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Song J, Zhang YX, Qin MN, Ren JX, Jia YN, Yu H, Zhou YQ. Experiences of returning to work in patients with schizophrenia after treatment: A longitudinal qualitative study. Int J Soc Psychiatry 2024; 70:588-600. [PMID: 38343195 DOI: 10.1177/00207640231223423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
BACKGROUND Returning to work (RTW) has always been regarded as one of the important indicators to evaluate the therapeutic effect of patients with schizophrenia. The existing studies on RTW in patients with schizophrenia are mostly focused on intervention measures, and the qualitative research on RTW is very limited. The purpose of this study was to evaluate the experience of the RTW after treatment in patients with schizophrenia. METHOD A longitudinal qualitative study was conducted involving 24 patients with schizophrenia in China. The interviews were held at three time-points during their RTW process, (1) when patients had improved and were close to discharge, (2) within 1 month post-discharge, and (3) 6 months post-discharge. The interview recordings were transcribed by the research team, and transcripts were independently analyzed by two independent coders using reflexive thematic analysis. RESULTS A total of 24 patients with schizophrenia participated in 72 personal interviews. The thematic framework based on the experience of patients with schizophrenia reveals a three-phases of the process of RTW: improved, being at a loss, and job crisis. The study identified one theme of the first phase: the expectation and optimism. Two themes in the second phase: (1) psychological distress of upcoming work; (2) expectation of assistance pre-work. And four themes in the third phase: (1) tremendous pressure of RTW; (2) lack of medical and social support; (3) social status and interpersonal relationships change; and (4) high level of financial pressure. CONCLUSION The experience of RTW is a dynamic process with great challenges in each phase, patients with schizophrenia have been deeply affected by what they have experienced. There is an urgent need to ensure that existing community and social support is integrated into daily care to support patients with schizophrenia to RTW successful. The findings of this study also suggest relevant departments and employers should be aware of the barriers to RTW for patients with schizophrenia, and take certain measures to change the current situation.
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Affiliation(s)
- Jin Song
- Department of Nursing, Harbin Medical University, Heilongjiang, China
| | - Yu-Xin Zhang
- Department of Nursing, Xuzhou Medical University, Jiangsu, China
| | - Meng-Nan Qin
- Department of Nursing, Harbin Medical University, Heilongjiang, China
| | - Jia-Xin Ren
- Department of Nursing, Harbin Medical University, Heilongjiang, China
| | - Yan-Nan Jia
- Department of Nursing, Harbin Medical University, Heilongjiang, China
| | - Hong Yu
- Department of Nursing, Harbin Medical University, Heilongjiang, China
| | - Yu-Qiu Zhou
- Department of Nursing, Harbin Medical University, Heilongjiang, China
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Iyo M, Ishigooka J, Nakamura M, Sakaguchi R, Okamoto K, Mao Y, Tsai J, Fitzgerald A, Takai K, Higuchi T. Safety and Effectiveness of Lurasidone in Patients with Schizophrenia: A 12-Week, Open-Label Extension Study. Neuropsychiatr Dis Treat 2021; 17:2683-2695. [PMID: 34429604 PMCID: PMC8379682 DOI: 10.2147/ndt.s320021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 07/24/2021] [Indexed: 12/02/2022] Open
Abstract
PURPOSE The goal of this study was to evaluate the safety and effectiveness of lurasidone among patients with schizophrenia in a 12-week open-label extension study. PATIENTS AND METHODS Patients who completed a 6-week, double-blind, placebo-controlled study were enrolled in a 12-week open-label extension study with flexible dosing of lurasidone at 40 or 80 mg/day. Safety assessments included adverse events, vital signs, laboratory tests, and electrocardiogram (ECG) parameters. Effectiveness measures included the Positive and Negative Syndrome Scale (PANSS) total score, Clinical Global Impression-Severity Scale (CGI-S), Calgary Depression Scale for Schizophrenia (CDSS) and quality of life measure. RESULTS A total of 289 patients were enrolled in the open-label extension study. Rates of treatment-emergent adverse events (TEAEs) were low; akathisia was the most common TEAE with an incidence of 6.6%. There were 54 patients (18.7%) who discontinued the extension study, with 17 (5.9%) discontinuing due to adverse events. Minimal or no effects of lurasidone on weight, body mass index, metabolic parameters, prolactin, and ECG parameters were evident. There was continued improvement to week 12 in PANSS and CGI-S scores beyond the initial gains made during the prior 6-week double-blind study. Non-responders to lurasidone 40 mg/day in the prior 6-week study showed a mean (standard deviation) improvement from open-label baseline of 10.7 (13.8) points on the PANSS total score after lurasidone dose was increased to a modal dose of 80 mg/day during the extension study. Changes from double-blind baseline in CDSS and quality of life were maintained in the extension study. CONCLUSION Treatment with lurasidone 40 or 80 mg once daily (flexibly dosed) continued to be well tolerated with patients demonstrating further improvement in symptoms over the course of a 12-week open-label extension study in patients with schizophrenia.
