closeness in the network at follow-up, as they had at baseline, while psychopathological variables remained more peripheral. The network structure and connectivity of non-recovered patients were similar to those observed in the whole sample, but very different from those in recovered subjects, in which we found few connections only. These data strongly suggest that tightly coupled symptoms/dysfunctions tend to maintain each other's activation, contributing to poor outcome in schizophrenia. Early and integrated treatment plans, targeting variables with high centrality, might prevent the emergence of self-reinforcing networks of symptoms and dysfunctions in people with schizophrenia.
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Affiliation(s)
- Silvana Galderisi
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Paola Rucci
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Armida Mucci
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Alessandro Rossi
- Section of Psychiatry, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Paola Rocca
- Section of Psychiatry, Department of Neuroscience, University of Turin, Turin, Italy
| | - Alessandro Bertolino
- Department of Neurological and Psychiatric Sciences, University of Bari, Bari, Italy
| | - Eugenio Aguglia
- Department of Clinical and Molecular Biomedicine, Psychiatry Unit, University of Catania, Catania, Italy
| | - Mario Amore
- Section of Psychiatry, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Antonello Bellomo
- Psychiatry Unit, Department of Medical Sciences, University of Foggia, Foggia, Italy
| | - Paola Bozzatello
- Section of Psychiatry, Department of Neuroscience, University of Turin, Turin, 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
| | - Enrico Collantoni
- Psychiatric Clinic, Department of Neurosciences, University of Padua, Padua, Italy
| | - Alessandro Cuomo
- Department of Molecular Medicine and Clinical Department of Mental Health, University of Siena, Siena, Italy
| | - Liliana Dell'Osso
- Section of Psychiatry, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Fabio Di Fabio
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | | | - Dino Gibertoni
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | | | - Carlo Marchesi
- Psychiatry Unit, Department of Neuroscience, University of Parma, Parma, Italy
| | - Palmiero Monteleone
- Section of Neuroscience, Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Salerno, Italy
| | - Lucio Oldani
- Department of Psychiatry, University of Milan, Milan, Italy
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Rita Roncone
- Unit of Psychiatry, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Rodolfo Rossi
- Section of Psychiatry, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Alberto Siracusano
- Psychiatry and Clinical Psychology Unit, Department of Systems Medicine, 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
| | - Patrizia Zeppegno
- Psychiatric Unit, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Mario Maj
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
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127
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Vita A, Perin AP, Cavanna M, Cobelli F, Rosa J, Valsecchi P, Zanigni M, Reggiardo G, Sacchetti E. Negative symptom severity at discharge from an index hospitalization and subsequent use of psychiatric care resources: A retrospective 1-year follow-up study on 450 patients with schizophrenia spectrum disorders. Schizophr Res 2020; 216:243-248. [PMID: 31818634 DOI: 10.1016/j.schres.2019.11.052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 10/15/2019] [Accepted: 11/26/2019] [Indexed: 11/26/2022]
Abstract
Negative symptoms of schizophrenia have a great impact on patients' functioning and are among the most important contributors to subject's disability. However, few studies have assessed the role of type and severity of symptomatology of schizophrenia on the psychiatric care resource utilization. We investigated if the clinical profile of patients at discharge from an index hospitalization might be associated with a different use of psychiatric care resources in the subsequent 1-year period in a large population of patients with schizophrenia spectrum disorders. Clinical records of 450 patients with schizophrenia spectrum disorders admitted in an acute psychiatric inpatient service and subsequently followed in the outpatient services of the same Department were reviewed. Patients with more severe negative symptoms at discharge from hospital showed a higher number and duration of hospitalizations in the 1-year follow-up, as well as a higher number of rehabilitative residential admissions than patients with milder severity of negative symptoms. The same was true for patients with predominant negative symptoms. A global resource utilization index indicated a higher use of psychiatric resources in patients with higher severity of negative symptoms. In conclusion, showing moderate to severe negative symptoms versus positive symptoms at discharge from a hospitalization for an acute exacerbation of schizophrenia spectrum disorder does predict a higher use of psychiatric care resources. This underlines the importance of relieving negative symptoms even in the acute phase of treatment and the need to develop more effective treatments for this symptom dimension.
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Affiliation(s)
- A Vita
- University of Brescia, School of Medicine, Italy; Department of Mental Health, Spedali Civili Hospital, Brescia, Italy.
| | - A P Perin
- University of Brescia, School of Medicine, Italy
| | - M Cavanna
- University of Brescia, School of Medicine, Italy
| | - F Cobelli
- University of Brescia, School of Medicine, Italy
| | - J Rosa
- University of Brescia, School of Medicine, Italy
| | - P Valsecchi
- University of Brescia, School of Medicine, Italy; Department of Mental Health, Spedali Civili Hospital, Brescia, Italy
| | - M Zanigni
- University of Brescia, School of Medicine, Italy
| | - G Reggiardo
- Biostatistics Unit, Medi Service, Genoa, Italy
| | - E Sacchetti
- University of Brescia, School of Medicine, Italy
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128
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He X, Ma Q, Fan Y, Zhao B, Wang W, Zhu F, Ma X, Zhou L. The Role of Cytokines in Predicting the Efficacy of Acute Stage Treatment in Patients with Schizophrenia. Neuropsychiatr Dis Treat 2020; 16:191-199. [PMID: 32021213 PMCID: PMC6982444 DOI: 10.2147/ndt.s218483] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 12/20/2019] [Indexed: 12/11/2022] Open
Abstract
PURPOSE Inflammatory response in schizophrenia (SCz) is related to its underlying pathological mechanism and might be significant in deciding a patient's prognosis. The current study aims to investigate the differences in the serum inflammation level between schizophrenic patients and healthy controls and identify inflammatory markers that can predict clinical therapeutic effects in early-stage SCz patients at the 6-month follow-up. PATIENTS AND METHODS In total, 71 subjects were recruited in this study, including 35 patients with Scz and 36 healthy controls. The 35 Scz patients, who were in the first-episode or acute relapse state at admission, had completed the 6-month follow-up. The Positive and Negative Syndrome Scale (PANSS) and the Clinical Global Impression (CGI) assessment results, demographic details, and blood samples were collected at the baseline and at follow-up. Data were analyzed using the Spearman correlation and multiple linear regression. RESULTS Serum interleukin (IL-1β, IL-4, IL-6, and IL-8) levels were significantly elevated in SCz patients at baseline compared with healthy controls, with a reduced IL-8 level at the follow-up. Furthermore, a higher IL-6 level and lower IL-8 level was found to predict better improvement in negative symptoms. The higher IL-6 level also predicted lesser improvement in depressive symptoms. Finally, a higher interferon (IFN)-γ level predicted a lower therapeutic effect for excitatory symptoms. CONCLUSION The serum levels of inflammatory markers were higher in patients with SCz than in healthy controls. These markers can be considered accurate predictors of therapeutic effects in patients with SCz.
