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Gonzales L, Saperstein AM, Jones N, Erlich MD, Medalia A. Perceived Stigma Toward Cognitive Impairment Among People With Schizophrenia. Psychiatr Serv 2024:appips20240106. [PMID: 39091170 DOI: 10.1176/appi.ps.20240106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/04/2024]
Abstract
OBJECTIVE Stigma toward schizophrenia spectrum disorders is pervasive and negatively influences service access and delivery. Cognitive impairment associated with schizophrenia (CIAS) is common, but its association with stigma is unknown. In this study, the authors examined whether individuals with CIAS receiving cognitive remediation treatment report experiencing CIAS-related stigma and sought to establish associations between CIAS-related stigma and recovery-relevant outcomes. METHODS Data from 48 individuals with schizophrenia spectrum diagnoses were drawn from a larger study evaluating cognitive remediation. Participants completed measures of CIAS-related stigma, internalized mental illness stigma, self-perceived cognitive impairment, cognitive performance, and interviewer-rated quality of life. RESULTS CIAS-related stigma was commonly reported and significantly positively associated with internalized stigma and self-perceived cognitive impairment. CIAS-related stigma was also significantly negatively associated with motivation to engage in goal-directed behavior and daily activities. CONCLUSIONS CIAS-related stigma exists and warrants additional exploration with regard to implications for psychiatric service delivery.
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Affiliation(s)
- Lauren Gonzales
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City, and New York State Office of Mental Health, Albany (Gonzales, Saperstein, Erlich, Medalia); School of Social Work, University of Pittsburgh, Pittsburgh (Jones)
| | - Alice M Saperstein
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City, and New York State Office of Mental Health, Albany (Gonzales, Saperstein, Erlich, Medalia); School of Social Work, University of Pittsburgh, Pittsburgh (Jones)
| | - Nev Jones
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City, and New York State Office of Mental Health, Albany (Gonzales, Saperstein, Erlich, Medalia); School of Social Work, University of Pittsburgh, Pittsburgh (Jones)
| | - Matthew D Erlich
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City, and New York State Office of Mental Health, Albany (Gonzales, Saperstein, Erlich, Medalia); School of Social Work, University of Pittsburgh, Pittsburgh (Jones)
| | - Alice Medalia
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City, and New York State Office of Mental Health, Albany (Gonzales, Saperstein, Erlich, Medalia); School of Social Work, University of Pittsburgh, Pittsburgh (Jones)
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Saperstein AM, Subhan BA, Golub JS, Medalia A. Hearing Loss in Older People With Schizophrenia: Audiologic Characteristics and Association With Psychosocial Functioning. Am J Geriatr Psychiatry 2024; 32:489-496. [PMID: 38030420 PMCID: PMC10950537 DOI: 10.1016/j.jagp.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 11/06/2023] [Accepted: 11/07/2023] [Indexed: 12/01/2023]
Abstract
OBJECTIVE The severity and impact of hearing deficits among adults with schizophrenia spectrum disorders may become increasingly relevant with advancing age. This study evaluated hearing ability and associated psychosocial functioning among older adults aged 50-70. DESIGN Cross-sectional analysis. SETTING Four outpatient psychiatry clinics in New York City. PARTICIPANTS Individuals aged 50-70 years with diagnoses of schizophrenia or schizoaffective disorder. MEASUREMENTS Unaided pure tone air conduction audiometry conducted using a portable audiometry system determined the pure tone average (PTA) hearing threshold across four frequencies: 500, 1k, 2k, and 4k Hz. Better ear PTA defined the hearing threshold. Audiometry data retrieved from the U.S. National Health and Nutrition Examination Survey aided interpretation of sample hearing loss rates. Standard measures evaluated psychiatric symptoms, perceived impact of hearing impairment, loneliness, and quality of life. RESULTS Among audiometry completers (N = 40), 35% (n = 14) demonstrated subclinical hearing loss (16-25 dB) and 35% (n = 14) had mild or worse hearing loss (≥26 dB). Rates were higher than expected based on age-based population data. Those who perceived hearing handicap rated it moderate (12.2%) or severe (7.3%); those who perceived tinnitus rated the impact as mild to moderate (12.2%) or catastrophic (2.4%). Neither psychiatric symptoms nor interviewer-rated quality of life was associated with hearing ability. Greater loneliness was significantly correlated with worse audiologic performance (r = 0.475, p <0.01) and greater perceived hearing handicap (r = 0.480, p <0.01). CONCLUSION Identifying the need for hearing loss treatment among aging adults with schizophrenia spectrum disorders is important given the potential implications for social functioning, cognitive, and mental health.