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Affiliation(s)
- Masaomi Iyo
- Department of Psychiatry, Graduate School of Medicine, Chiba University, Chiba, Japan
| | | | - Masatoshi Nakamura
- Department of Data Science, Drug Development Division, Sumitomo Dainippon Pharma Co., Ltd., Tokyo, Japan
| | - Reiko Sakaguchi
- Department of Clinical Research, Drug Development Division, Sumitomo Dainippon Pharma Co., Ltd., Tokyo, Japan
| | - Keisuke Okamoto
- Department of Clinical Operation, Drug Development Division, Sumitomo Dainippon Pharma Co., Ltd., Tokyo, Japan
| | - Yongcai Mao
- Division of Data Science, Sunovion Pharmaceuticals Inc., Fort Lee, NJ, USA
| | - Joyce Tsai
- Division of Clinical Research, Sunovion Pharmaceuticals Inc., Fort Lee, NJ, USA
| | - Alison Fitzgerald
- Division of Clinical Operations, Sunovion Pharmaceuticals Inc., Fort Lee, NJ, USA
| | - Kentaro Takai
- Medical Affairs, Sumitomo Dainippon Pharma Co., Ltd., Tokyo, Japan
| | - Teruhiko Higuchi
- Japan Depression Center, Tokyo, Japan
- National Center of Neurology and Psychiatry, Tokyo, Japan
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Hagi K, Lin SK, Yeh CB. Lurasidone switching in patients with schizophrenia who showed suboptimal effect and/or intolerability to current antipsychotics: A multi-center, open-label, single-arm, flexible dose study. TAIWANESE JOURNAL OF PSYCHIATRY 2021. [DOI: 10.4103/tpsy.tpsy_26_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Holm M, Taipale H, Tanskanen A, Tiihonen J, Mitterdorfer‐Rutz E. Employment among people with schizophrenia or bipolar disorder: A population-based study using nationwide registers. Acta Psychiatr Scand 2021; 143:61-71. [PMID: 33155273 PMCID: PMC7839734 DOI: 10.1111/acps.13254] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 10/22/2020] [Accepted: 10/26/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To assess the employment rate and the related background factors among people with schizophrenia or bipolar disorder. METHODS We identified all people in Sweden aged 18-64 years diagnosed with schizophrenia or bipolar disorder in nationwide registers in the years 2006-2013. The identified individuals were grouped by main activity or source of income. The association between background factors and employment was analyzed with generalized estimating equations (GEE). RESULTS Three years before the first psychosis or bipolar disorder diagnosis, 24% of the individuals with schizophrenia and 45% of the individuals with bipolar disorder were employed. However, the employment rate dropped around the time of the first diagnosis. Five years later, 10% of the individuals with schizophrenia and 34% of the individuals with bipolar disorder were employed. The most important factors associated with employment after diagnosis were a high level of education, older age at the first registered diagnosis, no substance use disorder, and a low number of previous hospitalizations. Marriage or cohabiting, higher level of education, and higher age at the first diagnosis were associated with an increased employment rate especially among people with schizophrenia, and substance use was associated with a lower employment rate, especially among people with bipolar disorder. Men with bipolar disorder had a higher employment rate than women. CONCLUSION The employment rate is low among people with schizophrenia and higher among people with bipolar disorder. The association of background characteristics with employment was mostly in the same direction both in schizophrenia and in bipolar disorder.
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Affiliation(s)
- Minna Holm
- Mental Health UnitFinnish Institute for Health and WelfareHelsinkiFinland,Department of Clinical NeuroscienceKarolinska InstitutetStockholmSweden
| | - Heidi Taipale
- Department of Clinical NeuroscienceKarolinska InstitutetStockholmSweden,School of PharmacyUniversity of Eastern FinlandKuopioFinland,Department of Forensic PsychiatryNiuvanniemi HospitalUniversity of Eastern FinlandKuopioFinland
| | - Antti Tanskanen
- Department of Clinical NeuroscienceKarolinska InstitutetStockholmSweden,Department of Forensic PsychiatryNiuvanniemi HospitalUniversity of Eastern FinlandKuopioFinland,The Impact Assessment UnitNational Institute for Health and WelfareHelsinkiFinland
| | - Jari Tiihonen
- Department of Clinical NeuroscienceKarolinska InstitutetStockholmSweden,Department of Forensic PsychiatryNiuvanniemi HospitalUniversity of Eastern FinlandKuopioFinland
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Fontecedro E, Furlan M, Tossut D, Pascolo-Fabrici E, Balestrieri M, Salvador-Carulla L, D’Avanzo B, Castelpietra G. Individual Health Budgets in Mental Health: Results of Its Implementation in the Friuli Venezia Giulia Region, Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17145017. [PMID: 32668599 PMCID: PMC7400620 DOI: 10.3390/ijerph17145017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/08/2020] [Accepted: 07/10/2020] [Indexed: 12/13/2022]
Abstract
Background: Individual Health Budget (IHB) is an intervention for recovery in mental health services, providing personalized care for subjects with severe disorders and complex needs. Little is known on its effectiveness and on the criteria for its delivery. Methods: A total of 67 IHB beneficiaries and 61 comparators were recruited among service users of the Mental Health Department of the Trieste Healthcare Agency, Italy. Data included sociodemographic and clinical variables, type of IHB, and Health of the Nation Outcome Scale (HoNOS) scores. Results: A comparison between groups showed significant differences in several socioeconomic and clinical characteristics. Multivariate logistic regression showed that IHB was positively associated to the 20–49 age group, single status, unemployment, low family support, cohabitation with relatives or friends, diagnosis of personality disorder, and a higher number of hospitalizations. The IHB group was at a higher risk of severe problems related to aggressive or agitated behaviors (OR = 1.4), hallucinations and delusions (OR = 1.5), and impairment in everyday life activities (OR = 2.1). Conclusions: IHB was used in patients with severe clinical and social problems. More resources, however, may be aimed at the working and social axes. More research is needed to better assess clinical and social outcomes of IHB and to adjust their intensity in a longitudinal perspective in order to enhance cost-effectiveness.
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Affiliation(s)
- Elisa Fontecedro
- Department of Medicine (DAME), University of Udine, 33100 Udine, Italy; (E.F.); (M.B.)
| | - Morena Furlan
- Central Health Directorate, Friuli Venezia Giulia Region, 34100 Trieste, Italy;
| | - Davide Tossut
- Welfare Area, Friuli Venezia Giulia Region, 33057 Palmanova, Italy;
| | - Elisabetta Pascolo-Fabrici
- Clinical Department of Medical, Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy;
- Mental Health Department, WHO Collaborating Centre for Research and Training in Mental Health, Health University Agency of Trieste, 34100 Trieste, Italy
| | - Matteo Balestrieri
- Department of Medicine (DAME), University of Udine, 33100 Udine, Italy; (E.F.); (M.B.)
| | - Luis Salvador-Carulla
- Centre for Mental Health Research, Research School of Population Health, ANU College of Health and Medicine, Australian National University, 2601 Canberra, Australia;
- Menzies Centre for Health Policy, Faculty of Medicine and Health, University of Sydney, Charles Perkins Centre, The University of Sydney, 2006 Sydney, Australia
| | - Barbara D’Avanzo
- Istituto di Ricerche Farmacologiche Mario Negri, IRCCS, 20156 Milano, Italy;
| | - Giulio Castelpietra
- Department of Medicine (DAME), University of Udine, 33100 Udine, Italy; (E.F.); (M.B.)
