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Deng J, Sarraf L, Hotte-Meunier A, El Asmar S, Shah J, Joober R, Malla A, Iyer S, Lepage M, Sauvé G. An intersectional perspective on the sociodemographic and clinical factors influencing the status of not in Education, Employment, or training (NEET) in patients with first-episode psychosis (FEP). Soc Psychiatry Psychiatr Epidemiol 2024:10.1007/s00127-024-02732-z. [PMID: 39120714 DOI: 10.1007/s00127-024-02732-z] [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: 02/07/2024] [Accepted: 07/21/2024] [Indexed: 08/10/2024]
Abstract
PURPOSE High rates of Not in Education, Employment or Training (NEET) are seen in people with first episode of psychosis (FEP). Sociodemographic and clinical factors were reported to be associated with NEET status in FEP patients. This study follows Intersectionality to examine the independent and additive effects, and most importantly the intersections of sociodemographic and clinical variables concerning NEET status in FEP patients. It was hypothesized that NEET status in FEP patients would be described by the intersection between at least two predictor variables. METHODS Secondary analyses with chi-square tests, multiple logistic regression and Chi-squared Automatic Interaction Detection (CHAID) analyses were performed on 440 participants with FEP. RESULTS Chi-square tests indicated that patient socioeconomic status and negative symptom severity were significantly and independently associated with their NEET status. Multiple logistic regression suggested additive effects of age (odds ratio = 1.61), patient socioeconomic status (odds ratio = 1.55) and negative symptom severity (odds ratio = 1.75) in predicting patients' NEET status. CHAID detected an intersection between patients' negative symptom severity and socioeconomic status in shaping their NEET status. CONCLUSION This study explored how the NEET status of patients with FEP was explained not only by the separate effects of negative symptom severity and socioeconomic status but also by the unique intersections of their clinical and social identities. Findings indicated that functional outcomes of patients appear co-constructed by the intersections of multiple identities. Crucial clinical implications of complementing care for negative symptom severity with vocational resources to improve functional outcomes of patients are discussed.
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Affiliation(s)
- Jiaxuan Deng
- Douglas Research Centre, Montreal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Lisa Sarraf
- Department of Psychology, Carleton University, Ottawa, ON, Canada
| | - Adèle Hotte-Meunier
- Douglas Research Centre, Montreal, QC, Canada
- Department of Sexology, Université du Québec À Montréal, Montreal, QC, Canada
| | | | - Jai Shah
- Douglas Research Centre, Montreal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Douglas Mental Health University Institute Prevention and Early Intervention Program for Psychosis Montréal, Montreal, QC, Canada
| | - Ridha Joober
- Douglas Research Centre, Montreal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Douglas Mental Health University Institute Prevention and Early Intervention Program for Psychosis Montréal, Montreal, QC, Canada
| | - Ashok Malla
- Douglas Research Centre, Montreal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Douglas Mental Health University Institute Prevention and Early Intervention Program for Psychosis Montréal, Montreal, QC, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Srividya Iyer
- Douglas Research Centre, Montreal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Douglas Mental Health University Institute Prevention and Early Intervention Program for Psychosis Montréal, Montreal, QC, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Martin Lepage
- Douglas Research Centre, Montreal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Douglas Mental Health University Institute Prevention and Early Intervention Program for Psychosis Montréal, Montreal, QC, Canada
- Department of Psychology, McGill University, Montreal, Canada
| | - Geneviève Sauvé
- Douglas Research Centre, Montreal, QC, Canada.
- Department of Education and Pedagogy - Career Counseling, Université du Québec À Montréal, Montreal, QC, Canada.
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2
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Brobakken MF, Nygård M, Vedul-Kjelsås E, Harvey PD, Wang E. Everyday function in schizophrenia: The impact of aerobic endurance and skeletal muscle strength. Schizophr Res 2024; 270:144-151. [PMID: 38908280 DOI: 10.1016/j.schres.2024.06.027] [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: 06/15/2023] [Revised: 04/03/2024] [Accepted: 06/15/2024] [Indexed: 06/24/2024]
Abstract
BACKGROUND Patients with schizophrenia suffer from physical health conditions, culminating in reduced physical functioning with enormous costs for patients and society. Although aerobic endurance and skeletal muscle strength, typically reduced in this population, relate to cognition and function, no study has explored their respective contributions to performance of functional skills and everyday tasks. METHODS In a cross-sectional study, 48 outpatients (28/20 men/women; 35 ± 11(SD) years) with schizophrenia spectrum disorders (ICD-10; F20-25) were administered the UCSD Performance-based Skills Assessment-Brief (UPSA-B; functional skills), Specific Level of Functioning (SLOF; functional performance) and the Positive and Negative Syndrome (PANSS) scale. Peak oxygen uptake (V̇O2peak) was assessed along with leg press maximal muscle strength (1RM) and mechanical power. RESULTS UPSA-B performance was associated with V̇O2peak (r = 0.28,p < 0.05), accounting for 8 % (p < 0.05) of shared variance, but was unrelated to 1RM and mechanical power. The SLOF physical functioning domain was associated with V̇O2peak (r = 0.30,p < 0.05) and 1RM (r = 0.24,p < 0.05), while SLOF personal care (r = 0.27,p < 0.05) and activities (r = 0.30,p < 0.05) were related only to V̇O2peak. Hierarchical regression analyses revealed that while V̇O2peak and age combined to account for 20 % (p < 0.05) of the variance in physical functioning, the contribution of 1RM was eliminated after adjusting for age. V̇O2peak and negative symptoms combined predicted 24 % and 35 % of the variance in personal care and activities, respectively. UPSA-B scores did not add to the prediction of SLOF scores. CONCLUSIONS Although V̇O2peak and 1RM both relate to functional outcomes, the combination of V̇O2peak, age, and negative symptoms exert the greatest detrimental influence on functional performance beyond skills deficits.