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Affiliation(s)
- Alice M Saperstein
- New York State Psychiatric Institute, Department of Psychiatry (AMS, AM), Columbia University Vagelos College of Physicians and Surgeons, and New York-Presbyterian, New York, NY.
| | - Bibi A Subhan
- New York State Psychiatric Institute, Department of Psychiatry (BAS), Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Justin S Golub
- Department of Otolaryngology-Head & Neck Surgery (JSG), Columbia University Vagelos College of Physicians and Surgeons, and New York-Presbyterian, New York, NY
| | - Alice Medalia
- New York State Psychiatric Institute, Department of Psychiatry (AMS, AM), Columbia University Vagelos College of Physicians and Surgeons, and New York-Presbyterian, New York, NY
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Mitchell-Miland C, McCarthy S, Chinman M. Peer specialists deliver cognitive behavioral social skills training compared to social skills training and treatment as usual to veterans with serious mental illness: study protocol for a randomized controlled trial. Trials 2022; 23:439. [PMID: 35610658 PMCID: PMC9128285 DOI: 10.1186/s13063-022-06376-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/02/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Serious mental illness (SMI) affects 4.6% of the American population. While treatments are available, adherence to specific regimens is often suboptimal. Multiple organizations, such as the Substance Abuse and Mental Health Services Administration (SAMHSA), have called for more options that improve accessibility and engagement to treatment among individuals with SMI. This study protocol answers such calls by testing the effectiveness of peer specialists-individuals with SMI trained to use their experience to help others with SMI-in delivering social skills training (SST) and cognitive behavioral social skills training (CBSST), evidence-based treatments effective at engaging individuals with SMI to make behavioral and cognitive changes. Peer specialists have been shown to be adept at engaging those with SMI in treatment; however, their ability to deliver these structured treatments is unknown. METHODS This study is a randomized, hybrid 1, research assistant-blinded, superiority trial. A total of 252 veterans with SMI will be recruited and randomized to one of three arms: CBSST-Peer vs. SST-Peer vs. treatment as usual. Participants randomized to CBSST-Peer or SST-Peer will participate in a 20-week group-based intervention that meets weekly for a 60-min class. All participants will complete 4 study assessments at baseline, 10 weeks, 20 weeks, and 32 weeks. A multidimensional battery of functional outcomes will be used with the Independent Living Skills Survey (ILSS) as the primary outcome measure. Post-study completion, veterans who participated in the CBSST-Peer or SST-Peer arms will randomly be invited to participate in focus groups, and peer specialists will complete interviews to further assess the effectiveness of each intervention. DISCUSSION Improving care and outcomes for individuals with SMI is a national priority. To improve care, it is imperative to think about new ways to improve engagement and accessibility to care. This study provides an innovative solution to this problem by evaluating how two different types of treatment, delivered by peer specialists, compare to usual care. The results of the study will allow for the expansion of treatment options that improve access and engagement among veterans with SMI.