- Central Health Directorate, Friuli Venezia Giulia Region, 34100 Trieste, Italy;
- Correspondence: ; Tel.: +39-040-377-5575
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Feng Y, Shi J, Wang L, Zhang X, Tan Y, Zhao J, Ning Y, Xie S, Liu X, Liu Q, Li K, Wang X, Li L, Xu X, Deng W, Luo X, Wang G. Randomized, double-blind, 6-week non-inferiority study of lurasidone and risperidone for the treatment of schizophrenia. Psychiatry Clin Neurosci 2020; 74:336-343. [PMID: 31823444 PMCID: PMC7317929 DOI: 10.1111/pcn.12965] [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: 07/01/2019] [Revised: 11/18/2019] [Accepted: 12/09/2019] [Indexed: 02/05/2023]
Abstract
AIM The aim of the present study was to evaluate the efficacy and safety of lurasidone for the treatment of Chinese schizophrenic patients. METHODS Hospitalized schizophrenia patients aged 18-65 were randomized to 6 weeks of double-blind, double-dummy, flexible-dose treatment with lurasidone (40 or 80 mg/day) or risperidone (2, 4 or 6 mg/day). Efficacy was evaluated using a non-inferiority comparison of lurasidone relative to risperidone based on week 6 change in the Positive and Negative Syndrome Scale (PANSS) total score. Safety assessments included adverse events, clinical laboratory measures, and electrocardiograms. RESULTS Four hundred and forty-four patients were screened to obtain an intent-to-treat sample of 384 patients, of whom 54 patients discontinued treatment prior to 6 weeks. Lurasidone met the criteria for non-inferiority versus risperidone on the PANSS total score. Adjusted mean (SE) change at week 6 on the PANSS total score was -31.2 (1.0) and -34.9 (1.0) in the lurasidone and risperidone group, respectively. The mean difference score was 3.7, and the upper boundary of the 95%-confidence interval (1.0-6.3) was less than the prespecified margin of 7.0. No clinically meaningful between-treatment group differences were evident on secondary efficacy measures, including PANSS positive, PANSS negative, Clinical Global Impression scale - Severity, and Calgary Depression Scale for Schizophrenia scales. The incidence of adverse events was lower for lurasidone vs risperidone for extrapyramidal symptoms (17.0% vs 38.2%), akathisia (7.2% vs 13.6%), prolactin increase (3.1% vs 14.1%), and weight increase (0.5% vs 5.2%). CONCLUSION Lurasidone was found to be non-inferior to risperidone on the primary endpoint with minimal effects on weight, metabolic parameters, or prolactin levels.
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Affiliation(s)
- Yuan Feng
- Department of Psychiatry, Beijing Anding Hospital, National Clinical Research Center for Mental Disorders, Capital Medical University, Beijing, China
| | - Jianguo Shi
- Department of Psychiatry, Xi'an Mental Health Center, Xi'an, China
| | - Lili Wang
- Department of Psychiatry, Tianjin Anding Hospital, Tianjin, China
| | - Xia Zhang
- Department of Psychiatry, Wuxi Mental Health Center, Wuxi, China
| | - Yunlong Tan
- Department of Psychiatry, Beijing Huilongguan Hospital, Beijing, China
| | - Jingyuan Zhao
- Department of Psychiatry, Henan Provincial Mental Hospital, Xinxiang, China
| | - Yuping Ning
- Department of Psychiatry, Guangzhou Brain Hospital, Guangzhou, China
| | - Shiping Xie
- Department of Psychiatry, Nanjing Brain Hospital, Nanjing, China
| | - Xuejun Liu
- Department of Psychiatry, Brain Hospital of Hunan Province, Changsha, China
| | - Qi Liu
- Department of Psychiatry, Sixth Hospital of Peking University, Beijing, China
| | - Keqing Li
- Department of Psychiatry, Hebei Mental Health Center, Baoding, China
| | - Xiaoliang Wang
- Mental Health Institute, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lehua Li
- Department of Psychiatry, Second Xiangya Hospital of Central South University, Changsha, China
| | - Xiufeng Xu
- Department of Psychiatry, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Wei Deng
- Department of Psychiatry, West China Hospital of Sichuan University, Chengdu, China
| | - Xiaoyan Luo
- Medical Division, Sumitomo Pharma(Suzhou)Co., Ltd, Beijing, China
| | - Gang Wang
- Department of Psychiatry, Beijing Anding Hospital, National Clinical Research Center for Mental Disorders, Capital Medical University, Beijing, China
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7
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Castelpietra G, Balestrieri M, Bovenzi M. Occupational status and hospitalisation for mental disorders: findings from Friuli Venezia Giulia region, Italy, 2008-2017. Int J Psychiatry Clin Pract 2019; 23:265-272. [PMID: 31094244 DOI: 10.1080/13651501.2019.1611864] [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] [Indexed: 10/26/2022]
Abstract
Purpose: To investigate to which extent occupational status, and job titles, were associated with types of hospitalisations and psychiatric diagnoses among inpatients of Friuli Venezia Giulia Region, Italy.Methods: Cross-sectional study based on 10 years register data (2008-2017) on 2929 subjects hospitalised in General Hospital Psychiatric Units. Odds ratios (OR) of hospitalisations and psychiatric diagnoses for occupational status and job titles were calculated by logistic regression analysis.Results: Employed were at lower risk of urgent and involuntary hospitalisation. The risk of urgent hospitalisation was higher for affective, organic or other disorders, while all psychiatric diagnoses were at lower risk of involuntary hospitalisation than psychosis. Using white collars as reference category, army showed a higher risk for urgent hospitalisation (OR = 2.3) and affective disorders (OR = 1.9). A higher risk for affective disorders was found in managers (OR = 2.0). Blue collars were at higher risk for alcohol and substance abuse (OR = 1.7).Conclusions: Employment was protective for urgent and involuntary hospitalisations and severe diagnoses. Hospitalisation for affective disorders was more likely in managers, army, and for substances abuse in blue collars. More research is needed to assess the association between specific occupational groups and involuntary hospitalisation.KeypointsEmployment was shown to be a protective factor for both urgent and involuntary hospitalisations and diagnosis of severe mental disorder.Managers, police and military forces were at higher risk of being hospitalised for affective disorders, while blue collars were at higher risk of hospitalisation for alcohol and substances abuse.Future research would benefit from a better analysis on the association between more specific occupational groups and hospitalisation for psychiatric disorders, with a particular focus on involuntary treatment.Further research is needed to compare the risk of hospitalisation for mental disorders in temporary or permanent position, according to recent international changes in labour market and its impact on mental health.