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Affiliation(s)
- Xiaoyan He
- Department of Psychiatry, The First Affiliated Hospital of Medical College of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
| | - Qingyan Ma
- Department of Psychiatry, The First Affiliated Hospital of Medical College of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
| | - Yajuan Fan
- Department of Psychiatry, The First Affiliated Hospital of Medical College of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
| | - Binbin Zhao
- Department of Psychiatry, The First Affiliated Hospital of Medical College of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
| | - Wei Wang
- Department of Psychiatry, The First Affiliated Hospital of Medical College of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
| | - Feng Zhu
- Center for Translational Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
| | - Xiancang Ma
- Department of Psychiatry, The First Affiliated Hospital of Medical College of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
| | - Lina Zhou
- Department of Psychiatry, The First Affiliated Hospital of Medical College of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
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129
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Mackintosh AJ, Borgwardt S, Studerus E, Riecher-Rössler A, de Bock R, Andreou C. EEG Microstate Differences in Medicated vs. Medication-Naïve First-Episode Psychosis Patients. Front Psychiatry 2020; 11:600606. [PMID: 33329154 PMCID: PMC7732503 DOI: 10.3389/fpsyt.2020.600606] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 10/30/2020] [Indexed: 12/21/2022] Open
Abstract
There has been considerable interest in the role of synchronous brain activity abnormalities in the pathophysiology of psychotic disorders and their relevance for treatment; one index of such activity are EEG resting-state microstates. These reflect electric field configurations of the brain that persist over 60-120 ms time periods. A set of quasi-stable microstates classes A, B, C, and D have been repeatedly identified across healthy participants. Changes in microstate parameters coverage, duration and occurrence have been found in medication-naïve as well as medicated patients with psychotic disorders compared to healthy controls. However, to date, only two studies have directly compared antipsychotic medication effects on EEG microstates either pre- vs. post-treatment or between medicated and unmedicated chronic schizophrenia patients. The aim of this study was therefore to directly compare EEG resting-state microstates between medicated and medication-naïve (untreated) first-episode (FEP) psychosis patients (mFEP vs. uFEP). We used 19-channel clinical EEG recordings to compare temporal parameters of four prototypical microstate classes (A-D) within an overall sample of 47 patients (mFEP n = 17; uFEP n = 30). The results demonstrated significant decreases of microstate class A and significant increases of microstate class B in mFEP compared to uFEP. No significant differences between groups were found for microstate classes C and D. Further studies are needed to replicate these results in longitudinal designs that assess antipsychotic medication effects on neural networks at the onset of the disorder and over time during illness progression. As treatment response and compliance in FEP patients are relatively low, such studies could contribute to better understand treatment outcomes and ultimately improve treatment strategies.
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Affiliation(s)
- Amatya J Mackintosh
- Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland
| | - Stefan Borgwardt
- University Psychiatric Clinics (UPK) Basel, University of Basel, Basel, Switzerland.,Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Erich Studerus
- Division of Personality and Developmental Psychology, Department of Psychology, University of Basel, Basel, Switzerland
| | | | - Renate de Bock
- Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland.,University Psychiatric Clinics (UPK) Basel, University of Basel, Basel, Switzerland
| | - Christina Andreou
- Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland.,Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
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130
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Deste G, Vita A, Nibbio G, Penn DL, Pinkham AE, Harvey PD. Autistic Symptoms and Social Cognition Predict Real-World Outcomes in Patients With Schizophrenia. Front Psychiatry 2020; 11:524. [PMID: 32581892 PMCID: PMC7294984 DOI: 10.3389/fpsyt.2020.00524] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 05/21/2020] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE Real-world functioning is a complex construct influenced by different factors. The impact of social cognition and autism spectrum disorder (ASD) symptoms on different aspects of the life of people with schizophrenia has been demonstrated independently, but it is unclear how these factors are related to functioning when considered concurrently. We hypothesized that ASD symptoms could play a major role in predicting real-world functioning in schizophrenia. METHODS Existent databases from two studies (SCOPE Phase 3 and SCOPE Phase 5), in which a total of 361 patients (mean age 41.7 years; 117 females) were assessed with measures of symptom severity, neuro- and socio-cognitive abilities, functional capacity, social skills, and informant-reported real-world functioning outcomes, were analyzed. RESULTS Active social avoidance, social skills, ASD symptoms, and emotion processing emerged as predictors of real-world interpersonal relationships. Cognitive performance, positive symptoms, and functional capacity emerged as predictors of real-world participation in daily activities. Cognitive performance, emotion processing, positive symptoms severity, and social skills emerged as predictors of real-world work outcomes. CONCLUSION Among other demographic, clinical, and functional capacity variables, increased ASD symptoms emerged as a significant predictor of poorer social relationships and may therefore represent a key factor in predicting real-world social functioning in schizophrenia.
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Affiliation(s)
- Giacomo Deste
- Department of Mental Health and Addiction Services, Spedali Civili Hospital, Brescia, Italy
| | - Antonio Vita
- Department of Mental Health and Addiction Services, Spedali Civili Hospital, Brescia, Italy.,School of Medicine, University of Brescia, Brescia, Italy
| | | | - David L Penn
- Department of Psychology, University of North Carolina, Chapel Hill, NC, United States.,School of Psychology, Australian Catholic University, Melbourne, VIC, Australia
| | - Amy E Pinkham
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX, United States.,Department of Psychiatry, University of Texas Southwestern Medical School, Dallas, TX, United States
| | - Philip D Harvey
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, United States.,Research Service, Miami VA Healthcare System, Miami, FL, United States
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131
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Gopal S, Gogate J, Pungor K, Kim E, Singh A, Mathews M. Improvement of Negative Symptoms in Schizophrenia with Paliperidone Palmitate 1-Month and 3-Month Long-Acting Injectables: Results from a Phase 3 Non-Inferiority Study. Neuropsychiatr Dis Treat 2020; 16:681-690. [PMID: 32184607 PMCID: PMC7064291 DOI: 10.2147/ndt.s226296] [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] [Received: 08/07/2019] [Accepted: 01/04/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Negative symptoms in schizophrenia are associated with impairments in social and cognitive functioning leading to substantial long-term disability. Available antipsychotic treatments have demonstrated only modest benefit in the improvement of negative symptoms. OBJECTIVE To compare improvements in negative symptoms among patients treated with paliperidone palmitate 3-month (PP3M) or paliperidone palmitate 1-month (PP1M) long-acting injectable (LAI) formulations. METHODS Data from a randomized double-blind (DB), phase-3, non-inferiority study in patients with schizophrenia were analyzed. Following screening, patients entered a 17-week open-label (OL) phase to receive flexibly dosed PP1M followed by a 48-week DB phase where patients were randomized (1:1) to receive either PP1M or PP3M. Positive and Negative Syndrome Scale (PANSS) total scores with emphasis on 7-item negative subscale scores for PP1M vs PP3M were assessed. RESULTS Of 1429 patients enrolled, 1016 were randomized to receive PP3M (n=504) or PP1M (n=512). At baseline, mean (SD) PANSS negative subscale was 23.2 (4.60) and negative symptom factor score was 22.3 (4.87), indicating moderate-to-severe negative symptoms. Negative subscale and symptoms factor scores showed continuous improvements throughout OL (15.9 [4.99]) and DB (14.9 [4.81]) phases. Mean (SD) changes from DB baseline in the PANSS negative subscale score were comparable between PP1M (-1.4 [3.67]) and PP3M (-1.4 [3.63]) treatment groups. CONCLUSION Treatment with PP3M or PP1M demonstrated comparable improvement in negative symptoms in patients with moderate-to-severe negative symptoms and in patients with prominent negative symptoms. Long-term treatment with PP3M demonstrated benefit, suggesting that continuous antipsychotic medication treatment for >1 year is needed to achieve greater benefit for negative symptoms. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01515423.