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Affiliation(s)
- Chantele Mitchell-Miland
- VA Pittsburgh Healthcare System University Drive Division, CHERP/MIRECC, Pittsburgh, PA USA
- University of Pittsburgh School of Medicine, 200 Meyran Ave., Suite 300, Pittsburgh, PA 15213 USA
| | - Sharon McCarthy
- VA Pittsburgh Healthcare System University Drive Division, Health Science, Pittsburgh, PA USA
| | - Matthew Chinman
- VA Pittsburgh Healthcare System University Drive Division, CHERP/MIRECC, Pittsburgh, PA USA
- RAND Corporation, Santa Monica, CA USA
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Park T, Hirani S. A Methodological Review of Quality of Life Scales Used in Schizophrenia. J Nurs Meas 2021; 29:34-52. [PMID: 33334848 DOI: 10.1891/jnm-d-18-00053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Evidence is lacking with regard to the most suitable instrument for measuring quality of life (QOL) in patients with schizophrenia. The researchers carried out a methodological review of literature pertaining to scales used to measure QOL in this population. METHODS Twenty-eight studies, assessing nine different QOL scales, were reviewed using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. RESULTS While the content of most scales proved valid, the Lancashire Quality of Life Profile (LQOLP), Self-Report Quality of Life Scale (SQOL), and Quality of Life in Schizophrenia (QLiS) outscored the other scales in almost every other domain measured by COSMIN. CONCLUSION LQOLP and SQOL stand out among QOL scales for patients with schizophrenia, but further evidence is required to verify this finding, and no one scale appears ideal for all patients with schizophrenia.
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Affiliation(s)
- Tanya Park
- University of Alberta, Edmonton, Alberta, Canada
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Impact of primary negative symptoms on functional outcomes in schizophrenia. Eur Psychiatry 2020; 29:449-55. [DOI: 10.1016/j.eurpsy.2014.01.007] [Citation(s) in RCA: 129] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 01/03/2014] [Accepted: 01/26/2014] [Indexed: 11/23/2022] Open
Abstract
AbstractObjectiveNegative symptoms are known to undermine functional outcomes in people with schizophrenia; however, most studies have not accounted for whether these symptoms were primary or secondary to other psychopathological factors. The present study examined the impact of primary negative symptoms on functional outcomes in patients with schizophrenia.MethodThe sample included 1427 patients with schizophrenia who completed the baseline visit in the CATIE study. Symptoms were assessed with the Positive and Negative Syndrome Scale and Calgary Depression Scale, extrapyramidal side effects with the Simpson-Angus scale, and functional status with the Heinrichs-Carpenter Quality of Life Scale.ResultsNegative symptoms were significantly and inversely related to each domain of functioning examined. These relationships remained after statistically controlling for the influence of potential sources of secondary negative symptoms. In addition, the relationships between negative symptoms and specific domains of functioning remained in patients who had mild/absent positive, depressive, anxiety and extrapyramidal symptoms. Negative symptoms were associated with functional outcomes even in antipsychotic-free patients.ConclusionsPrimary negative symptoms significantly contribute to the functional impairment seen in people with schizophrenia. A better understanding of the etiology and pathobiology of these symptoms is required to guide the search for effective therapeutics that promote functional recovery.
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Dinakaran D, Sreeraj VS, Venkatasubramanian G. Measurement based care in schizophrenia-Feasibility in routine clinical practice. Asian J Psychiatr 2020; 49:101954. [PMID: 32065965 DOI: 10.1016/j.ajp.2020.101954] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 12/30/2019] [Accepted: 02/09/2020] [Indexed: 12/18/2022]
Abstract
Measurement based care (MBC) implies the utilization of structured objective scales/batteries in the assessment and monitoring of an illness. Patients with schizophrenia with heterogeneous presentation would potentially benefit better through MBC. Time constraints and additional work burden are frequently cited as barriers in implementing objective assessments. In this selective review, the authors discuss the available standard scales for assessment in schizophrenia, the advantages and disadvantages in implementing MBC and a feasible approach to overcome the barriers by adapting shorter versions of structured scales.