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Affiliation(s)
- Giulio Castelpietra
- Primary Care Services Area, Central Health Directorate, Friuli Venezia Giulia Region, Trieste, Italy.,Department of Medical Sciences, University of Trieste, Trieste, Italy.,Department of Medicine (DAME), University of Udine, Udine, Italy
| | | | - Massimo Bovenzi
- Clinical Unit of Occupational Medicine, Department of Medical Sciences, University of Trieste, Trieste, Italy
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Aas M, Djurovic S, Ueland T, Mørch RH, Fjæra Laskemoen J, Reponen EJ, Cattaneo A, Eiel Steen N, Agartz I, Melle I, Andreassen OA. The relationship between physical activity, clinical and cognitive characteristics and BDNF mRNA levels in patients with severe mental disorders. World J Biol Psychiatry 2019; 20:567-576. [PMID: 30560709 DOI: 10.1080/15622975.2018.1557345] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Here we aimed to clarify the association of physical activity with cognitive function and current mood in severe mental disorders in the most extensive sample to date. Secondly, we aimed to investigate the relationship between physical activity and BDNF mRNA levels.Methods: Three hundred and six patients with a DSM-IV schizophrenia (SZ) or bipolar disorder (BD) spectrum diagnosis were included. Clinical characteristics were assessed using the Structured Clinical Interview for DSM-IV. Depressive symptomatology was measured using the Inventory of Depressive Symptoms (IDS-C) and the Calgary Depression Scale for Schizophrenia (CDSS). All patients underwent neuropsychological assessment. Physical activity was measured as hours spent on any regular physical activity (≥ or ˂90 min) per week. BDNF mRNA was measured in plasma using standardised procedures.Results: Patients with ≥90 min of physical activity per week had fewer depressive symptoms (P ˂0.001, Cohen's d = 0.48) and performed significantly better on working memory (P ˂ 0.001, d = 0.44) and executive functioning tasks (P ˂ 0.001, d = 0.50) compared to the ˂90-min group. BDNF mRNA was positively associated with physical activity (P = 0.046) and cognitive functioning (P = 0.037).Conclusions: Our study suggests a positive association between self-reported physical activity, cognitive function, mood and BDNF mRNA levels in severe mental disorders.
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Affiliation(s)
- Monica Aas
- NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,NORMENT, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Srdjan Djurovic
- Department of Medical Genetics, Oslo University Hospital, Oslo, Norway.,NORMENT, KG Jebsen Centre for Psychosis Research, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Torill Ueland
- NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Psychology, University of Oslo, Oslo, Norway
| | - Ragni H Mørch
- NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - Elina J Reponen
- NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Annamaria Cattaneo
- Biological Psychiatry Unit, IRCCS Fatebenefratelli Brescia, Brescia, Italy.,Institute of Psychiatry, Kings College London, London, UK
| | - Nils Eiel Steen
- NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,NORMENT, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Ingrid Agartz
- NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,NORMENT, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Ingrid Melle
- NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,NORMENT, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Ole A Andreassen
- NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,NORMENT, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
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Validation of the ICF Core Sets for schizophrenia from the perspective of psychiatrists: An international Delphi study. J Psychiatr Res 2018; 103:134-141. [PMID: 29852420 DOI: 10.1016/j.jpsychires.2018.05.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 04/26/2018] [Accepted: 05/12/2018] [Indexed: 11/23/2022]
Abstract
Schizophrenia is a chronic mental illness associated with several functional impairments. The International Classification of Functioning, Disability and Health (ICF) Core Sets for schizophrenia are shortlists of ICF categories that are relevant for describing the functioning and disability of people suffering from schizophrenia. The aims of this study were to explore the content validity of these Core Sets from the perspective of psychiatrists and to identify - from this perspective and using the ICF framework - the most common problems of patients with schizophrenia. In a three-round survey using the Delphi technique, psychiatrists experienced in schizophrenia treatment were asked about the problems they commonly encounter in these patients. A total of 352 psychiatrists from 63 countries representing all six WHO regions responded to the first-round questionnaire, and 303 completed all three rounds (86% response rate). From the first-round responses, 7133 concepts were extracted and linked to 387 ICF categories and 35 personal factors. Of these, consensus (≥75% agreement) was reached for 91 ICF categories and 31 personal factors. Eighty-seven of the 97 ICF categories that form the Comprehensive ICF Core Set for schizophrenia were represented in this list. Only four of the categories for which consensus was reached do not feature in the Comprehensive Core Set. From the perspective of psychiatrists the content validity of the ICF Core Sets for schizophrenia was largely supported. This suggests that these Core Sets offer an effective framework for describing functioning and disability in individuals with schizophrenia.