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Affiliation(s)
- Srihari Gopal
- Janssen Research and Development, LLC, Titusville, NJ, USA
| | | | | | - Edward Kim
- Janssen Scientific Affairs, Janssen Pharmaceuticals, Titusville, NJ, USA
| | - Arun Singh
- Janssen Research and Development, LLC, Titusville, NJ, USA
| | - Maju Mathews
- Janssen Research and Development, LLC, Titusville, NJ, USA
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Abstract
LEARNING OBJECTIVE After participating in this activity, learners should be better able to:• Evaluate the relationship between negative symptoms and functioning in youth at clinical high risk for psychosis. AIM Youth at CHR for psychosis often demonstrate significant negative symptoms and poor functioning, though the magnitude and direction of the relationship between the two remains unknown. The objective of this systematic review is to summarize the relationship between negative symptoms and functioning in CHR samples. METHOD Electronic databases CINAHL, EBM, Embase, MEDLINE, and PsycINFO were searched from inception. Studies were selected if they included any study that reported a relationship between negative symptoms and functioning in youth at clinical high risk (CHR). The correlation coefficient r was converted to Cohen's d, and all random-effects meta-analyses were performed using the transformed values. RESULTS Forty-one studies met the inclusion criteria, including a total of 4574 individuals at CHR for psychosis. Negative symptom total scores were significantly associated with poorer global functioning (d, -1.40; 95% CI, -1.82 to -0.98; I = 79.4%; p < .001 [9 studies, n = 782]), social functioning (d, -1.10; 95% CI, -1.27 to -0.93; I = 10.40%; p < .001 [12 studies, n = 811]), and role functioning (d, -0.96; 95% CI, -1.17 to -0.76; I = 41.1%; p < .001 [9 studies, n = 881]). In addition, negative symptoms were consistently associated with poor premorbid functioning. When examining negative symptom domains, avolition, anhedonia, and blunted affect were each significantly and independently associated with poorer social functioning and role functioning. In terms of prediction models, negative symptoms contributed to the prediction of lower functioning across multiple studies. CONCLUSION This meta-analysis demonstrates a strong relationship between negative symptoms and functioning in youth at clinical high risk for psychosis.
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Kim J, Shin JH, Ryu JK, Jung JH, Kim CH, Lee HB, Kim DH, Lee SK, Roh D. Association of Depression With Functional Mobility in Schizophrenia. Front Psychiatry 2020; 11:854. [PMID: 32973589 PMCID: PMC7472778 DOI: 10.3389/fpsyt.2020.00854] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 08/05/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Functional immobility can cause functional disability in patients with schizophrenia and has been linked to prognosis and mortality. Although depression might be a barrier for physical activity engagement, scarce data are present on the relationship between depression and functional mobility (FM) in schizophrenia. Thus, we aimed to investigate the associations among FM, depression, and other clinical correlates in individuals with schizophrenia. METHODS FM was evaluated by the pedometer-assessed daily steps and Timed Up-and-Go (TUG) test in the daily-living and clinical settings, respectively. Psychiatric symptoms were assessed using the Beck Depression Inventory, Brief Psychiatric Rating Scale (BPRS), and State-Trait Anxiety Inventory. Cognitive function was evaluated using the Sternberg Working Memory (SWM) Task. Multiple regression analyses were performed to identify predictive factors associated with FM, with adjustment for relevant covariates. RESULTS Sixty patients were enrolled in this study. Depression was the most consistent explanatory variable for both pedometer (β = -0.34, p = 0.011) and TUG time (β = 0.32, p = 0.018). Additionally, SWM accuracy (β = -0.29, p = 0.018), BPRS-Withdrawal (β = 0.19, p = 0.139), and fasting blood sugar (β = 0.34, p = 0.008) were associated with TUG time. However, psychotic symptoms and anxiety were not associated with pedometer and TUG. CONCLUSIONS We identified an association between depression and FM after adjusting for other disorder-related correlates in schizophrenia. Since the intervention goal is functional recovery, improving FM by treating depression may have considerable therapeutic value.
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Affiliation(s)
- Jiheon Kim
- Mind-Neuromodulation Laboratory and Department of Psychiatry, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, South Korea
| | - Ji-Hyeon Shin
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Uijeongbu, South Korea
| | - Jeh-Kwang Ryu
- Department of Physical Education, College of Education, Dongguk University, Seoul, South Korea
| | - Jae Hoon Jung
- Mind-Neuromodulation Laboratory and Department of Psychiatry, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, South Korea
| | - Chan-Hyung Kim
- Department of Psychiatry, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Hwa-Bock Lee
- Gwangmyeong Mental Health Welfare Center, Gwangmyeong, South Korea
| | - Do Hoon Kim
- Mind-Neuromodulation Laboratory and Department of Psychiatry, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, South Korea
| | - Sang-Kyu Lee
- Mind-Neuromodulation Laboratory and Department of Psychiatry, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, South Korea
| | - Daeyoung Roh
- Mind-Neuromodulation Laboratory and Department of Psychiatry, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, South Korea
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Correll CU, Schooler NR. Negative Symptoms in Schizophrenia: A Review and Clinical Guide for Recognition, Assessment, and Treatment. Neuropsychiatr Dis Treat 2020; 16:519-534. [PMID: 32110026 PMCID: PMC7041437 DOI: 10.2147/ndt.s225643] [Citation(s) in RCA: 328] [Impact Index Per Article: 82.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 01/29/2020] [Indexed: 12/11/2022] Open
Abstract
Schizophrenia is frequently a chronic and disabling disorder, characterized by heterogeneous positive and negative symptom constellations. The objective of this review was to provide information that may be useful for clinicians treating patients with negative symptoms of schizophrenia. Negative symptoms are a core component of schizophrenia that account for a large part of the long-term disability and poor functional outcomes in patients with the disorder. The term negative symptoms describes a lessening or absence of normal behaviors and functions related to motivation and interest, or verbal/emotional expression. The negative symptom domain consists of five key constructs: blunted affect, alogia (reduction in quantity of words spoken), avolition (reduced goal-directed activity due to decreased motivation), asociality, and anhedonia (reduced experience of pleasure). Negative symptoms are common in schizophrenia; up to 60% of patients may have prominent clinically relevant negative symptoms that require treatment. Negative symptoms can occur at any point in the course of illness, although they are reported as the most common first symptom of schizophrenia. Negative symptoms can be primary symptoms, which are intrinsic to the underlying pathophysiology of schizophrenia, or secondary symptoms that are related to psychiatric or medical comorbidities, adverse effects of treatment, or environmental factors. While secondary negative symptoms can improve as a consequence of treatment to improve symptoms in other domains (ie, positive symptoms, depressive symptoms or extrapyramidal symptoms), primary negative symptoms generally do not respond well to currently available antipsychotic treatment with dopamine D2 antagonists or partial D2 agonists. Since some patients may lack insight about the presence of negative symptoms, these are generally not the reason that patients seek clinical care, and clinicians should be especially vigilant for their presence. Negative symptoms clearly constitute an unmet medical need in schizophrenia, and new and effective treatments are urgently needed.
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Affiliation(s)
- Christoph U Correll
- The Zucker Hillside Hospital, Division of Psychiatry Research, Northwell Health, Glen Oaks, NY, USA.,The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department of Psychiatry and Molecular Medicine, New York, NY, USA.,Charité Universitätsmedizin, Department of Child and Adolescent Psychiatry, Berlin, Germany
| | - Nina R Schooler
- State University of New York, Downstate Medical Center, Brooklyn, NY, USA
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Jantzi C, Mengin AC, Serfaty D, Bacon E, Elowe J, Severac F, Meyer N, Berna F, Vidailhet P. Retrieval practice improves memory in patients with schizophrenia: new perspectives for cognitive remediation. BMC Psychiatry 2019; 19:355. [PMID: 31711448 PMCID: PMC6849190 DOI: 10.1186/s12888-019-2341-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 10/23/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Schizophrenia is associated with severe cognitive deficits, particularly episodic memory deficits, that interfere with patients' socio-professional functioning. Retrieval practice (also known as testing effect) is a well-established episodic memory strategy that involves taking an initial memory test on a previously learned material. Testing later produces robust long-term memory improvements in comparison to the restudy of the same material both in healthy subjects and in some clinical populations with memory deficits. While retrieval practice might represent a relevant cognitive remediation strategy in patients with schizophrenia, studies using optimal procedures to explore the benefits of retrieval practice in this population are still lacking. Therefore, the purpose of our study was to investigate the benefits of retrieval practice in patients with schizophrenia. METHODS Nineteen stabilised outpatients with schizophrenia (DSM-5 criteria) and 20 healthy controls first studied a list of 60 word-pairs (30 pairs with weak semantic association and 30 non associated pairs). Half the pairs were studied again (restudy condition), while only the first word of the pair was presented and the subject had to recall the second word for the other half (retrieval practice condition). The final memory test consisted in a cued-recall which took place 2 days later. Statistical analyses were performed using Bayesian methods. RESULTS Cognitive performances were globally altered in patients. However, in both groups, memory performances for word-pairs were significantly better after retrieval practice than after restudy (56.1% vs 35.7%, respectively, Pr(RP > RS) > 0.999), and when a weak semantic association was present (64.7% vs 27.1%, respectively; Pr(weak > no) > 0.999). Moreover, the positive effect of RP was observed in all patients but one. CONCLUSIONS Our study is the first to demonstrate that retrieval practice efficiently improves episodic memory in comparison to restudy in patients with schizophrenia. This learning strategy should therefore be considered as a useful tool for cognitive remediation programs. In this perspective, future studies might explore retrieval practice using more ecological material.