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Affiliation(s)
- Mathias Forsberg Brobakken
- Faculty of Health and Social Sciences, Molde University College, Molde, Norway; Department of Psychosis and Rehabilitation, Psychiatry Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
| | - Mona Nygård
- Department of Psychosis and Rehabilitation, Psychiatry Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
| | - Einar Vedul-Kjelsås
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Research and Development, Division of Psychiatry, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
| | - Philip D Harvey
- Department of Psychiatry and Behavioral Sciences, University of Miami, Miller School of Medicine, Miami, FL, USA; Research Service, Miami VA Healthcare System, Miami, FL, USA.
| | - Eivind Wang
- Faculty of Health and Social Sciences, Molde University College, Molde, Norway; Department of Psychosis and Rehabilitation, Psychiatry Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
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3
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Mohn C, Olsson AK, van Dijk Härd I, Helldin L. Neurocognitive function and mortality in patients with schizophrenia spectrum disorders. Schizophr Res Cogn 2023; 33:100284. [PMID: 37078076 PMCID: PMC10106500 DOI: 10.1016/j.scog.2023.100284] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 03/28/2023] [Accepted: 03/30/2023] [Indexed: 04/09/2023] Open
Abstract
Individuals with schizophrenia spectrum disorders (SSD) have significantly lower life-expectancy than healthy people. Previously, we have identified baseline neurocognitive function in general and verbal memory and executive function in particular as related to mortality nearly two decades later. In this study, we aim to replicate these findings with a larger and age-matched sample. The patient group consisted of 252 individuals, 44 of whom were deceased and 206 alive. Neurocognition was assessed with a comprehensive battery. Results showed that the deceased group, compared to the living group, had significantly more severe neurocognitive deficits across nearly all domains. There were no differences in sex, remission status, psychosis symptoms, or function level between the groups. Immediate verbal memory and executive function were the strongest predictors of survival status. These results were nearly identical to our previous studies, and we conclude that baseline neurocognitive function is an important predictor for mortality in SSD. Clinicians should be mindful of this relationship in patients with significant cognitive deficits.
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Affiliation(s)
- Christine Mohn
- NORMENT Centre for Mental Disorders Research, Institute of Clinical Medicine, University of Oslo, Norway
- Corresponding author at: NORMENT, Institute of Clinical Medicine, University of Oslo, P O Box 4956 Nydalen, 0424 Oslo, Norway.
| | - Anna-Karin Olsson
- Department of Psychiatry, NU Health-Care Hospital, Västra Götaland Region, Sweden
- Department of Psychology, Karlstad University, Sweden
| | - Iris van Dijk Härd
- Department of Psychiatry, NU Health-Care Hospital, Västra Götaland Region, Sweden
| | - Lars Helldin
- Department of Psychiatry, NU Health-Care Hospital, Västra Götaland Region, Sweden
- Department of Psychology, Karlstad University, Sweden
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4
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Martinuzzi LJ, Strassnig MT, Depp CA, Moore RC, Ackerman R, Pinkham AE, Harvey PD. A closer look at avolition in schizophrenia and bipolar disorder: Persistence of different types of activities over time. Schizophr Res 2022; 250:188-195. [PMID: 36436498 PMCID: PMC9810384 DOI: 10.1016/j.schres.2022.11.019] [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: 09/14/2021] [Revised: 07/18/2022] [Accepted: 11/15/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Avolition is associated cross-diagnostically with extensive functional impairment. Participants with schizophrenia and bipolar disorder (BD) engage in fewer productive activities than healthy controls, with more sedentary activities such as sitting. We examined the temporal variability in activities of participants with schizophrenia and bipolar disorder, focusing on persistence of activities and the likelihood of performing more than one activity at a time. METHODS 101 participants with schizophrenia and 76 participants with BD were sampled 3 times per day for 30 days utilizing Ecological Momentary Assessment surveys. Each survey queried current activities along with questions about who they were with and if they were home or away and moods. We separated activities into productive, unproductive, or passive recreational categories. RESULTS Participants with schizophrenia and bipolar disorder reported one activity on most surveys, with that activity commonly being passive or unproductive. No participant reported engaging in more than one productive activity. Productive activities were more likely to occur away from home, with 17 % of surveys from home reporting productive activities. All three activities were persistent, but passive and unproductive activities were more likely than productive activities to be persistent at home. Negative mood states predicted unproductive and passive activities in BD participants only. DISCUSSION The low numbers of activities, combined with persistence of unproductive and passive activities highlights the impact of avolition. Most persistent activities reflected sedentary behavior. People with schizophrenia or bipolar disorder may benefit from interventions targeting leaving home more often to improve their general levels of functioning and overall health.
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Affiliation(s)
| | - Martin T Strassnig
- Department of Psychiatry, University of Miami Miller School of Medicine, USA
| | - Colin A Depp
- Department of Psychiatry UCSD Medical Center, USA; San Diego VA Healthcare System, USA
| | | | - Robert Ackerman
- Department of Psychology, University of Texas at Dallas, USA
| | - Amy E Pinkham
- Department of Psychology, University of Texas at Dallas, USA; Department of Psychiatry, UT Southwestern Medical Center, USA
| | - Philip D Harvey
- Department of Psychiatry, University of Miami Miller School of Medicine, USA; Research Service, Bruce W. Carter VA Medical Center, Miami, FL, USA.
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5
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Perez MM, Tercero BA, Durand F, Gould F, Moore RC, Depp CA, Ackerman RA, Pinkham AE, Harvey PD. Revisiting how People with Schizophrenia Spend Their Days: Associations of lifetime milestone Achievements with Daily Activities examined with Ecological Momentary Assessment. PSYCHIATRY RESEARCH COMMUNICATIONS 2022; 2:100060. [PMID: 36118412 PMCID: PMC9477426 DOI: 10.1016/j.psycom.2022.100060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Milestone achievements are reduced in people with schizophrenia and are lower in comparison to people with bipolar disorder. However, it is not clear what the implications are for engagement in momentary activities based on milestone achievements. Further, some recent research has suggested that psychotic symptoms are associated with challenges in self-assessment of activities, but there is less information about the correlations of milestone achievements and ongoing psychotic symptoms. We examined momentary activities and symptoms as a function of lifetime milestone achievement in 102 individuals with schizophrenia and 71 with bipolar disorder. Ecological Momentary Assessment (EMA) was used to sample daily activities and concurrent symptoms 3 times per day for 30 days. Each survey asked the participant where they were, who they were with, and what they were doing, as well as sampling the concurrent presence of psychotic symptoms. Not being financially responsible for their residence was associated with engaging in fewer productive activities. Participants who never had a relationship were more commonly home and alone and engaged in fewer social interactions. A lifetime history of employment was correlated with engaging in more productive activities, including at home. More common momentary psychosis was seen in participants who failed to achieve each of the functional milestones. Lifetime milestone achievements were associated with greater frequencies of productive behaviors and with fewer momentary experiences of psychosis, suggesting that psychotic symptoms may have importance for sustaining disability that would be challenging to detect without momentary information.