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Cardoso D, Tyrrell K, Mancias Guerra C, Rikhraj S. Chlorpromazine versus lithium for people with schizophrenia. Hippokratia 2017. [DOI: 10.1002/14651858.cd012737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Daniel Cardoso
- University of Fortaleza; School of Medicine; Fortaleza Brazil
| | - Katie Tyrrell
- Institute of Mental Health, University of Nottingham; Department of Psychiatry and Applied Psychology; Nottingham UK
| | - Claudia Mancias Guerra
- Institute of Mental Health, University of Nottingham; Department of Psychiatry and Applied Psychology; Nottingham UK
| | - Shareen Rikhraj
- Institute of Mental Health, University of Nottingham; Department of Psychiatry and Applied Psychology; Nottingham UK
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Falkum E, Klungsøyr O, Lystad JU, Bull HC, Evensen S, Martinsen EW, Friis S, Ueland T. Vocational rehabilitation for adults with psychotic disorders in a Scandinavian welfare society. BMC Psychiatry 2017; 17:24. [PMID: 28095813 PMCID: PMC5240414 DOI: 10.1186/s12888-016-1183-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 12/30/2016] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND This study examined the outcomes of a vocational rehabilitation program (The Job Management Program, JUMP) for persons with psychotic disorders based on close collaboration between health and welfare services. METHODS Participants (N = 148) with broad schizophrenia spectrum disorders (age 18-65) were recruited from six counties in Norway. Three counties were randomized to vocational rehabilitation augmented with cognitive behaviour therapy (CBT), while the remaining three counties were randomized to vocational rehabilitation augmented with cognitive remediation (CR). This paper compares the vocational activity of the total group of JUMP participants with a treatment as usual group (N = 341), and further examines differences between the two JUMP interventions. Employment status (working/not working) was registered at the time of inclusion and at the end of the intervention period. RESULTS The total number of JUMP participants in any kind of vocational activity increased from 17 to 77% during the intervention. Of these, 8% had competitive employment, 36% had work placements in ordinary workplaces with social security benefits as their income, and 33% had sheltered work. The total number of working participants in the TAU group increased from 15.5 to 18.2%. The JUMP group showed significant improvements of positive (t = -2.33, p = 0.02) and general (t = -2.75, p = 0.007) symptoms of psychosis. Significant differences between the CBT and CR interventions were not demonstrated. CONCLUSIONS The study supports existing evidence that the majority of persons with broad schizophrenia spectrum disorders can cope with some kind of work, given that internal and external barriers are reduced. Those who wish to work should be offered vocational rehabilitation. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01139502 . Registered on 6 February 2010.
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Affiliation(s)
- Erik Falkum
- Department of Research and Development, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ole Klungsøyr
- Department of Research and Development, Oslo University Hospital, Oslo, Norway
| | | | | | - Stig Evensen
- Department of Research and Development, Oslo University Hospital, Oslo, Norway
| | - Egil W. Martinsen
- Department of Research and Development, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Svein Friis
- Department of Research and Development, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Torill Ueland
- Department of Research and Development, Oslo University Hospital, Oslo, Norway
- Institute of Psychology, University of Oslo, Oslo, Norway
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Barrios M, Guilera G, Selb M, Gómez-Benito J. Identification of problems in the functioning of individuals with schizophrenia from the expert perspective: an Internet-based survey. Disabil Rehabil 2016; 39:2055-2062. [PMID: 27712119 DOI: 10.1080/09638288.2016.1217073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE The purpose of the study was to identify aspects of functioning and related environmental factors that are relevant to schizophrenia from the perspective of health professionals experienced in treating individuals with this disorder using the International Classification of Functioning, Disability and Health (ICF). METHOD An international pool of experts from diverse health care disciplines was surveyed to identify problems in functioning experienced by individuals with schizophrenia and the environmental factors that impact their functioning. On the basis of established rules, all answers were translated to the ICF by two independent researchers. RESULTS One-hundred and eighty-nine experts from all six World Health Organization regions identified 4776 meaningful concepts, of which 92% were linked to 347 different ICF categories. Of the 347 categories, 194 were second-level categories, 151 were third-level categories and 2 were fourth-level categories. Ninety-five second-level ICF categories, 43 third-level categories and 1 fourth-level category reached percentage frequency of at least 5%. The majority of the categories were attributed to body functions, activities and participation, and environmental factors. CONCLUSIONS Health professionals identified a wide range of problems in functioning that reflect the complexity and breadth of schizophrenia, specifically activity limitations and participation restrictions that are particularly relevant for individuals with schizophrenia. Knowing these functioning problems can guide the design of patient-oriented rehabilitation programmes. Implications for rehabilitation Schizophrenia may result in impaired functioning in multiple daily life activities. The International Classification of Functioning, Disability and Health (ICF) can help in identifying the needs and problems of these individuals. The reported list of ICF categories can facilitate a systematic application of the ICF in schizophrenia and can help to design and implement coordinated and patient oriented rehabilitation programmes with a biopsychosocial approach. According to health professionals surveyed, activity limitations and participation restrictions are broadly affected in this population and are highly influenced by neurocognitive and social cognitive deficits and environmental factors.
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Affiliation(s)
- Maite Barrios
- a Department of Behavioral Sciences Methods , University of Barcelona , Barcelona , Spain.,b Institute for Brain, Cognition and Behavior (IR3C), University of Barcelona , Barcelona , Spain
| | - Georgina Guilera
- a Department of Behavioral Sciences Methods , University of Barcelona , Barcelona , Spain.,b Institute for Brain, Cognition and Behavior (IR3C), University of Barcelona , Barcelona , Spain
| | - Melissa Selb
- c ICF Research Branch, a cooperation partner within the WHO Collaborating Centre for the Family of International Classifications in Germany (at DIMDI) , Nottwil , Switzerland.,d Swiss Paraplegic Research , Nottwil , Switzerland
| | - Juana Gómez-Benito
- a Department of Behavioral Sciences Methods , University of Barcelona , Barcelona , Spain.,b Institute for Brain, Cognition and Behavior (IR3C), University of Barcelona , Barcelona , Spain
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Adamczyk P, Daren A, Sułecka A, Błądziński P, Cichocki Ł, Kalisz A, Gawęda Ł, Cechnicki A. Do better communication skills promote sheltered employment in schizophrenia? Schizophr Res 2016; 176:331-339. [PMID: 27546092 DOI: 10.1016/j.schres.2016.08.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 07/01/2016] [Accepted: 08/15/2016] [Indexed: 12/01/2022]
Abstract
Alongside various psychopathological symptoms and neurocognitive dysfunctions, communication skill impairments may be considered core feature of schizophrenia. Although many studies examined the relation between employment status and neurocognition in schizophrenia, we still know very little about the role of communication skills in vocational status among people with schizophrenia. The purpose of this study is to identify the most characteristic communication, neurocognitive and social cognition differences which separate the employed schizophrenia outpatients from those who do not work. The study included three groups: 33 schizophrenia outpatients employed in social firms, 29 unemployed schizophrenia outpatients participating in occupational therapy and sex & age matched 31 healthy controls. We assessed communication skills, global cognitive functioning, executive functions, memory, social cognition as well as severity of psychopathology. Our results indicate that the most characteristic differences between employed and unemployed schizophrenia outpatients are associated with selective language and communication skills, i.e. paralinguistic aspects of communication, understanding of discrete meaning of linguistic context and figurative meaning of language. We find no significant differences between both clinical groups with regard to neurocognition and social cognition. Moreover, unemployed group had more severe psychopathology than the employed group, so we re-analyzed results controlling for symptom severity. The only differences that endured were related to general communication skills and explanation of pictured metaphors, but only when controlling solely for positive or negative syndrome. In conclusion, the present study indicates that employment in schizophrenia is associated with better symptomatic remission and communication skills, but not with better neurocognition and social cognition.