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Affiliation(s)
- Camille Jantzi
- Université de Strasbourg, Faculté de Médecine, Strasbourg, France
- Hôpitaux Universitaires de Strasbourg, Service de Psychiatrie, 1 place de l'Hôpital, 67091, Strasbourg, France
| | - Amaury C Mengin
- Université de Strasbourg, Faculté de Médecine, Strasbourg, France.
- Hôpitaux Universitaires de Strasbourg, Service de Psychiatrie, 1 place de l'Hôpital, 67091, Strasbourg, France.
| | - David Serfaty
- Université de Strasbourg, Faculté de Médecine, Strasbourg, France
- Hôpitaux Universitaires de Strasbourg, Service de Psychiatrie, 1 place de l'Hôpital, 67091, Strasbourg, France
| | - Elisabeth Bacon
- Inserm U1114 - Neuropsychologie cognitive et Physiopathologie de la Schizophrénie, Strasbourg, France
| | - Julien Elowe
- Université de Strasbourg, Faculté de Médecine, Strasbourg, France
- Hôpitaux Universitaires de Strasbourg, Service de Psychiatrie, 1 place de l'Hôpital, 67091, Strasbourg, France
| | - François Severac
- Université de Strasbourg, Faculté de Médecine, Strasbourg, France
- Hôpitaux Universitaires de Strasbourg, Département de Santé Publique, GMRC, Strasbourg, France
- Université de Strasbourg, Laboratoire de Biostatistique et Informatique Médicale, iCUBE UMR 7357, Illkirch, France
| | - Nicolas Meyer
- Université de Strasbourg, Faculté de Médecine, Strasbourg, France
- Hôpitaux Universitaires de Strasbourg, Département de Santé Publique, GMRC, Strasbourg, France
- Université de Strasbourg, Laboratoire de Biostatistique et Informatique Médicale, iCUBE UMR 7357, Illkirch, France
| | - Fabrice Berna
- Université de Strasbourg, Faculté de Médecine, Strasbourg, France
- Hôpitaux Universitaires de Strasbourg, Service de Psychiatrie, 1 place de l'Hôpital, 67091, Strasbourg, France
- Inserm U1114 - Neuropsychologie cognitive et Physiopathologie de la Schizophrénie, Strasbourg, France
- Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France
| | - Pierre Vidailhet
- Université de Strasbourg, Faculté de Médecine, Strasbourg, France
- Hôpitaux Universitaires de Strasbourg, Service de Psychiatrie, 1 place de l'Hôpital, 67091, Strasbourg, France
- Inserm U1114 - Neuropsychologie cognitive et Physiopathologie de la Schizophrénie, Strasbourg, France
- Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France
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Demirkol ME, Tamam L, Çakmak S, Yeşiloğlu C. Şizofreni tanılı hastalarda metabolik sendrom ve D vitamini düzeyleri ilişkisi. CUKUROVA MEDICAL JOURNAL 2019. [DOI: 10.17826/cumj.569373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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137
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Carruthers SP, Van Rheenen TE, Gurvich C, Sumner PJ, Rossell SL. Characterising the structure of cognitive heterogeneity in schizophrenia spectrum disorders. A systematic review and narrative synthesis. Neurosci Biobehav Rev 2019; 107:252-278. [PMID: 31505202 DOI: 10.1016/j.neubiorev.2019.09.006] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 08/19/2019] [Accepted: 09/02/2019] [Indexed: 12/13/2022]
Abstract
The aim of the present review was to systematically summarise our current understanding of the structure of the cognitive heterogeneity that exists within schizophrenia spectrum disorder (SSD). Fifty-two relevant studies were identified from January 1980 to March 2019 that investigated cognitive subgroups within SSD. Twenty-five studies employed classification criteria based on current neuropsychological function, 14 studies employed various data-driven subgrouping methodologies and 13 studies investigated putative cognitive symptom trajectories. Despite considerable methodological variability, three distinct cognitive subgroups reliability emerged; a relatively intact cognitive subgroup characterised by high cognitive performance, an intermediate cognitive subgroup defined by mixed or moderate levels of cognitive function/dysfunction and a globally impaired subgroup characterised by severe cognitive deficits. Whilst preliminary evidence suggests that these subgroups may have further investigative relevance in and of themselves, additional research is required and discussed. A set of reporting guidelines are also presented to overcome the methodological inconsistencies identified in the reviewed literature.
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Affiliation(s)
- Sean P Carruthers
- Centre for Mental Health, Faculty of Health, Arts and Design, Swinburne University of Technology, Victoria, 3122, Australia.
| | - Tamsyn E Van Rheenen
- Centre for Mental Health, Faculty of Health, Arts and Design, Swinburne University of Technology, Victoria, 3122, Australia; Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, Carlton South, Victoria, 3053, Australia
| | - Caroline Gurvich
- Monash Alfred Psychiatry Research Centre (MAPrc), Monash University Central Clinical School and The Alfred Hospital, Melbourne, 3004, Australia
| | - Philip J Sumner
- Centre for Mental Health, Faculty of Health, Arts and Design, Swinburne University of Technology, Victoria, 3122, Australia
| | - Susan L Rossell
- Centre for Mental Health, Faculty of Health, Arts and Design, Swinburne University of Technology, Victoria, 3122, Australia; St Vincent's Hospital, Melbourne, Victoria, 3065, Australia
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138
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Mallet J, Gorwood P, Le Strat Y, Dubertret C. Major Depressive Disorder (MDD) and Schizophrenia- Addressing Unmet Needs With Partial Agonists at the D2 Receptor: A Review. Int J Neuropsychopharmacol 2019; 22:651-664. [PMID: 31406978 PMCID: PMC6822140 DOI: 10.1093/ijnp/pyz043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 06/20/2019] [Accepted: 08/07/2019] [Indexed: 12/28/2022] Open
Abstract
Second-generation antipsychotics are common candidates for the adjunctive treatment of major depressive disorder and for the treatment of schizophrenia. However, unmet needs remain in the treatment of both disorders. Considering schizophrenia, antipsychotics are the most common treatment and have demonstrated good efficacy. Still, side effects of these treatments are commonly reported and may impact adherence to the medication and functioning in patients with schizophrenia. Regarding major depressive disorder, despite the availability of several classes of antidepressants, many patients do not achieve remission. Adjunctive treatment with antipsychotics may improve clinical and functional outcomes. Compared with dopamine D2 receptor antagonism that is exhibited by most antipsychotics, partial agonism may result in improved outcomes in major depressive disorder and in schizophrenia. Aripiprazole, cariprazine, and brexpiprazole have partial agonism at the dopamine D2 receptor and could potentially overcome limitations associated with D2 antagonism. The objectives of this review were (1) to discuss the goal of treatment with second-generation antipsychotics in major depressive disorder and schizophrenia, and the clinical factors that should be considered, and (2) to examine the short- and long-term existing data on the efficacy and safety of D2 receptor partial agonists (aripiprazole, cariprazine, and brexpiprazole) in the adjunctive treatment of major depressive disorder and in the treatment of schizophrenia.
