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Lundsgaard J, Kristensen TD, Nordentoft M, Glenthøj LB. Premorbid functioning in adolescence associates with comorbid disorders in individuals at ultra-high risk for psychosis: A brief report. Early Interv Psychiatry 2023; 17:422-426. [PMID: 36693622 DOI: 10.1111/eip.13373] [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] [Received: 02/18/2022] [Revised: 08/12/2022] [Accepted: 01/02/2023] [Indexed: 01/26/2023]
Abstract
AIM This study examines associations between premorbid adjustment and comorbid disorders in individuals at ultra-high risk (UHR) for psychosis. METHODS Premorbid social and academic adjustment data were collected from 146 UHR individuals using the Premorbid Adjustment Scale. Comorbid disorders were determined by the Structural Clinical Interview for DSM-IV. RESULTS Logistic regressions showed lower premorbid social adjustment associated with personality disorders. Lower premorbid academic adjustment associated with affective disorders. More specifically, poor premorbid social adjustment in early and late adolescence associated with personality disorders. Lower premorbid social adjustment in late adolescence and lower premorbid academic adjustment in early adolescence associated with affective disorders. CONCLUSION Partly corroborating evidence from schizophrenia samples, our findings suggest that poor premorbid adjustment relate to distinct comorbid disorders in UHR individuals. If replicated, it indicates that premorbid adjustment deficits may be a key area for targeted interventions improving the clinical prognosis of UHR individuals.
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Affiliation(s)
- Julie Lundsgaard
- Copenhagen Research Centre for Mental Health (CORE), Copenhagen University Hospital, Copenhagen, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Tina Dam Kristensen
- Centre for Neuropsychiatric Schizophrenia Research, CNSR, Mental Health Centre Glostrup, University of Copenhagen, Glostrup, Denmark
| | - Merete Nordentoft
- Copenhagen Research Centre for Mental Health (CORE), Copenhagen University Hospital, Copenhagen, Denmark
- Centre for Neuropsychiatric Schizophrenia Research, CNSR, Mental Health Centre Glostrup, University of Copenhagen, Glostrup, Denmark
| | - Louise Birkedal Glenthøj
- Copenhagen Research Centre for Mental Health (CORE), Copenhagen University Hospital, Copenhagen, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
- Centre for Neuropsychiatric Schizophrenia Research, CNSR, Mental Health Centre Glostrup, University of Copenhagen, Glostrup, Denmark
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2
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González-Blanch C, Gleeson JF, McEnery C, O'Sullivan S, Ayesa-Arriola R, D'Alfonso S, Valentine L, Tremain H, Bell I, Bendall S, Alvarez-Jimenez M. The impact of persistent social anxiety on social functioning and health-related quality of life in young people with remitted first-episode psychosis. Early Interv Psychiatry 2022; 16:868-874. [PMID: 34716667 DOI: 10.1111/eip.13228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 08/26/2021] [Accepted: 10/19/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Comorbid social anxiety is common in psychotic disorders and is associated with multiple negative consequences. However, the long-term effects of persistent social anxiety versus fluctuating or no anxiety on social functioning and health-related quality of life (HR-QoL) have received scant attention. Therefore, we aimed to examine the prevalence of persistent social anxiety to determine its effect on social functioning and HR-QoL in first-episode psychosis (FEP). METHODS One hundred and eight individuals with remitted FEP were classified into three groups (persistent, fluctuating or no social anxiety) according to the Social Interaction Anxiety Scale over an 18-month follow-up period. The three groups were then compared at 18 months follow-up to assess the influence of social anxiety on social functioning and HR-QoL before and after controlling for confounders. RESULTS Of the 108 individuals with FEP, 25 (23.1%) had persistent social anxiety. This group presented lower social functioning and HR-QoL levels compared to the groups with fluctuating or no anxiety symptoms. The effect on HR-QoL remained significant after controlling for positive psychotic and depressive symptoms. CONCLUSIONS In this study, nearly one-quarter of young people with remitted FEP experienced persistent social anxiety symptoms, which had a negative impact on HR-QoL. Thus, individuals with persistent social anxiety constitute a highly vulnerable group and may require targeted interventions to improve their social functioning and HR-QoL.
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Affiliation(s)
- César González-Blanch
- Mental Health Centre, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - John F Gleeson
- Healthy Brain and Mind Research Centre and School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Victoria, Australia
| | - Carla McEnery
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia.,Orygen, Melbourne, Victoria, Australia
| | - Shaunagh O'Sullivan
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia.,Orygen, Melbourne, Victoria, Australia
| | | | - Simon D'Alfonso
- Orygen, Melbourne, Victoria, Australia.,School of Computing and Information Systems, University of Melbourne, Parkville, Victoria, Australia
| | - Lee Valentine
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia.,Orygen, Melbourne, Victoria, Australia
| | - Hailey Tremain
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia.,Orygen, Melbourne, Victoria, Australia
| | - Imogen Bell
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia.,Orygen, Melbourne, Victoria, Australia
| | - Sarah Bendall
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia.,Orygen, Melbourne, Victoria, Australia
| | - Mario Alvarez-Jimenez
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia.,Orygen, Melbourne, Victoria, Australia
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3
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Validity and Reliability of the Staden Schizophrenia Anxiety Rating Scale. Diagnostics (Basel) 2022; 12:diagnostics12040831. [PMID: 35453879 PMCID: PMC9028449 DOI: 10.3390/diagnostics12040831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 03/21/2022] [Accepted: 03/22/2022] [Indexed: 11/16/2022] Open
Abstract
In schizophrenia, none of the standard anxiety measures exhibit strong psychometric properties, and all performed poorly against quality assessment criteria. Developed for the schizophrenia population, this study examined the validity and reliability of the Staden Schizophrenia Anxiety Rating Scale (S-SARS) that measures both specified and undifferentiated anxiety. Among 353 schizophrenia patients, strong correlations with anxiety parameters supported the S-SARS's convergent validity. Criterion-related validity testing yielded accuracy, sensitivity, and specificity rates of around 95%. Its discriminant validity was observed for measures of depression, psychosis, akathisia, fatigue, vigour, procrastination, behavioural inhibition and activation, and personal growth and initiative. Structural validity was found in a single-factor unidimensional model with a 0.953 factor score. Excellent results were found for internal consistency (Cronbach's alpha = 0.931; Spearman-Brown coefficient = 0.937; Guttman split-half coefficient = 0.928) and inter-rater reliability (Krippendorff's alpha = 0.852). It incurred no more than a small error of measurement whereby the observed scores were within 1.54 to 3.58 of a true score on a zero to 50 scale. These strong psychometric properties suggest that the S-SARS is a valid and reliable instrument for measuring specified and undifferentiated anxiety in schizophrenia, providing the means for the accurate measurement of anxiolytic treatment effects.