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Affiliation(s)
- Przemysław Adamczyk
- Department of Community Psychiatry, Chair of Psychiatry, Medical College, Jagiellonian University, Krakow, Poland; Psychosis Research and Psychotherapy Unit, Association for the Development of Psychiatry and Community Care, Krakow, Poland.
| | - Artur Daren
- Department of Community Psychiatry, Chair of Psychiatry, Medical College, Jagiellonian University, Krakow, Poland; Psychosis Research and Psychotherapy Unit, Association for the Development of Psychiatry and Community Care, Krakow, Poland
| | - Aleksandra Sułecka
- Psychosis Research and Psychotherapy Unit, Association for the Development of Psychiatry and Community Care, Krakow, Poland
| | - Piotr Błądziński
- Department of Community Psychiatry, Chair of Psychiatry, Medical College, Jagiellonian University, Krakow, Poland
| | - Łukasz Cichocki
- Department of Community Psychiatry, Chair of Psychiatry, Medical College, Jagiellonian University, Krakow, Poland
| | - Aneta Kalisz
- Department of Community Psychiatry, Chair of Psychiatry, Medical College, Jagiellonian University, Krakow, Poland
| | - Łukasz Gawęda
- II Department of Psychiatry, Medical University of Warsaw, Poland; Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Andrzej Cechnicki
- Department of Community Psychiatry, Chair of Psychiatry, Medical College, Jagiellonian University, Krakow, Poland; Psychosis Research and Psychotherapy Unit, Association for the Development of Psychiatry and Community Care, Krakow, Poland
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Abstract
While the influence of negative symptoms on vocational outcome is well documented, the specific contribution of apathy is less explored. The current study examined the influence of apathy on vocational outcome. A total of 148 participants were included in a vocational rehabilitation study, offering cognitive remediation (CR) or cognitive behavior therapy (CBT) to address work-related issues. Clinical and functional measures were assessed on inclusion and at posttreatment after approximately 10 months. The level of apathy was not related to the acquisition of work, but higher levels of apathy predicted fewer hours worked per week during the study. Previous employment predicted future employment, and higher education predicted more hours worked and higher score on the Work Behavior Inventory. The results did not differ across interventions. Thus, despite apathy, people with schizophrenia were able to work when the barriers to employment were addressed and adequate support was given.
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Evensen S, Wisløff T, Lystad JU, Bull H, Ueland T, Falkum E. Prevalence, Employment Rate, and Cost of Schizophrenia in a High-Income Welfare Society: A Population-Based Study Using Comprehensive Health and Welfare Registers. Schizophr Bull 2016; 42:476-83. [PMID: 26433216 PMCID: PMC4753607 DOI: 10.1093/schbul/sbv141] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Schizophrenia is associated with recurrent hospitalizations, need for long-term community support, poor social functioning, and low employment rates. Despite the wide- ranging financial and social burdens associated with the illness, there is great uncertainty regarding prevalence, employment rates, and the societal costs of schizophrenia. The current study investigates 12-month prevalence of patients treated for schizophrenia, employment rates, and cost of schizophrenia using a population-based top-down approach. Data were obtained from comprehensive and mandatory health and welfare registers in Norway. We identified a 12-month prevalence of 0.17% for the entire population. The employment rate among working-age individuals was 10.24%. The societal costs for the 12-month period were USD 890 million. The average cost per individual with schizophrenia was USD 106 thousand. Inpatient care and lost productivity due to high unemployment represented 33% and 29%, respectively, of the total costs. The use of mandatory health and welfare registers enabled a unique and informative analysis on true population-based datasets.
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Affiliation(s)
- Stig Evensen
- Department of Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway;
| | - Torbjørn Wisløff
- Department of Biostatistics, Epidemiology and Health Economics, Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - June Ullevoldsæter Lystad
- Department of Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Helen Bull
- Department of Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Torill Ueland
- Department of Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway;,Department of Psychology, University of Oslo, Oslo, Norway
| | - Erik Falkum
- Department of Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway;,Department of Clinical Medicine, University of Oslo, Oslo, Norway
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Neurocognition and occupational functioning in schizophrenia spectrum disorders: The MATRICS Consensus Cognitive Battery (MCCB) and workplace assessments. Schizophr Res 2016; 170:143-9. [PMID: 26692347 DOI: 10.1016/j.schres.2015.12.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 11/22/2015] [Accepted: 12/03/2015] [Indexed: 01/25/2023]
Abstract
The MCCB is widely used in clinical trials of schizophrenia, but its relationship to occupational functioning still needs further elaboration. While previous research has indicated that various domains of neurocognition assessed by individual tests are related to work functioning, these reports preceded the development of the MCCB as the standard neurocognitive test battery in the field. In the current study, the vocational functioning of 131 Norwegian participants with schizophrenia spectrum disorders who were enrolled in a vocational rehabilitation program were assessed on the Vocational Cognitive Rating Scale (VCRS), the Work Behavior Inventory (WBI), and the Complexity Scale (CS) as well as on the MCCB. Significant correlations were found between most MCCB domains and VCRS Total Score. MCCB processing speed and attention were most powerfully related to and predictive of WBI scores. When participants were divided into "low complexity" or "higher complexity" work categories, participants in the "low-complexity" group performed significantly worse than participants in the "higher-complexity" group regarding processing speed, working memory, visual learning and the composite score. The same pattern emerged for participants working sheltered compared to competitive jobs. The VCRS, WBI and CS may be useful in vocational rehabilitation. They bridge an important gap between test- and occupational-setting, providing valuable information about impairments related to occupational functioning. We found the MCCB to be sensitive to occupational functioning as measured by VCRS, WBI and CS, with neurocognition accounting for a small but significant proportion of the variance in these different measures of occupational functioning.