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Affiliation(s)
- Damodharan Dinakaran
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India.
| | - Vanteemar S Sreeraj
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Ganesan Venkatasubramanian
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
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Puveendrakumaran P, Fervaha G, Caravaggio F, Remington G. Assessing analytic and intuitive reasoning using the cognitive reflection test in young patients with schizophrenia. Psychiatry Res 2020; 284:112683. [PMID: 31818543 DOI: 10.1016/j.psychres.2019.112683] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 09/27/2019] [Accepted: 11/06/2019] [Indexed: 12/29/2022]
Abstract
Cognitive biases may contribute to the formation and maintenance of positive symptoms in patients with schizophrenia. However, cognitive reflection (i.e., the ability to use analytical thinking to override intuitive responses) has not been explicitly examined in schizophrenia patients using the cognitive reflection test (CRT). Using the CRT, we examined the degree of analytical and intuitive reasoning employed during problem solving in patients with schizophrenia versus healthy controls. Fifty-eight outpatients with schizophrenia and fifty-eight age- and sex-matched healthy controls (18-35 years of age) participated in this study. In addition to CRT performance, neurocognition, apathy, impulsivity, depression, insight, and clinical symptoms were evaluated. Patients with schizophrenia produced significantly fewer analytical responses (U = 1167.00, p<0.05) and more intuitive responses (U = 1273.50, p<0.05) compared to healthy controls. Patients without significant cognitive impairment also produced fewer analytical responses compared to controls (U = 894.50, p<0.05). Among patients, analytical thinking was positively correlated with working memory (r = 0.27, p<0.05), and affective symptoms (r = 0.31, p<0.05). Analytical reasoning was not significantly correlated with positive symptoms, avolition, or impulsivity. Patients with schizophrenia demonstrate less analytical and more intuitive reasoning while problem solving compared to healthy controls. This reduction in cognitive reflection is not significantly explained by global cognitive impairment or motivational deficits.
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Affiliation(s)
- Pugaliya Puveendrakumaran
- Research Imaging Centre, Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario M5T 1R8, Canada
| | - Gagan Fervaha
- School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Fernando Caravaggio
- Research Imaging Centre, Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario M5T 1R8, Canada; Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario M5T 1R8, Canada.
| | - Gary Remington
- Research Imaging Centre, Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario M5T 1R8, Canada; Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario M5T 1R8, Canada
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Fervaha G, Takeuchi H, Foussias G, Hahn MK, Agid O, Remington G. Achievement motivation in early schizophrenia: Relationship with symptoms, cognition and functional outcome. Early Interv Psychiatry 2018; 12:1038-1044. [PMID: 28230315 DOI: 10.1111/eip.12405] [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: 01/25/2016] [Revised: 07/15/2016] [Accepted: 09/20/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Individuals with schizophrenia engage in goal-directed activities significantly less often compared to healthy individuals in the community. There is ample evidence documenting the presence of motivational deficits in schizophrenia using observer-based ratings; however, purely self-reported accounts of patients' motivation are less well understood. This study examined subjective accounts of trait achievement motivation among relatively young, clinically stable, early-course outpatients with schizophrenia. METHODS Thirty-nine early-course patients and 39 healthy comparison subjects completed clinical and cognitive assessments in addition to a self-report inventory measuring achievement motivation. RESULTS Patients were found to endorse significantly lower levels of motivation, a mean difference which translated to a large effect size (Cohen's d = 1.1). Patients' self-reported motivation was significantly related to clinician ratings of motivational deficits which were based on behavioural output, and to vocational functioning. Within the patient sample, 33.3% of individuals were found to experience prominent or clinically significant levels of amotivation based on patients' own self-report. Self-reported achievement motivation was not associated with other clinical variables such as positive symptom severity or expressive negative symptoms. CONCLUSIONS Our results serve to highlight the occurrence and prevalence of motivational deficits in patients with schizophrenia who are in the early stages of their illness. Subjective accounts of motivation in this population were found to be related to important outcomes such as community functioning, highlighting the importance of this domain of illness. Targeting these deficits early in the course of the illness offers the potential to curb potential prospective poor outcomes and sets the stage for recovery.