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4
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Tee H, Chevalier A, Webber M, Xanthopoulou P, Priebe S, Giacco D. Who wants more social contacts? A cross-sectional study of people with psychotic disorders in England. Schizophr Res 2022; 240:46-51. [PMID: 34923207 DOI: 10.1016/j.schres.2021.11.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 10/02/2021] [Accepted: 11/27/2021] [Indexed: 10/19/2022]
Abstract
Many people with psychosis have few social contacts which can significantly reduce quality of life. While the symptoms of psychosis are thought to contribute to social isolation, they could also lead to the perception that patients are uninterested in increasing their social contacts or in socialisation interventions. Hence, those who most need support to reduce isolation may be less likely to receive it. Despite this, studies have yet to identify the characteristics of patients who do and do not want to increase their social contacts. A cross-sectional study was conducted with 548 participants with psychosis in community mental health teams across England, covering urban and rural areas. Logistic regression analysis was used to determine predictors of wanting to vs. not wanting to increase social contacts. Content analysis was used to explore reasons. The majority (68%) of participants reported a desire for more social contacts, which was significantly associated with lower quality of life. While people with lower quality of life were more likely to express a desire for more contacts, they were less likely to feel confident in increasing them. Reasons for not wanting to increase contacts were related either to perceived barriers or to feeling content with current circumstances. It may be concluded that people with psychosis who have a lower quality of life and little confidence in socialising have a greater desire for more social contacts. Hence, contrary to traditional beliefs, they are likely to be motivated to engage with support to reduce isolation if it is offered.
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Affiliation(s)
- Helena Tee
- Unit for Social and Community Psychiatry, (WHO Collaborating Centre for Mental Health Services Development), Queen Mary University of London, Glen Road, London E13 8SP, United Kingdom; East London NHS Foundation Trust, Glen Road, London E13 8SP, United Kingdom
| | - Agnes Chevalier
- Unit for Social and Community Psychiatry, (WHO Collaborating Centre for Mental Health Services Development), Queen Mary University of London, Glen Road, London E13 8SP, United Kingdom; East London NHS Foundation Trust, Glen Road, London E13 8SP, United Kingdom
| | - Martin Webber
- Department of Social Policy and Social Work, University of York, Heslington, York YO10 5DD, United Kingdom
| | - Penny Xanthopoulou
- College of Medicine and Health, University of Exeter, St Luke's Campus, Exeter EX2 4TH, United Kingdom
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, (WHO Collaborating Centre for Mental Health Services Development), Queen Mary University of London, Glen Road, London E13 8SP, United Kingdom
| | - Domenico Giacco
- Unit for Social and Community Psychiatry, (WHO Collaborating Centre for Mental Health Services Development), Queen Mary University of London, Glen Road, London E13 8SP, United Kingdom; East London NHS Foundation Trust, Glen Road, London E13 8SP, United Kingdom; Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry CV4 7HL, United Kingdom.
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5
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Lin XB, Lim CG, Lee TS. Social Deficits or Interactional Differences? Interrogating Perspectives on Social Functioning in Autism. Front Psychiatry 2022; 13:823736. [PMID: 35546922 PMCID: PMC9084456 DOI: 10.3389/fpsyt.2022.823736] [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: 11/28/2021] [Accepted: 03/30/2022] [Indexed: 11/13/2022] Open
Abstract
Social dysfunction is a key characteristic of autism. Determining and treating autism-related social deficits have been challenging. The medical model views interpersonal difficulties in autism as a localized set of deficits to be managed, whereas the neurodiversity movement calls for the accommodation of differences by the larger community. One common assumption underlying these perspectives is a misalignment in social behaviors between autistic individuals and neurotypicals. This paper reviews and interrogates current perspectives on social functioning in autism to uncover the intricacies of such a notion. Even though extant literature has alluded to a misalignment in social behaviors between autistic and neurotypical individuals, it is uncertain where this disparity lies. Implications for future research and practice are discussed.
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Affiliation(s)
- Xiangting Bernice Lin
- Neuroscience and Behavioral Disorders Program, Duke-NUS Medical School, Singapore, Singapore.,School of Social Sciences, Nanyang Technological University, Singapore, Singapore
| | - Choon Guan Lim
- Neuroscience and Behavioral Disorders Program, Duke-NUS Medical School, Singapore, Singapore.,School of Social Sciences, Nanyang Technological University, Singapore, Singapore.,Department of Child and Adolescent Psychiatry, Institute of Mental Health, Singapore, Singapore
| | - Tih-Shih Lee
- Neuroscience and Behavioral Disorders Program, Duke-NUS Medical School, Singapore, Singapore.,Department of Psychiatry, Singapore General Hospital, Singapore, Singapore
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6
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Lakhan R, Summers L, Tataw D, Hackbert P, Sharma M. Correlates of COVID-19 Pandemic on Anxiety among Adults in Appalachia, USA. J Res Health Sci 2021; 21:e00531. [PMID: 36511227 PMCID: PMC8957669 DOI: 10.34172/jrhs.2021.68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 10/18/2021] [Accepted: 10/16/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Anxiety problems have increased in the COVID-19 pandemic worldwide. However, very little is known about the anxiety rates in the new normal phase of the disease when adults have been assumed to be adjusted. The study aimed to find out the difference in anxiety in a convenience sample of Appalachian adults during the new normal phase of the COVID-19 pandemic, examine its association with sociodemographic factors, and compare it with the anxiety levels before the pandemic as recalled by the participants. STUDY DESIGN A cross-sectional study. METHODS The Generalized Anxiety Disorder-7 scale was used in the present study. The Chi-square test was used to examine the difference between the severity of anxiety before and during the new normal phase of the COVID-19 pandemic in terms of sociodemographic and behavioral correlates. Pearson correlation was used to see the strength of the association between anxiety and age. RESULTS Although the anxiety rate was stabilized by the time people approached the new normal phase of the COVID-19 pandemic, its severity increased significantly among those with preexisting anxiety (P=0.001). Anxiety was found highly associated with female and minority gender, student status, lower education and income level, marital status, cohabitation with parents, and cigarette consumption (P=0.001). A slight inverse association was observed between age and anxiety before and during the new normal phase of the COVID-19 pandemic (P=0.001). CONCLUSION The young and females seem to be suffering from a higher burden of anxiety. Research is suggested to identify ways to develop social support-based community programs to address this issue.
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Affiliation(s)
- Ram Lakhan
- Department of Health and Human Performance, Berea College, Berea, KY, USA
,Correspondence: Ram Lakhan (DrPH) Tel: +1 (859) 985-3573 E-mail:
| | - Louisa Summers
- Department of Health and Human Performance, Berea College, Berea, KY, USA
| | - David Tataw
- Department of Allied Health, Northern Kentucky University, Highland Heights, KY, USA
| | - Peter Hackbert
- Department of General Studies, Berea College, Berea, KY, USA
| | - Manoj Sharma
- Department of Environmental and Occupational Health, University of Nevada, Las Vegas, NV, USA
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7
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Kuhney FS, Damme KSF, Pelletier-Baldelli A, Chun C, Ellman LM, Schiffman J, Mittal VA. Prevalence and Functional Consequences of Social Anxiety in Individuals at Clinical High-Risk for Psychosis: Perspective From a Community Sample Comparison. ACTA ACUST UNITED AC 2021; 2:sgab025. [PMID: 34308353 PMCID: PMC8295730 DOI: 10.1093/schizbullopen/sgab025] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Background Social anxiety disorder (SAD) commonly occurs among individuals at clinical high-risk (CHR) for psychosis. Extant research has yet to examine the prevalence and clinical/functional correlates of SAD in this population compared to a community control (CC) sample. This comparison may improve the generalizability that traditional nonpsychiatric control samples cannot provide. Additionally, it remains unknown how SAD contributes to symptom severity and social impairments in individuals at CHR for psychosis. Methods Both CHR and CC groups were recruited from general community sources; CC participants were not excluded in this analysis on the basis of any psychopathology except psychosis. A total of 245 adolescents and young adults (CHR = 81; CC = 164) were administered the Social Phobia Scale, the Structured Interview for Psychosis-risk Syndromes, Structured Clinical Interview for DSM-5 Research Version, and the Social Functioning Scale. Results The CHR group was at increased risk for having SAD relative to CC (42% CHR; 13% CC; RR = 3.28) and, to a lesser degree, a non-SAD anxiety disorder (41% CHR; 29% CC; RR = 1.42). Greater social anxiety was related to higher levels of negative (r = 0.29) but not positive (r = 0.05) symptoms within the CHR group. Furthermore, elevated social anxiety was found to be linked with poor social functioning in the CHR group (r = -0.31). Conclusions These findings demonstrate the specificity of SAD over and above other anxiety disorders in individuals at CHR for psychosis and the critical target of SAD to treat subclinical psychotic symptoms and social functioning.