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Cella M, Reeder C, Wykes T. Lessons learnt? The importance of metacognition and its implications for Cognitive Remediation in schizophrenia. Front Psychol 2015; 6:1259. [PMID: 26388797 PMCID: PMC4555655 DOI: 10.3389/fpsyg.2015.01259] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 08/05/2015] [Indexed: 11/24/2022] Open
Abstract
The cognitive problems experienced by people with schizophrenia not only impede recovery but also interfere with treatments designed to improve overall functioning. Hence there has been a proliferation of new therapies to treat cognitive problems with the hope that improvements will benefit future intervention and recovery outcomes. Cognitive remediation therapy (CR) that relies on intensive task practice can support basic cognitive functioning but there is little evidence on how these therapies lead to transfer to real life skills. However, there is increasing evidence that CR including elements of transfer training (e.g., strategy use and problem solving schemas) produce higher functional outcomes. It is hypothesized that these therapies achieve higher transfer by improving metacognition. People with schizophrenia have metacognitive problems; these include poor self-awareness and difficulties in planning for complex tasks. This paper reviews this evidence as well as research on why metacognition needs to be explicitly taught as part of cognitive treatments. The evidence is based on research on learning spanning from neuroscience to the field of education. Learning programmes, and CRT, may be able to achieve better outcomes if they explicitly teach metacognition including metacognitive knowledge (i.e., awareness of the cognitive requirements and approaches to tasks) and metacognitive regulation (i.e., cognitive control over the different task relevant cognitive requirements). These types of metacognition are essential for successful task performance, in particular, for controlling effort, accuracy and efficient strategy use. We consider metacognition vital for the transfer of therapeutic gains to everyday life tasks making it a therapy target that may yield greater gains compared to cognition alone for recovery interventions.
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Affiliation(s)
- Matteo Cella
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London London, UK
| | - Clare Reeder
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London London, UK
| | - Til Wykes
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London London, UK
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18
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Joseph J, Kremen WS, Glatt SJ, Franz CE, Chandler SD, Liu X, Johnson BK, Tsuang MT, Twamley EW. Assessment of Lifespan Functioning Attainment (ALFA) scale: A quantitative interview for self-reported current and functional decline in schizophrenia. J Psychiatr Res 2015; 65:102-7. [PMID: 25898804 PMCID: PMC4439273 DOI: 10.1016/j.jpsychires.2015.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 03/30/2015] [Accepted: 04/02/2015] [Indexed: 12/11/2022]
Abstract
Schizophrenia has been characterized as a disorder with poor outcomes across various functional domains, especially social and occupational functioning. Although these outcomes have been investigated based on patients' current functioning, few studies have considered the assessment of functional outcomes across the lifespan in schizophrenia. We developed a novel and brief scale of adulthood lifespan functioning, the Assessment of Lifespan Functioning Attainment (ALFA). We assessed current functioning and percentage of pre- and post-psychosis onset engagement for five functional domains including paid employment, living independently, romantic partnerships, close friendships, and recreational engagement with others. Pre-to post-psychosis functional decline was observed for all domains, with paid employment having the greatest decline (d = 2.68) and living independently having the least decline (d = .59). Our exploratory factor analysis suggests that a single factor accounted for the most variance in Pre-Psychosis Functioning in ALFA domains. Two factors explain the majority of variance in Post-Psychosis Functioning and Pre-to-Post Psychosis Decline: a sociability factor (close friendships and recreational engagement with others) and an independence factor (paid employment, living independently, romantic relationships). To our knowledge, this is the first study to report on a self-reported quantitative assessment of adult lifespan functioning in schizophrenia. The ALFA scale may be a useful tool for future research on functional outcomes in schizophrenia.
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Affiliation(s)
- Jamie Joseph
- Center for Behavior Genomics, Department of Psychiatry, School of Medicine, University of California San Diego, 9500 Gilman Drive #0603, La Jolla, CA 92093-0603
| | - William S. Kremen
- Center for Behavior Genomics, Department of Psychiatry, School of Medicine, University of California San Diego, 9500 Gilman Drive #0603, La Jolla, CA 92093-0603, Center of Excellence for Stress and Mental Health, Veterans Affairs San Diego Healthcare System, 3350 La Jolla Village Drive (116A), San Diego, CA 92161
| | - Stephen J. Glatt
- Psychiatric Genetic Epidemiology & Neurobiology Laboratory (PsychGENe Lab); Department of Psychiatry, SUNY Upstate Medical University, 750 East Adams Street, 3710 Neuroscience Research Building, Institute for Human Performance, Syracuse, NY 13210
| | - Carol E. Franz
- Center for Behavior Genomics, Department of Psychiatry, School of Medicine, University of California San Diego, 9500 Gilman Drive #0603, La Jolla, CA 92093-0603
| | - Sharon D. Chandler
- Center for Behavior Genomics, Department of Psychiatry, School of Medicine, University of California San Diego, 9500 Gilman Drive #0603, La Jolla, CA 92093-0603
| | - Xiaohua Liu
- Center for Behavior Genomics, Department of Psychiatry, School of Medicine, University of California San Diego, 9500 Gilman Drive #0603, La Jolla, CA 92093-0603
| | - Barbara K. Johnson
- Center for Behavior Genomics, Department of Psychiatry, School of Medicine, University of California San Diego, 9500 Gilman Drive #0603, La Jolla, CA 92093-0603
| | - Ming T. Tsuang
- Center for Behavior Genomics, Department of Psychiatry, School of Medicine, University of California San Diego, 9500 Gilman Drive #0603, La Jolla, CA 92093-0603, Center of Excellence for Stress and Mental Health, Veterans Affairs San Diego Healthcare System, 3350 La Jolla Village Drive (116A), San Diego, CA 92161
