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Takeda T, Umehara H, Matsumoto Y, Yoshida T, Nakataki M, Numata S. Schizophrenia and cognitive dysfunction. THE JOURNAL OF MEDICAL INVESTIGATION 2024; 71:205-209. [PMID: 39462553 DOI: 10.2152/jmi.71.205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2024]
Abstract
Schizophrenia is a psychiatric disorder with cognitive dysfunction as a core symptom along with positive and negative symptoms. Cognitive dysfunction in schizophrenia can be broadly classified into neurocognitive and social cognitive deficits, with these deficits significantly influencing social functioning. Therapeutic interventions aiming to enhance neurocognition and social cognition have been developed. In this review, we describe the characteristics of cognitive dysfunction in patients with schizophrenia, its relationship to social function, and intervention strategies. J. Med. Invest. 71 : 205-209, August, 2024.
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Affiliation(s)
- Tomoya Takeda
- Department of Psychological Sciences, University of Human Environments, Ehime, Japan
- Department of Psychiatry, Graduate School of Biomedical Science, Tokushima University, Tokushima, Japan
| | - Hidehiro Umehara
- Department of Psychiatry, Graduate School of Biomedical Science, Tokushima University, Tokushima, Japan
| | - Yui Matsumoto
- Department of Psychiatry, Graduate School of Biomedical Science, Tokushima University, Tokushima, Japan
| | - Tomohiro Yoshida
- Department of Psychiatry, Graduate School of Biomedical Science, Tokushima University, Tokushima, Japan
| | - Masahito Nakataki
- Department of Psychiatry, Graduate School of Biomedical Science, Tokushima University, Tokushima, Japan
| | - Shusuke Numata
- Department of Psychiatry, Graduate School of Biomedical Science, Tokushima University, Tokushima, Japan
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Effectiveness and Factors Associated with Improved Life Skill Levels of Participants of a Large-Scale Youth-Focused Life Skills Training and Counselling Services Program (LSTCP): Evidence from India. Behav Sci (Basel) 2022; 12:bs12060191. [PMID: 35735401 PMCID: PMC9220777 DOI: 10.3390/bs12060191] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 06/07/2022] [Accepted: 06/08/2022] [Indexed: 12/10/2022] Open
Abstract
(1) Background: To empower and facilitate mental health promotion for nearly 18 million youth, a pioneering state-wide Life Skills Training and Counselling Services Program (LSTCP) was implemented in Karnataka, India. This study assesses the changes in life skills scores, level of life skills and factors associated with increased life skills among participants of the LSTCP. (2) Method: This pre-post study design was conducted on 2669 participants who underwent a six-day structured LSTCP. Changes in mean life skills scores and level of life skill categories pre- and post-LSTCP were assessed. Multivariate logistic regression was performed to assess the factors associated with increases in life skills. (3) Results: The LSTCP resulted in significant changes in life skill scores and level of life skills, indicating the effectiveness of the training. All life skill domains, except empathy and self-awareness, increased post-training. There was a positive shift in the level of life skills. Age (AOR = 1.34, CI = 1.11-1.62), gender (AOR = 1.39, CI = 1.15-1.68), education (AOR = 1.44, CI = 1.05-1.97) and physical (AOR = 1.02, CI = 1.01-1.03) and psychological (AOR = 1.02, CI = 1.01-1.03) quality of life was associated with an increase in life skills among participants. (4) Conclusions: The LSTCP is effective in improving the life skills of participants. The LSTCP modules and processes can be used to further train youth and contribute to mental health promotion in the state.
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Nevarez-Flores AG, Breslin M, Carr VJ, Morgan VA, Waterreus A, Harvey C, Sanderson K, Neil AL. Proposing a causal pathway for health-related quality of life in people with psychotic disorders. J Psychiatr Res 2021; 138:550-559. [PMID: 33990026 DOI: 10.1016/j.jpsychires.2021.05.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 04/22/2021] [Accepted: 05/01/2021] [Indexed: 10/21/2022]
Abstract
This study aimed to establish independent predictors for health-related quality of life (HRQoL) in people with psychotic disorders, and the mediating role of global functioning in those relationships. Data for 1642 people collected as part of the second Australian National Survey of Psychosis were analyzed. The Assessment of Quality of Life (AQoL)-4D and the Personal and Social Performance scale were used for assessing HRQoL and global functioning respectively. The study commenced with a theoretical model comprised of 26 sociodemographic and clinical variables. A predictive model for HRQoL was built up using a purposeful selection strategy to arrive at a set of clinically meaningful, independent predictors. The mediating effect of global functioning was then assessed. Seven variables were found to have an independent effect on HRQoL: perception of loneliness, number of negative symptoms, use of psychotropic and anticholinergic medications, course of disorder, lifetime histories of chronic pain and cardiovascular disease and living arrangements at the time of the interview. All variables except perceived loneliness and chronic pain were partially mediated through global functioning. This final model explained 46% of the variance in HRQoL, with loneliness and number of negative symptoms the strongest predictors. Evidence in support of a credible causal pathway for HRQoL in people with psychotic disorders, mediated by global functioning was presented. The importance of the quality of social relationships was highlighted, and potential targets for improving the HRQoL of this population identified.
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Affiliation(s)
| | - Monique Breslin
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Vaughan J Carr
- Research Unit for Schizophrenia Epidemiology, School of Psychiatry, University of New South Wales, St Vincent's Hospital, Darlinghurst Sydney, New South Wales, Australia; Department of Psychiatry, School of Clinical Sciences, Monash Medical Centre, Monash University, Clayton Melbourne, Victoria, Australia
| | - Vera A Morgan
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia; Neuropsychiatric Epidemiology Research Unit, School of Population and Global Health, The University of Western Australia, Crawley, Western Australia, Australia; Centre for Clinical Research in Neuropsychiatry, Division of Psychiatry, Medical School, The University of Western Australia, Crawley, Western Australia, Australia
| | - Anna Waterreus
- Neuropsychiatric Epidemiology Research Unit, School of Population and Global Health, The University of Western Australia, Crawley, Western Australia, Australia; Centre for Clinical Research in Neuropsychiatry, Division of Psychiatry, Medical School, The University of Western Australia, Crawley, Western Australia, Australia
| | - Carol Harvey
- Psychosocial Research Centre, Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia; North Western Mental Health, Melbourne, Victoria, Australia
| | - Kristy Sanderson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia; School of Health Sciences, University of East Anglia. Norwich Research Park Norwich, NR4 7TJ, UK
| | - Amanda L Neil
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.
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Hamaideh SH, Hamdan-Mansour A, Alhamdan AA. Levels and Correlates of Disability in Life Skills among Patients with Schizophrenia. CURRENT PSYCHIATRY RESEARCH AND REVIEWS 2021. [DOI: 10.2174/2666082216999200905133918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background:
Schizophrenia is a severe mental disability disorder that affects all life aspects,
including life functioning, general well-being, and overall life skills resulting in prominent impairments
in life functioning.
Objectives:
The objective of the study was to assess life skills and disabilities and its correlates among
Jordanian patients with schizophrenia.
Methods:
A cross-sectional correlational design was used. A convenience sampling technique was
used to recruit 250 hospitalized patients with schizophrenia. Data were collected using a questionnaire
that consisted of demographic variables, Life Skills Profile, Global Assessment of Functioning, and
Positive and Negative Syndrome Scale.
Results:
The level of disability in life skills was 89.23. The highest disability level was observed in
social contact and in communication domains, and the lowest level was in the responsibility domain.
The disability levels regarding family history of psychiatric illness, marital and employment status,
and the number of previous hospitalizations were statistically different (p < .05). The presence of negative
symptoms, global assessment of functioning, psychopathology symptoms, duration of treatment,
and positive symptoms were identified as predictors of the disability in life skills and accounted for
65% of the total variance.
Conclusions:
Planning and conducting life skills programs that help enhance the communication and
social interaction are required to improve life skills.
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Affiliation(s)
- Shaher Hamad Hamaideh
- Community and Mental Health Nursing Department, Faculty of Nursing, The Hashemite University, Zarqa, Jordan
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Hori H, Atake K, Katsuki A, Yoshimura R. Effects of the number of hospitalizations on cognitive function in Japanese patients with stable schizophrenia. CNS Spectr 2020; 26:1-6. [PMID: 32883397 DOI: 10.1017/s1092852920001728] [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] [Indexed: 11/06/2022]
Abstract
BACKGROUND The present study aimed to determine whether the number of hospitalizations in schizophrenia patients is associated with reduced cognitive performance, which may in turn imply that recurrences indirectly lead to a worsening in the disorder's progression. METHODS Cognitive performance in stable schizophrenia patients was assessed using the Brief Assessment of Cognition in Schizophrenia, Japanese-language version, on 30 patients who had not experienced any hospitalizations (G0), 57 patients who had experienced only one hospitalization (G1), 47 patients with two hospitalizations (G2), and 59 patients with three or more hospitalizations (G3). RESULTS Significant differences in motor function and attention and processing speed were found between patients with G0 and those with G1. Significant differences in working memory and verbal fluency were found between patients with G1 and those with G2. Patients with G3 performed even more poorly in comparison with those with G1, showing deficits in verbal memory, working memory, executive function, and composite score. The patients with G3 displayed a greater range of impairment and demonstrated deficits in executive function compared with patients with G2. Finally, G2 and G3 performed more poorly than G0, with deficits in the various cognitive areas. CONCLUSION The number of hospitalizations predicted cognitive performance, which suggests that relapse or recurrence may have a long-term neuropsychological impact. Prospective follow-up studies must be completed to explore this effect further because better treatment adherence may have a protective effect on neurocognitive function.
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Affiliation(s)
- Hikaru Hori
- Department of Psychiatry, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Kiyokazu Atake
- Department of Psychiatry, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Asuka Katsuki
- Department of Psychiatry, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Reiji Yoshimura
- Department of Psychiatry, University of Occupational and Environmental Health, Fukuoka, Japan
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Psychiatric symptoms and quality of life in older adults with schizophrenia spectrum disorder: results from a multicenter study. Eur Arch Psychiatry Clin Neurosci 2020; 270:673-688. [PMID: 31134378 DOI: 10.1007/s00406-019-01026-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 05/15/2019] [Indexed: 12/16/2022]
Abstract
The severity of psychopathology has a strong negative impact on quality of life (QoL) among older adults with schizophrenia spectrum disorder. However, because these subjects generally experience multiple psychiatric symptoms, it remains unclear whether decreased QoL in this population is due to specific symptoms (e.g., hallucinations), specific dimensions of psychopathology (e.g., negative symptoms), a general psychopathology dimension representing the shared effect across all psychiatric symptoms, or a combination of these explanations. Data were derived from the Cohort of individuals with Schizophrenia Aged 55 years or more (CSA) study, a large (N = 353) multicenter sample of older adults with schizophrenia spectrum disorder recruited from French public-sector psychiatric departments. We used structural equation modeling to examine the shared and specific effects of psychiatric symptoms on QoL, while adjusting for sociodemographic characteristics, general medical conditions, global cognitive functioning and psychotropic medications. Psychiatric symptoms and QoL were assessed face-to-face by psychiatrists using the Brief Psychiatric Rating Scale (BPRS) and the Quality of Life Scale (QLS). Among older adults with schizophrenia spectrum disorder, effects of psychiatric symptoms on QoL were exerted mostly through a general psychopathology dimension (β = - 0.43, p < 0.01). Negative symptom dimension had an additional negative effect on QoL beyond the effect of that factor (β = - 0.28, p < 0.01). Because psychiatric symptoms affect QoL mainly through two dimensions of psychopathology, i.e., a general psychopathology dimension and a negative symptom dimension, mechanisms underlying those dimensions should be considered as promising targets for therapeutic interventions to substantially improve quality of life of this vulnerable population.