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Affiliation(s)
- Franchesca S Kuhney
- Department of Psychology, University of Illinois at Chicago, Chicago, IL, USA
| | - Katherine S F Damme
- Department of Psychology, Northwestern University, Evanston, IL, USA.,Institute for Innovations in Developmental Sciences (DevSci), Northwestern University, Evanston and Chicago, IL, USA
| | | | - Charlotte Chun
- Department of Psychology, Temple University, Philadelphia, PA, USA
| | - Lauren M Ellman
- Department of Psychology, Temple University, Philadelphia, PA, USA
| | - Jason Schiffman
- Department of Psychology, University of Maryland Baltimore County, Baltimore, MD, USA.,Department of Psychology, University of California at Irvine, Irvine, CA, USA
| | - Vijay A Mittal
- Department of Psychology, Northwestern University, Evanston, IL, USA.,Institute for Innovations in Developmental Sciences (DevSci), Northwestern University, Evanston and Chicago, IL, USA.,Department of Psychiatry, Northwestern University, Chicago, IL, USA.,Medical Social Sciences, Northwestern University, Chicago, IL, USA.,Institute for Policy Research (IPR), Northwestern University, Chicago, IL, USA
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8
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Aunjitsakul W, McGuire N, McLeod HJ, Gumley A. Candidate Factors Maintaining Social Anxiety in the Context of Psychotic Experiences: A Systematic Review. Schizophr Bull 2021; 47:1218-1242. [PMID: 33778868 PMCID: PMC8379542 DOI: 10.1093/schbul/sbab026] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Social anxiety is common in psychosis and associated with impaired functioning, poorer quality of life, and higher symptom severity. This study systematically reviewed factors maintaining social anxiety in people with attenuated, transient, or persistent psychotic experiences. Other correlates of social anxiety were also examined. MEDLINE, Embase, CENTRAL, and PsycINFO were searched for relevant literature up to October 19, 2020. Forty-eight articles were eligible for narrative synthesis: 38 cross-sectional studies, 8 prospective studies, 1 uncontrolled trial, and 1 qualitative study. From 12060 participants, the majority was general population (n = 8771), followed by psychosis samples (n = 2532) and those at high risk of psychosis (n = 757). The methodological quality and risk of bias were assessed using the Mixed Methods Appraisal Tool. Ninety percent of studies were rated as high to very-high quality. Poorer quality studies typically failed to adequately control for confounds and provided insufficient information on the measurement validity and reliability. Prominent psychological factors maintaining social anxiety included self-perceptions of stigma and shame. Common correlates of social anxiety included poorer functioning and lower quality of life. In conclusion, stigma and shame could be targeted as a causal mechanism in future interventional studies. The integration of findings from this review lead us to propose a new theoretical model to guide future intervention research.
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Affiliation(s)
- Warut Aunjitsakul
- Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand,Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK,To whom correspondence should be addressed; Glasgow Institute of Health and Wellbeing, Glasgow Mental Health Research Facility, University of Glasgow, Fleming Pavilion, West of Scotland Science Park (Todd Campus), Glasgow, G20 0XA, UK; tel: 0141-330-4852, e-mail:
| | - Nicola McGuire
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Hamish J McLeod
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Andrew Gumley
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
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9
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McEnery C, Lim MH, Knowles A, Rice S, Gleeson J, Howell S, Russon P, Miles C, D'Alfonso S, Alvarez-Jimenez M. Social anxiety in young people with first-episode psychosis: Pilot study of the EMBRACE moderated online social intervention. Early Interv Psychiatry 2021; 15:76-86. [PMID: 31889431 DOI: 10.1111/eip.12912] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 10/15/2019] [Accepted: 12/14/2019] [Indexed: 12/15/2022]
Abstract
AIM We conducted a single-group pilot study to evaluate the feasibility, acceptability and safety of a novel online intervention (entitled EMBRACE) that includes expert and peer moderation, therapeutic comics and social networking features. The cognitive-behavioural-based intervention was specifically designed to treat social anxiety as a primary treatment target in youth with first-episode psychosis (FEP). METHODS The 10 participants (17-26 years; Mage = 23 years) had a diagnosis of FEP and experienced significant levels of social anxiety as defined by exceeding a sub-threshold clinical score (>30) on the Social Interaction Anxiety Scale (SIAS). They had access to the EMBRACE intervention for 2 months. RESULTS In total, seven out of ten participants completed eight modules or more (total of 12 modules). All participants rated the intervention as positive and safe, and endorsed recommending it to others who experience social anxiety. Improvement in pre-post social anxiety symptoms, as measured via the SIAS (d = -1.70, P = .0005) and the Liebowitz Social Anxiety Scale (d = -1.35, P = .002) were found. No statistically significant pre-post improvements were found for depressive or loneliness symptoms. CONCLUSION EMBRACE was shown to be a feasible, acceptable, and safe online intervention to specifically target social anxiety as a primary treatment concern in young people with FEP.
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Affiliation(s)
- Carla McEnery
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia.,Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia
| | - Michelle H Lim
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia.,Iverson Health Innovation Research Institute, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Ann Knowles
- Department of Psychology, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Simon Rice
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia.,Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia
| | - John Gleeson
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Victoria, Australia
| | - Simmone Howell
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia
| | - Penni Russon
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia
| | - Chris Miles
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia
| | - Simon D'Alfonso
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia.,School of Computing and Information Systems, University of Melbourne, Parkville, Victoria, Australia
| | - Mario Alvarez-Jimenez
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia.,Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia
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10
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Comorbidity rates of depression and anxiety in first episode psychosis: A systematic review and meta-analysis. Schizophr Res 2020; 216:322-329. [PMID: 31791816 DOI: 10.1016/j.schres.2019.11.035] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 08/09/2019] [Accepted: 11/22/2019] [Indexed: 01/09/2023]
Abstract
Anxiety and depression symptoms are frequently experienced by individuals with psychosis, although prevalence rates have not been reviewed in first-episode psychosis (FEP). The aim of this systematic review was to focus on the prevalence rates for both anxiety and depression, comparing the rates within the same study population. A systematic review and meta-analysis was completed for all studies measuring both anxiety and depression in FEP at baseline. The search identified 6040 citations, of which n = 10 met inclusion criteria. These reported 1265 patients (age 28.3 ± 9.1, females: 39.9%) with diagnosed FEP. Studies which used diagnosis to define comorbidity count were included in separate meta-analyses for anxiety and depression, although the heterogeneity was high limiting interpretation of separate prevalence rates. A random-effects meta-analysis also compared the mean difference between anxiety and depression within the same studies. We show that anxiety and depression co-occur at a similar rate within FEP, although the exact rates are not reliable due to the heterogeneity between the small number of studies. Future research in FEP should consider routinely measuring anxiety and depression using continuous self-report measures of symptoms. Clinically we recommend that both anxiety and depression are equally targeted during psychological intervention in FEP, together with the psychotic symptoms.