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Affiliation(s)
- Michelle M. Perez
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, 1120 NW 14th Street, Suite 1450, Miami, FL 33136 USA
| | - Bianca A. Tercero
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, 1120 NW 14th Street, Suite 1450, Miami, FL 33136 USA
| | | | - Felicia Gould
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, 1120 NW 14th Street, Suite 1450, Miami, FL 33136 USA
| | - Raeanne C. Moore
- Department of Psychiatry, University of California, San Diego, California, USA
| | - Colin A. Depp
- Department of Psychiatry, University of California, San Diego, California, USA
- VA San Diego Healthcare System, San Diego, California, USA
| | - Robert A. Ackerman
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX, USA
| | - Amy E. Pinkham
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX, USA
- Department of Psychiatry, University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Philip D. Harvey
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, 1120 NW 14th Street, Suite 1450, Miami, FL 33136 USA
- Research Service, Miami VA Healthcare System, Miami, FL, USA
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6
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Harvey PD, Bosia M, Cavallaro R, Howes OD, Kahn RS, Leucht S, Müller DR, Penadés R, Vita A. Cognitive dysfunction in schizophrenia: An expert group paper on the current state of the art. Schizophr Res Cogn 2022; 29:100249. [PMID: 35345598 PMCID: PMC8956816 DOI: 10.1016/j.scog.2022.100249] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 03/14/2022] [Accepted: 03/17/2022] [Indexed: 11/12/2022]
Abstract
Cognitive impairment in schizophrenia represents one of the main obstacles to clinical and functional recovery. This expert group paper brings together experts in schizophrenia treatment to discuss scientific progress in the domain of cognitive impairment to address cognitive impairments and their consequences in the most effective way. We report on the onset and course of cognitive deficits, linking them to the alterations in brain function and structure in schizophrenia and discussing their role in predicting the transition to psychosis in people at risk. We then address the assessment tools with reference to functioning and social cognition, examining the role of subjective measures and addressing new methods for measuring functional outcomes including technology based approaches. Finally, we briefly review treatment options for cognitive deficits, focusing on cognitive remediation programs, highlighting their effects on brain activity and conclude with the potential benefit of individualized integrated interventions combing cognitive remediation with other approaches.
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Affiliation(s)
- Philip D Harvey
- Division of Psychology, Department of Psychiatry, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Marta Bosia
- Vita-Salute San Raffaele University School of Medicine, Milan, Italy; Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute Hospital, Milan, Italy
| | - Roberto Cavallaro
- Vita-Salute San Raffaele University School of Medicine, Milan, Italy; Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute Hospital, Milan, Italy
| | - Oliver D Howes
- Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, UK.,MRC London Institute of Medical Sciences, Imperial College London, London, UK
| | - René S Kahn
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Stefan Leucht
- Section Evidence-Based Medicine in Psychiatry and Psychotherapy, Department of Psychiatry and Psychotherapy, Technical University of Munich, School of Medicine, Munich, Germany
| | - Daniel R Müller
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Rafael Penadés
- Department of Psychiatry and Psychology, Hospital Clinic of Barcelona, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel Street, 08036 Barcelona, Spain
| | - Antonio Vita
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,Department of Mental Health and Addiction Services, Spedali Civili Hospital, Brescia, Italy
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7
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Xiang M, Zheng L, Pu D, Lin F, Ma X, Ye H, Pu D, Zhang Y, Wang D, Wang X, Zou K, Chen L, Zhang Y, Sun Z, Zhang T, Wu G. Intestinal Microbes in Patients With Schizophrenia Undergoing Short-Term Treatment: Core Species Identification Based on Co-Occurrence Networks and Regression Analysis. Front Microbiol 2022; 13:909729. [PMID: 35783418 PMCID: PMC9247572 DOI: 10.3389/fmicb.2022.909729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/12/2022] [Indexed: 01/12/2023] Open
Abstract
Schizophrenia, a common mental disorder, has a tremendous impact on the health and economy of people worldwide. Evidence suggests that the microbial-gut-brain axis is an important pathway for the interaction between the gut microbiome and the development of schizophrenia. What is not clear is how changes in the gut microbiota composition and structure during antipsychotic treatment improve the symptoms of schizophrenia. In this study, 25 patients with schizophrenia were recruited. Their fecal samples were collected before and after hospital treatment for 14–19 days. The composition and structure of the intestinal microbiota were evaluated by 16S rRNA sequencing analysis, and the results showed significant differences in fecal microbiota before and after treatment. Firmicutes (relative abundances of 82.60 and 86.64%) and Gemminger (relative abundances of 14.17 and 13.57%) were the first dominant species at the phylum and genus levels, respectively. The random forest algorithm and co-occurrence network analysis demonstrated that intestinal flora (especially the core species ASV57) could be used as biomarkers to distinguish different clinical states and match treatment regimens accordingly. In addition, after fecal microbiota transplantation, antibiotic-treated recipient mice showed multiple behavioral improvements. These included decreased psychomotor hyperactivity, increased social interaction, and memory. In conclusion, this study suggests that differences in the composition and structure of gut microbiota after treatment are associated with the development and severity of schizophrenia. Results may provide a potential target for the treatment of this disorder.