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Moeini B, Hazavehei SMM, Faradmal J, Ahmadpanah M, Dashti S, Hashemian M, Shahrabadi R. The relationship between readiness for treatment of substance use and self-efficacy based on life skills. J Ethn Subst Abuse 2020; 21:364-376. [PMID: 32497463 DOI: 10.1080/15332640.2020.1772930] [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: 10/24/2022]
Abstract
Substance use is a social harm. Promoting substance users readiness for treatment of substance use with a non-medical approach is important besides the medical approach. The current study aimed to determine the relationship between readiness for treatment of substance use and self-efficacy based on life skills. In this descriptive-analytical study, a number of 118 substance users in Hamadan city (Iran) were participated. The data collection tools were Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES) and Drug Avoidance Self-Efficacy Scale (DASES). Analytical and descriptive tests were used for data analysis, at 95% significant level, using Statistical Package for the Social Sciences 16. The results of this study showed that the readiness for treatment of substance use had a significant relationship with the self-efficacy includes assertiveness and communication (Df:1; Pvalue<0.05). Self-efficacy based on life skills can be used to promote substance users readiness for treatment of substance use in educational interventions.
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Affiliation(s)
- Babak Moeini
- Social Determinants of Health Research Center, Hamadan University of Medical Sciences, Hamadan, Iran.,Hamadan University of Medical Sciences, Hamadan, Iran
| | | | | | | | - Saeid Dashti
- Birjand University of Medical Sciences, Birjand, Iran
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Tominaga T, Tomotake M, Takeda T, Ueoka Y, Tanaka T, Watanabe SY, Kameoka N, Nakataki M, Numata S, Izaki Y, Sumitani S, Kubo H, Kaneda Y, Ohmori T. Predictors of life skills in people with schizophrenia. THE JOURNAL OF MEDICAL INVESTIGATION 2020; 67:75-82. [PMID: 32378622 DOI: 10.2152/jmi.67.75] [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: 11/14/2022]
Abstract
Objective : The purpose of the present study is to examine clinical factors related to life skills in people with schizophrenia. Method : The participants were 51 stabilized outpatients with schizophrenia. Their mean age was 38.91 (SD = 10.73) years. Life skills were assessed using the Life skills profile (LSP). Cognitive function was evaluated with the Measurement and Treatment Research to Improve Cognition in Schizophrenia Consensus Cognitive Battery (MCCB). Clinical symptoms were assessed using the Positive and Negative Syndrome scale (PANSS), the Calgary Depression Scale for Schizophrenia (CDSS) and the Drug-Induced Extrapyramidal Symptoms Scale (DIEPSS). Results : Cognitive function was not correlated with the LSP scores at all. Among clinical symptoms, scores of the PANSS positive and negative syndrome scales, the CDSS, and the DIEPSS had negative correlations with the LSP total score and the subscales. Stepwise regression analyses showed that the CDSS and PANSS negative syndrome scale scores were independent predictors of the LSP total score and two of the subscales. Conclusions : These results indicate that cognitive function is not associated with life skills but clinical symptoms such as depressive and negative symptoms have considerable impacts on life skills in people with schizophrenia. J. Med. Invest. 67 : 75-82, February, 2020.
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Affiliation(s)
- Takeo Tominaga
- Department of Psychiatry, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Masahito Tomotake
- Department of Mental Health, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Tomoya Takeda
- Department of Psychology, Fukuyama University, Fukuyama, Japan
| | - Yoshinori Ueoka
- Department of Early Childhood Care and Education, Shikoku University, Junior College, Tokushima, Japan
| | - Tsunehiko Tanaka
- Faculty of Education Specialized courses educational psychology, Niigata University, Niigata, Japan
| | - Shin-Ya Watanabe
- Department of Psychiatry, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Naomi Kameoka
- Department of Psychiatry, Tokushima University Hospital, Tokushima, Japan
| | - Masahito Nakataki
- Department of Psychiatry, Tokushima University Hospital, Tokushima, Japan
| | - Shusuke Numata
- Department of Psychiatry, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Yumiko Izaki
- Health service, counseling and accessibility center, Tokushima University, Tokushima, Japan
| | - Satsuki Sumitani
- Academic support office for students with special needs, Tokushima University, Tokushima, Japan
| | - Hiroko Kubo
- Department of Psychiatry, Aizato Hospital, Itano-gun, Japan
| | | | - Tetsuro Ohmori
- Department of Psychiatry, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
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9
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Wang TT, Beckstead JW, Yang CY. Social interaction skills and depressive symptoms in people diagnosed with schizophrenia: The mediating role of auditory hallucinations. Int J Ment Health Nurs 2019; 28:1318-1327. [PMID: 31433115 DOI: 10.1111/inm.12643] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 07/09/2019] [Accepted: 07/16/2019] [Indexed: 11/30/2022]
Abstract
Past studies have presented evidence that depressive symptoms are affected in different ways by social interaction skills and auditory hallucinatory symptoms in people with schizophrenia. However, few studies have focused on examining the relationship among auditory hallucinatory severity, social interaction skills, and depressive symptoms. This study aimed to explore the mediating effect of auditory hallucinatory severity on social interaction skills and depressive symptoms in people with long-term schizophrenia. We propose that auditory hallucination severity functions as a mechanism through which impaired social interaction skills increase depressive symptoms. In this study, a convenience sample of 186 people with schizophrenia was obtained from hospital-based rehabilitation wards. Four instruments were used: A demographic data questionnaire, the Assessment of Communication and Interaction Skills-Chinese version, the Characteristics of Auditory Hallucinations Questionnaire, and the Beck Depression Inventory II. To investigate the mediating effect of auditory hallucinatory severity after controlling for six covariates, we tested an indirect effect in a simple mediation model using the SPSS macro PROCESS, which is a regression-based approach. The indirect effect and the results of Sobel's test were significant (Z = -2.824, P = 0.005), which confirms that auditory hallucination severity mediates social interaction skills and depressive symptoms. This finding suggests that psychiatric nurses must teach people with schizophrenia to use auditory hallucination management strategies to prevent them from becoming immersed in auditory hallucinations and reducing their social interaction with the real world, so that depressive symptoms can be improved.
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Affiliation(s)
- Tzu-Ting Wang
- School of Nursing National Yang-Ming University, Taipei, Taiwan.,Cardinal Tien Junior College of Healthcare & Management, New Taipei City, Taiwan
| | - Jason W Beckstead
- College of Public Health, Epidemiology and Biostatistics, University of South Florida, Tampa, Florida, USA
| | - Chiu-Yueh Yang
- School of Nursing, National Yang Ming University, Taipei, Taiwan.,Department of Nursing, National Yang-Ming University Hospital, Yilan, Taiwan
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Modeling the Longitudinal Effects of Insight on Depression, Quality of Life and Suicidality in Schizophrenia Spectrum Disorders: Results from the FACE-SZ Cohort. J Clin Med 2019; 8:jcm8081196. [PMID: 31405155 PMCID: PMC6723809 DOI: 10.3390/jcm8081196] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 08/06/2019] [Accepted: 08/07/2019] [Indexed: 12/15/2022] Open
Abstract
Background: Up to half of the patients with schizophrenia attempt suicide during their lifetime. Better insight is associated with better functioning but also with increased suicidality. The direction of the relationship between insight and suicidality is not clear, hence we aimed to provide new elements using structural equation modeling. Methods: Insight, quality of life (QoL), depression, and suicidality were measured at baseline and at 12 months in individuals with schizophrenia spectrum disorders. The relationships between these variables were investigated by latent difference score models, controlling for chlorpromazine doses, positive and negative symptoms, and general psychopathology. Results: 738 patients were included, and 370 completed the study. Baseline levels of insight predicted changes in suicidality, whereas baseline levels of suicidality did not predict changes in insight, suggesting that better insight underlies suicidality and predicts its worsening. Our results suggest this temporal sequence: better insight → worse QoL → increased depression → increased suicidality, while insight also affects the three variables in parallel. Conclusion: Better insight predicts a worsening of QoL, depression and suicidality. These findings contribute to our global understanding of the longitudinal influence of insight on suicidality. We advocate that insight-targeted interventions should not be proposed without the monitoring of depression and suicide prevention.
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Ang MS, Nurjono M, Lee J. The effects of clinical illness severity and physical activity on health-related quality of life in schizophrenia. Qual Life Res 2019; 28:1509-1520. [PMID: 30805880 DOI: 10.1007/s11136-019-02126-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Quality of life is an important clinical outcome in individuals with schizophrenia. Illness severity and physical activity (PA) were independently reported to influence health-related quality of life (HRQoL) in people with schizophrenia. This study attempts to examine the intensity and types of PA and their impact on HRQoL, as well as the relative contributions of illness severity, PA, and sedentary behavior (SB) to HRQoL in people with schizophrenia. METHODS Demographic information was collected from 297 community-dwelling individuals with schizophrenia. Severity of illness was assessed on the Clinical Global Impression-Severity (CGI-S); PA and SB were assessed on the Global Physical Activity Questionnaire (GPAQ); HRQoL was assessed on the RAND-36. Regression analyses were conducted to examine the impact of different types and intensities of PA on HRQoL, and the relative impact of CGI-S, GPAQ-PA, and GPAQ-SB on HRQoL. RESULTS Most participants had low PA level, and travel is the main type of PA adopted. Leisure time, travel-related, work-related, moderate-, and vigorous-intensity PA were all not associated with HRQoL. Lower severity of illness was significantly associated with better physical (PHC), mental (MHC) and global (GHC) health composites of the RAND-36 (GHC: t = - 5.628, p < 0.001, PHC: t = - 4.026, p < 0.001, MHC: t = - 5.534, p < 0.001). Both PA and SB were not significantly associated with PHC, MHC, and GHC. CONCLUSION Severity of illness has a significant impact on HRQoL in people with schizophrenia. However, we found no evidence to support the association between physical activity and sedentary behavior with HRQoL.
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Affiliation(s)
- Mei San Ang
- Research Division, Institute of Mental Health, 10 Buangkok View, Buangkok Green Medical Park, Singapore, 539747, Singapore
| | - Milawaty Nurjono
- Centre for Health Services Research and Policy Research, Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore
| | - Jimmy Lee
- Research Division, Institute of Mental Health, 10 Buangkok View, Buangkok Green Medical Park, Singapore, 539747, Singapore. .,North Region & Department of Psychosis, Institute of Mental Health, Singapore, Singapore. .,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
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12
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Takeda T, Nakataki M, Ohta M, Hamatani S, Matsuura K, Yoshida R, Kameoka N, Tominaga T, Umehara H, Kinoshita M, Watanabe S, Numata S, Sumitani S, Ohmori T. Negative and positive self-thoughts predict subjective quality of life in people with schizophrenia. Neuropsychiatr Dis Treat 2019; 15:293-301. [PMID: 30718955 PMCID: PMC6345191 DOI: 10.2147/ndt.s190381] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Recently, cognitive variables such as negative and positive self-belief and thoughts have attracted much attention because they are associated with functional outcomes and quality of life (QOL). However, it is unclear how cognitive variables affect subjective and objective QOL. This study aimed to investigate the relationship of negative and positive self-belief and thoughts with subjective and objective QOL. PARTICIPANTS AND METHODS Thirty-six people with schizophrenia participated in this study. Subjective and objective QOL were assessed with the Schizophrenia Quality of Life Scale (SQLS) and Quality of Life Scale (QLS), respectively. Neurocognitive function was assessed with the Brief Assessment of Cognition in Schizophrenia (BACS). Clinical symptoms were assessed with the Positive and Negative Syndrome Scale and Calgary Depression Scale for Schizophrenia. Side effects were assessed with the Drug-induced Extrapyramidal Symptoms Scale (DIEPSS). Negative and positive self-belief and thoughts were assessed with the Defeatist Performance Belief Scale and Automatic Thoughts Questionnaire-Revised. A generalized linear model was tested, with subjective and objective QOL as the response variable and symptoms, neurocognitive function, and cognitive variables that were significantly correlated with subjective and objective QOL as explanatory variables. RESULTS In the schizophrenia group, the common objects score on the QLS was predicted by the composite BACS score, and the total QLS score was predicted by the DIEPSS score. Motivation and Energy, Psychosocial, and Symptoms and Side effects scores on the SQLS were predicted by depression and by negative automatic thought (NAT) and positive automatic thought (PAT). CONCLUSION Our results indicated that key targets for improving objective and subjective QOL in people with schizophrenia are side effects, neurocognitive function, depression, and NAT and PAT.