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Affiliation(s)
- Jasmina Mallet
- INSERM U1266, Institute of Psychiatry and Neurosciences of Paris (IPNP), France,Psychiatry Department, University Hospital Louis Mourier; Paris Diderot University, France
| | - Philip Gorwood
- INSERM U1266, Institute of Psychiatry and Neurosciences of Paris (IPNP), France,GHU Paris, CMME, Sainte-Anne hospital; University of Paris, France,Correspondence: Professor Philip Gorwood, MD, PhD, CMME, GHU Paris Psychiatrie, 100 rue de la Sante, 75014 Paris, France ()
| | - Yann Le Strat
- INSERM U1266, Institute of Psychiatry and Neurosciences of Paris (IPNP), France,Psychiatry Department, University Hospital Louis Mourier; Paris Diderot University, France
| | - Caroline Dubertret
- INSERM U1266, Institute of Psychiatry and Neurosciences of Paris (IPNP), France,Psychiatry Department, University Hospital Louis Mourier; Paris Diderot University, France
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139
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Ohi K, Sumiyoshi C, Fujino H, Yasuda Y, Yamamori H, Fujimoto M, Sumiyoshi T, Hashimoto R. A 1.5-Year Longitudinal Study of Social Activity in Patients With Schizophrenia. Front Psychiatry 2019; 10:567. [PMID: 31447715 PMCID: PMC6697059 DOI: 10.3389/fpsyt.2019.00567] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 07/19/2019] [Indexed: 11/13/2022] Open
Abstract
Patients with schizophrenia exhibit impairments in their social activity, intelligence quotient (IQ), daily living skills, and social function. Social activity is a high-order outcome measure of their lives. Here we attempted to longitudinally evaluate the effects of IQ, daily living skills, social function, psychiatric symptoms, and medications on social activity in patients with schizophrenia. The purpose of the current study is to identify the specific factor that affects longitudinal changes in social activity. Sixty-five patients with schizophrenia were assessed at two time points [time 2 (T2, follow-up) - time 1 (T1, baseline) = 1.71 ± 0.79 years]. Social activity, IQ, daily living skills, and social function were assessed using the Social Activity Assessment (SAA; h/week), short form of the Wechsler Adult Intelligence Scale (WAIS)-III (WAIS-SF), University of California San Diego (UCSD) Performance-Based Skills Assessment (UPSA), and Social Functioning Scale (SFS), respectively. IQ, daily living skills, social function, and social activity were significantly improved between T1 and T2 (t = 2.0-4.4, p = 0.048-3.60 × 10-5). IQ, daily living skills, and social function positively correlated with social activity (lowest p = 1.27 × 10-5), and psychiatric symptoms negatively correlated with social activity over time (lowest p = 3.26 × 10-9). The longitudinal change in social activity was independently and positively correlated with a change in social function (beta = 0.35, p = 4.63 × 10-3), particularly interpersonal communication (beta = 0.35, p = 4.32 × 10-3). The longitudinal changes in other factors did not directly affect the change in social activity (p > 0.05). Based on these findings, social activity is more affected by social function than by other factors.
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Affiliation(s)
- Kazutaka Ohi
- Department of Neuropsychiatry, Kanazawa Medical University, Uchinada, Japan
- Medical Research Institute, Kanazawa Medical University, Uchinada, Japan
| | - Chika Sumiyoshi
- Faculty of Human Development and Culture, Fukushima University, Fukushima, Japan
| | - Haruo Fujino
- Graduate School of Education, Oita University, Oita, Japan
| | - Yuka Yasuda
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hidenaga Yamamori
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
| | - Michiko Fujimoto
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tomiki Sumiyoshi
- Department of Clinical Epidemiology, Translational Medical Center, National Center of Neurology and Psychiatry, Kodaira, Japan
- Department of Preventive Intervention for Psychiatric Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Ryota Hashimoto
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
- Molecular Research Center for Children’s Mental Development, United Graduate School of Child Development, Osaka University, Suita, Japan
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan
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Caruana E, Allott K, Farhall J, Parrish EM, Davey CG, Chanen AM, Killackey E, Cotton SM. Factors associated with vocational disengagement among young people entering mental health treatment. Early Interv Psychiatry 2019; 13:961-968. [PMID: 30019851 DOI: 10.1111/eip.12718] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 06/12/2018] [Accepted: 06/19/2018] [Indexed: 11/27/2022]
Abstract
AIM Most mental disorders have their onset by age 25, disrupting normative vocational engagement. Factors associated with vocational disengagement at first contact with specialist treatment are important for service planning. The aim of this paper was to investigate the association between theoretically important factors and vocational disengagement for youth entering mental health treatment. METHODS A file audit was used to extract vocational data of 145 young people aged 15 to 25 years entering treatment in 2011 at a public youth mental health service in Melbourne, Australia. Comparisons were made across three specialist programs for: psychosis (n = 50), mood disorders (n = 52) and borderline personality pathology (n = 43). Individual characteristics were entered into univariate and multivariate logistic regressions to investigate their associations with vocational disengagement. RESULTS Educational disengagement was associated with being older (OR = 4.38, P = 0.004) and not living with parents (OR = 2.87, P = 0.038). Unemployment and being NEET (Not in Education, Employment or Training) were both associated with not having commenced tertiary education (OR = 0.23, P = 0.022; OR = 0.05, P = 0.002; respectively). Being NEET was also associated with being older (OR = 6.18, P = 0.004). Primary diagnostic grouping was not associated with vocational disengagement, once accounting for other factors. CONCLUSIONS The likelihood of vocational disengagement did not differ across disorder groups, implying that intervention should be "transdiagnostic" and might best target education first, specifically post-secondary qualifications. Other domains or variables not measured in this study are also likely to be important, and this might include young people's support systems and symptom severity. Qualitative studies may be useful for exploring further factors relevant to vocational engagement.
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Affiliation(s)
- Emma Caruana
- Department of Psychology and Counselling, La Trobe University, Bundoora, Victoria
| | - Kelly Allott
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria
| | - John Farhall
- Department of Psychology and Counselling, La Trobe University, Bundoora, Victoria.,North Western Mental Health, Parkville, Victoria
| | - Emma M Parrish
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria.,Northeastern University, Boston, Massachusetts
| | - Christopher G Davey
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria.,Orygen Youth Health, Parkville, Victoria
| | - Andrew M Chanen
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria.,North Western Mental Health, Parkville, Victoria.,Orygen Youth Health, Parkville, Victoria
| | - Eoin Killackey
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria
| | - Susan M Cotton
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria
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Habtamu K, Medhin G, Selamu M, Tirfessa K, Hanlon C, Fekadu A. Functional impairment among people diagnosed with depression in primary healthcare in rural Ethiopia: a comparative cross-sectional study. Int J Ment Health Syst 2019; 13:50. [PMID: 31346349 PMCID: PMC6635998 DOI: 10.1186/s13033-019-0305-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 07/10/2019] [Indexed: 12/24/2022] Open
Abstract
Background There have been few studies examining the functioning of clinically-diagnosed people with depression in primary healthcare (PHC) in low- and middle-income countries (LMICs). The aim of this study was to identify factors associated with functional impairment among people diagnosed with depression in PHC in Ethiopia as part of implementation of a task-shared model of mental healthcare. Methods A comparative cross-sectional study was conducted. As part of the Programme for Improving Mental health carE (PRIME), PHC clinicians were trained to diagnose depression using an adapted version of the World Health Organization (WHO) mental health Gap Action Programme (mhGAP). A total of 2038 adult consecutive PHC attendees were screened for depressive symptoms using the 9-item Patient Health Questionnaire (PHQ-9). Those who scored five or above on the PHQ-9 (n = 131) were assessed by PHC workers. Of these, 92 were diagnosed to have depression (“PHC diagnosed cases”) and the remaining 39 people were PHQ positive but considered not to have depression (“non-diagnosed controls”). PHC diagnosed cases were also compared to a community representative sample of adult healthy controls (n = 197; “community controls”). The 12-item version of the WHO Disability Assessment Schedule (WHODAS-2.0) was used to assess functional impairment. Multivariable negative binomial regression models were fitted to examine the association of demographic, social, economic and clinical characteristics with functional impairment. Results No significant difference in functional impairment was found between diagnosed cases and non-diagnosed controls. PHC diagnosed cases were found to have higher depressive symptom severity and suicidality, but lower social support compared to non-diagnosed controls (P < 0.05). In the multivariable model, greater functional impairment was associated with higher depressive symptoms (RR = 1.04; 95% CI 1.02, 1.05) and lower social support (RR = 0.96; 95% CI 0.95, 0.98). Diagnosed cases were found to have higher functional impairment compared to community controls (RR = 1.91; 95% CI 1.74, 2.09). Conclusion In this study, PHC clinicians identified cases of depression with high symptom burden, suicidality and functional impairment. These findings support current initiatives to scale-up mental health services at the PHC level; and indicate that social support is an important target for intervention.