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Affiliation(s)
- Min Xiang
- Medical Laboratory, The Fourth People's Hospital of Ya'an, Ya'an, China
| | - Liqin Zheng
- MOE Key Lab for Neuroinformation, High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, University of Electronic Science and Technology of China, Chengdu, China
| | - Daoshen Pu
- The Fourth People's Hospital of Ya'an, Ya'an, China
| | - Feng Lin
- Medical Laboratory, The Fourth People's Hospital of Ya'an, Ya'an, China
| | - Xiaodong Ma
- Medical Laboratory, The Fourth People's Hospital of Ya'an, Ya'an, China
| | - Huiqian Ye
- Medical Laboratory, The Fourth People's Hospital of Ya'an, Ya'an, China
| | - Daoqiong Pu
- Medical Laboratory, The Fourth People's Hospital of Ya'an, Ya'an, China
| | - Ying Zhang
- Medical Laboratory, The Fourth People's Hospital of Ya'an, Ya'an, China
| | - Dong Wang
- Psychiatry Department, The Fourth People's Hospital of Ya'an, Ya'an, China
| | - Xiaoli Wang
- Internal Medicine, The Fourth People's Hospital of Ya'an, Ya'an, China
| | - Kaiqing Zou
- The Outpatient Department, The Fourth People's Hospital of Ya'an, Ya'an, China
| | - Linqi Chen
- MOE Key Lab for Neuroinformation, High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, University of Electronic Science and Technology of China, Chengdu, China
| | - Yong Zhang
- MOE Key Lab for Neuroinformation, High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, University of Electronic Science and Technology of China, Chengdu, China
| | - Zhanjiang Sun
- MOE Key Lab for Neuroinformation, High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, University of Electronic Science and Technology of China, Chengdu, China
| | - Tao Zhang
- MOE Key Lab for Neuroinformation, High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, University of Electronic Science and Technology of China, Chengdu, China
- Tao Zhang
| | - Guolin Wu
- Medical Laboratory, The Fourth People's Hospital of Ya'an, Ya'an, China
- *Correspondence: Guolin Wu
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8
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Get up! Functional mobility and metabolic syndrome in chronic schizophrenia: Effects on cognition and quality of life. Schizophr Res Cogn 2022; 28:100245. [PMID: 35251942 PMCID: PMC8892146 DOI: 10.1016/j.scog.2022.100245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/19/2022] [Accepted: 02/20/2022] [Indexed: 11/21/2022] Open
Abstract
Low mobility and poor physical health, especially metabolic syndrome, are frequently reported in patients with schizophrenia and tend to increase with age. Recent evidence suggests that metabolic syndrome may affect cognition and quality of life, while the role functional mobility is still less addressed and their interplay needs to be further explored. This study aims to analyze the effects of functional mobility on cognitive performance, symptoms and quality of life, taking into account age and also modeling it relationship with metabolic syndrome in a sample of 103 adults with chronic schizophrenia. Data were analyzed by means of Pearson's correlations, forward stepwise regressions and mediation models. Results showed that poorer functional mobility is associated with metabolic syndrome and related to more severe negative symptoms, worse cognitive abilities and more disrupted quality of life. Moreover, functional mobility proved to be a significant predictor of cognitive abilities and quality of life, even when other influencing factors were taken into account and independently of age. Finally, analyses showed that functional mobility mediates the effect of metabolic syndrome on both cognition and quality of life. Taken together, these results suggest that functional mobility and metabolic syndrome may represent relevant aspects that further contribute to the evolution of cognitive deficits through all stages of the disease, with also impact on quality of life. In this perspective, the assessment of functional mobility, a non-invasive and quickly performed test may be worth to be implemented in clinical practice, with important implications for treatment and monitoring.
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9
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Miller ML, Raugh IM, Strauss GP, Harvey PD. Remote digital phenotyping in serious mental illness: Focus on negative symptoms, mood symptoms, and self-awareness. Biomark Neuropsychiatry 2022. [DOI: 10.1016/j.bionps.2022.100047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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10
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Cotton SM, Filia KM, Lambert M, Berk M, Ratheesh A, Schimmelmann BG, Macneil C, Hasty M, McGorry PD, Conus P. Not in education, employment and training status in the early stages of bipolar I disorder with psychotic features. Early Interv Psychiatry 2022; 16:609-617. [PMID: 34313390 DOI: 10.1111/eip.13203] [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: 11/12/2020] [Revised: 03/30/2021] [Accepted: 07/15/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE There is a lack of existing research regarding young people with bipolar I disorder (BD-I) and psychotic features, who are not in education, employment, and training (NEET). Thus, the aims of the study were to: (a) establish rates of NEET at service entry to a specialist early intervention service; (b) delineate premorbid and current variables associated with NEET status at service entry and (c) examine correlates of NEET status at discharge. METHOD Medical file audit methodology was utilized to collect information on 118 patients with first episode psychotic mania treated at the Early Psychosis Prevention and Intervention Centre (EPPIC), Melbourne, Australia. NEET status was determined using the modified vocation status index (MVCI). Bivariate and multivariable logistic variables were used to examine relationships between premorbid, service entry and treatment variables, and NEET status at service entry and discharge. RESULTS The NEET rate was 33.9% at service entry, and 39.2% at discharge. Variables associated with NEET status at service entry were premorbid functioning and polysubstance use. NEET status at service entry was the only significant correlate of NEET status at discharge. When service entry NEET was taken out of the model, substance use during treatment was predictive of NEET status at discharge. CONCLUSIONS NEET status at service entry was related to a history of premorbid decline, and risk factors such as substance use and forensic issues. NEET status can decline during treatment, and utility of vocational intervention programs specifically for BD, in addition to specialist early intervention, needs to be examined.
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Affiliation(s)
- Sue M Cotton
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia.,Orygen, Parkville, Victoria, Australia
| | - Kate M Filia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia.,Orygen, Parkville, Victoria, Australia
| | - Martin Lambert
- Psychosis Early Detection and Intervention Centre (PEDIC), Department for Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Berk
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia.,Orygen, Parkville, Victoria, Australia.,IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Aswin Ratheesh
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia.,Orygen, Parkville, Victoria, Australia
| | - Benno G Schimmelmann
- University Hospital of Child and Adolescent Psychiatry, University Hospital Hamburg-Eppendorf, Hamburg, Germany.,University Hospital of Child and Adolescent Psychiatry, University of Bern, Bern, Switzerland
| | - Craig Macneil
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia.,Orygen, Parkville, Victoria, Australia
| | - Melissa Hasty
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia.,Orygen, Parkville, Victoria, Australia
| | - Patrick D McGorry
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia.,Orygen, Parkville, Victoria, Australia
| | - Philippe Conus
- Treatment and Early Intervention in Psychosis Program (TIPP), Departement de Psychiatrie CHUV, Université de Lausanne, Prilly, Switzerland
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11
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Koene J, Zyto S, van der Stel J, van Lang N, Ammeraal M, Kupka RW, van Weeghel J. The relations between executive functions and occupational functioning in individuals with bipolar disorder: a scoping review. Int J Bipolar Disord 2022; 10:8. [PMID: 35286505 PMCID: PMC8921376 DOI: 10.1186/s40345-022-00255-7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 01/31/2022] [Indexed: 11/24/2022] Open
Abstract
Background Patients with bipolar disorder experience impairments in their occupational functioning, despite remission of symptoms. Previous research has shown that neurocognitive deficits, especially deficits in executive functions, may persist during euthymia and are associated with diminished occupational functioning. Objectives The aim of this scoping review was to identify published studies that report on the relationships between executive functions and occupational functioning in BD to review current knowledge and identify knowledge gaps. In addition to traditional neuropsychological approaches, we aimed to describe executive functioning from a self-regulation perspective, including emotion regulation. Methods We applied the methodological framework as described by Arksey and O’Malley (Int J Soc Res Methodol Theory Pract 8:19–32, 2005) and Levac et al. (Implement Sci 5:1–9, 2010). We searched PubMed and psycINFO for literature up to November 2021, after which we screened papers based on inclusion criteria. Two reviewers independently performed the screening process, data charting process, and synthesis of results. Results The search yielded 1202 references after deduplication, of which 222 remained after initial screening. The screening and inclusion process yielded 82 eligible papers in which relationships between executive functions and occupational functioning are examined. Conclusion Neurocognitive deficits, including in executive functions and self-regulation, are associated with and predictive of diminished occupational functioning. Definitions and measurements for neurocognitive functions and occupational functioning differ greatly between studies, which complicates comparisons. Studies on functional remediation show promising results for improving occupational functioning in patients with BD. In research and clinical practice more attention is needed towards the quality of work functioning and the various contexts in which patients with BD experience deficits. Supplementary Information The online version contains supplementary material available at 10.1186/s40345-022-00255-7.