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Affiliation(s)
- Gagan Fervaha
- Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada.,Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Hiroyoshi Takeuchi
- Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - George Foussias
- Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada.,Institute of Medical Science, University of Toronto, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Margaret K Hahn
- Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada.,Institute of Medical Science, University of Toronto, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Ofer Agid
- Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada.,Institute of Medical Science, University of Toronto, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Gary Remington
- Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada.,Institute of Medical Science, University of Toronto, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
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Monroe-DeVita M, Morse G, Mueser KT, McHugo GJ, Xie H, Hallgren KA, Peterson R, Miller J, Akiba C, York M, Gingerich S, Stiles B. Implementing Illness Management and Recovery Within Assertive Community Treatment: A Pilot Trial of Feasibility and Effectiveness. Psychiatr Serv 2018; 69:562-571. [PMID: 29446335 PMCID: PMC6433370 DOI: 10.1176/appi.ps.201700124] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE In a pilot feasibility and effectiveness study, illness management and recovery (IMR), a curriculum-based program to help people with serious mental illness pursue personal recovery goals, was integrated into assertive community treatment (ACT) to improve participants' recovery and functioning. METHODS A small-scale cluster randomized controlled design was used to test implementation of IMR within ACT teams in two states. Eight high-fidelity ACT teams were assigned to provide IMR (ACT+IMR; four teams) or standard ACT services (ACT only; four teams). Clinical outcomes from 101 individuals with schizophrenia-spectrum or bipolar disorders were assessed at baseline, six months, and one year. RESULTS Exposure to IMR (session attendance and module completion) varied between the ACT+IMR teams, with participants on one team having significantly less exposure. Results from intent-to-treat analyses showed that participants in ACT+IMR demonstrated significantly better outcomes with a medium effect size at follow-up on clinician-rated illness self-management. A nonsignificant, medium effect size was found for one measure of functioning, and small effect sizes were observed for client-rated illness self-management and community integration. Session and module completion predicted better outcomes on four of the 12-month outcome measures. CONCLUSIONS Findings support the feasibility of implementing IMR within ACT teams. Although there were few significant findings, effect sizes on some variables in this small-scale study and the dose-response relationships within ACT+IMR teams suggest this novel approach could be promising for improving recovery for people with serious mental illness. Further large-scale studies utilizing a hybrid effectiveness-implementation design could provide a promising direction in this area.
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Affiliation(s)
- Maria Monroe-DeVita
- Dr. Monroe-DeVita, Dr. Hallgren, and Mr. Stiles are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle. Dr. Morse and Mr. Miller are with Places for People, St. Louis. Dr. Mueser is with the Center for Psychiatric Rehabilitation, Boston University, Boston. Dr. McHugo and Dr. Xie are with the Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire. Ms. Peterson is with the Department of Psychology, University of Central Florida, Orlando. Mr. Akiba is with the Gillings School of Global Public Health, University of North Carolina, Chapel Hill. Ms. York is with the Department of Psychology, Southern Illinois University, Carbondale, Illinois. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania
| | - Gary Morse
- Dr. Monroe-DeVita, Dr. Hallgren, and Mr. Stiles are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle. Dr. Morse and Mr. Miller are with Places for People, St. Louis. Dr. Mueser is with the Center for Psychiatric Rehabilitation, Boston University, Boston. Dr. McHugo and Dr. Xie are with the Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire. Ms. Peterson is with the Department of Psychology, University of Central Florida, Orlando. Mr. Akiba is with the Gillings School of Global Public Health, University of North Carolina, Chapel Hill. Ms. York is with the Department of Psychology, Southern Illinois University, Carbondale, Illinois. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania
| | - Kim T Mueser
- Dr. Monroe-DeVita, Dr. Hallgren, and Mr. Stiles are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle. Dr. Morse and Mr. Miller are with Places for People, St. Louis. Dr. Mueser is with the Center for Psychiatric Rehabilitation, Boston University, Boston. Dr. McHugo and Dr. Xie are with the Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire. Ms. Peterson is with the Department of Psychology, University of Central Florida, Orlando. Mr. Akiba is with the Gillings School of Global Public Health, University of North Carolina, Chapel Hill. Ms. York is with the Department of Psychology, Southern Illinois University, Carbondale, Illinois. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania