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Affiliation(s)
- Kassahun Habtamu
- 1School of Psychology, College of Education and Behavioral Studies, Addis Ababa University, P.O.BOX: 1176, Addis Ababa, Ethiopia
| | - Girmay Medhin
- 2Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Medhin Selamu
- 3Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Kebede Tirfessa
- 3Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Charlotte Hanlon
- 3Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.,4Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, Centre for Global Mental Health, Kings College London, London, UK
| | - Abebaw Fekadu
- 3Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.,5Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, Centre for Affective Disorders, King's College London, London, UK.,6Global health & Infection, Brighton and Sussex Medical School, Brighton, UK
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142
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Harvey PD, Strassnig MT. Cognition and disability in schizophrenia: cognition-related skills deficits and decision-making challenges add to morbidity. World Psychiatry 2019; 18:165-167. [PMID: 31059625 PMCID: PMC6502430 DOI: 10.1002/wps.20647] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Affiliation(s)
- Philip D. Harvey
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA,Research Service, Miami VA Healthcare System, Miami, FL, USA
| | - Martin T. Strassnig
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA,Palm Beach County Mental Health Services, Delray Beach, FL, USA
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143
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Chien WT, Clifton AV, Zhao S, Lui S. Peer support for people with schizophrenia or other serious mental illness. Cochrane Database Syst Rev 2019; 4:CD010880. [PMID: 30946482 PMCID: PMC6448529 DOI: 10.1002/14651858.cd010880.pub2] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Peer support provides the opportunity for peers with experiential knowledge of a mental illness to give emotional, appraisal and informational assistance to current service users, and is becoming an important recovery-oriented approach in healthcare for people with mental illness. OBJECTIVES To assess the effects of peer-support interventions for people with schizophrenia or other serious mental disorders, compared to standard care or other supportive or psychosocial interventions not from peers. SEARCH METHODS We searched the Cochrane Schizophrenia Group's Study-Based Register of Trials on 27 July 2016 and 4 July 2017. There were no limitations regarding language, date, document type or publication status. SELECTION CRITERIA We selected all randomised controlled clinical studies involving people diagnosed with schizophrenia or other related serious mental illness that compared peer support to standard care or other psychosocial interventions and that did not involve 'peer' individual/group(s). We included studies that met our inclusion criteria and reported useable data. Our primary outcomes were service use and global state (relapse). DATA COLLECTION AND ANALYSIS The authors of this review complied with the Cochrane recommended standard of conduct for data screening and collection. Two review authors independently screened the studies, extracted data and assessed the risk of bias of the included studies. Any disagreement was resolved by discussion until the authors reached a consensus. We calculated the risk ratio (RR) and 95% confidence interval (CI) for binary data, and the mean difference and its 95% CI for continuous data. We used a random-effects model for analyses. We assessed the quality of evidence and created a 'Summary of findings' table using the GRADE approach. MAIN RESULTS This review included 13 studies with 2479 participants. All included studies compared peer support in addition to standard care with standard care alone. We had significant concern regarding risk of bias of included studies as over half had an unclear risk of bias for the majority of the risk domains (i.e. random sequence generation, allocation concealment, blinding, attrition and selective reporting). Additional concerns regarding blinding of participants and outcome assessment, attrition and selective reporting were especially serious, as about a quarter of the included studies were at high risk of bias for these domains.All included studies provided useable data for analyses but only two trials provided useable data for two of our main outcomes of interest, and there were no data for one of our primary outcomes, relapse. Peer support appeared to have little or no effect on hospital admission at medium term (RR 0.44, 95% CI 0.11 to 1.75; participants = 19; studies = 1, very low-quality evidence) or all-cause death in the long term (RR 1.52, 95% CI 0.43 to 5.31; participants = 555; studies = 1, very low-quality evidence). There were no useable data for our other prespecified important outcomes: days in hospital, clinically important change in global state (improvement), clinically important change in quality of life for peer supporter and service user, or increased cost to society.One trial compared peer support with clinician-led support but did not report any useable data for the above main outcomes. AUTHORS' CONCLUSIONS Currently, very limited data are available for the effects of peer support for people with schizophrenia. The risk of bias within trials is of concern and we were unable to use the majority of data reported in the included trials. In addition, the few that were available, were of very low quality. The current body of evidence is insufficient to either refute or support the use of peer-support interventions for people with schizophrenia and other mental illness.
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Affiliation(s)
- Wai Tong Chien
- The Chinese University of Hong KongNethersole School of Nursing8/F., Esther Lee Building, Chung Chi CampusThe Chinese University of Hong KongShatinNew TerritoriesHong Kong
| | - Andrew V Clifton
- De Montfort UniversityFaculty of Health and Life Sciences3.10 Edith Murphy HouseThe GatewayLeicesterUKLE1 9BH
| | - Sai Zhao
- The Ingenuity Centre, The University of NottinghamSystematic Review Solutions LtdTriumph RoadNottinghamUKNG7 2TU
| | - Steve Lui
- University of HuddersfieldSchool of Human and Health SciencesHarold Wilson BuildingQueensgateHuddersfieldUKHD1 3DH
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144
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Lee SJ, Lawrence R, Bryce S, Ponsford J, Tan EJ, Rossell SL. Emotional discomfort mediates the relationship between self-efficacy and subjective quality of life in people with schizophrenia. J Ment Health 2019; 30:20-26. [PMID: 30879374 DOI: 10.1080/09638237.2019.1581355] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND In people with schizophrenia, self-efficacy (i.e. the belief in one's capability to perform particular tasks/skills) is associated with and motivates performance of social, health and independent living behaviours. Less well known is whether self-efficacy is associated with subjective quality of life (sQoL) or whether psychopathology impacts this relationship. AIMS Measure whether greater self-efficacy is associated with greater community functioning and sQoL and whether emotional discomfort mediates this relationship. METHOD Fifty-two community living people with schizophrenia completed measures of self-efficacy for everyday living and social situations, clinical symptoms, sQoL and community functioning. RESULTS Greater everyday living and social self-efficacy was significantly correlated with greater sQoL and community functioning and lower emotional discomfort (p < 0.05). Only social self-efficacy was correlated with negative symptoms. The relationship between both aspects of self-efficacy and sQoL was, however, mediated by emotional discomfort. Greater confidence in performing social and everyday living behaviours therefore indirectly impacted sQoL through reducing emotional distress. CONCLUSIONS Holding negative capability self-beliefs may contribute to poorer outcome for people with schizophrenia. Intervention aimed at facilitating recovery should therefore provide opportunities to develop knowledge and skills required for success in desired life roles and the belief that tasks required for success can be performed.