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Affiliation(s)
- Juul Koene
- University of Applied Sciences Leiden, Leiden, The Netherlands.,Tranzo, Scientific Centre for Care and Wellbeing, Tilburg University, Tilburg, The Netherlands
| | - Susan Zyto
- Department of Psychiatry, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, The Netherlands. .,Mental Health Service Organisation North Holland North, Hoorn, The Netherlands.
| | | | | | - Marion Ammeraal
- GGZinGeest Center for Mental Health Care, Amsterdam, The Netherlands
| | - Ralph W Kupka
- Department of Psychiatry, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, The Netherlands.,GGZinGeest Center for Mental Health Care, Amsterdam, The Netherlands
| | - Jaap van Weeghel
- Tranzo, Scientific Centre for Care and Wellbeing, Tilburg University, Tilburg, The Netherlands.,Phrenos Center of Expertise, Utrecht, The Netherlands
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12
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Browne J, Harvey PD, Buchanan RW, Kelly DL, Strauss GP, Gold JM, Holden JL, Granholm E. A Longitudinal Examination of Real-World Sedentary Behavior in Adults with Schizophrenia-Spectrum Disorders in a Clinical Trial of Combined Oxytocin and Cognitive Behavioral Social Skills Training. Behav Sci (Basel) 2022; 12:bs12030060. [PMID: 35323379 PMCID: PMC8945120 DOI: 10.3390/bs12030060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/13/2022] [Accepted: 02/18/2022] [Indexed: 12/11/2022] Open
Abstract
Sedentary behavior contributes to a shortened life expectancy in individuals with schizophrenia-spectrum disorders (SSDs), highlighting the need for effective interventions to improve health. This study examined whether reduced ecological momentary assessment (EMA) measures of sedentary activities were observed in individuals with SSDs who participated in a 24-week randomized trial of cognitive behavioral social skills training (CBSST) and either intranasal oxytocin or placebo (NCT01752712). Participants (n = 57) were prompted with EMA surveys seven times per day for seven days during the baseline, 12-week, and 24-week timepoints to sample sedentary behavior ratings, positive and negative affect, interpersonal interactions, and interpersonal interaction appraisals. Results revealed that sedentary behavior and social interactions did not significantly change over the 24-week clinical trial; however, positive and negative affect and defeatist interaction appraisals improved with treatment, and oxytocin produced modest additional improvements in these EMA outcomes. Greater momentary positive affect was significantly associated with greater activity and greater frequency of interactions. Overall, CBSST was effective at improving functioning, momentary affect, and defeatist interaction appraisals, although it did not reduce sedentary behavior; therefore, targeting these factors is not sufficient to reduce sedentary behavior, and adjunct interventions are needed.
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Affiliation(s)
- Julia Browne
- Geriatric Research, Education and Clinical Center, Durham VA Health Care System, Durham, NC 27705, USA
- Correspondence:
| | - Philip D. Harvey
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL 33136, USA;
- Research Service, Bruce W. Carter VA Medical Center, Miami, FL 33125, USA
| | - Robert W. Buchanan
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21228, USA; (R.W.B.); (D.L.K.); (J.M.G.)
| | - Deanna L. Kelly
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21228, USA; (R.W.B.); (D.L.K.); (J.M.G.)
| | | | - James M. Gold
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21228, USA; (R.W.B.); (D.L.K.); (J.M.G.)
| | - Jason L. Holden
- Veterans Affairs San Diego Healthcare System, San Diego, CA 92161, USA; (J.L.H.); (E.G.)
| | - Eric Granholm
- Veterans Affairs San Diego Healthcare System, San Diego, CA 92161, USA; (J.L.H.); (E.G.)
- Department of Psychiatry, University of California San Diego School of Medicine, San Diego, CA 92093, USA
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13
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Dominiak M, Jażdżyk P, Antosik-Wójcińska AZ, Konopko M, Bieńkowski P, Świȩcicki Ł, Sienkiewicz-Jarosz H. The impact of bipolar spectrum disorders on professional functioning: A systematic review. Front Psychiatry 2022; 13:951008. [PMID: 36090375 PMCID: PMC9448890 DOI: 10.3389/fpsyt.2022.951008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 07/28/2022] [Indexed: 11/24/2022] Open
Abstract
AIMS The impact of bipolar spectrum (BS) disorders on professional functioning has not been systematically reviewed yet. Since even subsyndromal symptoms may disturb functioning, the determination of the prognostic value of the spectrum of bipolarity for employment seems extremely relevant. The aim of this study was to assess the impact of BS disorders on professional functioning. MATERIALS AND METHODS A systematic review of the literature (namely, cohort and cross-sectional studies) investigating a link between BS disorders and employment was performed in accordance with PRISMA guidelines. BS was defined based on the concept of two-dimensional BS by Angst. Occupational outcomes and factors affecting employment were evaluated as well. RESULTS Seventy-four studies were included. All disorders comprising BS had a negative impact on occupational status, work performance, work costs, and salary, with the greatest unfavorable effect reported by bipolar disorder (BD), followed by borderline personality disorder (BPD), major depressive disorder (MDD), and dysthymia. Employment rates ranged from 40 to 75% (BD), 33 to 67% (BPD), 61 to 88% (MDD), and 86% (dysthymia). The factors affecting employment most included: cognitive impairments, number/severity of symptoms, namely, subsyndromal symptoms (mainly depressive), older age, education, and comorbidity (substance abuse, personality disorders, anxiety, depression, ADHD, PTSD). CONCLUSION Bipolar spectrum symptoms exert a negative impact on professional functioning. Further evaluation of affecting factors is crucial for preventing occupational disability.