| | - Gregory J McHugo
- Dr. Monroe-DeVita, Dr. Hallgren, and Mr. Stiles are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle. Dr. Morse and Mr. Miller are with Places for People, St. Louis. Dr. Mueser is with the Center for Psychiatric Rehabilitation, Boston University, Boston. Dr. McHugo and Dr. Xie are with the Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire. Ms. Peterson is with the Department of Psychology, University of Central Florida, Orlando. Mr. Akiba is with the Gillings School of Global Public Health, University of North Carolina, Chapel Hill. Ms. York is with the Department of Psychology, Southern Illinois University, Carbondale, Illinois. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania
| | - Haiyi Xie
- Dr. Monroe-DeVita, Dr. Hallgren, and Mr. Stiles are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle. Dr. Morse and Mr. Miller are with Places for People, St. Louis. Dr. Mueser is with the Center for Psychiatric Rehabilitation, Boston University, Boston. Dr. McHugo and Dr. Xie are with the Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire. Ms. Peterson is with the Department of Psychology, University of Central Florida, Orlando. Mr. Akiba is with the Gillings School of Global Public Health, University of North Carolina, Chapel Hill. Ms. York is with the Department of Psychology, Southern Illinois University, Carbondale, Illinois. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania
| | - Kevin A Hallgren
- Dr. Monroe-DeVita, Dr. Hallgren, and Mr. Stiles are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle. Dr. Morse and Mr. Miller are with Places for People, St. Louis. Dr. Mueser is with the Center for Psychiatric Rehabilitation, Boston University, Boston. Dr. McHugo and Dr. Xie are with the Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire. Ms. Peterson is with the Department of Psychology, University of Central Florida, Orlando. Mr. Akiba is with the Gillings School of Global Public Health, University of North Carolina, Chapel Hill. Ms. York is with the Department of Psychology, Southern Illinois University, Carbondale, Illinois. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania
| | - Roselyn Peterson
- Dr. Monroe-DeVita, Dr. Hallgren, and Mr. Stiles are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle. Dr. Morse and Mr. Miller are with Places for People, St. Louis. Dr. Mueser is with the Center for Psychiatric Rehabilitation, Boston University, Boston. Dr. McHugo and Dr. Xie are with the Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire. Ms. Peterson is with the Department of Psychology, University of Central Florida, Orlando. Mr. Akiba is with the Gillings School of Global Public Health, University of North Carolina, Chapel Hill. Ms. York is with the Department of Psychology, Southern Illinois University, Carbondale, Illinois. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania
| | - Joris Miller
- Dr. Monroe-DeVita, Dr. Hallgren, and Mr. Stiles are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle. Dr. Morse and Mr. Miller are with Places for People, St. Louis. Dr. Mueser is with the Center for Psychiatric Rehabilitation, Boston University, Boston. Dr. McHugo and Dr. Xie are with the Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire. Ms. Peterson is with the Department of Psychology, University of Central Florida, Orlando. Mr. Akiba is with the Gillings School of Global Public Health, University of North Carolina, Chapel Hill. Ms. York is with the Department of Psychology, Southern Illinois University, Carbondale, Illinois. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania
| | - Christopher Akiba
- Dr. Monroe-DeVita, Dr. Hallgren, and Mr. Stiles are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle. Dr. Morse and Mr. Miller are with Places for People, St. Louis. Dr. Mueser is with the Center for Psychiatric Rehabilitation, Boston University, Boston. Dr. McHugo and Dr. Xie are with the Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire. Ms. Peterson is with the Department of Psychology, University of Central Florida, Orlando. Mr. Akiba is with the Gillings School of Global Public Health, University of North Carolina, Chapel Hill. Ms. York is with the Department of Psychology, Southern Illinois University, Carbondale, Illinois. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania
| | - Mary York
- Dr. Monroe-DeVita, Dr. Hallgren, and Mr. Stiles are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle. Dr. Morse and Mr. Miller are with Places for People, St. Louis. Dr. Mueser is with the Center for Psychiatric Rehabilitation, Boston University, Boston. Dr. McHugo and Dr. Xie are with the Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire. Ms. Peterson is with the Department of Psychology, University of Central Florida, Orlando. Mr. Akiba is with the Gillings School of Global Public Health, University of North Carolina, Chapel Hill. Ms. York is with the Department of Psychology, Southern Illinois University, Carbondale, Illinois. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania