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Affiliation(s)
- Tomoya Takeda
- Graduate School of Medical Science, Tokushima University, Tokushima, Japan
| | - Masahito Nakataki
- Department of Psychiatry, Tokushima University Hospital, Tokushima, Japan,
| | - Masashi Ohta
- Department of Psychiatry, Tokushima University Hospital, Tokushima, Japan,
| | - Sayo Hamatani
- Research Center for Child Mental Development, Chiba University, Chiba, Japan
| | - Kanae Matsuura
- Department of Psychiatry, Tokushima University Hospital, Tokushima, Japan,
| | - Reona Yoshida
- Department of Psychiatry, Tokushima University Hospital, Tokushima, Japan,
| | - Naomi Kameoka
- Department of Psychiatry, Tokushima University Hospital, Tokushima, Japan,
| | - Takeo Tominaga
- Department of Psychiatry, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Hidehiro Umehara
- Department of Psychiatry, Tokushima University Hospital, Tokushima, Japan,
| | - Makoto Kinoshita
- Department of Psychiatry, Tokushima University Hospital, Tokushima, Japan,
| | - Shinya Watanabe
- Department of Psychiatry, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Shusuke Numata
- Department of Psychiatry, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Satsuki Sumitani
- Academic Support Office for Students with Special Needs, Tokushima University, Tokushima, Japan
| | - Tetsuro Ohmori
- Department of Psychiatry, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
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13
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Aunjitsakul W, Teetharatkul T, Vitayanont A, Liabsuetrakul T. Correlations between self-reported and psychiatrist assessments of well-being among patients with schizophrenia. Gen Hosp Psychiatry 2019; 56:52-53. [PMID: 30448207 DOI: 10.1016/j.genhosppsych.2018.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 11/05/2018] [Accepted: 11/08/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Warut Aunjitsakul
- Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand.
| | - Teerapat Teetharatkul
- Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
| | - Arnont Vitayanont
- Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
| | - Tippawan Liabsuetrakul
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
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The Relationship of Motivation and Neurocognition with Functionality in Schizophrenia: A Meta-analytic Review. Community Ment Health J 2018; 54:1019-1049. [PMID: 29605875 DOI: 10.1007/s10597-018-0266-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 03/21/2018] [Indexed: 01/10/2023]
Abstract
The role that neurocognition plays in functionality in schizophrenia has been widely examined, although in recent years increasing attention has been paid to the influence of motivation instead. This study provides a review of the relationship of neurocognition and motivation with functionality in schizophrenia, taking into account objective/subjective functionality assessment, demographic variables, and the different terms used when referring to motivation. A search of electronic databases identified 34 studies that met the inclusion criteria for review. Correlation coefficients between motivation and functionality and between neurocognition and functionality were extracted. For a better understanding, potential moderator variables were also extracted. Meta-analysis showed that both motivation and neurocognition assessments were strongly associated with functioning, with correlations between motivation and functional outcomes being stronger. However, more than three-quarters of the variance in outcome remained unexplained by the moderating factors examined. The paper concludes with recommendations for clinical practice and future research.
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Tominaga T, Tomotake M, Takeda T, Ueoka Y, Tanaka T, Watanabe SY, Kameoka N, Nakataki M, Numata S, Izaki Y, Sumitani S, Kubo H, Kaneda Y, Ohmori T. Relationship between social and cognitive functions in people with schizophrenia. Neuropsychiatr Dis Treat 2018; 14:2215-2224. [PMID: 30214211 PMCID: PMC6121750 DOI: 10.2147/ndt.s171207] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
PURPOSE The purpose of the present study was to examine clinical factors related to social function in people with schizophrenia. PATIENTS AND METHODS The participants were 55 stabilized outpatients with schizophrenia. Their mean age was 39.36 (SD =10.65) years. Social function was assessed using the Quality of Life Scale (QLS). Cognitive function was evaluated with the Measurement and Treatment Research to Improve Cognition in Schizophrenia Consensus Cognitive Battery (MCCB). Clinical symptoms were assessed using the Positive and Negative Syndrome Scale (PANSS), the Calgary Depression Scale for Schizophrenia, and the Drug-Induced Extrapyramidal Symptoms Scale. RESULTS Neither the MCCB cognitive domain score nor composite score was correlated with the QLS scores. However, of the 10 MCCB subtests, the Trail Making Test Part A and the Brief Assessment of Cognition in Schizophrenia-Symbol Coding (BACS-SC) scores were positively correlated with the QLS scores. Among clinical variables, especially the PANSS negative syndrome scale score had a strong negative correlation with the QLS scores. Stepwise regression analyses showed that the PANSS negative syndrome scale score was an independent predictor of the QLS scores, and although the BACS-SC score predicted the QLS common objects and activities subscale score, the association was not so strong compared to the PANSS negative syndrome scale score. CONCLUSION These results indicate that speed of processing evaluated by BACS-SC could predict some aspect of social function but negative symptoms have a much stronger impact on global social function in people with schizophrenia.
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Affiliation(s)
- Takeo Tominaga
- Department of Psychiatry, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan,
| | - Masahito Tomotake
- Department of Mental Health, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Tomoya Takeda
- Department of Psychiatry, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan,
| | - Yoshinori Ueoka
- Field of Psychology, Department of Human Sciences, Graduate School of Technology, Industrial and Social Sciences, Tokushima University, Tokushima, Japan
| | - Tsunehiko Tanaka
- Faculty of Education, Specialized Courses Educational Psychology, Niigata University, Niigata, Japan
| | - Shin-Ya Watanabe
- Department of Psychiatry, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan,
| | - Naomi Kameoka
- Department of Psychiatry, Tokushima University Hospital, Tokushima, Japan
| | - Masahito Nakataki
- Department of Psychiatry, Tokushima University Hospital, Tokushima, Japan
| | - Shusuke Numata
- Department of Psychiatry, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan,
| | - Yumiko Izaki
- Health Service and Counseling Center, Tokushima University, Tokushima, Japan
| | - Satsuki Sumitani
- Academic Support Office for Students with Special Needs, Tokushima University, Tokushima, Japan
| | - Hiroko Kubo
- Department of Psychiatry, Aizato Hospital, Itano-gun, Tokushima, Japan
| | - Yasuhiro Kaneda
- Department of Psychiatry, Iwaki Clinic, Anan, Tokushima, Japan
| | - Tetsuro Ohmori
- Department of Psychiatry, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan,
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16
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Samuel R, Thomas E, Jacob KS. Instrumental Activities of Daily Living Dysfunction among People with Schizophrenia. Indian J Psychol Med 2018; 40:134-138. [PMID: 29962569 PMCID: PMC6008996 DOI: 10.4103/ijpsym.ijpsym_308_17] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Life skills are the basic skills that are needed to live independently and that support meaningful, productive roles. The negative symptoms and cognitive dysfunction seen in schizophrenia may lead to deterioration in the life skills of the patient. The assessment of current life skills of the patient and subsequent intervention becomes necessary for comprehensive rehabilitation of people with mental illness. This study attempted to assess the instrumental activities of daily living among people with schizophrenia in India. METHODS One hundred consecutive patients with schizophrenia, between 18 and 60 years, who presented to a tertiary psychiatric facility were assessed using (i) Lawton instrumental activities of daily living scale (LIADL), (ii) positive and negative symptom scale (PANSS), (iii) pro forma for sociodemographic and clinical characteristics. RESULTS The majority of the patients were male, young adults, married, with secondary school education, middle socioeconomic status, from nuclear families, unemployed and were diagnosed to have paranoid schizophrenia. The reported IADL dysfunction included difficulties in handling medications (86%), preparing food (85%), shopping (78%), handling finances (61%), doing laundry (52%), housekeeping (47%), using public transport (32%), and using telephones (5%). The dysfunction documented differs from that reported in the west. Total PANSS score (P = 0.015) and its general psychopathology subscale (P = 0.005) correlated inversely with the total LIADL score; PANSS scores and sociodemographic variables were associated with some subscales of LIADL. CONCLUSIONS IADL dysfunction, common in people with schizophrenia, demands detailed assessment, and tailored training to ensure optimum functioning.
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Affiliation(s)
- Reema Samuel
- Department of Psychiatry, Christian Medical College, Vellore, Tamil Nadu, India
| | - Elizabeth Thomas
- Department of Occupational Therapy, Christian Medical College, Vellore, Tamil Nadu, India
| | - K S Jacob
- Department of Psychiatry, Christian Medical College, Vellore, Tamil Nadu, India
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17
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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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18
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Lim MWZ, Lee J. Determinants of Health-Related Quality of Life in Schizophrenia: Beyond the Medical Model. Front Psychiatry 2018; 9:712. [PMID: 30618882 PMCID: PMC6305274 DOI: 10.3389/fpsyt.2018.00712] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 12/04/2018] [Indexed: 01/05/2023] Open
Abstract
Background: Improving Quality of Life (QoL) in Schizophrenia is an important treatment objective in the shift toward person-centered and recovery-oriented care. Health-Related Quality of Life (HRQoL) is a focused aspect of QoL that is directly impacted by healthcare intervention. This aim of the current study was to ascertain the clinical determinants of HRQoL in Schizophrenia and their collective contribution to HRQoL. Methods: 157 stable outpatients with schizophrenia were recruited for this study. Data collected included sociodemographic information and clinical characteristics. HRQoL was assessed on the RAND-36. Psychopathology was assessed on the Positive and Negative Syndrome Scale (PANSS) and functioning measured on the Global Assessment Scale (GAS). Findings: Multiple regression revealed that the Physical Health Component (PHC) of the RAND-36 was associated with positive symptoms (beta = -0.218, p = 0.005) and presence of psychiatric comorbidity (beta = -0.215, p = 0.003). The Mental Health Component (MHC) was associated with depressive (beta = -0.364, p < 0.001) and positive (beta = -0.175, p = 0.021,) symptoms. Symptoms, functioning, presence of psychiatric comorbidities, gender and age account for 20.3% of the total variance observed in HRQoL. Conclusion: Depressive and positive symptoms are key clinical determinants of HRQoL in people with schizophrenia. However, the medical model-looking solely at clinical determinants-could not account for a large proportion of variance in HRQoL. Hence, future research beyond the medical model is required to uncover the determinants of HRQoL in Schizophrenia. Identifying these factors will contribute toward developing a holistic and person-centered management plan for people with schizophrenia.