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Affiliation(s)
- Monika Dominiak
- Department of Pharmacology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Piotr Jażdżyk
- Department of Affective Disorders, Institute of Psychiatry and Neurology, Warsaw, Poland.,Chair and Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, Warsaw, Poland
| | | | - Magdalena Konopko
- First Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | | | - Łukasz Świȩcicki
- Department of Affective Disorders, Institute of Psychiatry and Neurology, Warsaw, Poland
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14
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Dalkner N, Bengesser S, Birner A, Rieger A, Seebauer J, Platzer M, Hamm C, Maget A, Queissner R, Pilz R, Fellendorf FT, Reininghaus B, Strassnig MT, Kapfhammer HP, Weiss EM, Reininghaus EZ. Body Mass Index Predicts Decline in Executive Function in Bipolar Disorder: Preliminary Data of a 12-Month Follow-up Study. Neuropsychobiology 2021; 80:1-11. [PMID: 32454501 DOI: 10.1159/000505784] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 01/05/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Obesity and associated risk factors have been linked to cognitive decline before. OBJECTIVES In the present study, we evaluated potential cumulative negative effects of overweight and obesity on cognitive performance in euthymic patients with bipolar disorder (BD) in a longitudinal design. METHODS Neurocognitive measures (California Verbal Learning Test, Trail Making Test [TMT] A/B, Digit-Symbol-Test, Digit-Span, d2 Test), anthropometrics (e.g., body mass index [BMI]), and clinical ratings (Hamilton Depression Scale, Young Mania Rating Scale) were collected over a 12-month observation period. Follow-up data of 38 patients with BD (mean age 40 years; 15 males, 23 females) were available. RESULTS High baseline BMI predicted a decrease in the patient's performance in the Digit-Span backwards task measuring working memory performance. In contrast, cognitive performance was not predicted by increases in BMI at follow-up. Normal weight bipolar patients (n = 19) improved their performance on the TMT B, measuring cognitive flexibility and executive functioning, within 1 year, while overweight bipolar patients (n = 19) showed no change in this task. CONCLUSIONS The results suggest that overweight can predict cognitive performance changes over 12 months.
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Affiliation(s)
- Nina Dalkner
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria
| | - Susanne Bengesser
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria,
| | - Armin Birner
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria
| | - Alexandra Rieger
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria
| | - Julia Seebauer
- Department of Biological Psychology, University of Graz, Graz, Austria
| | - Martina Platzer
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria
| | - Carlo Hamm
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria
| | - Alexander Maget
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria
| | - Robert Queissner
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria
| | - René Pilz
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria
| | - Frederike T Fellendorf
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria
| | - Bernd Reininghaus
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria
| | - Martin T Strassnig
- Department of Integrated Medical Science, Florida Atlantic University, Charles E. Schmidt College of Medicine, Boca Raton, Florida, USA
| | - Hans-Peter Kapfhammer
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria
| | - Elisabeth M Weiss
- Department of Biological Psychology, University of Graz, Graz, Austria.,Department of Psychology, University of Innsbruck, Clinical Psychology, Innsbruck, Austria
| | - Eva Z Reininghaus
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria
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15
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Strassnig MT, Miller ML, Moore R, Depp CA, Pinkham AE, Harvey PD. Evidence for avolition in bipolar disorder? A 30-day ecological momentary assessment comparison of daily activities in bipolar disorder and schizophrenia. Psychiatry Res 2021; 300:113924. [PMID: 33848963 PMCID: PMC8141033 DOI: 10.1016/j.psychres.2021.113924] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 04/02/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Disability is common in bipolar disorder (BD) and predicted by persistent sadness. We used ecological momentary assessment (EMA) to examine daily activities in people with BD and schizophrenia. We classified activities as productive, unproductive, or passive recreation, relating them to momentary sadness, location, and social context. METHODS 71 people with BD and 102 people with schizophrenia were sampled 3 times/day for 30 days with an EMA survey. Each survey asked where they were, with whom, what they were doing, and if they were sad. RESULTS People with BD were home more than 50% of the time. There were no differences in prevalence of activity types across diagnoses. People with BD were less likely to report only one activity since the prior survey, but the most surveys still reported only one. For both groups, sadness and being home and alone since the last survey was associated with less productive activity and more passive recreation. CONCLUSIONS Participants with BD and schizophrenia manifested high levels of unproductive and passive activities, predicted by momentary sadness. These activity patterns are consistent with descriptions of avolition and they minimally differentiated people with BD and schizophrenia. Previous reports of negative symptoms in BD may have been identifying these behaviors.
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Affiliation(s)
| | - Michelle L Miller
- University of Miami Miller School of Medicine, Miami, FL, United States
| | - Raeanne Moore
- UCSD Health Sciences Center, La Jolla, CA, United States
| | - Colin A Depp
- UCSD Health Sciences Center, La Jolla, CA, United States; San Diego VA Medical Center La Jolla, CA, United States
| | - Amy E Pinkham
- University of Texas at Dallas, Richardson, TX, United States; University of Texas Southwestern Medical Center, Dallas TX, United States
| | - Philip D Harvey
- University of Miami Miller School of Medicine, Miami, FL, United States; Bruce W. Carter VA Medical Center, Miami, FL, United States.