| | - Susan Gingerich
- Dr. Monroe-DeVita, Dr. Hallgren, and Mr. Stiles are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle. Dr. Morse and Mr. Miller are with Places for People, St. Louis. Dr. Mueser is with the Center for Psychiatric Rehabilitation, Boston University, Boston. Dr. McHugo and Dr. Xie are with the Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire. Ms. Peterson is with the Department of Psychology, University of Central Florida, Orlando. Mr. Akiba is with the Gillings School of Global Public Health, University of North Carolina, Chapel Hill. Ms. York is with the Department of Psychology, Southern Illinois University, Carbondale, Illinois. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania
| | - Bryan Stiles
- Dr. Monroe-DeVita, Dr. Hallgren, and Mr. Stiles are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle. Dr. Morse and Mr. Miller are with Places for People, St. Louis. Dr. Mueser is with the Center for Psychiatric Rehabilitation, Boston University, Boston. Dr. McHugo and Dr. Xie are with the Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire. Ms. Peterson is with the Department of Psychology, University of Central Florida, Orlando. Mr. Akiba is with the Gillings School of Global Public Health, University of North Carolina, Chapel Hill. Ms. York is with the Department of Psychology, Southern Illinois University, Carbondale, Illinois. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania
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de Pinho L, Pereira A, Chaves C, Batista P. Quality of Life Scale and symptomatology of schizophrenic patients – A systematic review. EUROPEAN JOURNAL OF PSYCHIATRY 2018. [DOI: 10.1016/j.ejpsy.2017.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Pinho LGD, Pereira A, Chaves C. Influence of sociodemographic and clinical characteristics on the quality of life of patients with schizophrenia. Rev Esc Enferm USP 2017; 51:e03244. [PMID: 28902324 DOI: 10.1590/s1980-220x2016031903244] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 03/28/2017] [Indexed: 11/21/2022] Open
Abstract
Abstract OBJECTIVE Evaluating the quality of life of Portuguese patients with schizophrenia and linking it to sociodemographic and clinical aspects. METHOD A quantitative cross-sectional study carried out with individuals affected by schizophrenia, living in the entire continental territory of Portugal, through application of a sociodemographic and clinical questionnaire and the Quality of Life Scale short version (QLS7PT). Parametric and non-parametric tests were performed to evaluate the correlation between variables. RESULTS The sample consisted of 282 participants. The results point to a better quality of life for individuals living in autonomous residences or with their parents, who are employed/students, who have had the disorder for less time and are younger, who have completed the 12th grade of schooling and who are not medicated with first-generation neuroleptics. CONCLUSION The results indicate that some sociodemographic and clinical characteristics influence the quality of life of patients with schizophrenia and should be considered in the patient evaluation and in planning appropriate and effective strategies for their psychosocial rehabilitation.
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Abstract
In the DSM5, negative symptoms are 1 of the 5 core dimensions of psychopathology evaluated for schizophrenia. However, negative symptoms are not pathognomonic-they are also part of the diagnostic criteria for other schizophrenia-spectrum disorders, disorders that sometimes have comorbid psychosis, diagnoses not in the schizophrenia-spectrum, and the general "nonclinical" population. Although etiological models of negative symptoms have been developed for chronic schizophrenia, there has been little attention given to whether these models have transdiagnostic applicability. In the current review, we examine areas of commonality and divergence in the clinical presentation and etiology of negative symptoms across diagnostic categories. It was concluded that negative symptoms are relatively frequent across diagnostic categories, but individual disorders may differ in whether their negative symptoms are persistent/transient or primary/secondary. Evidence for separate dimensions of volitional and expressive symptoms exists, and there may be multiple mechanistic pathways to the same symptom phenomenon among DSM-5 disorders within and outside the schizophrenia-spectrum (ie, equifinality). Evidence for a novel transdiagnostic etiological model is presented based on the Research Domain Criteria (RDoC) constructs, which proposes the existence of 2 such pathways-a hedonic pathway and a cognitive pathway-that can both lead to expressive or volitional symptoms. To facilitate treatment breakthroughs, future transdiagnostic studies on negative symptoms are warranted that explore mechanisms underlying volitional and expressive pathology.