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Affiliation(s)
- Madeline W Z Lim
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Jimmy Lee
- Research Division, Institute of Mental Health, Singapore, Singapore.,Department of Psychosis, Institute of Mental Health, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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19
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Ohta M, Nakataki M, Takeda T, Numata S, Tominaga T, Kameoka N, Kubo H, Kinoshita M, Matsuura K, Otomo M, Takeichi N, Harada M, Ohmori T. Structural equation modeling approach between salience network dysfunction, depressed mood, and subjective quality of life in schizophrenia: an ICA resting-state fMRI study. Neuropsychiatr Dis Treat 2018; 14:1585-1597. [PMID: 29942132 PMCID: PMC6007191 DOI: 10.2147/ndt.s163132] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
PURPOSE Quality of life (QOL) is an important clinical outcome for patients with schizophrenia, and recent studies have focused on subjective QOL. We evaluated the causal relationship between psychosocial aspect of subjective QOL, symptoms, cognitive functions, and salience network (SN) dysfunction in schizophrenia using structural equation modeling (SEM). PATIENTS AND METHODS We performed a cross-sectional study of 21 patients with symptomatically stabilized schizophrenia and 21 age-, sex-, and education level-matched healthy controls who underwent resting-state functional magnetic resonance imaging. We evaluated SN dysfunction in schizophrenia using independent component analysis (ICA). We rated participant psychopathology using the Positive and Negative Syndrome Scale (PANSS), the Brief Assessment of Cognition in Schizophrenia (BACS), and the Calgary Depression Scale for Schizophrenia (CDSS). We rated psychosocial aspect of subjective QOL using the Schizophrenia Quality of Life Scale (SQLS) psychosocial subscale. We applied SEM to examine the relationships between SN dysfunction, PANSS positive and negative scores, CDSS total scores, BACS composite scores, and SQLS psychosocial subscale scores. RESULTS In second-level analysis after group ICA, patient group had significant lower right pallidum functional connectivity (FC) within the SN than the controls did (Montreal Neurological Institute [MNI] [x y z] = [22 -2 -6]) (p = 0.027, family-wise error [FWE] corrected). In SEM, we obtained a good fit for an SEM model in which SN dysfunction causes depressed mood, which in turn determines psychosocial aspect of subjective QOL (chi-squared p = 0.9, root mean square error of approximation (RMSEA) < 0.001, comparative fit index [CFI] = 1.00, and standardized root mean square residual [SRMR]= 0.020). CONCLUSION We found a continuous process by which SN dysfunction causes depressed moods that determine psychosocial aspect of subjective QOL in schizophrenia. This is the first report that offers a unified explanation of functional neuroimaging, symptoms, and outcomes. Future studies combining neuroimaging techniques and clinical assessments would elucidate schizophrenia's pathogenesis.
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Affiliation(s)
- Masashi Ohta
- Department of Psychiatry, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Masahito Nakataki
- Department of Psychiatry, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Tomoya Takeda
- Department of Psychiatry, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Shusuke Numata
- Department of Psychiatry, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Takeo Tominaga
- Department of Psychiatry, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Naomi Kameoka
- Department of Psychiatry, Tokushima University Hospital, Tokushima, Japan
| | - Hiroko Kubo
- Department of Psychiatry, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Makoto Kinoshita
- Department of Psychiatry, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Kanae Matsuura
- Department of Psychiatry, Tokushima University Hospital, Tokushima, Japan
| | - Maki Otomo
- Department of Radiology and Radiation Oncology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Naoya Takeichi
- Department of Radiology, Tokushima University Hospital, Tokushima, Japan
| | - Masafumi Harada
- Department of Radiology and Radiation Oncology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Tetsuro Ohmori
- Department of Psychiatry, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
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Quality of life in individuals with attenuated psychotic symptoms: Possible role of anxiety, depressive symptoms, and socio-cognitive impairments. Psychiatry Res 2017; 257:431-437. [PMID: 28837932 DOI: 10.1016/j.psychres.2017.08.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 08/08/2017] [Accepted: 08/13/2017] [Indexed: 11/20/2022]
Abstract
Individuals with Clinical High-Risk state for Psychosis (CHR-P) are reported to exhibit impaired quality of life (QOL) similar to that observed in schizophrenia, but its determinants remain unclear. We investigated the QOL of 33 subjects with CHR-P, 45 patients with schizophrenia, and 63 healthy subjects using the Quality of Life Scale (QLS). The CHR-P and schizophrenia groups were administered the Brief Assessment of Cognition in Schizophrenia (BACS), the Schizophrenia Cognition Rating Scale (SCoRS), and the Social and Occupational Functioning Assessment Scale (SOFAS) for socio-cognitive functions; and the Positive and Negative Syndrome Scale (PANSS) and the State-Trait Anxiety Inventory for clinical symptoms. The CHR-P group was also assessed using the Beck Depression Inventory. The CHR-P and schizophrenia groups had a significantly lower QLS score to the same degree compared with controls, which was predominantly associated with the SOFAS, SCoRS, and PANSS negative/general scores. For the CHR-P, the severity of anxiety and depressive symptoms was also correlated with a lower QLS score. Regression analyses demonstrated that the QLS score was predicted by SOFAS (for both groups) and SCoRS (for CHR-P) scores. Our findings suggest the importance of addressing socio-cognitive dysfunctions as well as anxiety and depressive symptoms for better QOL in CHR-P.
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21
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The associations between quality of life and clinical symptoms in individuals with an at-risk mental state and first-episode psychosis. Psychiatry Res 2017; 254:54-59. [PMID: 28448805 DOI: 10.1016/j.psychres.2017.04.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 01/27/2017] [Accepted: 04/18/2017] [Indexed: 11/22/2022]
Abstract
Quality of life (QOL) is strongly associated with severity of clinical symptoms and is often compromised in patients with chronic or first-episode psychosis (FEP). However, it remains unclear whether baseline QOL in individuals with an at-risk mental state (ARMS) for psychosis is higher or lower than that in patients with FEP, or what specific clinical symptoms relate to a decreased QOL in individuals with ARMS and FEP. The World Health Organization's WHOQOL-BREF, an instrument assessing QOL, was administered to 104 individuals with ARMS and 53 with FEP. Clinical symptoms were assessed by the Positive and Negative Syndrome Scale and the Beck Depression Inventory-II. We compared the four domain scores of the WHOQOL-BREF between the two groups, and calculated Pearson correlations between each WHOQOL-BREF domain score and the clinical symptoms and compared these correlations between the groups. We observed significant correlations between poor QOL and severity of depressive symptoms in both the FEP and ARMS group. No between-group differences were found in any correlation coefficients between WHOQOL-BREF domains and clinical symptoms. Thus, depressive symptoms should be investigated as a key factor relating to poor QOL in both individuals with ARMS and those with FEP.
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22
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Grover S, Sahoo S, Nehra R, Chakrabarti S, Avasthi A. Relationship of depression with cognitive insight and socio-occupational outcome in patients with schizophrenia. Int J Soc Psychiatry 2017; 63:181-194. [PMID: 28162014 DOI: 10.1177/0020764017691314] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
AIM To evaluate the prevalence of depression using different measures in patients with schizophrenia and to study the relationship of depression in schizophrenia with cognitive insight and clinical insight, disability and socio-occupational functioning. METHODS A total of 136 patients with schizophrenia were evaluated for depression, cognitive insight and socio-occupational functioning. RESULTS Of the 136 patients included in the study, one-fourth ( N = 34; 25%) were found to have depression as per the Mini International Neuropsychiatric Interview (MINI). The prevalence of depression as assessed by Calgary Depression Scale for Schizophrenia (CDSS), Hamilton depression rating scale (HDRS) and Depressive Subscale of Positive and Negative Syndrome Scale (PANSS-D) was 23.5%, 19.9% and 91.9%, respectively. Among the different scales, CDSS has highest concordance with clinician's diagnosis. Sensitivity, specificity, positive predictive value and negative predictive value for CDSS was also higher than that noted for HDRS and PANSS-D. When those with and without depression as per clinician's diagnosis were compared, those with depression were found to have significantly higher scores on Positive and Negative Syndrome Scale (PANSS) positive and general psychopathology subscales, PANSS total score, participation restriction as assessed by P-scale and had lower level of functioning as assessed by Global Assessment of Functioning (GAF). No significant difference was noted on negative symptom subscale of PANSS, clinical insight as assessed on G-12 item of PANSS, disability as assessed by Indian Disability Evaluation and Assessment Scale (IDEAS) and socio-occupational functioning as assessed by Social and Occupational Functioning Assessment Scale (SOFS). In terms of cognitive insight, those with depression had significantly higher score for both the subscales, that is, self-reflective and self-certainty subscales as well as the mean composite index score. CONCLUSION Our results suggest that one-fourth of patients with schizophrenia have depression, compared to HDRS and PANSS-D, CDSS has highest concordance with clinician's diagnosis of depression and presence of depression is related to cognitive insight.
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Affiliation(s)
- Sandeep Grover
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Swapnajeet Sahoo
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Ritu Nehra
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Subho Chakrabarti
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Ajit Avasthi
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh, India
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Siani C, de Peretti C, Millier A, Boyer L, Toumi M. Predictive models to estimate utility from clinical questionnaires in schizophrenia: findings from EuroSC. Qual Life Res 2016; 25:925-34. [PMID: 26385367 PMCID: PMC4830865 DOI: 10.1007/s11136-015-1120-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2015] [Indexed: 12/02/2022]
Abstract
OBJECTIVE The clinical symptoms of schizophrenia are associated with serious social, quality of life and functioning alterations. Typically, data on health utilities are not available in clinical studies in schizophrenia. This makes the economic evaluation of schizophrenia treatments challenging. The purpose of this article was to provide a mapping function to predict unobserved utility values in patients with schizophrenia from the available clinical and socio-demographic information. METHODS The analysis was performed using data from EuroSC, a 2-year, multi-centre, cohort study conducted in France (N = 288), Germany (N = 618), and the UK (N = 302), totalling 1208 patients. Utility was calculated based on the EQ-5D questionnaire. The relationships between the utility values and the patients' socio-demographic and clinical characteristics (Positive and Negative Syndrome Scale--PANSS, Calgary Depression Scale for Schizophrenia--CDSS, Global Assessment of Functioning--GAF, extra-pyramidal symptoms measured by Barnes Akathisia Scale-BAS, age, sex, country, antipsychotic type) were modelled using a random and a fixed individual effects panel linear model. RESULTS The analysis demonstrated the prediction ability of the used parameters for estimating utility measures in patients with schizophrenia. Although there are small variations between countries, the same variables appear to be the key predictors. From a clinical perspective, age, gender, psychopathology, and depression were the most important predictors associated with the EQ-5D. CONCLUSION This paper proposed a reliable, robust and easy-to-apply mapping method to estimate EQ-5D utilities based on demographic and clinical measures in schizophrenia.
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Affiliation(s)
- Carole Siani
- Research Laboratory in Knowledge Engineering (ERIC, EA3083), Institute of Pharmaceutical and Biological Sciences (ISPB), University Claude Bernard Lyon 1, 11 Rue Guillaume Paradin, 69372, Lyon Cedex 08, France.
| | - Christian de Peretti
- Laboratory of Actuarial and Financial Sciences (SAF, EA2429), Institute of Financial and Insurance Sciences (ISFA School), University Claude Bernard Lyon 1, 50 Avenue Tony Garnier, 69366, Lyon Cedex 7, France
| | - Aurélie Millier
- Creativ-Ceutical, 215 Rue du Faubourg Saint Honoré, 75008, Paris, France.
| | - Laurent Boyer
- Laboratory of Public Health (EA 3279), Faculty of Medicine, Aix-Marseille University, 27 bd Jean Moulin, 13385, Marseille Cedex 05, France
| | - Mondher Toumi
- Aix-Marseille University, 27 bd Jean Moulin, 13385, Marseille Cedex 05, France
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A structural equation modelling approach to explore the determinants of quality of life in schizophrenia. Schizophr Res 2016; 171:27-34. [PMID: 26781001 DOI: 10.1016/j.schres.2016.01.012] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 12/03/2015] [Accepted: 01/04/2016] [Indexed: 11/21/2022]
Abstract
OBJECTIVE This study aimed to analyse the relationships among psychotic symptoms, depression, neurocognition and functioning as determinants of quality of life (QoL) in patients with schizophrenia. METHODS In this cross-sectional study, we evaluated QoL with the Schizophrenia Quality of Life 18-item scale (S-QoL 18), neurocognition with multiple tests exploring memory, attention and executive functions, the severity of psychotic symptoms with the Positive and Negative Syndrome Scale (PANSS), depression with the Calgary Depression Scale for Schizophrenia (CDSS) and functioning using the Functional Remission Of General Schizophrenia (FROGS) scale. We used Structural Equation Modelling (SEM) to describe the relationships among the severity of psychotic symptoms, depression, neurocognition, functioning and QoL. RESULTS Two hundred and seventy-one outpatients with schizophrenia participated in our study. SEM showed good fit with χ(2)/df=1.97, root mean square error of approximation=0.06, comparative fit index=0.93 and standardized root mean square residuals=0.05. This model revealed that depression was the most important feature associated with QoL, mainly for the self-esteem, autonomy and resilience dimensions (direct path coefficient=-0.46). The direct path between functioning and QoL was also significant (path coefficient=0.26). The severity of psychotic symptoms and neurocognitive impairment were weakly and indirectly associated with QoL via functioning (path coefficients=-0.18 and 0.04, respectively). CONCLUSIONS This study contributes to a better understanding of the determinants of QoL in schizophrenia. Our findings should be considered in developing effective strategies for improving QoL among this population.