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11
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Naidu K, van Staden W, Fletcher L. Discerning undifferentiated anxiety from syndromal anxiety in acute-phase schizophrenia. Ann Gen Psychiatry 2020; 19:26. [PMID: 32318113 PMCID: PMC7158120 DOI: 10.1186/s12991-020-00277-4] [Citation(s) in RCA: 3] [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: 09/05/2019] [Accepted: 04/04/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Literature on anxiety in schizophrenia is confined to well-established diagnostic syndromes and the diagnostic category of unspecified anxiety disorder has not been quantitatively verified in this population. This study examined whether anxiety that is not differentiated into the well-established syndromes is empirically discernible from syndromal anxiety and no anxiety in acute-phase schizophrenia. METHODS After sampling 111 acute-phase schizophrenia patients, they were stratified into three groups: syndromal anxiety; undifferentiated anxiety; and without anxiety disorder. The groups were compared statistically in two data sets on measures for anxiety, psychotic severity, depressive features, akathisia and medication use. RESULTS On two measures of anxiety and for both data sets, the groups were significantly different without evidence of a confounding influence by akathisia, medication, or psychotic severity. The undifferentiated group was different from the syndromal group on the Staden Schizophrenia Anxiety Rating Scale (S-SARS) for both data sets (mean difference = 7.46, p < 0.001; mean difference = 7.69, p < 0.002) and on the Hamilton Anxiety Rating Scale for the one data set (mean difference = 14.68, p < 0.001) but not for the replicative data set (mean difference = 1.49, p = 0.494). The undifferentiated anxiety group was different from the no anxiety group for the respective data sets on both anxiety scales (S-SARS: mean difference = 8.67, p < 0.001; mean difference = 8.64, p < 0.001)(HAM-A: mean difference = 6.05, p < 0.001; mean difference = 8.67, p = 0.002). When depressive features had a confounding effect, it was small relative to the group differences. CONCLUSIONS The results suggest some patients in acute-phase schizophrenia present with undifferentiated anxiety that is discernible from both syndromal anxiety and those without an anxiety disorder. This finding may serve as empirical grounds for clinicians to recognise undifferentiated anxiety in acute-phase schizophrenia, and for further research into the clinical importance of undifferentiated anxiety in this population.
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Affiliation(s)
- Kalai Naidu
- 1Department of Psychiatry, University of Pretoria, Pretoria, South Africa
| | - Werdie van Staden
- 1Department of Psychiatry, University of Pretoria, Pretoria, South Africa.,2Centre for Ethics and Philosophy of Health Sciences, Faculty of Health Sciences, University of Pretoria, Arcadia, Private Bag X323, Pretoria, 0007 South Africa
| | - Lizelle Fletcher
- 3Department of Statistics, University of Pretoria, Pretoria, South Africa
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12
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Hasan AA, Tumah H. Determinants of quality of life among people diagnosed with schizophrenia at outpatient clinics. Perspect Psychiatr Care 2019; 55:30-39. [PMID: 29645261 DOI: 10.1111/ppc.12278] [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] [Received: 09/06/2017] [Revised: 02/26/2018] [Accepted: 03/06/2018] [Indexed: 01/09/2023] Open
Abstract
PURPOSE The study examines the determinants of the quality of life (QoL) among outpatients with schizophrenia in Jordan. DESIGN AND METHODS A cross-sectional study design was used with 157 people with schizophrenia treated in outpatient clinics. Demographic, clinical and psychosocial variables were examined for their influence on QoL. Data were analysed with descriptive statistics, Pearson product moment correlation and stepwise forward multiple linear regression. FINDINGS The majority of the study participants were female, single, unemployed, had secondary level of education or less and were being supported financially by family members. QoL correlated negatively with advanced age, male gender, longer duration of illness, high body mass index and prescribed typical anti-psychotic medication. However, it was correlated positively with employment and being married. Illness duration, recurrent hospitalisation, knowledge level about schizophrenia, psychiatric symptoms and coping mechanisms were found to be key significant predictors of QoL among participants. PRACTICAL IMPLICATIONS The study findings enhance our understanding of socio-demographic, clinical and psychosocial characteristics influencing the QoL in people with schizophrenia. Involvement of families in the management process may improve patients' ability to be integrated in the community and be more socially active.
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Affiliation(s)
- Abd Alhadi Hasan
- Fakeeh College for Medical Sciences, Alhamra District, Palestine Street, Jeddah, Saudi Arabia
| | - Hussein Tumah
- Fakeeh College for Medical Sciences, Alhamra District, Palestine Street, Jeddah, Saudi Arabia
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Hasan AAH. The correlation between the quality of life and clinical variables among outpatients with schizophrenia. Psychiatry Res 2019; 271:39-45. [PMID: 30465980 DOI: 10.1016/j.psychres.2018.09.062] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 05/08/2018] [Accepted: 09/28/2018] [Indexed: 01/09/2023]
Abstract
The study identifies the correlation between the quality of life (QoL) among outpatients with schizophrenia and clinical outcomes. A cross-sectional study design was used with 157 people with schizophrenia treated in outpatient clinics. Demographic, clinical and psychosocial variables were examined for their influence on QoL. Data were analysed with descriptive statistics, Pearson product moment correlation and stepwise forward multiple linear regression. The majority of the study participants were female, single, unemployed, had secondary level of education or less and were being supported financially by family members. QoL correlated negatively with advanced age, male gender, longer duration of illness, high body mass index and prescribed typical anti-psychotic medication. However, it was related positively with employment and being married. Illness duration, recurrent hospitalisation, knowledge level about schizophrenia, psychiatric symptoms and coping mechanisms were found to be key significant predictors of QoL among participants. The study findings enhance our understanding of socio-demographic, clinical and psychosocial characteristics influencing the QoL in people with schizophrenia. Involvement of families in the management process may improve patients' ability to be integrated in the community and be more socially active.
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Affiliation(s)
- Abd Al-Hadi Hasan
- Fakeeh College for Medical Sciences, Fakeeh College for Medical Science, 1222, Jeddah, Saudi Arabia.