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Affiliation(s)
- Gregory P Strauss
- Department of Psychology, University of Georgia, 125 Baldwin Street, Athens, GA 30602
| | - Alex S Cohen
- Department of Psychology, Louisiana State University, Baton Rouge, LA
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Fervaha G, Foussias G, Agid O, Remington G. Motivational and neurocognitive deficits are central to the prediction of longitudinal functional outcome in schizophrenia. Acta Psychiatr Scand 2014; 130:290-9. [PMID: 24850369 DOI: 10.1111/acps.12289] [Citation(s) in RCA: 165] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/23/2014] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Functional impairment is characteristic of most individuals with schizophrenia; however, the key variables that undermine community functioning are not well understood. This study evaluated the association between selected clinical variables and one-year longitudinal functional outcomes in patients with schizophrenia. METHOD The sample included 754 patients with schizophrenia who completed both baseline and one-year follow-up visits in the CATIE study. Patients were evaluated with a comprehensive battery of assessments capturing symptom severity and cognitive performance among other variables. The primary outcome variable was functional status one-year postbaseline measured using the Heinrichs-Carpenter Quality of Life Scale. RESULTS Factor analysis of negative symptom items revealed two factors reflecting diminished expression and amotivation. Multivariate regression modeling revealed several significant independent predictors of longitudinal functioning scores. The strongest predictors were baseline amotivation and neurocognition. Both amotivation and neurocognition also had independent predictive value for each of the domains of functioning assessed (e.g., vocational). CONCLUSION Both motivational and neurocognitive deficits independently contribute to longitudinal functional outcomes assessed 1 year later among patients with schizophrenia. Both of these domains of psychopathology impede functional recovery; hence, it follows that treatments ameliorating each of these symptoms should promote community functioning among individuals with schizophrenia.
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Affiliation(s)
- G Fervaha
- Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada
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Fervaha G, Foussias G, Siddiqui I, Agid O, Remington G. Abbreviated quality of life scales for schizophrenia: comparison and utility of two brief community functioning measures. Schizophr Res 2014; 154:89-92. [PMID: 24630140 DOI: 10.1016/j.schres.2014.02.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 02/14/2014] [Accepted: 02/17/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND The Heinrichs-Carpenter Quality of Life Scale (QLS) is the most extensively used real-world community functioning scale in schizophrenia research. However, the extensive time required to administer it and the inclusion of items that overlap conceptually with negative symptoms limit its use across studies. The present study examined the validity and utility of two abbreviated QLS measures against the full QLS excluding negative symptom items. METHOD The sample included 1427 patients with schizophrenia who completed the baseline visit in the CATIE study. The validity of two abbreviated QLS measures (7-item and 4-item) were examined with the full QLS, excluding the intrapsychic foundations subscale, using correlation analysis. The utility of the abbreviated measures was explored by examining associations between the functioning scales and clinical variables and longitudinal change. RESULTS Both abbreviated QLS measures were highly predictive of the full QLS (both r=0.91, p<0.001), with no difference in predictive value between the abridged measures. Functional status was significantly associated with symptoms and cognition. Importantly, the strength of these associations was similar between the abbreviated and full QLS. Finally, multiple regression models examining the explanatory power of amotivation/apathy in predicting functioning scores after other symptoms and neurocognition had been accounted for were essentially identical irrespective of the QLS instrument used as the dependent measure. Longitudinal change was also similar across the three scales. CONCLUSIONS The 7-item abbreviated QLS is recommended as a brief measure of community functioning for individuals with schizophrenia, especially when assessment of functional outcome is not the focus.
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Affiliation(s)
- Gagan Fervaha
- Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada.
| | - George Foussias
- Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Ishraq Siddiqui
- Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Ofer Agid
- Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Gary Remington
- Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
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