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16
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Strassnig MT, Harvey PD, Miller ML, Depp CA, Granholm E. Real world sedentary behavior and activity levels in patients with schizophrenia and controls: An ecological momentary assessment study. Ment Health Phys Act 2021; 20:10.1016/j.mhpa.2020.100364. [PMID: 34221125 PMCID: PMC8247127 DOI: 10.1016/j.mhpa.2020.100364] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND People with schizophrenia often experience poor health, leading to shortened lifespans. The health of people with schizophrenia may be further exacerbated by increased sedentary behavior, which independently predicts health risk in the general population. However, the prevalence and patterns of objectively measured sedentary behavior in schizophrenia have not been studied extensively on a momentary basis. METHODS Activity of 100 patients with schizophrenia was compared to that of healthy controls (HC; n=71) using ecological momentary assessment (EMA). EMA provides real-time, real-world monitoring of behavior. We sampled behavior seven times per day for seven days, quantifying active versus inactive behaviors and four different movement patterns (recumbent, seated, standing, and moving). Due to different employment rates between samples, we focused on surveys completed at home. RESULTS Four of the five most commonly reported activities for participants with schizophrenia involved sitting or lying down. When considering activity during the last hour, participants with schizophrenia were more likely to be sitting or pacing and less likely to be standing than HC. If participants with schizophrenia only did one thing in the last hour, it was more likely to involve sitting and less likely to involve standing compared to HC. DISCUSSION People with schizophrenia were significantly more likely to be seated and less likely to be standing or active during the past hour than HC, despite high frequencies of seated behaviors in the HC as well. The adverse health consequences of sitting for extended periods may be especially relevant for people with schizophrenia and likely contribute to premature mortality in this population.
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Affiliation(s)
| | - Philip D Harvey
- University of Miami Miller School of Medicine, Miami, FL
- Bruce W. Carter VA Medical Center, Miami, FL
| | | | - Colin A Depp
- UCSD Health Sciences Center, La Jolla, CA
- San Diego VA Medical Center La Jolla, CA
| | - Eric Granholm
- UCSD Health Sciences Center, La Jolla, CA
- San Diego VA Medical Center La Jolla, CA
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17
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Liao PC, Chung KH, Chen PH, Kuo CJ, Huang YJ, Tsai SY. Differences in outcomes between older community-dwelling patients with bipolar disorder and schizophrenia with illness onset at young age. Psychogeriatrics 2020; 20:363-369. [PMID: 31975543 DOI: 10.1111/psyg.12514] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 06/03/2019] [Accepted: 01/04/2020] [Indexed: 12/18/2022]
Abstract
AIM Older community-dwelling patients with severe mental illness (SMI), particularly those with illness onset at young age, constitute a group of survivors with unique long-term care needs. Using an Asian sample in Taiwan, we attempted to find out the differences in outcomes related to physical health, cognition, and social functioning between older community-dwelling adults with bipolar disorder and schizophrenia with early age onset. METHODS Community-dwelling patients aged >50 years with bipolar I disorder or schizophrenia whose illness developed before the age of 40 years were recruited. Clinical data were obtained by reviewing all available medical records and by interviewing the patients and their reliable family members. Medical morbidities, Mini-Mental State Examination (MMSE), Cumulative Illness Rating Scale for Geriatrics (CIRS-G), and Global Assessment of Functioning (GAF) scores were compared between the two groups. RESULTS In total, 113 bipolar patients and 104 schizophrenic ones (mean ages = 59.8 and 59.2 years, respectively) became the final subjects. The rates of cognitive impairment (MMSE score <24) were comparable in bipolar disorder (26.5%) and schizophrenia (24.0%) and the mean MMSE scores did not significantly differ from each other. The concurrence (54.9%) of cardiovascular disease (CVD) in the bipolar group was also similar to 51.0% in the schizophrenic one. In a multiple logistic regression analysis, the bipolar group exhibited significantly higher CIRS-G total scores (95% confidence interval (CI) for odds ratio (OR) = 1.01-1.27), body mass index (95% CI for OR = 1.02-1.21), and GAF scores (95% CI for OR = 1.04-1.14). CONCLUSION Given better social functioning and the same cognitive function in older community-dwelling patients with bipolar disorder, they may remain at higher risk for obesity and medical morbidity than schizophrenic patients. Treatments targeting cognitive impairment and CVDs across their life span are both necessary to promote the health of community-dwellers with SMI.
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Affiliation(s)
- Po-Chiao Liao
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Kuo-Hsuan Chung
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Psychiatry and Psychiatric Research Center, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan
| | - Pao-Huan Chen
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Psychiatry and Psychiatric Research Center, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chian-Jue Kuo
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Taipei City Psychiatric Center, Taipei City Hospital, Songde Branch, Taipei, Taiwan
| | - Yu-Jui Huang
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Shang-Ying Tsai
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Psychiatry and Psychiatric Research Center, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan
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18
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Depp CA, Bashem J, Moore RC, Holden JL, Mikhael T, Swendsen J, Harvey PD, Granholm EL. GPS mobility as a digital biomarker of negative symptoms in schizophrenia: a case control study. NPJ Digit Med 2019; 2:108. [PMID: 31728415 PMCID: PMC6841669 DOI: 10.1038/s41746-019-0182-1] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 09/23/2019] [Indexed: 12/20/2022] Open
Abstract
Mobility is an important correlate of physical, cognitive, and mental health in chronic illness, and can be measured passively with mobile phone global positional satellite (GPS) sensors. To date, GPS data have been reported in a few studies of schizophrenia, yet it is unclear whether these data correlate with concurrent momentary reports of location, vary by people with schizophrenia and healthy comparison subjects, or associate with symptom clusters in schizophrenia. A total of 142 participants with schizophrenia (n = 86) or healthy comparison subjects (n = 56) completed 7 days of ecological momentary assessment (EMA) reports of location and behavior, and simultaneous GPS locations were tracked every five minutes. We found that GPS-derived indicators of average distance travelled overall and distance from home, as well as percent of GPS samples at home were highly correlated with EMA reports of location at the day- and week-averaged level. GPS-based mobility indicators were lower in schizophrenia with medium to large effect sizes. Less GPS mobility was related to greater negative symptom severity, particularly diminished motivation, whereas greater GPS mobility was weakly associated with more community functioning. Neurocognition, depression, and positive symptoms were not associated with mobility indicators. Therefore, passive GPS sensing could provide a low-burden proxy measure of important outcomes in schizophrenia, including negative symptoms and possibly of functioning. As such, passive GPS sensing could be used for monitoring and timely interventions for negative symptoms in young persons at high risk for schizophrenia.