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14
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McEnery C, Lim MH, Knowles A, Rice S, Gleeson J, Howell S, Russon P, Miles C, D'Alfonso S, Alvarez-Jimenez M. Development of a Moderated Online Intervention to Treat Social Anxiety in First-Episode Psychosis. Front Psychiatry 2019; 10:581. [PMID: 31474889 PMCID: PMC6702333 DOI: 10.3389/fpsyt.2019.00581] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 07/23/2019] [Indexed: 01/09/2023] Open
Abstract
Background: It is well established that social anxiety disorder (SAD) is a significant clinical problem for individuals with a psychotic disorder. Comorbid social anxiety in individuals with psychosis has been associated with poorer premorbid functioning, increased depression, and a reduced quality of life. Cognitive behavior therapy (CBT) is recommended for people with psychosis as a first-line psychological treatment; however, its focus and evaluation primarily revolves around reducing psychotic symptoms and not necessarily targeting comorbid social anxiety symptoms. We developed a novel online social cognitive behavioral intervention (entitled EMBRACE) specifically designed to treat social anxiety symptoms in first episode psychosis (FEP). Methods: The key clinical and engagement features of the intervention were established through integrating evidence-based material derived from 1) CBT-based treatment models for SAD, 2) relevant literature findings related to psychosis and its clinical correlates (e.g., shame, social rank, and its relationship with social anxiety and paranoia), 3) feedback from youth focus groups in order to inform a user-centered intervention design, and 4) a highly multidisciplinary collaborative development approach to design therapy comics. Results: A detailed description of the final version of the 12-week online social intervention to treat social anxiety in FEP is presented. Conclusion: The EMBRACE intervention was designed to provide young people with the necessary skills and confidence to overcome social anxiety within a supportive, safe online space. By design, it allows young people the opportunity to practice their newly learnt skills to connect with others and in doing so, learn to embrace their true authentic selves.
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Affiliation(s)
- Carla McEnery
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.,Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia
| | - Michelle H Lim
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia.,Iverson Health Innovation Research Institute, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Ann Knowles
- Department of Psychological Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Simon Rice
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.,Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia
| | - John Gleeson
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, VIC, Australia
| | - Simmone Howell
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.,Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia
| | - Penni Russon
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.,Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia
| | - Chris Miles
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.,Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia
| | - Simon D'Alfonso
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.,Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia.,School of Computing and Information Systems, University of Melbourne, Parkville, VIC, Australia
| | - Mario Alvarez-Jimenez
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.,Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia
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Watson P, Zhang JP, Rizvi A, Tamaiev J, Birnbaum ML, Kane J. A meta-analysis of factors associated with quality of life in first episode psychosis. Schizophr Res 2018; 202:26-36. [PMID: 30005933 DOI: 10.1016/j.schres.2018.07.013] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 06/12/2018] [Accepted: 07/02/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Improving quality of life for people with first episode psychosis is an important aspect of recovery. Our objective was to review the associative factors on quality of life in first episode psychosis. A meta-analysis was conducted on the associations between quality of life, symptom severity, and duration of untreated psychosis. METHOD Fifty-one articles were identified (published through 08/29/2016) that provided data on the relationship between quality of life and at least one other outcome measure of interest in first episode psychosis. Of those studies, 21 were included in a meta-analysis (n = 3992) of the relationship between quality of life, severity of psychosis, and duration of untreated psychosis. RESULTS Meta-analysis identified significant negative correlations between quality of life and severity of symptoms (total symptom scores: r = -0.32, p < 0.001) and quality of life and duration of untreated psychosis (r = -0.21, p < 0.001). Heinrich's quality of life scale emerged as being more sensitive to the presence of psychotic symptoms than other measures of quality of life. CONCLUSIONS Associations were found between certain disease specific variables and quality of life in first episode psychosis, highlighting the relationship between symptom presentation and quality of life and the need for early intervention. Proper assessment of quality of life is important to promote improved quality of life in patients with first episode psychosis. Future research is needed to examine the interacting effects of symptom presentation, duration of untreated psychosis, and other variables, such as neurocognition, on quality of life.
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Affiliation(s)
- Philip Watson
- Zucker Hillside Hospital, 75-59 263rd Street, Glen Oaks, NY 11004, USA.
| | - Jian-Ping Zhang
- Zucker Hillside Hospital, 75-59 263rd Street, Glen Oaks, NY 11004, USA; Feinstein Institute for Medical Research, 350 Community Drive, Manhasset, NY 11030, USA; Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra Boulevard, Hempstead, NY 11549, USA
| | - Asra Rizvi
- Zucker Hillside Hospital, 75-59 263rd Street, Glen Oaks, NY 11004, USA; Feinstein Institute for Medical Research, 350 Community Drive, Manhasset, NY 11030, USA
| | - Jonathan Tamaiev
- Zucker Hillside Hospital, 75-59 263rd Street, Glen Oaks, NY 11004, USA
| | - Michael L Birnbaum
- Zucker Hillside Hospital, 75-59 263rd Street, Glen Oaks, NY 11004, USA; Feinstein Institute for Medical Research, 350 Community Drive, Manhasset, NY 11030, USA; Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra Boulevard, Hempstead, NY 11549, USA
| | - John Kane
- Zucker Hillside Hospital, 75-59 263rd Street, Glen Oaks, NY 11004, USA; Feinstein Institute for Medical Research, 350 Community Drive, Manhasset, NY 11030, USA; Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra Boulevard, Hempstead, NY 11549, USA
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Núñez D, Fresno A, van Borkulo CD, Courtet P, Arias V, Garrido V, Wigman JTW. Examining relationships between psychotic experiences and suicidal ideation in adolescents using a network approach. Schizophr Res 2018; 201:54-61. [PMID: 29804930 DOI: 10.1016/j.schres.2018.05.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 01/30/2018] [Accepted: 05/12/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Suicide is one of the leading causes of death in young individuals. Timely and adequate identification of individuals with suicidal ideation could prevent from suicidal behavior. Psychotic experiences (PE) have been shown to increase levels of suicidal ideation (SI) in the general population. Therefore, detailed investigation of the relationship of PE and SI is relevant. However, the exact nature of the relationship between these two phenomena remains unclear. Understanding psychopathology as a complex network of interacting symptoms could be helpful to elucidate specific associations existing between PE and SI. METHOD A specific type of network analysis, the Ising model, was used to examine connections between dichotomized questions on psychotic experiences and suicidal ideation in a cross-sectional study with 1685 adolescents from the general population aged 13-18 years. RESULTS SI was mostly connected to the PE domains perceptual anomalies (PA) and bizarre experiences (BE), which have higher strength values in the network. Central nodes within these domains, as indexed by higher centrality measures (strength and betweenness) were: auditory experiences (PA1: hearing voices when you are alone), persecutory ideation (BE1: feelings of being persecuted; BE2: conspiracy against you), and social anxiety (SANX) (SANX1: I cannot get close to people). CONCLUSIONS Suicidal ideation is differentially connected to specific psychotic experiences. Auditory PE, persecutory ideation, and social anxiety symptoms could play a central role in the interconnectedness of the two constructs.