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Uwatoko T, Yoshizumi M, Miyata J, Ubukata S, Fujiwara H, Kawada R, Kubota M, Sasamoto A, Sugihara G, Aso T, Urayama S, Fukuyama H, Murai T, Takahashi H. Insular Gray Matter Volume and Objective Quality of Life in Schizophrenia. PLoS One 2015; 10:e0142018. [PMID: 26544607 PMCID: PMC4636237 DOI: 10.1371/journal.pone.0142018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 10/15/2015] [Indexed: 12/21/2022] Open
Abstract
Improving quality of life has been recognized as an important outcome for schizophrenia treatment, although the fundamental determinants are not well understood. In this study, we investigated the association between brain structural abnormalities and objective quality of life in schizophrenia patients. Thirty-three schizophrenia patients and 42 age-, sex-, and education-matched healthy participants underwent magnetic resonance imaging. The Quality of Life Scale was used to measure objective quality of life in schizophrenia patients. Voxel-based morphometry was performed to identify regional brain alterations that correlate with Quality of Life Scale score in the patient group. Schizophrenia patients showed gray matter reductions in the frontal, temporal, limbic, and subcortical regions. We then performed voxel-based multiple regression analysis in these regions to identify any correlations between regional gray matter volume and Quality of Life Scale scores. We found that among four subcategories of the scale, the Instrumental Role category score correlated with gray matter volume in the right anterior insula in schizophrenia patients. In addition, this correlation was shown to be mediated by negative symptoms. Our findings suggest that the neural basis of objective quality of life might differ topographically from that of subjective QOL in schizophrenia.
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Affiliation(s)
- Teruhisa Uwatoko
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Kyoto University Health Service, Kyoto, Japan
| | - Miho Yoshizumi
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Jun Miyata
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shiho Ubukata
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hironobu Fujiwara
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Kyoto University Hospital Integrated Clinical Education Center, Kyoto, Japan
| | - Ryosaku Kawada
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Manabu Kubota
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Molecular Neuroimaging Program, Molecular Imaging Center, National Institute of Radiological Sciences, Chiba, Japan
| | - Akihiko Sasamoto
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Genichi Sugihara
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Toshihiko Aso
- Human Brain Research Center, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shinichi Urayama
- Human Brain Research Center, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hidenao Fukuyama
- Human Brain Research Center, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Toshiya Murai
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hidehiko Takahashi
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Zeng Y, Zhou Y, Lin J, Zhou Y, Yu J. Generic and disease-specific quality of life and its predictors among Chinese inpatients with schizophrenia. Psychiatry Res 2015; 228:724-8. [PMID: 26077848 DOI: 10.1016/j.psychres.2015.05.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 05/26/2015] [Accepted: 05/28/2015] [Indexed: 11/24/2022]
Abstract
This study aims to describe generic and disease-specific quality of life (QOL) and its predictors among Chinese inpatients with schizophrenia. A total of 209 subjects participated in this study: 121 men and 88 women. Their ages ranged from 18 to 64, with a mean age of 33.85 (S.D.=10.84). The total scores of generic and disease-specific QOL were statistically significant, correlated with patients׳ total symptom severity scores and social support scores (all P values less than 0.01). Multiple regression analysis revealed that monthly household income and subjective social support were statistically significant predictors of generic and disease-specific QOL. Duration of hospitalization, support use degree, negative and general psychopathology symptoms were additional significant predictors of disease-specific QOL. This study suggests the importance of improving subjective social support in order to promote generic and disease-specific QOL. Controlling negative and general psychopathology symptoms and improving support use degree could additionally enhance the disease-specific QOL in patients with schizophrenia.
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Affiliation(s)
- Yingchun Zeng
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Meidcal University, No 63 DuoBao Road, Liwan District, Guangzhou, Guangdong Province 510150 China.
| | - Ying Zhou
- School of Nursing, Guangzhou Medical University, Guangzhou, China
| | - Jiankui Lin
- Department of Nursing, Guangzhou Psychiatric Hospital, Guangzhou, China
| | - Yuqiu Zhou
- School of Nursing, Harbin Medical university, Daqing China
| | - Jianying Yu
- Department of Nursing, Hunan Psychiatric Hospital, Changsha, China
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Norlelawati AT, Kartini A, Norsidah K, Ramli M, Wan Azizi WS, Tariq AR. Relationship of psychological symptoms, antipsychotics and social data with psychosocial function in schizophrenia patients in Malaysia. Asia Pac Psychiatry 2015; 7:45-53. [PMID: 23857669 DOI: 10.1111/appy.12089] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Accepted: 04/15/2013] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The present study investigated the relationship between psychological symptoms and psychosocial function and the role of relevant sociodemographic data and antipsychotic use in the prediction of psychosocial function among multiracial schizophrenia outpatients in Malaysia. METHODS A total of 223 participants were recruited in this cross-sectional study conducted from December 2010 to April 2011. Psychological symptoms were assessed using the Positive and Negative Syndrome Scale whilst the psychosocial function was assessed using the Personal and Social Performance scale. Sociodemographic and treatment variables were gathered through interview or review of the medical records. RESULTS All dimensions of psychosocial functions were inversely correlated with Positive and Negative Syndrome Scale sub-domains. Only the disorganization sub-domain significantly predicts all dimensions of psychosocial function. For social data, body mass index and employment status were significant predictors of all dimensions of psychosocial functions. Typical antipsychotics significantly predict social function negatively as compared to sulpiride (β = -0.152, P = 0.028). DISCUSSION We found that the relationship between psychological symptoms and psychosocial functions were relatively consistent with the findings from the Caucasian population. Additionally, disorganization was the only significant predictor of all dimensions of psychosocial functions. This further emphasized the importance of cognition in psychosocial function. The roles of sulpiride, body mass index and employment status as predictors of psychosocial function were also discussed.
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Affiliation(s)
- A Talib Norlelawati
- Department of Basic Medical Sciences, Faculty of Medicine, International Islamic University Malaysia, Kuantan, Malaysia
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Depressive Symptoms during an Acute Schizophrenic Episode: Frequency and Clinical Correlates. DEPRESSION RESEARCH AND TREATMENT 2015; 2015:674641. [PMID: 26664745 PMCID: PMC4667057 DOI: 10.1155/2015/674641] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 11/03/2015] [Accepted: 11/10/2015] [Indexed: 11/29/2022]
Abstract
Introduction. Depressive symptoms are common in schizophrenia and are associated with poorer functioning, lower quality of life, and an elevated risk of suicidal behaviour. There are few studies on the occurrence and correlates of these symptoms in acutely ill patients with schizophrenia. Method. 72 acutely ill patients with schizophrenia were assessed for depression using the Calgary Depression Scale for Schizophrenia (CDSS). A cut-off score of ≥6 on the CDSS was used to identify clinically significant depressive symptoms. The relationship between depression and illness variables, including psychotic symptom dimensions as measured by the Positive and Negative Syndrome Scale for Schizophrenia (PANSS), was examined. Results. Eleven (15.3%) patients had clinically significant depressive symptoms. These patients scored higher on the positive and general psychopathology scales of the PANSS and had higher rates of suicidal behavior and poorer functioning. The severity of depressive symptoms was positively correlated with the PANSS positive subscale and negatively correlated with the PANSS negative subscale. Discussion. These findings confirm previous reports that depressive symptoms in active schizophrenia is related to the severity of positive psychotic symptoms and is a risk factor for suicidal behaviour in these patients.
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Hayhurst KP, Massie JA, Dunn G, Lewis SW, Drake RJ. Validity of subjective versus objective quality of life assessment in people with schizophrenia. BMC Psychiatry 2014; 14:365. [PMID: 25539658 PMCID: PMC4300039 DOI: 10.1186/s12888-014-0365-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 12/17/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Quality of life (QoL) is considered an important outcome in health research. It can be rated by the patient, or by an external assessor. We wished to identify the predictors of any discrepancies between these two approaches in people with schizophrenia. METHODS Patients with DSM schizophrenia and related disorders (N = 80) completed both patient-rated (Lancashire Quality of Life Profile; LQOLP) and assessor-rated (Heinrich's Quality of Life Scale; QLS) measures of QoL. RESULTS Patient-rated (LQOLP) and assessor-rated (QLS) measures showed a modest correlation (r = 0.38). In a regression analysis, independent predictors of subjectively-rated QoL being higher than objectively-assessed QoL in the same patient, were low insight score (BIS), negative symptoms (PANSS), absence of depression (CDSS), and less positive attitude toward prescribed treatment (DAI). CONCLUSIONS In people with schizophrenia, scores on objectively- and subjectively-rated measures of quality of life can differ markedly. When comparing subjective to objective assessments, patients with depressive symptoms will value their QoL lower, and those with low insight will value their QoL higher. This has important implications for the utility and interpretation of QoL measures in schizophrenia.
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Affiliation(s)
- Karen P Hayhurst
- Institute of Brain, Behaviour and Mental Health, The University of Manchester, Manchester, M13 9PL, UK.
| | - Jennifer A Massie
- Laureate House Mental Health Unit, Manchester Mental Health & Social Care Trust, Wythenshawe Hospital, Southmoor Road, Manchester, UK.
| | - Graham Dunn
- Centre for Biostatistics, Institute of Population Health, The University of Manchester, Manchester, UK.
| | - Shôn W Lewis
- Institute of Brain, Behaviour and Mental Health, The University of Manchester, Manchester, M13 9PL, UK.
| | - Richard J Drake
- Institute of Brain, Behaviour and Mental Health, The University of Manchester, Manchester, M13 9PL, UK.
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Relative contributions of negative symptoms, insight, and coping strategies to quality of life in stable schizophrenia. Psychiatry Res 2014; 220:102-11. [PMID: 25128248 DOI: 10.1016/j.psychres.2014.07.019] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 07/02/2014] [Accepted: 07/05/2014] [Indexed: 11/24/2022]
Abstract
The purpose of this cross-sectional study was to examine the relative contributions of negative symptomatology, insight, and coping to quality of life (QOL) in a sample of 92 consecutive outpatients with stable schizophrenia referring to the Department of Neuroscience, Psychiatric Section, University of Turin, Struttura Semplice di Coordinamento a Valenza Dipartimentale (SSCVD), Department of Mental Health ASL TO1, Molinette, Italy, in the period between July 2009 and July 2011. In order to assess the specific effect of negative symptoms on QOL and the possible mediating role of insight and coping, two mediation hypotheses were tested, using multiple regression analyses specified by Baron and Kenny (1986). Our findings suggest that (a) higher negative symptoms predict a worse Quality of Life Scale (QLS) intrapsychic foundations (IF) subscale score; (b) attribution of symptoms and coping-social diversion have a direct and positive association with QLS-IF; (c) patients high in negative symptoms are less likely to use attribution of symptoms and coping-social diversion; and (d) attribution of symptoms and coping-social diversion act as partial mediators in the negative symptoms-QOL relationship. The prediction model accounts for 45.3% of the variance of the QLS-IF subscale score in our sample. In conclusion, our results suggest that insight and coping-social diversion substantially contribute to QOL in patients with higher negative symptoms. These factors are potentially modifiable from specific therapeutic interventions, which can produce considerable improvements in the QOL of this population.