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Affiliation(s)
- Colin A Depp
- 1Department of Psychiatry, UC San Diego, La Jolla, CA USA.,Psychology Service, VA San Diego, San Diego, CA USA
| | - Jesse Bashem
- Psychology Service, VA San Diego, San Diego, CA USA
| | - Raeanne C Moore
- 1Department of Psychiatry, UC San Diego, La Jolla, CA USA.,Psychology Service, VA San Diego, San Diego, CA USA
| | - Jason L Holden
- 1Department of Psychiatry, UC San Diego, La Jolla, CA USA
| | | | - Joel Swendsen
- 4National Center for Scientific Research, University of Bordeaux (UMR 5287); EPHE PSL Research University, Bordeaux, France
| | - Philip D Harvey
- 5Department of Psychiatry and Behavioral Sciences, University of Miami, Miami, FL USA
| | - Eric L Granholm
- 1Department of Psychiatry, UC San Diego, La Jolla, CA USA.,Psychology Service, VA San Diego, San Diego, CA USA
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19
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Harvey PD, Strassnig MT. Cognition and disability in schizophrenia: cognition-related skills deficits and decision-making challenges add to morbidity. World Psychiatry 2019; 18:165-167. [PMID: 31059625 PMCID: PMC6502430 DOI: 10.1002/wps.20647] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Affiliation(s)
- Philip D. Harvey
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA,Research Service, Miami VA Healthcare System, Miami, FL, USA
| | - Martin T. Strassnig
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA,Palm Beach County Mental Health Services, Delray Beach, FL, USA
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20
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Abstract
The recent approval of treatments for tardive dyskinesia (TD) has rekindled interest in this chronic and previously recalcitrant condition. A large proportion of patients with chronic mental illness suffer from various degrees of TD. Even the newer antipsychotics constitute a liability for TD, and their liberal prescription might lead to emergence of new TD in patient populations previously less exposed to antipsychotics, such as those with depression, bipolar disorder, autism, or even attention deficit hyperactivity disorder. The association of TD with activity limitations remains poorly understood. We review potential new avenues of assessing the functional sequelae of TD, such as the performance of instrumental activities of daily living, residential status, and employment outcomes. We identify several mediating aspects, including physical performance measures and cognition, that may represent links between TD and everyday performance, as well as potential treatment targets.
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21
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Moradi H, Harvey PD, Helldin L. Correlates of risk factors for reduced life expectancy in schizophrenia: Is it possible to develop a predictor profile? Schizophr Res 2018; 201:388-392. [PMID: 29859858 DOI: 10.1016/j.schres.2018.05.035] [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] [Received: 09/28/2017] [Revised: 01/11/2018] [Accepted: 05/25/2018] [Indexed: 12/18/2022]
Abstract
Patients with schizophrenia have significantly greater mortality rates than the general population, with an estimated reduced lifespan of 10-20 years. We previously reported on a link between impairment in cognition and premature death in a prospective 20-year study. Patients who had died prematurely showed neurocognitive impairment in nine different cognitive tests compared to those who did not. Based on those findings, in this study the surviving patients in the cohort were divided into three different groups based on neurocognitive impairment and compared on symptom severity including remission status, RAND-36, weight and BMI at onset of illness and baseline of the study, and medical/physical symptomatology (i.e., blood pressure, symptom awareness, vertigo and orthostatic symptoms). Differences were most prominent between the cognitively unimpaired and severely cognitively impaired (SCI) groups, with remission, negative symptoms, general symptoms and PANSS total scores differing. For SF-36 (RAND) Physical functioning and Role limitations due to physical health subscales the SCI were worst. The findings indicate that greater impairments in cognitive ability during the illness are associated with several potential indicators of risk for early mortality. Together these factors may be of guidance for establishing an algorithm to detect patients at risk of premature death early in their illness.
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Affiliation(s)
- Hawar Moradi
- Department of Psychiatry, NU Health Care Hospital, Trollhättan, Sweden; Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Sweden.
| | - Philip D Harvey
- Department of Psychiatry, University of Miami Miller School of Medicine, United States; Research Service, Bruce W. Carter VA Medical Center, Miami, FL, United States
| | - Lars Helldin
- Department of Psychiatry, NU Health Care Hospital, Trollhättan, Sweden; Department of Psychology, Karlstad University, Karlstad, Sweden
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22
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Strassnig M, Kotov R, Fochtmann L, Kalin M, Bromet EJ, Harvey PD. Associations of independent living and labor force participation with impairment indicators in schizophrenia and bipolar disorder at 20-year follow-up. Schizophr Res 2018; 197:150-155. [PMID: 29472164 PMCID: PMC6098976 DOI: 10.1016/j.schres.2018.02.009] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 02/07/2018] [Accepted: 02/11/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Since the Iowa 500 study, residential and occupational status have been frequently used as indicators of everyday achievements in research on schizophrenia and bipolar disorder. The relationships of residential and occupational status with impairment in multiple domains including physical health indicators across these two diagnoses, however, have rarely been studied. We examined these relationships at the 20-year follow-up assessment of a first-admission sample. METHODS We included 146 participants with schizophrenia and 87 with bipolar disorder with psychosis who participated in the 20-year follow-up of the Suffolk County Mental Health Project. In addition to interviewer-based ratings of employment and residential independence, we examined self-reported impairment derived from the WHODAS, standard measures of current psychopathology, indicators of obesity, as well as performance-based measures of physical and cognitive functioning. RESULTS Participants with bipolar disorder were more likely to live independently and be gainfully employed; they also performed significantly better on each indicator of impairment apart from balance ability. In both groups, unemployment, but not residential independence, was associated with greater self-reported disability on the WHODAS. Residential independence, gainful employment, and subjective disability were also associated with better physical functioning. Across the two groups, psychiatric symptoms and physical functioning were the major determinants of subjective disability. DISCUSSION People with psychotic bipolar disorder were more likely to be gainfully employed and living independently than participants with schizophrenia but as a group, much less frequently than population standards. Interventions aimed at physical fitness may have the potential to improve both objective functioning and perceived disability.
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Affiliation(s)
- M Strassnig
- Florida Atlantic University College of Medicine, Department of Integrated Medical Science, United States.
| | - R Kotov
- Stony Brook University School of Medicine, Department of Psychiatry
| | - L Fochtmann
- Stony Brook University School of Medicine, Department of Psychiatry
| | - M Kalin
- University of Wisconsin School of Medicine, Department of Psychiatry
| | - EJ Bromet
- Stony Brook University School of Medicine, Department of Psychiatry
| | - PD Harvey
- University of Miami Miller School of Medicine, Psychiatry,Bruce W. Carter VA Medical Center, Research Service
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