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Affiliation(s)
- D Núñez
- Faculty of Psychology, Universidad de Talca, Chile.
| | - A Fresno
- Faculty of Psychology, Universidad de Talca, Chile
| | - C D van Borkulo
- Faculty of Psychology, University of Amsterdam, Amsterdam, the Netherlands
| | - P Courtet
- Département d'Urgences & Post Urgence Psychiatrique, CHU Montpellier, University of Montpellier, France
| | - V Arias
- Faculty of Psychology, Department of Personality, Assessment and Psychological Treatment, Universidad de Salamanca, Spain; Institute of Community Integration (INICO), Universidad de Salamanca, Spain
| | - V Garrido
- Universidad Católica del Maule, Talca, Chile
| | - J T W Wigman
- University of Groningen, University Medical Center Groningen, Dept. of Psychiatry, the Netherlands
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Cacciotti-Saija C, Langdon R, Ward PB, Hickie IB, Guastella AJ. Clinical symptoms predict concurrent social and global functioning in an early psychosis sample. Early Interv Psychiatry 2018; 12:177-184. [PMID: 26626426 DOI: 10.1111/eip.12295] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 10/22/2015] [Indexed: 11/30/2022]
Abstract
AIM Although well established in chronic schizophrenia, the key determinants of functioning remain unknown during the early phase of a psychotic disorder. The aim of this study was to comprehensively examine the social cognitive, basic neurocognitive and clinical predictors of concurrent social functioning and global functioning in an early psychosis sample. METHODS This study examined the relationship between social cognition, basic neurocognition and clinical symptoms with concurrent functioning in 51 early psychosis individuals. Assessments included a range of self-report, observational and clinician-rated measures of cognitive, symptom severity and functioning domains. RESULTS Results revealed a significant association between self-reported social function and lower levels of both social interaction anxiety and negative psychotic symptoms. A significant association was also observed between lower levels of negative psychotic symptoms and observed social functioning. Lastly, results demonstrated a significant association between reduced negative psychotic symptoms and clinician-rated global functioning. CONCLUSIONS Clinical domains such as negative symptoms and social interaction anxiety significantly contribute to an optimal model predicting outcome during the early phase of a psychotic disorder. These clinical features may also provide useful markers of an individual's capacity for social participation. Clinical implications include the need for early targeted intervention to address social anxiety and negative psychotic symptoms to facilitate optimum patient outcome.
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Affiliation(s)
| | - Robyn Langdon
- ARC Centre of Excellence in Cognition and Its Disorders (CCD), Macquarie University, Sydney, New South Wales, Australia
| | - Philip B Ward
- Schizophrenia Research Unit, South Western Sydney Local Health District, University of New South Wales, Sydney, New South Wales, Australia
| | - Ian B Hickie
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Adam J Guastella
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
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18
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Lim MH, Gleeson JFM, Alvarez-Jimenez M, Penn DL. Loneliness in psychosis: a systematic review. Soc Psychiatry Psychiatr Epidemiol 2018; 53:221-238. [PMID: 29327166 DOI: 10.1007/s00127-018-1482-5] [Citation(s) in RCA: 115] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 12/31/2017] [Indexed: 12/24/2022]
Abstract
PURPOSE The aim of the review is to understand the relationships between loneliness and related psychological and social factors in individuals with psychosis. Loneliness is poorly understood in people with psychosis. Given the myriad of social challenges facing individuals with psychosis, these findings can inform psychosocial interventions that specifically target loneliness in this vulnerable group. METHODS We adhered to the PRISMA guidelines and systematically reviewed empirical studies that measured loneliness either as a main outcome or as an associated variable in individuals with psychosis. RESULTS A total of ten studies examining loneliness in people diagnosed with a psychotic disorder were examined. Heterogeneity in the assessment of loneliness was found, and there were contradictory findings on the relationship between loneliness and psychotic symptomatology. In individuals with psychosis, loneliness may be influenced by psychological and social factors such as increased depression, psychosis, and anxiety, poor social support, poor quality of life, more severe internalised stigma and perceived discrimination, and low self-esteem. CONCLUSIONS The relationship between loneliness and psychosis remains poorly understood due to a lack of rigorous studies. Although having strong social relationships is crucial to facilitate recovery from serious mental illness, psychosocial interventions that specifically target loneliness in individuals with psychosis are lacking and sorely needed. Interventions targeting loneliness in those with psychosis will also need to account for additional barriers associated with psychosis (e.g., social skill deficits, impoverished social networks, and negative symptoms).
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Affiliation(s)
- Michelle H Lim
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, Victoria, 3122, Australia.
| | - John F M Gleeson
- School of Psychology, Australian Catholic University, Melbourne, Victoria, Australia
| | - Mario Alvarez-Jimenez
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - David L Penn
- School of Psychology, Australian Catholic University, Melbourne, Victoria, Australia.,Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
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The incidence, psychiatric co-morbidity and pharmacological treatment of severe mental disorders in children and adolescents. Eur Psychiatry 2018; 49:16-22. [PMID: 29366845 DOI: 10.1016/j.eurpsy.2017.12.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 12/15/2017] [Accepted: 12/17/2017] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Antipsychotic drug use among children and adolescents is increasing, and there is growing concern about off-label use and adverse effects. The present study aims to investigate the incidence, psychiatric co-morbidity and pharmacological treatment of severe mental disorder in Norwegian children and adolescents. METHODS We obtained data on mental disorders from the Norwegian Patient Registry on 0-18 year olds who during 2009-2011 were diagnosed for the first time with schizophrenia-like disorder (International Classification of Diseases, 10th revision codes F20-F29), bipolar disorder (F30-F31), or severe depressive episode with psychotic symptoms (F32.3 or F33.3). Data on filled prescriptions for psychotropic drugs were obtained from the Norwegian Prescription Database. RESULTS A total of 884 children and adolescents (25.1 per 100 000 person years) were first time diagnosed with schizophrenia-like disorder (12.6 per 100 000 person years), bipolar disorder (9.2 per 100 000 person years), or severe depressive episode with psychotic symptoms (3.3 per 100 000 person years) during 2009-2011. The most common co-morbid mental disorders were depressive (38.1%) and anxiety disorders (31.2%). Antipsychotic drugs were prescribed to 62.4% of the patients, 72.0% of the schizophrenia-like disorder patients, 51.7% of the bipolar disorder patients, and 55.4% of the patients with psychotic depression. The most commonly prescribed drugs were quetiapine (29.5%), aripiprazole (19.6%), olanzapine (17.3%), and risperidone (16.6%). CONCLUSIONS When a severe mental disorder was diagnosed in children and adolescents, the patient was usually also prescribed antipsychotic medication. Clinicians must be aware of the high prevalence of depressive and anxiety disorders among early psychosis patients.