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Affiliation(s)
- Stuart J Lee
- Monash Alfred Psychiatry Research Centre, Central Clinical School, The Alfred and Monash University, Melbourne, Australia.,Department of Psychiatry, Alfred Health, Melbourne, Australia
| | - Richard Lawrence
- Monash Alfred Psychiatry Research Centre, Central Clinical School, The Alfred and Monash University, Melbourne, Australia.,School of Psychological Sciences, Monash University, Clayton, Australia
| | - Shayden Bryce
- Monash Alfred Psychiatry Research Centre, Central Clinical School, The Alfred and Monash University, Melbourne, Australia.,School of Psychological Sciences, Monash University, Clayton, Australia
| | - Jennie Ponsford
- School of Psychological Sciences, Monash University, Clayton, Australia.,Monash-Epworth Rehabilitation Research Centre, Richmond, Australia
| | - Eric J Tan
- Monash Alfred Psychiatry Research Centre, Central Clinical School, The Alfred and Monash University, Melbourne, Australia.,Centre for Mental Health, Swinburne University of Technology, Hawthorn, Australia.,Department of Psychiatry, St Vincent's Hospital, Fitzroy, Australia
| | - Susan L Rossell
- Monash Alfred Psychiatry Research Centre, Central Clinical School, The Alfred and Monash University, Melbourne, Australia.,Centre for Mental Health, Swinburne University of Technology, Hawthorn, Australia.,Department of Psychiatry, St Vincent's Hospital, Fitzroy, Australia
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145
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Limited changes in activities of daily life performance ability among people with schizophrenia at clinical settings and the factors moderating the changes. Schizophr Res Cogn 2019; 16:29-35. [PMID: 30705832 PMCID: PMC6348733 DOI: 10.1016/j.scog.2018.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 12/05/2018] [Accepted: 12/10/2018] [Indexed: 11/23/2022]
Abstract
Background Impaired community functioning and functional ability are common among people with schizophrenia spectrum disorders (SSD). However, changes occurring in activities of daily life (ADL) ability through interventions provided at clinical settings have not been systematically examined in this population. Methods We retrospectively collated and analysed changes in ADL ability between admissions and discharges, measured utilising the Assessment of Motor and Process Skills (AMPS), among 72 people with SSD at a public inpatient treatment and rehabilitation facility in Western Australia. Clinical and demographic factors moderating the changes were also determined. Results The standardised AMPS motor (p = 0.0088) and process scores (p < 0.0001) improved significantly between admission and discharge. However, overall, the improvements were of small to moderate magnitude, and >60% of participants did not experience significant or meaningful changes. Furthermore, mild to moderate impairment in the AMPS standardised motor (-1.3 SD), and process (-1.6 SD) ability was present at discharge. A logistic regression analysis revealed that low admission AMPS scores and duration of illness of more than five years predicted improvement of the AMPS motor score by discharge, but only the former predicted changes in the process scores. Other demographic, clinical, and treatment-related variables did not affect the outcome of the AMPS scores. Conclusions Impairment of ADL ability is recalcitrant in schizophrenia. The improvement was modest and occurred only in a proportion of participants. However, promisingly, chronic illness, low baseline ADL ability, treatment with clozapine and presence of treatment-resistant schizophrenia did not have an adverse effect on the outcome.
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146
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Abstract
In many European countries, deinstitutionalisation has been an ongoing process over the last few decades. Mental health organisations were transformed to provide support in a more integrated and comprehensive manner, preferably in their own homes in the community. Yet, despite the welcome aspiration of community integration for all, people with complex mental health problems (also termed severe mental illness) have continued to require high levels of support, in inpatient settings and in the community. This group's needs make them highly dependent on their caregivers. The attitudes, knowledge and skills of the staff providing treatment and support is crucial to their recovery. Rehabilitation programmes provide a much-needed framework to guide practitioners and help them organise and focus their recovery-oriented approach. In this editorial, we will provide a non-exhaustive overview of such rehabilitation programmes and interventions to illuminate the wide scope and practical usability of these interventions for this group of people with complex mental health problems.
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147
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Peer JE, Strong Kinnaman JE, Tenhula WN. Modified Work Behavior Inventory assessment: Evaluation of psychometric properties. SCHIZOPHRENIA RESEARCH-COGNITION 2019; 16:25-28. [PMID: 30671352 PMCID: PMC6327903 DOI: 10.1016/j.scog.2018.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 12/10/2018] [Accepted: 12/13/2018] [Indexed: 11/20/2022]
Abstract
The Work Behavior Inventory (WBI) is a widely used and validated assessment of work functioning in people with schizophrenia. WBI ratings are based on workplace observation and interview with work supervisors. Workplace observation may not be acceptable in all employment settings. A WBI assessment based only on supervisor interview may offer more utility. The current study evaluated the psychometric properties of a modified WBI among individuals with schizophrenia participating in VA vocational rehabilitation programs – similar to the original WBI validation study. Results suggest evidence for reliability, validity and sensitivity to change for an interview only format. Limitations and future research directions are discussed.
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Affiliation(s)
- Jason E. Peer
- VA Maryland Health Care System, Baltimore VA Medical Center, MD, USA
- Corresponding author at: VA Maryland Health Care System, 209 W. Fayette St., Baltimore, MD 21201, USA.
| | | | - Wendy N. Tenhula
- Office of Mental Health and Suicide Prevention, Veterans Health Administration, Washington, DC, USA
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148
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Le TP, Holden JL, Link PC, Granholm EL. Neurocognitive and theory of mind deficits and poor social competence in schizophrenia: The moderating role of social disinterest attitudes. Psychiatry Res 2018; 270:459-466. [PMID: 30551311 PMCID: PMC6347469 DOI: 10.1016/j.psychres.2018.10.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 08/31/2018] [Accepted: 10/04/2018] [Indexed: 12/11/2022]
Abstract
Neurocognitive and theory of mind deficits, dysfunctional attitudes, and negative symptoms have all been linked to poor functioning in schizophrenia, but interactions among these factors have not been extensively examined. We investigated whether dysfunctional attitudes (e.g., defeatist performance beliefs and social disinterest attitudes) moderated associations between neurocognition and theory of mind and poor everyday functioning and social competence in 146 participants with schizophrenia. We examined whether cognitive deficits are more likely to influence functioning in participants with more severe dysfunctional attitudes. Social disinterest, but not defeatist performance, attitudes were found to moderate associations between cognitive deficits and social competence but not everyday functioning, such that neurocognition and theory of mind deficits were only associated with poorer social competence in participants with more severe social disinterest attitudes. In contrast, no significant moderation effects were found for defeatist performance beliefs. Findings indicate that deficits in abilities were less likely to impact social competence in participants with greater interest in socializing. It may be that greater motivation for socializing engenders increased practice and engagement in social interactions, which then leads to greater social competence despite poor cognitive abilities. Treatments that target social disinterest attitudes may lead to greater social competence and engagement.
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Affiliation(s)
- Thanh P. Le
- Department of Psychology, Louisiana State University, Baton Rouge, LA, USA,Send correspondence to: Thanh P. Le, B.S., Louisiana State University, Department of Psychology, 236 Audubon Hall, Baton Rouge, LA, USA 70803,
| | - Jason L. Holden
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Peter C. Link
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Eric L. Granholm
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA,Veterans Affairs San Diego Healthcare System, San Diego, CA USA
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149
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Disorganization and real-world functioning in schizophrenia: Results from the multicenter study of the Italian Network for Research on Psychoses. Schizophr Res 2018; 201:105-112. [PMID: 29898819 DOI: 10.1016/j.schres.2018.06.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 05/29/2018] [Accepted: 06/03/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND A general consensus has not yet been reached regarding the role of disorganization symptoms in real-world functioning in schizophrenia. METHODS We used structural equations modeling (SEM) to analyze the direct and indirect associations between disorganization and real-world functioning assessed through the Specific Levels of Functioning Scale (SLOF) in 880 subjects with schizophrenia. RESULTS We found that: 1) conceptual disorganization was directly and strongly connected with SLOF daily activities; difficulty in abstract thinking was associated with moderate strength to all SLOF domains, and poor attention was connected with SLOF work skills; 2) grandiosity was only related with poor work skills, and delusions were associated with poor functioning in all SLOF domains; interpersonal relationships were weakly indirectly influenced by hallucinatory behavior, delusions and unusual thought contents through the mediation of social cognition (SC); 3) among the negative symptoms, avolition had only direct links with SLOF work skills and SLOF activities; anhedonia had direct links with SLOF work skills and SLOF interpersonal and indirect link with SLOF work skills through functional capacity (FC); asociality with SLOF interpersonal; blunted affect had direct links with SLOF activities and indirect links with SLOF interpersonal relationships mediated by SC. Lastly, alogia had only indirect links mediated by SC, FC, and neurocognition (NC). CONCLUSIONS Overall conceptual disorganization is the symptom that contributed more (both directly and indirectly) to the activities of community living in real-world. Thus, it should be considered as a treatment target in intervention programs for patients with schizophrenia.