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Relationship between depressive symptoms and quality of life in Nigerian patients with schizophrenia. Soc Psychiatry Psychiatr Epidemiol 2014; 49:1191-8. [PMID: 24549838 DOI: 10.1007/s00127-014-0838-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 02/03/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Quality of life (QOL) in patients with schizophrenia is influenced by various factors such as depressive symptoms. This study assessed the relationship between depressive symptoms and QOL in outpatients with schizophrenia in Nigeria and evaluated the associated socio-demographic and clinical factors. METHODS One hundred patients with 10th edition of the International Classification of Diseases diagnosis of schizophrenia participated in this study. Socio-demographic and clinical factors such as depression were assessed with Zung Self-rating Depression Scale and symptoms of schizophrenia with the Positive and Negative Syndrome Scale of schizophrenia (PANSS). The level of functioning was assessed with the Global Assessment of Functioning Scale. QOL was assessed using the brief version of the World Health Organisation Quality of Life Scale. RESULTS There were 27 (27.0 %) patients with depression. The depressed patients reported significant lower scores in all QOL domains when compared with the non-depressed group. All QOL domains were significantly negatively correlated with the total PANSS and all its subscales (except for psychological domain with total PANSS and social relationship and environmental domains with PANSS positive). Severity of depressive symptoms was significantly negatively correlated with all QOL domains. Functioning was significantly positively correlated with all QOL domains except in the environmental domain. Multiple regression analysis showed that depressive symptoms predicted all QOL domains except the social relationship domain while negative symptoms predicted social relationship and environmental domains. CONCLUSION Depression is a common occurrence during the course of schizophrenia. Depressive and negative symptoms have a significant impact on the QOL of patients with schizophrenia.
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Hamaideh S, Al-Magaireh D, Abu-Farsakh B, Al-Omari H. Quality of life, social support, and severity of psychiatric symptoms in Jordanian patients with schizophrenia. J Psychiatr Ment Health Nurs 2014; 21:455-65. [PMID: 24118684 DOI: 10.1111/jpm.12112] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/30/2013] [Indexed: 11/30/2022]
Abstract
The major purposes of this study were to examine levels and correlations of quality of life (QOL), social support, and severity of psychiatric symptoms as well as to identify the variables that best predict QOL among Jordanian patients with schizophrenia. Descriptive cross-sectional design was used to collect data from 160 patients selected through systematic random sampling from two psychiatric outpatient clinics. Results showed that the highest domain of QOL was the social relationship domain, and the highest source of social support was perceived from significant others. Severity of affective symptoms was the highest, and severity of positive symptoms was the lowest. QOL correlated positively with social support, patients' educational and income level, and employment; and negatively with severity of psychiatric symptoms, duration of untreated illness, and duration of treatment. Support from friends, duration of untreated illness, income level, and severity of affective symptoms predicted QOL and accounting for 47.3% of the variance.
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Affiliation(s)
- S Hamaideh
- Community and Mental Health Nursing Department, Faculty of Nursing, The Hashemite University, Zarqa, Jordan
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Chou CY, Ma MC, Yang TT. Determinants of subjective health-related quality of life (HRQoL) for patients with schizophrenia. Schizophr Res 2014; 154:83-8. [PMID: 24613000 DOI: 10.1016/j.schres.2014.02.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Revised: 01/24/2014] [Accepted: 02/14/2014] [Indexed: 11/25/2022]
Abstract
PURPOSE To identify the determinants of schizophrenia-specific HRQoL levels, five types of factors (i.e., sociodemographic, clinical, psychopathological, neurocognitive, and psychosocial factors) were simultaneously investigated in the same cross-sectional sample. METHODS A total of 120 patients with a diagnosis of schizophrenia but not spectrum conditions were recruited by convenience sampling. Subjective HRQoL levels were measured using the disease-specific S-QoL-C. After sociodemographic and clinical data were collected, psychopathological data were self-rated with the Beck Depression Inventory-II (BDI-II) and were assessed with the Positive and Negative Syndrome Scale (PANSS) by professionally trained raters. Two neurocognitive assessments were conducted by licensed occupational therapists (OTs). Psychosocial factors were assessed using self-reports measures, including the, General Self-Efficacy Scale (GSES), Rosenberg Self-Esteem Scale (RSES), and Social Impact Scale (SIS). All measures were administered in random order. OTs, PANSS raters, and participants were blinded to score computation, and multiple hierarchical regression with the stepwise method was conducted. RESULTS The S-QoL-C scores were most strongly affected by psychosocial factors and the psychopathological factors, followed by clinical and sociodemographic factors. Total scores on the BDI-II had the largest contributions to S-QoL-C index scores and seven of eight S-QoL-C subscales. In addition, the GSES, RSES, and SIS showed effects across the S-QoL-C subscales. The BDI-II, GSES, and RSES all influenced the S-QoL-C index scores, in addition to the number of hospitalizations. CONCLUSION Psychosocial factors and psychopathological factors measured by the BDI-II had the greatest impact on schizophrenia-specific HRQoL levels. Psychiatric treatment programs focusing on psychosocial status and depressive symptoms can improve schizophrenia-specific HRQoL levels.
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Affiliation(s)
- Chia-Yeh Chou
- Department of Occupational Therapy, College of Medicine, Fu-Jen Catholic University, No. 510, ZhongZheng Road, Xinzhuang Dist., New Taipei City 24205 Taiwan.
| | - Mi-Chia Ma
- Department of Statistics, National Cheng Kung University, No. 1, University Road, Tainan City 701 Taiwan
| | - Tsung-Tsair Yang
- Department of Psychiatry, National Defense Medical Center, No. 161, Sec 6, Minquan E. Road, Neihu Dist., Taipei City 114 Taiwan
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Torres-González F, Ibanez-Casas I, Saldivia S, Ballester D, Grandón P, Moreno-Küstner B, Xavier M, Gómez-Beneyto M. Unmet needs in the management of schizophrenia. Neuropsychiatr Dis Treat 2014; 10:97-110. [PMID: 24476630 PMCID: PMC3897352 DOI: 10.2147/ndt.s41063] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Studies on unmet needs during the last decades have played a significant role in the development and dissemination of evidence-based community practices for persistent schizophrenia and other severe mental disorders. This review has thoroughly considered several blocks of unmet needs, which are frequently related to schizophrenic disorders. Those related to health have been the first block to be considered, in which authors have examined the frequent complications and comorbidities found in schizophrenia, such as substance abuse and dual diagnosis. A second block has been devoted to psychosocial and economic needs, especially within the field of recovery of the persistently mentally ill. Within this block, the effects of the current economic difficulties shown in recent literature have been considered as well. Because no patient is static, a third block has reviewed evolving needs according to the clinical staging model. The fourth block has been dedicated to integrated evidence-based interventions to improve the quality of life of persons with schizophrenia. Consideration of community care for those reluctant to maintain contact with mental health services has constituted the fifth block. Finally, authors have aggregated their own reflections regarding future trends. The number of psychosocial unmet needs is extensive. Vast research efforts will be needed to find appropriate ways to meet them, particularly regarding so-called existential needs, but many needs could be met only by applying existing evidence-based interventions. Reinforcing research on the implementation strategies and capacity building of professionals working in community settings might address this problem. The final aim should be based on the collaborative model of care, which rests on the performance of a case manager responsible for monitoring patient progress, providing assertive follow-up, teaching self-help strategies, and facilitating communication among the patient, family doctor, mental health specialist, and other specialists.
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Affiliation(s)
- Francisco Torres-González
- Centro de Investigación Biomédica en Red de Salud Mental, University of Granada, Spain ; Maristán Network, University of Granada, Granada, Spain
| | - Inmaculada Ibanez-Casas
- Centro de Investigación Biomédica en Red de Salud Mental, University of Granada, Spain ; Maristán Network, University of Granada, Granada, Spain
| | - Sandra Saldivia
- Department of Psychiatry and Mental Health, Faculty of Medicine, University of Concepcion, Chile ; Maristán Network, University of Granada, Granada, Spain
| | - Dinarte Ballester
- Sistema de Saúde Mãe de Deus, Escola Superior de Saúde, Universidade do Vale do Rio dos Sinos, Brazil ; Maristán Network, University of Granada, Granada, Spain
| | - Pamela Grandón
- Department of Psychology, Faculty of Social Sciences, University of Concepcion, Chile ; Maristán Network, University of Granada, Granada, Spain
| | - Berta Moreno-Küstner
- Andalusian Psychosocial Research Group and Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology, University of Malaga, Spain ; Maristán Network, University of Granada, Granada, Spain
| | - Miguel Xavier
- Department of Mental Health, NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal ; Maristán Network, University of Granada, Granada, Spain
| | - Manuel Gómez-Beneyto
- Centro de Investigación Biomédica en Red de Salud Mental, University of Valencia, Spain ; Maristán Network, University of Granada, Granada, Spain
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Functional recovery results from the risperidone long-acting injectable versus quetiapine relapse prevention trial (ConstaTRE). Acta Neuropsychiatr 2013; 25:297-306. [PMID: 25287730 DOI: 10.1017/neu.2013.7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE ConstaTRE is an open-label, randomised, controlled, relapse prevention trial in patients with stable schizophrenia or schizoaffective disorder switched to risperidone long-acting injectable (RLAI) or oral quetiapine, and was designed to test the hypothesis that injectable antipsychotic treatment with risperidone would be more effective than oral therapy with quetiapine. Here we report the functional recovery results from the ConstaTRE trial. METHODS Clinically stable adults previously treated with oral risperidone, olanzapine, or oral first-generation antipsychotics were randomised to RLAI or quetiapine for 24 months. Functional recovery was assessed using the Social and Occupational Functioning Assessment Scale (SOFAS) and two quality-of-life (QoL) measures [Medical Outcomes Survey Short Form-12 (SF-12) and Schizophrenia Quality-of-Life Scale Revision 4 (SQLS-R4)]. RESULTS A total of 666 patients were randomised and treated with RLAI (n = 329) or quetiapine (n = 337). Relapse occurred in 16.5% RLAI and 31.3% quetiapine patients. Significant improvements in SOFAS, SF-12, and SQLS-R4 scores were observed from baseline to month 24 with both RLAI and quetiapine. At months 6, and 12, and endpoint, improvement in SOFAS score was significantly greater for RLAI than quetiapine (p < 0.05). CONCLUSIONS Among patients with stable schizophrenia or schizoaffective disorder, the likelihood of functional recovery appears to be higher in those switching to RLAI than to quetiapine, although improvements in functional status and QoL were observed with both treatments.
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Subjective well-being, but not subjective mental functioning shows positive associations with neuropsychological performance in schizophrenia-spectrum disorders. Compr Psychiatry 2013; 54:824-30. [PMID: 23602393 DOI: 10.1016/j.comppsych.2013.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Revised: 01/25/2013] [Accepted: 02/04/2013] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To assess the association of subjective quality of life as measured by the Subjective Well-being under Neuroleptic Treatment questionnaire (SWN-K) with neuropsychological functioning; to address interactions with the SWN-K domain mental functioning as a measure of subjective cognitive dysfunction; and to examine the interaction of subjective well-being and psychopathology ratings. METHODS Forty-five patients diagnosed with schizophrenia spectrum disorder (SSD) were assessed regarding subjective well-being (SWN-K), neuropsychological impairment, and psychopathology (Brief Psychiatric Rating Scale; BPRS). RESULTS After controlling for multiple comparisons, SWN-K total score showed significant positive correlations with concentration/attention (r=.498), working memory (r=.537), verbal memory (r=.522), and global cognition (r=.459). No correlations of SWN mental functioning and neuropsychological impairment remained significant after Bonferroni correction. Correlations between SWN-K subscales and neuropsychological functioning were generally positive, indicating higher subjective well-being in patients with better neurocognition. In multivariate analyses, global cognition was a significant predictor (p=.011), accounting for 19.7% of SWN total score variance. Adding BPRS total score as predictor (p=.054) explained an additional 6.9% of SWN-K variance. Linear regression analyses with SWN-K mental functioning as dependent variable did not yield statistically significant models. CONCLUSION Subjective well-being and objective neuropsychological functioning show only moderate associations and can be seen as largely independent parameters. In particular, subjective mental functioning cannot serve as a proxy for objective neuropsychological testing.