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Vrbova K, Prasko J, Ociskova M, Holubova M. Comorbidity of schizophrenia and social phobia - impact on quality of life, hope, and personality traits: a cross sectional study. Neuropsychiatr Dis Treat 2017; 13:2073-2083. [PMID: 28831256 PMCID: PMC5548278 DOI: 10.2147/ndt.s141749] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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
OBJECTIVE The purpose of the study was to explore whether the comorbidity of social phobia affects symptoms severity, positive and negative symptoms, self-stigma, hope, and quality of life in patients with schizophrenia spectrum disorders. METHODS This is a cross-sectional study in which all participants completed the Internalized Stigma of Mental Illness (ISMI) scale, Adult Dispositional Hope Scale (ADHS), Liebowitz Social Anxiety Scale (LSAS), Beck Anxiety Inventory (BAI), Beck Depression Inventory-II (BDI-II), Positive and Negative Syndrome Scale (PANSS), Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q), Temperament and Character Inventory - Revised (TCI-R), and the demographic questionnaire. The disorder severity was assessed both by a psychiatrist (Clinical Global Impression Severity - the objective version [objCGI-S] scale) and by the patients (Clinical Global Impression Severity - the subjective version [subjCGI-S] scale). The patients were in a stabilized state that did not require changes in the treatment. Diagnosis of schizophrenia, schizoaffective disorder, or delusional disorder was determined according to the International Classification of Diseases 10th Revision (ICD-10) research criteria. A structured interview by Mini International Neuropsychiatric Interview was used to confirm the diagnosis. RESULTS The study included 61 patients of both genders. Clinically, the patients with comorbid social phobia had the earlier onset of the illness, more severe current psychopathology, more intense anxiety (general and social), and higher severity of depressive symptoms. The patients with comorbid social phobia showed the significantly lower quality of life compared to the patients without this comorbidity. The patients with comorbid social phobia also had a statistically lower mean level of hope and experienced a higher rate of the self-stigma. They also exhibited higher average scores of personality trait harm avoidance (HA) and a lower score of personality trait self-directedness (SD). CONCLUSION The study demonstrated differences in demographic factors, the severity of the disorder, self-stigma, hope, HA, and SD between patients with schizophrenia spectrum disorders with and without comorbid social phobia.
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Affiliation(s)
- Kristyna Vrbova
- Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University Olomouc, University Hospital Olomouc, Olomouc, Czech Republic
| | - Jan Prasko
- Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University Olomouc, University Hospital Olomouc, Olomouc, Czech Republic
| | - Marie Ociskova
- Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University Olomouc, University Hospital Olomouc, Olomouc, Czech Republic
| | - Michaela Holubova
- Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University Olomouc, University Hospital Olomouc, Olomouc, Czech Republic.,Department of Psychiatry, Hospital Liberec, Liberec, Czech Republic
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Attenuated positive psychotic symptoms and social anxiety: Along a psychotic continuum or different constructs? Psychiatry Res 2016; 235:139-47. [PMID: 26657307 DOI: 10.1016/j.psychres.2015.11.027] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 11/04/2015] [Accepted: 11/17/2015] [Indexed: 11/23/2022]
Abstract
Social anxiety commonly occurs across the course of schizophrenia, including in the premorbid and prodromal phases of psychotic disorders. Some have posited that social anxiety may exist on a continuum with paranoia; however, empirical data are lacking. The study aim was to determine whether attenuated positive psychotic symptoms are related to social anxiety. Young adults (N=1378) were administered the Prodromal Questionnaire (PQ), which measures attenuated positive psychotic symptoms (APPS), and the Social Phobia Scale (SPS), which measures a subset of social anxiety symptoms. Confirmatory factor analyses were conducted to address the extent to which social anxiety and APPS tap distinct dimensions. Confirmatory factor analyses support the existence of a separate social anxiety factor scale and four separate, though interrelated, APPS factor domains (unusual thought content, paranoia/suspiciousness, disorganized thinking, and perceptual abnormalities). Additionally, social anxiety was significantly, but not differently related to each APPS domain, although the magnitude was reduced between social anxiety and distressing APPS. The current study suggests that social anxiety and attenuated positive psychotic symptoms are separable constructs, but are significantly associated with each other.
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Meyer PS, Gottlieb JD, Penn D, Mueser K, Gingerich S. Individual Resiliency Training: An Early Intervention Approach to Enhance Well-Being in People with First-Episode Psychosis. Psychiatr Ann 2015. [DOI: 10.3928/00485713-20151103-06] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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23
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Cheng G, Zhang D, Ding F. Self-esteem and fear of negative evaluation as mediators between family socioeconomic status and social anxiety in Chinese emerging adults. Int J Soc Psychiatry 2015; 61:569-76. [PMID: 25550327 DOI: 10.1177/0020764014565405] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS The social causation hypothesis suggests that the stress in connection with a depressing social position results in the development of mental disorders. This study examines the psychological mechanisms underlying the link between family socioeconomic status (SES) and social anxiety in Chinese emerging adults. METHODS A self-administered questionnaire was given to a representative sample (N = 717) of undergraduate students (17-23 years old) at three universities in China. Correlational and structural equation modeling analyses were employed to test the hypothesized three-path effect of self-esteem and fear of negative evaluation (FNE) as mediators between family SES and social anxiety. RESULTS Findings suggest the following: (1) the emerging adults belonging to families with low SES are at an increased risk of social anxiety, and (2) lower family SES caused lower self-esteem, which, in turn, serves to enhance the levels of FNE, thereby increasing social anxiety. CONCLUSION In addressing the prevention and treatment of social anxiety, we conclude that preventive efforts toward improving self-esteem may help reduce social anxiety in individuals with low family SES.
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Affiliation(s)
- Gang Cheng
- School of Psychology, Southwest University, Chongqing, China Center for Mental Health Education, Southwest University, Chongqing, China School of Educational Science, Guizhou Normal University, Guiyang, China
| | - Dajun Zhang
- School of Psychology, Southwest University, Chongqing, China Center for Mental Health Education, Southwest University, Chongqing, China
| | - Fangyuan Ding
- School of Psychology, Southwest University, Chongqing, China
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Bratlien U, Øie M, Haug E, Møller P, Andreassen OA, Lien L, Melle I. Self-reported symptoms and health service use in adolescence in persons who later develop psychotic disorders: a prospective case-control study. Early Interv Psychiatry 2015; 9:221-7. [PMID: 24224904 DOI: 10.1111/eip.12102] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 09/22/2013] [Indexed: 01/12/2023]
Abstract
AIM To investigate self-reported psychiatric and somatic symptoms and health service use at age 16 in persons who later developed a psychotic disorder compared with a control group from the same geographical areas. METHOD Responses concerning psychiatric or somatic health and health service use from Norwegian youth studies in a cohort of 15- and 16-year-olds in three Norwegian counties (N = 11 101, 90% response rate) were gathered. The questionnaire responses from persons later identified with a lifetime diagnosis of DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) psychotic disorders (n = 30) (confirmed psychosis, CP) were compared with responses from the rest of the group (population control, PC) (n = 11 067). Follow-up analyses were made for cases with a confirmed onset of a psychotic disorder after the time of the survey (n = 21). RESULTS The main significant differences between the CP and PC groups were more self-reported anxiety, depression and 'feeling in need of treatment for eating disorders' at age 16 in the CP group. The rate of self-reported eating disorder symptoms alone reached the level of statistical significance in the follow-up analyses. The CP group did not use available health services to a markedly greater extent than the control group. CONCLUSION We found that, in comparison with others, youths who were later identified with a psychotic disorder reported more symptoms at age 16.