| | - Elizabeth W. Twamley
- Center for Behavior Genomics, Department of Psychiatry, School of Medicine, University of California San Diego, 9500 Gilman Drive #0603, La Jolla, CA 92093-0603, Center of Excellence for Stress and Mental Health, Veterans Affairs San Diego Healthcare System, 3350 La Jolla Village Drive (116A), San Diego, CA 92161,To whom correspondence should be addressed: Dr. Elizabeth W. Twamley, Ph.D., Associate Professor of Psychiatry, University of California, San Diego, 140 Arbor Drive (0851), San Diego, CA 92103, Phone: (619) 543-6684, Fax: (619) 543-6489
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19
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Lystad JU, Falkum E, Mohn C, Haaland VØ, Bull H, Evensen S, Rund BR, Ueland T. The MATRICS Consensus Cognitive Battery (MCCB): performance and functional correlates. Psychiatry Res 2014; 220:1094-101. [PMID: 25242432 DOI: 10.1016/j.psychres.2014.08.060] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Revised: 08/27/2014] [Accepted: 08/29/2014] [Indexed: 02/01/2023]
Abstract
Neurocognitive impairment is a core feature in psychotic disorders and the MATRICS Consensus Cognitive Battery (MCCB) is now widely used to assess neurocognition in this group. The MATRICS has been translated into several languages, including Norwegian; although this version has yet to be investigated in an adult clinical population. Further, the relationship between the MATRICS and different measures of functioning needs examination. The purpose of this study was to describe neurocognition assessed with the Norwegian version of the MATRICS battery in a sample of patients with psychotic disorders compared to age and gender matched healthy controls and to examine the association with educational-, occupational- and social-functioning in the patient group. One hundred and thirty one patients and 137 healthy controls completed the battery. The Norwegian version of the MATRICS was sensitive to the magnitude of neurocognitive impairments in patients with psychotic disorders, with patients displaying significant impairments on all domains relative to healthy controls. Neurocognition was also related to both self-rated and objective functional measures such as social functioning, educational- and employment-history.
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Affiliation(s)
- June Ullevoldsæter Lystad
- Division of Mental Health and Addiction, Oslo University Hospital, Bygg 12, Gaustad Sykehus, PO Box 4956, Nydalen, 0424 Oslo, Norway.
| | - Erik Falkum
- Division of Mental Health and Addiction, Oslo University Hospital, Bygg 12, Gaustad Sykehus, PO Box 4956, Nydalen, 0424 Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Norway
| | - Christine Mohn
- Department of Research, Vestre Viken Hospital Trust, Drammen, Norway
| | - Vegard Øksendal Haaland
- Department of Psychology, University of Oslo, Norway; Department of Psychiatry, Sørlandet Hospital Trust, Kristiansand, Norway
| | - Helen Bull
- Division of Mental Health and Addiction, Oslo University Hospital, Bygg 12, Gaustad Sykehus, PO Box 4956, Nydalen, 0424 Oslo, Norway
| | - Stig Evensen
- Division of Mental Health and Addiction, Oslo University Hospital, Bygg 12, Gaustad Sykehus, PO Box 4956, Nydalen, 0424 Oslo, Norway
| | - Bjørn Rishovd Rund
- Department of Psychology, University of Oslo, Norway; Department of Research, Vestre Viken Hospital Trust, Drammen, Norway
| | - Torill Ueland
- Division of Mental Health and Addiction, Oslo University Hospital, Bygg 12, Gaustad Sykehus, PO Box 4956, Nydalen, 0424 Oslo, Norway
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Dodell-Feder D, Tully LM, Lincoln SH, Hooker CI. The neural basis of theory of mind and its relationship to social functioning and social anhedonia in individuals with schizophrenia. NEUROIMAGE-CLINICAL 2013; 4:154-63. [PMID: 24371798 PMCID: PMC3871293 DOI: 10.1016/j.nicl.2013.11.006] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Revised: 11/16/2013] [Accepted: 11/18/2013] [Indexed: 11/28/2022]
Abstract
Theory of mind (ToM), the ability to attribute and reason about the mental states of others, is a strong determinant of social functioning among individuals with schizophrenia. Identifying the neural bases of ToM and their relationship to social functioning may elucidate functionally relevant neurobiological targets for intervention. ToM ability may additionally account for other social phenomena that affect social functioning, such as social anhedonia (SocAnh). Given recent research in schizophrenia demonstrating improved neural functioning in response to increased use of cognitive skills, it is possible that SocAnh, which decreases one's opportunity to engage in ToM, could compromise social functioning through its deleterious effect on ToM-related neural circuitry. Here, twenty individuals with schizophrenia and 18 healthy controls underwent fMRI while performing the False-Belief Task. Aspects of social functioning were assessed using multiple methods including self-report (Interpersonal Reactivity Index, Social Adjustment Scale), clinician-ratings (Global Functioning Social Scale), and performance-based tasks (MSCEIT—Managing Emotions). SocAnh was measured with the Revised Social Anhedonia Scale. Region-of-interest and whole-brain analyses revealed reduced recruitment of medial prefrontal cortex (MPFC) for ToM in individuals with schizophrenia. Across all participants, activity in this region correlated with most social variables. Mediation analysis revealed that neural activity for ToM in MPFC accounted for the relationship between SocAnh and social functioning. These findings demonstrate that reduced recruitment of MPFC for ToM is an important neurobiological determinant of social functioning. Furthermore, SocAhn may affect social functioning through its impact on ToM-related neural circuitry. Together, these findings suggest ToM ability as an important locus for intervention. Individuals with schizophrenia exhibited reduced recruitment of MPFC for ToM. MPFC and RTPJ activities correlate with measures of social functioning and ability. MPFC activity mediates the relationship between social anhedonia and functioning. Neural circuitry supporting ToM may represent an important area for remediation.
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Affiliation(s)
| | - Laura M Tully
- Department of Psychology, Harvard University, Cambridge, MA 02138, USA
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