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Wärdig RE, Bachrach-Lindström M, Foldemo A, Lindström T, Hultsjö S. Prerequisites for a healthy lifestyle-experiences of persons with psychosis. Issues Ment Health Nurs 2013; 34:602-10. [PMID: 23909672 DOI: 10.3109/01612840.2013.790525] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The purpose of this study is to explore prerequisites for a healthy lifestyle as described by individuals diagnosed with psychosis. Forty participants who had performed a lifestyle intervention focusing on physical activities and lifestyle education were interviewed. Conventional content analysis was used. The results are described in two categories: (1) Individual Prerequisites and (2) Being a Part of Society. The individuals said that they got stuck in a state of planning without taking action. It was pointless to make a bigger effort because the psychotic disorder could, at any time, worsen the prerequisites. They also said that they wanted to live like everybody else and therefore tried to adopt a normal lifestyle. Future interventions or professional support by mental health nurses and other health care givers should target the transition from planning to action to achieve a healthy lifestyle, and should help the individual to taking part in society.
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Affiliation(s)
- Rikard Erik Wärdig
- Department of Medical and Health Sciences, Linköpings University, Linköping, Sweden.
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Jetha MK, Goldberg JO, Schmidt LA. Temperament and its relation to social functioning in schizophrenia. Int J Soc Psychiatry 2013; 59:254-63. [PMID: 22271885 DOI: 10.1177/0020764011433639] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND We previously noted increased shyness in stable community outpatients with schizophrenia compared to healthy controls and that shyness may be a risk factor for social functioning impairment in this population (Goldberg & Schmidt, 2001). AIMS We attempted to replicate and extend these findings by comparing the use of a brief trait measure of shyness and sociability (SS; Cheek, 1983; Cheek & Buss, 1981) with the longer Temperament and Character Inventory (TCI; Cloninger, Przybeck, Svrakic, & Wetzel, 1994) used traditionally in work to measure personality dimensions in this population. METHODS A group of stable outpatients with schizophrenia (n = 41) and healthy controls (n = 41) matched on age and gender were compared on the SS and TCI measures. Patients were assessed on clinical symptoms using the Positive and Negative Symptom Scale (PANSS) and on social functioning measures using a Quality of Life Scale (QLS). RESULTS Patients reported significantly higher shyness, retrospective inhibition and harm avoidance, and lower novelty seeking, self-directedness and cooperativeness than healthy adults, replicating previous findings. Shyness and sociability were related to conceptually linked dimensional sub-scales of the TCI and were predictive of social functioning in the patient group. Importantly, scores on these measures were unrelated to symptom profiles and explained additional variance in social functioning beyond clinical symptoms. CONCLUSIONS These findings suggest that individual differences in trait shyness and sociability may influence social functioning in stable outpatients with schizophrenia. The results also support the use of the brief trait measures of shyness and sociability in this population.
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Affiliation(s)
- Michelle K Jetha
- Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, Ontario, Canada.
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Ubukata S, Miyata J, Yoshizumi M, Uwatoko T, Hirao K, Fujiwara H, Kawada R, Fujimoto S, Tanaka Y, Kubota M, Sasamoto A, Sawamoto N, Fukuyama H, Takahashi H, Murai T. Regional gray matter reduction correlates with subjective quality of life in schizophrenia. J Psychiatr Res 2013; 47:548-54. [PMID: 23391130 DOI: 10.1016/j.jpsychires.2013.01.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Revised: 11/23/2012] [Accepted: 01/07/2013] [Indexed: 10/27/2022]
Abstract
Subjective quality of life (QOL) has been recognized as an important consideration in schizophrenia. Several symptoms and neurocognitive functions were shown to be correlated with subjective QOL; however its determinants are not well understood. In this study, we investigated the association between brain structural abnormalities and subjective QOL in patients with schizophrenia. Forty-five schizophrenia patients and 48 age, sex, and education-matched healthy participants underwent magnetic resonance imaging (MRI), and the Schizophrenia Quality of Life Scale (SQLS) was used to rate subjective QOL. We performed voxel-based morphometry (VBM) to investigate regional brain alterations. Relative to normal controls, schizophrenia patients exhibited gray matter reductions mainly in the frontal and temporal regions. Worse psychosocial subscale of SQLS was associated with gray matter (GM) reduction in the right dorsolateral prefrontal cortex (DLPFC), and worse motivation/energy subscale was associated with gray matter reduction in the left superior frontal sulcus, left parahippocampal gyrus, and the left inferior temporal gyrus. The correlation between DLPFC GM volume and psychosocial subscale of SQLS disappeared after controlling for severity of psychopathology, while the other correlations remained significant when controlled by demographic and clinical variables. Combining imaging techniques with psychosocial methods would help to elucidate those factors that are associated with QOL.
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Affiliation(s)
- Shiho Ubukata
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Shogoin-Kawaharacho 54, Kyoto 606-8507, Japan
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Caqueo-Urízar A, Gutiérrez-Maldonado J, Ferrer-García M, Morales AU, Fernández-Dávila P. Typology of schizophrenic symptoms and quality of life in patients and their main caregivers in northern Chile. Int J Soc Psychiatry 2013; 59:93-100. [PMID: 21971984 DOI: 10.1177/0020764011423465] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Schizophrenia is a serious mental disorder characterized by the presence of both 'positive' and 'negative' symptoms that affect the essential functions through which a person gains his or her sense of individuality and capacity for independent functioning. AIMS To describe the typology of schizophrenic symptoms and their relationship to quality of life in patients with schizophrenia and their main caregivers. METHODS Participants were 45 patients and 45 relatives seen by the mental health services in Arica, Chile. Patients were assessed using the Positive and Negative Syndrome Scale (PANSS), the Seville Quality of Life Questionnaire (SQLQ), and the Social Functioning Scale (SFS). The latter was also administered to caregivers, along with the Zarit Burden Interview. RESULTS Patients reported moderate levels of quality of life, there being a strong relationship with the negative syndrome and the general psychopathology of the disorder. The quality of life of main caregivers was related with the general psychopathology of patients. The results regarding social functioning and the caregivers' perceptions of patients' functional capacity showed that patients had a very limited degree of social integration. CONCLUSIONS Negative symptoms and general psychopathology are the main predictors of quality of life in both patients and their caregivers.
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Fujimaki K, Morinobu S, Yamashita H, Takahashi T, Yamawaki S. Predictors of quality of life in inpatients with schizophrenia. Psychiatry Res 2012; 197:199-205. [PMID: 22370148 DOI: 10.1016/j.psychres.2011.10.023] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2011] [Accepted: 10/31/2011] [Indexed: 10/28/2022]
Abstract
Shortening hospital stays has become a key focus in psychiatric care in recent years. However, patients with schizophrenia account for about 60% of inpatients in psychiatry departments in Japan. This study was designed to investigate the relationship between quality of life (QOL) and key indicators for long-term hospital stays among schizophrenia inpatients. A further aim was to elucidate the clinical determinants of QOL among long-stay inpatients. The study sample consisted of 217 inpatients with schizophrenia. Age, duration of illness, duration of hospitalization, years of education, body mass index, neurocognitive function, drug-induced extrapyramidal symptoms, involuntary movements, psychiatric symptoms, and dose equivalents of antipsychotics and anticholinergic agents were used as index factors. Pearson linear correlation and regression analyses were performed to examine the associations between QOL and the above-mentioned factors. Negative symptoms, psychological discomfort, and resistance as rated on the Brief Psychiatric Rating Scale (BPRS) were correlated with all subscale scores of the Japanese version of the Schizophrenia Quality of Life Scale (JSQLS). Stepwise regression showed that negative symptoms, psychological discomfort, and resistance predicted the dysfunction of psycho-social activity score and the dysfunction of motivation and energy score on the JSQLS. This study shows that active treatment for negative symptoms, psychological discomfort, and resistance should be recommended to improve QOL among inpatients with schizophrenia.
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Affiliation(s)
- Koichiro Fujimaki
- Faculty of Health and Welfare, Prefectural University of Hiroshima, Mihara, Japan.
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Fujimaki K, Takahashi T, Morinobu S. Association of typical versus atypical antipsychotics with symptoms and quality of life in schizophrenia. PLoS One 2012; 7:e37087. [PMID: 22615901 PMCID: PMC3353903 DOI: 10.1371/journal.pone.0037087] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Accepted: 04/18/2012] [Indexed: 11/18/2022] Open
Abstract
Background Several reports on patients with chronic schizophrenia suggest that atypical versus typical antipsychotics are expected to lead to better quality of life (QOL) and cognitive function. Our aim was to examine the association of chronic treatment with typical or atypical antipsychotics with cognitive function, psychiatric symptoms, QOL, and drug-induced extrapyramidal symptoms in long-hospitalized patients with schizophrenia. Methodology and Principal Findings The Hasegawa Dementia Scale-Revised (HDS-R), Brief Psychiatric Rating Scale (BPRS), the Schizophrenia Quality of Life Scale, translated into Japanese (JSQLS), and the Drug-Induced Extrapyramidal Symptoms Scale (DIEPSS) were used to evaluate cognitive function, psychiatric symptoms, QOL, and drug-induced extrapyramidal symptoms. We examined the correlation between the dose of antipsychotics and each measure derived from these psychometric tests. The student t-test was used to compare scores obtained from psychometric tests between patients receiving typical and atypical antipsychotics. Results showed significant correlations between chlorpromazine (CPZ)-equivalent doses of typical antipsychotics and atypical antipsychotics, and the total BPRS score and BPRS subscale scores for positive symptoms. CPZ-equivalent doses of typical antipsychotics were correlated with the JSQLS subscale score for dysfunction of psycho-social activity and DIEPSS score. Furthermore, the total BPRS scores, BPRS subscale score for positive symptoms, the JSQLS subscale score for dysfunction of psycho-social activity, and the DIEPSS score were significantly higher in patients receiving typical antipsychotics than atypical antipsychotics. Conclusion and Significance These findings suggest that long-term administration of typical antipsychotics has an unfavorable association with feelings of difficulties mixing in social situations in patients with chronic schizophrenia.
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Affiliation(s)
- Koichiro Fujimaki
- Faculty of Health and Welfare, Prefectural University of Hiroshima, Hiroshima, Japan.
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Ouzir M, Azorin JM, Adida M, Boussaoud D, Battas O. Insight in schizophrenia: from conceptualization to neuroscience. Psychiatry Clin Neurosci 2012; 66:167-79. [PMID: 22443240 DOI: 10.1111/j.1440-1819.2012.02325.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Lack of insight into illness is a prevalent and distinguishing feature of schizophrenia, which has a complex history and has been given a variety of definitions. Currently, insight is measured and treated as a multidimensional phenomenon, because it is believed to result from psychological, neuropsychological and organic factors. Thus, schizophrenia patients may display dramatic disorders including demoralization, depression and a higher risk of suicide, all of which are directly or indirectly related to a lack of insight into their illness, and make the treatment difficult. To improve the treatment of people with schizophrenia, it is thus crucial to advance research on insight into their illness. Insight is studied in a variety of ways. Studies may focus on the relationship between insight and psychopathology, may view behavioral outcomes or look discretely at the cognitive dysfunction versus anatomy level of insight. All have merit but they are dispersed across a wide body of literature and rarely are the findings integrated and synthesized in a meaningful way. The aim of this study was to synthesize findings across the large body of literature dealing with insight, to highlight its multidimensional nature, measurement, neuropsychology and social impact in schizophrenia. The extensive literature on the cognitive consequences of lack of insight and the contribution of neuroimaging techniques to elucidating neurological etiology of insight deficits, is also reviewed.
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Affiliation(s)
- Mounir Ouzir
- Laboratory of Clinical Neuroscience and Mental Health, Faculty of Medicine and Pharmacy, Casablanca, Morocco.