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Affiliation(s)
- Unni Bratlien
- Division of Mental Health, Innlandet Hospital Trust, Ottestad, Norway
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Sutliff S, Roy MA, Achim AM. Social anxiety disorder in recent onset schizophrenia spectrum disorders: The relation with symptomatology, anxiety, and social rank. Psychiatry Res 2015; 227:39-45. [PMID: 25818255 DOI: 10.1016/j.psychres.2015.02.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 01/02/2015] [Accepted: 02/19/2015] [Indexed: 01/08/2023]
Abstract
Social anxiety disorder (SAD) represents a common comorbidity in schizophrenia, but questions remain regarding how this comorbidity is related to symptomatology and self-perceptions. Forty-two patients with recent-onset schizophrenia were evaluated for SAD, and assessed with the Positive and Negative Syndrome Scale (PANSS), as well as the Social Comparison Scale (SCS), which assessed how participants perceived themselves in relation with others (i.e., social rank). Eighteen patients met criteria for SAD (SZ+) while 24 patients did not (SZ-). Analysis of symptoms using a five-factor model of the PANSS revealed that the SZ- group had more severe symptoms than SZ+ on the Cognitive/Disorganization factor. Further analyses of individual symptoms demonstrated that the SZ- group was more affected in attention, abstract thinking, and cognitive disorganization (Cognitive/Disorganization symptoms), while the SZ+ group was more severely affected in anxiety, suspiciousness/persecution, and active social avoidance. Interestingly, severity of social anxiety symptom ratings correlated with certain PANSS symptoms only in the SZ- group. Perception of social rank, which was reduced in SZ+, displayed a trend level correlation with the positive symptoms in SZ-. Overall, the results suggest that SZ+ and SZ- may have different clinical profiles that could be important to consider when tailoring treatments for these patients.
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Affiliation(s)
- Stephanie Sutliff
- Département de Psychiatrie et neurosciences, Université Laval, Centre de Recherche de l׳Institut Universitaire en Santé Mentale de Québec, Canada, 2601 Chemin de la Canardière, Québec, QC G1J 2G3
| | - Marc-André Roy
- Département de Psychiatrie et neurosciences, Université Laval, Centre de Recherche de l׳Institut Universitaire en Santé Mentale de Québec, Canada, 2601 Chemin de la Canardière, Québec, QC G1J 2G3
| | - Amélie M Achim
- Département de Psychiatrie et neurosciences, Université Laval, Centre de Recherche de l׳Institut Universitaire en Santé Mentale de Québec, Canada, 2601 Chemin de la Canardière, Québec, QC G1J 2G3.
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Belvederi Murri M, Respino M, Innamorati M, Cervetti A, Calcagno P, Pompili M, Lamis DA, Ghio L, Amore M. Is good insight associated with depression among patients with schizophrenia? Systematic review and meta-analysis. Schizophr Res 2015; 162:234-47. [PMID: 25631453 DOI: 10.1016/j.schres.2015.01.003] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 12/23/2014] [Accepted: 01/02/2015] [Indexed: 12/22/2022]
Abstract
Among patients with schizophrenia, better insight may be associated with depression, but the findings on this issue are mixed. We examined the association between insight and depression in schizophrenia by conducting a systematic review and meta-analysis. The meta-analysis was based on 59 correlational studies and showed that global clinical insight was associated weakly, but significantly with depression (effect size r=0.14), as were the insight into the mental disorder (r=0.14), insight into symptoms (r=0.14), and symptoms' attributions (r=0.17). Conversely, neither insight into the social consequences of the disorder nor into the need for treatment was associated with symptoms of depression. Better cognitive insight was significantly associated with higher levels of depression. The exploratory meta-regression showed that methodological factors (e.g. the instrument used to assess depression and the phase of the illness) can significantly influence the magnitude of the association between insight and depression. Moreover, results from longitudinal studies suggest that the relation between insight and depression might be stronger than what is observed at the cross-sectional level. Finally, internalized stigma, illness perception, recovery attitudes, ruminative style, and premorbid adjustment seem to be relevant moderators and/or mediators of the association between insight and depression. In conclusion, literature indicates that among patients with schizophrenia, better insight is associated with higher levels of depressive symptoms. Thus, interventions aimed at promoting patients' insight should take into account the clinical implications of these findings.
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Affiliation(s)
- Martino Belvederi Murri
- Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Italy; Institute of Psychiatry, Department of Psychological Medicine, King's College London, London, UK.
| | - Matteo Respino
- Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Italy
| | - Marco Innamorati
- Department of Human Sciences, European University of Rome, Italy
| | - Alice Cervetti
- Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Italy
| | - Pietro Calcagno
- Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Italy
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Italy
| | - Dorian A Lamis
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Lucio Ghio
- Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Italy
| | - Mario Amore
- Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Italy
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Abstract
In the context of the development of early intervention for first-episode psychosis, this manuscript reviews new data with respect to its incidence, risk factors and evolution. Annual incidence of non-affective psychosis appeared to be between 14 and 30/100,000 in people aged 18-64. Incidence decreases with age and is twice higher in men than in women. There is an interaction between age and gender; the risk of psychosis decreases with age faster in men than in women. Thus, for schizophrenia, incidence rate is twice higher in men under 45 year-old and similar in both genders after. There is evidence that genetic and environmental factors may cause enduring liability to psychotic disorder, and, in addition, that genes and environment may interact synergistically. Some environmental factors have been identified; they concern foetal life, childhood or adolescence and may be conceptualized at the individual or the contextual level. The definition of recent onset psychosis may be based on duration of psychosis, between two and five years. Its development is identified through the occurrence of major psychotic symptoms, such as positive, negative symptomatology or disorganization, and impairment of social functioning. The types and patterns of occurrence and of evolution of psychotic symptoms have a prognostic impact. A long duration of untreated psychosis impacts symptomatology. It is associated with less severe positive symptoms at baseline and more severe after three years, insidious onset, male gender, early onset, and diagnosis of schizophrenia. Recent onset psychosis is often associated with comorbidities, such as depression, anxiety disorders, suicidal behaviours, and addiction. Symptomatic remission rates are found between 25 and 60%. Symptomatic and functional remissions favour each other. A third to half of patients is active, employed or students. Symptoms and evolution are various in studies, probably corresponding to various patho-physiological mechanisms.
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Affiliation(s)
- M Tournier
- Université de Bordeaux, U657, F-33000 Bordeaux, France; INSERM, U657, F-33000 Bordeaux, France; Centre hospitalier Charles Perrens, F-33000 Bordeaux, France.
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Sönmez N, Hagen R, Andreassen OA, Romm KL, Grande M, Jensen LH, Morrison AP, Melle I, Røssberg JI. Cognitive Behavior Therapy in First-Episode Psychosis With a Focus on Depression, Anxiety, and Self-Esteem. COGNITIVE AND BEHAVIORAL PRACTICE 2014. [DOI: 10.1016/j.cbpra.2013.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Welfare-Wilson A, Newman R. Cognitive behavioural therapy for psychosis and anxiety. ACTA ACUST UNITED AC 2013; 22:1061-5. [PMID: 24121850 DOI: 10.12968/bjon.2013.22.18.1061] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This article discusses the effectiveness of a cognitive behavioural therapy (CBT) group for clients with a first episode of psychosis, who were also experiencing comorbid symptoms of anxiety. Clients of 18-35 years of age who reported anxiety symptoms, either as a direct or indirect result of psychotic symptoms, were invited to attend a 12-week CBT-based group. The effectiveness of the intervention was evaluated at screening and 3-month follow-up with the Depression, Anxiety and Stress Scale (DASS-21) (Lovibond and Lovibond, 2004). The results showed a statistically significant improvement in symptoms (depression, p=0.06; anxiety, p=0.05; stress, p=.014), sustainable at 3-month follow-up. The authors concluded that a CBT group for people with a first episode of psychosis that focuses on the management of anxiety can be an effective and viable means of reducing levels of anxiety and associated stress and depression. This model is recommended for use by community mental health teams.
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