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150
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Roux P, Urbach M, Fonteneau S, Berna F, Brunel L, Capdevielle D, Chereau I, Dubreucq J, Faget-Agius C, Fond G, Leignier S, Perier CC, Richieri R, Schneider P, Schürhoff F, Tronche AM, Yazbek H, Zinetti-Bertschy A, Passerieux C, Brunet-Gouet E. Psychiatric disability as mediator of the neurocognition-functioning link in schizophrenia spectrum disorders: SEM analysis using the Evaluation of Cognitive Processes involved in Disability in Schizophrenia (ECPDS) scale. Schizophr Res 2018; 201:196-203. [PMID: 29941294 DOI: 10.1016/j.schres.2018.06.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 06/05/2018] [Accepted: 06/09/2018] [Indexed: 11/17/2022]
Abstract
The functional outcome in schizophrenia spectrum disorders is affected by multiple factors such as cognitive performance and clinical symptoms. Psychiatric disability may be another important determinant of functional outcome. The purpose of this study was to test whether schizophrenia symptoms and psychiatric disability mediated the association between cognition and functioning. Between April 2013 and July 2017, we included 108 community-dwelling adults with stable schizophrenia spectrum disorder in a multicenter study. Psychiatric disability was assessed with the Evaluation of Cognitive Processes involved in Disability in Schizophrenia (ECPDS) scale by relatives of patients. ECPDS focused on the broad array of motivational, neurocognitive, sociocognitive, and metacognitive impairments that result in activity restrictions. We used a battery of tests to assess seven cognition domains (processing speed, attention/vigilance, working, verbal and visual memory, reasoning and problem solving, and executive functioning) and cross-sectional structural equation modeling (SEM) for the mediation analyses. We estimated the one-year temporal stability of ECPDS scores in 45 participants. The model provided showed good fit and explained 43.9% of the variance in functioning. The effect of neurocognition on functioning was fully mediated by symptoms (proportion mediated: 36.5%) and psychiatric disability (proportion mediated: 31.3%). The ECPDS score had acceptable one-year temporal stability. The ECPDS scale has satisfactory psychometric properties, and shows significant convergence with neurocognition and functioning, suggesting a role for this tool in the routine evaluation of cognitive remediation needs. Our model validates psychiatric disability as a crucial step from cognitive impairment to restricted participation in life situations.
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Affiliation(s)
- Paul Roux
- Fondation FondaMental, Créteil, France; Department of Adult Psychiatry, Versailles Hospital, Le Chesnay, France; HandiRESP Laboratory, EA4047, Health Sciences Department Simone Veil, University of Versailles Saint-Quentin-En-Yvelines, Montigny-le-Bretonneux, France.
| | - Mathieu Urbach
- Fondation FondaMental, Créteil, France; Department of Adult Psychiatry, Versailles Hospital, Le Chesnay, France; HandiRESP Laboratory, EA4047, Health Sciences Department Simone Veil, University of Versailles Saint-Quentin-En-Yvelines, Montigny-le-Bretonneux, France
| | - Sandrine Fonteneau
- Fondation FondaMental, Créteil, France; Department of Adult Psychiatry, Versailles Hospital, Le Chesnay, France; HandiRESP Laboratory, EA4047, Health Sciences Department Simone Veil, University of Versailles Saint-Quentin-En-Yvelines, Montigny-le-Bretonneux, France
| | - Fabrice Berna
- Fondation FondaMental, Créteil, France; Strasbourg University Hospital, INSERM U1114, Strasbourg Federation of Translational Psychiatry, Strasbourg, France
| | - Lore Brunel
- Fondation FondaMental, Créteil, France; INSERM U955, Translational Psychiatry team, Université Paris-Est Créteil (UPEC), AP-HP, DHU Pe-PSY, Department of Adult Psychiatry, University Hospitals H Mondor, Créteil, France
| | - Delphine Capdevielle
- Fondation FondaMental, Créteil, France; Academic Department of Adult Psychiatry, La Colombière Hospital, CHU Montpellier, University of Montpellier 1, INSERM 1061, Montpellier, France
| | - Isabelle Chereau
- Fondation FondaMental, Créteil, France; CMP B, Clermont-Ferrand University Hospital, EA 7280, Faculty of Medicine, Auvergne University, Clermont-Ferrand, France
| | - Julien Dubreucq
- Fondation FondaMental, Créteil, France; Psychosocial Rehabilitation Reference Centre, Alpes Isère Hospital, Grenoble, France
| | - Catherine Faget-Agius
- Fondation FondaMental, Créteil, France; Academic Department of Psychiatry (AP-HM), Sainte-Marguerite University Hospital, Marseille, France
| | | | - Sylvain Leignier
- Fondation FondaMental, Créteil, France; Psychosocial Rehabilitation Reference Centre, Alpes Isère Hospital, Grenoble, France
| | - Claire-Cécile Perier
- Fondation FondaMental, Créteil, France; Psychosocial Rehabilitation Reference Centre, Alpes Isère Hospital, Grenoble, France
| | - Raphaëlle Richieri
- Fondation FondaMental, Créteil, France; Academic Department of Psychiatry (AP-HM), Sainte-Marguerite University Hospital, Marseille, France
| | - Priscille Schneider
- Fondation FondaMental, Créteil, France; Strasbourg University Hospital, INSERM U1114, Strasbourg Federation of Translational Psychiatry, Strasbourg, France
| | - Franck Schürhoff
- Fondation FondaMental, Créteil, France; INSERM U955, Translational Psychiatry team, Université Paris-Est Créteil (UPEC), AP-HP, DHU Pe-PSY, Department of Adult Psychiatry, University Hospitals H Mondor, Créteil, France
| | - Anne-Marie Tronche
- Fondation FondaMental, Créteil, France; CMP B, Clermont-Ferrand University Hospital, EA 7280, Faculty of Medicine, Auvergne University, Clermont-Ferrand, France
| | - Hanan Yazbek
- Fondation FondaMental, Créteil, France; Academic Department of Adult Psychiatry, La Colombière Hospital, CHU Montpellier, University of Montpellier 1, INSERM 1061, Montpellier, France
| | - Anna Zinetti-Bertschy
- Fondation FondaMental, Créteil, France; Strasbourg University Hospital, INSERM U1114, Strasbourg Federation of Translational Psychiatry, Strasbourg, France
| | - Christine Passerieux
- Fondation FondaMental, Créteil, France; Department of Adult Psychiatry, Versailles Hospital, Le Chesnay, France; HandiRESP Laboratory, EA4047, Health Sciences Department Simone Veil, University of Versailles Saint-Quentin-En-Yvelines, Montigny-le-Bretonneux, France
| | - Eric Brunet-Gouet
- Fondation FondaMental, Créteil, France; Department of Adult Psychiatry, Versailles Hospital, Le Chesnay, France; HandiRESP Laboratory, EA4047, Health Sciences Department Simone Veil, University of Versailles Saint-Quentin-En-Yvelines, Montigny-le-Bretonneux, France
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