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Wilson-d'Almeida K, Karrow A, Bralet MC, Bazin N, Hardy-Baylé MC, Falissard B. In patients with schizophrenia, symptoms improvement can be uncorrelated with quality of life improvement. Eur Psychiatry 2011; 28:185-9. [PMID: 22153916 DOI: 10.1016/j.eurpsy.2011.10.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Revised: 10/05/2011] [Accepted: 10/05/2011] [Indexed: 10/14/2022] Open
Abstract
OBJECTIVES Quality of life has been found to be associated with symptoms in patients with schizophrenia. Nevertheless, the mechanism that underlies this association is still unclear. The objective of this paper is to prospectively evaluate the quality of life of patients with schizophrenia in relation to the concurrent evolution of their symptoms, their expectations and their perceived position in life. METHODS Participants included 306 outpatients with schizophrenia who were interviewed at baseline, 6 and 12 months, about their quality of life (Outcome revealed by Preference in Schizophrenia, OPS) and symptoms (Positive and Negative Syndrome Scale, PANSS). RESULTS Quality of life relative to subject expectations remained stable over time. A decrease in symptoms was correlated to an increase in both expectations and perceived position in life but did not correlate to quality of life. CONCLUSION The level of expectations seems to play a major role in the subjective assessment of quality of life in patients with schizophrenia. Symptom improvement is not necessarily associated with quality of life improvement relative to subject expectations. Caregivers should be aware of this result so as to deal with possible disappointments in patients receiving a new efficient treatment.
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Affiliation(s)
- K Wilson-d'Almeida
- Inserm U669, Maison de Solenn, 97, boulevard du Port-Royal, 75679 Paris cedex 14, France
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Vila-Rodriguez F, Ochoa S, Autonell J, Usall J, Haro JM. Complex interaction between symptoms, social factors, and gender in social functioning in a community-dwelling sample of schizophrenia. Psychiatr Q 2011; 82:261-74. [PMID: 21301960 DOI: 10.1007/s11126-011-9168-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Social functioning (SF) is the ultimate target aimed in treatment plans in schizophrenia, thus it is critical to know what are the factors that determine SF. Gender is a well-established variable influencing SF, yet it is not known how social variables and symptoms interact in schizophrenia patients. Furthermore, it remains unclear whether the interaction between social variables and symptoms is different in men compared to women. Our aim is to test whether social variables are better predictors of SF in community-dwelled individuals with schizophrenia, and whether men and women differ in how symptoms and social variables interact to impact SF. Community-dwelling individuals with schizophrenia (N = 231) were randomly selected from a register. Participants were assessed with symptom measures (PANSS), performance-based social scale (LSP), objective social and demographic variables. Stratification by gender and stepwise multivariate regression analyses by gender were used to find the best-fitting models that predict SF in both gender. Men had poorer SF than women in spite of showing similar symptom scores. On stepwise regression analyses, gender was the main variable explaining SF, with a significant contribution by disorganized and excitatory symptoms. Age of onset made a less marked, yet significant, contribution to explain SF. When the sample was stratified by gender, disorganized symptoms and 'Income' variable entered the model and accounted for a 30.8% of the SF variance in women. On the other hand, positive and disorganized symptoms entered the model and accounted for a 36.1% of the SF variance in men. Community-dwelling men and women with schizophrenia differ in the constellation of variables associated with SF. Symptom scores still account for most of the variance in SF in both genders.
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Affiliation(s)
- F Vila-Rodriguez
- Department of Psychiatry, BC Mental Health and Addiction Research Institute, University of British Columbia, 3rd Floor-938 West 28th Ave., CFRI Building, Vancouver, BC, V5Z 4H4, Canada.
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Karadayi G, Emiroğlu B, Uçok A. Relationship of symptomatic remission with quality of life and functionality in patients with schizophrenia. Compr Psychiatry 2011; 52:701-7. [PMID: 21296345 DOI: 10.1016/j.comppsych.2010.11.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2009] [Revised: 11/16/2010] [Accepted: 11/29/2010] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The aim of this study was to investigate the relationship between remission and quality of life (QoL) of patients with schizophrenia. METHOD Quality of life was investigated with the Quality-of-Life Scale, the Personal and Social Performance Scale (PSP), and the Evaluation of Functional Remission Scale in 102 outpatients with schizophrenia. Positive and Negative Syndrome Scale and Calgary Depression Scale for Schizophrenia (CDSS) were used to assess symptom severity. Remission was defined based on the Andreasen et al criteria (2005). RESULTS The remission group had higher levels of QoL and functionality as measured by the Quality-of-Life Scale (P = .001), PSP (P = .001), and Evaluation of Functional Remission Scale (P = .001). The remission group also had higher employment rates, lower smoking rates, and less depressive symptoms. We found that negative (P = .001) and positive symptoms of the Positive and Negative Syndrome Scale (P = .05) and CDSS score (P = .005) independently contributed to PSP score in a linear regression analysis. Years of education and positive symptoms were related to CDSS score. All of the 3 scales that we used to assess QoL and functionality were highly correlated with each other. In addition, the opinions of patients or relatives/partners about functionality of the patient was highly correlated with all of the scales. CONCLUSION We found significant differences between patients with schizophrenia with and without remission for QoL and functionality. Relative/partner's evaluation of functional status provides a reliable measure of QoL as well.
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Affiliation(s)
- Gülşah Karadayi
- Department of Psychiatry, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey.
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Is personal and social functioning associated with subjective quality of life in schizophrenia patients living in the community? Eur Arch Psychiatry Clin Neurosci 2011; 261:509-17. [PMID: 21384166 DOI: 10.1007/s00406-011-0200-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2011] [Accepted: 02/15/2011] [Indexed: 10/18/2022]
Abstract
Subjective quality of life (QoL) and psychosocial functioning constitute important treatment outcomes in schizophrenia. We aimed to investigate the relationship between them in schizophrenia patients living in the community. Symptom severity and insight were assessed with the Positive and Negative Syndrome Scale (PANSS) in 76 community schizophrenia patients. Social functioning was measured with the Portuguese version of Personal and Social Performance (PSP) scale, and subjective QoL was measured with the Portuguese version of the WHO Quality of Life Measure-Abbreviated Version (WHOQOL-Bref). The majority of patients were single (78%) and unemployed/inactive (74%). Mean PSP total score was 55.5, and mean scores on WHOQOL-Bref domains ranged from 54.1 to 63.0. Greater symptom severity and worse insight were significantly associated with worse functioning in all PSP domains. Symptoms were more moderately correlated with QoL, with no significant correlations between QoL and positive symptoms and insight levels. Partial correlations controlling for symptom severity revealed no significant associations between social functioning and subjective QoL. Symptom severity may exert a greater influence on social functioning than on subjective QoL; however, social functioning was not associated with subjective QoL. The results suggest these constructs might be independent and should be assessed separately. A broader research approach, with increased attention to social and psychological factors, may help identify treatment targets to improve schizophrenia patients' social functioning and QoL.
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Tomotake M. Quality of life and its predictors in people with schizophrenia. THE JOURNAL OF MEDICAL INVESTIGATION 2011; 58:167-74. [PMID: 21921416 DOI: 10.2152/jmi.58.167] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
The author reviewed measurement of quality of life (QOL) of schizophrenia patients and the clinical factors related to their QOL. As schizophrenia patients were thought to be unable to assess their own QOL because of their cognitive impairment, objective QOL measures had been frequently used. However, nowadays, there is general agreement that symptomatically stabilized patients could assess their QOL by themselves. Therefore, researchers gradually have become interested in subjective QOL measure. Although most researchers often evaluate schizophrenia patients' QOL using only subjective or objective QOL measure, considering the fact that there is a discrepancy between the two types of measures, it is recommended to use both of them as complementary measures. As for clinical factors related to lowered QOL, several studies reported that depressive symptom was most associated with lowered subjective QOL, negative symptom was strongly related to lowered objective one and poor life skill was associated with both. Moreover, several studies found that cognitive dysfunctions in some cognitive domains were related to lowered objective QOL but the effects of them were much smaller than those of negative symptoms. It is suggested that improving depressive and negative symptoms and life skills may contribute to enhancement of QOL of schizophrenia patients.
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Affiliation(s)
- Masahito Tomotake
- Department of Mental Health, Institute of Health Biosciences, University of Tokushima Graduate School, Tokushima, Japan
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Llorca PM, Blanc O, Samalin L, Bosia M, Cavallaro R. Factors involved in the level of functioning of patients with schizophrenia according to latent variable modeling. Eur Psychiatry 2011; 27:396-400. [PMID: 21723098 DOI: 10.1016/j.eurpsy.2011.01.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2010] [Revised: 01/13/2011] [Accepted: 01/14/2011] [Indexed: 01/09/2023] Open
Abstract
PURPOSE This study aimed at using latent variable modelling to explore the significantly contributing variables to functioning in schizophrenia patients. METHODS The study cohort comprised 296 schizophrenia patients evaluated once for demographic characteristics, functioning (FROGS, SWN-K, QLS) and symptomatology (Positive and Negative Syndrome Scale [PANSS]). First exploratory multivariate analyses were conducted and then a model with functioning as a latent variable was proposed and tested with the data. RESULTS Symptomatology as negative, cognitive and excitation factor are significant predictors of functioning assessed through FROGS (P<0.0001), SWN-K and QLS (P<0.001). The model was constructed with functioning defined as a latent variable, indicators are subscores on FROGS, SWN-K, QLS and exogenous variable included symptomatology, Duration of Untreated Psychosis (DUP) and educational level. CONCLUSION Using the five clinical dimensions of the PANSS, (Positive, Negative, Cognitive, Anxiety/Depression and Excitation) the negative and cognitive dimensions are highly correlated via the latent variable to the three dimensions of functioning evaluated by the FROGS: "daily life", "social functioning" and "treatment" and the QLS subscores (interpersonnal, common object, instrumental role). Educationnal level is positively linked to functioning but not DUP. The model emphasizes the need for treatment strategies that have an effect on cognitive-factors, to improve functioning in schizophrenia.
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Affiliation(s)
- P-M Llorca
- Service de psychiatrie B, CHU de Clermont-Ferrand, 58, rue Montalembert, 63000 Clermont-Ferrand, France.
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Kurtz MM, Tolman A. Neurocognition, insight into illness and subjective quality-of-life in schizophrenia: what is their relationship? Schizophr Res 2011; 127:157-62. [PMID: 21211943 PMCID: PMC3051009 DOI: 10.1016/j.schres.2010.12.004] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2010] [Revised: 12/01/2010] [Accepted: 12/06/2010] [Indexed: 11/16/2022]
Abstract
Subjective quality-of-life (SQOL) has been recognized as a crucial domain of outcome in schizophrenia treatment, and yet its determinants are not well understood. In a recent meta-analytic investigation of 10 studies of neurocognition and SQOL in schizophrenia (Tolman and Kurtz, Scz Bull, 2010) measures of crystallized verbal ability and processing speed were moderately negatively correlated with SQOL. One potential explanation for inverse relationships between measures of elementary neurocognition and SQOL is that higher levels of cognition may serve as a proxy for better insight into the illness, and better consequent recognition of illness-related functional impairment. This study sought to determine whether: (1) symptoms, neurocognitive variables, and insight into illness influence SQOL; and, (2) whether insight mediated or moderated a relationship between elementary neurocognitive function and SQOL. Seventy-one stabilized clients with schizophrenia or schizoaffective disorder were administered a neuropsychological test battery, symptom and subjective quality-of-life measures. Elementary neuropsychological measures of crystallized verbal ability, attention and working memory, and problem-solving were all inversely related to SQOL. Insight into illness and depression severity, but not positive and negative symptoms, was also inversely related to SQOL. Insight was not found to mediate or moderate any of the relationships between elementary neurocognition and SQOL. Taken together, these findings suggest that neurocognition and insight into illness have inverse relationships to SQOL and that elementary neurocognition does not influence SQOL through its link with illness insight.
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Affiliation(s)
- Matthew M. Kurtz
- To whom correspondence should be addressed: Department of Psychology, Wesleyan University, Judd Hall, 207 High Street, Middletown, CT. 06549; fax: 860-685-2761;
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