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Ding M, Lang X, Wang J, Shangguan F, Zhang XY. Prevalence, demographic characteristics, and clinical features of suicide risk in first episode drug-naïve schizophrenia patients with comorbid severe anxiety. J Psychiatr Res 2024; 176:232-239. [PMID: 38889553 DOI: 10.1016/j.jpsychires.2024.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 05/19/2024] [Accepted: 06/10/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND Both anxiety symptoms and suicide risk are common in schizophrenia. However, previous findings about the association between anxiety and suicide risk in schizophrenia were controversial. This study is the first to examine the prevalence of suicide risk and related demographic, clinical features in a large sample of first episode drug-naïve (FEDN) schizophrenia patients with comorbid severe anxiety. METHODS In total, 316 patients with FEDN schizophrenia were enrolled in this study. Patients' symptoms were assessed using the Hamilton Depression Scale (HAMD), Hamilton Anxiety Rating Scale (HAMA), and Positive and Negative Syndrome Scale (PANSS). Serum levels of glucose, insulin, uric acid, and lipids including total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C), were evaluated. RESULTS In the current study, 56.3% patients presented comorbid severe anxiety. The rate of suicide risk was higher in the severe anxiety group (55.6%) than in the mild-moderate anxiety group (33.3%). The interactions among severe anxiety, uric acid and HDL-C were associated with suicide risk. Compared with patients with normal uric acid, those with abnormal uric acid exhibited a stronger association between HAMA scores and HAMD-suicide item scores. This enhanced association was also observed for patients with abnormal HDL-C levels. CONCLUSIONS In FEDN schizophrenia patients with comorbid severe anxiety, our findings suggested a high incidence of suicide risk. Abnormal levels of uric acid and low levels of HDL-C, as well as high depression may be associated with an increased risk of suicide in FEDN schizophrenia patients with comorbid severe anxiety.
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Affiliation(s)
- Mengjie Ding
- Key Laboratory of Learning and Cognition, School of Psychology, Capital Normal University, Beijing, 100037, China.
| | - Xiaoe Lang
- Department of Psychiatry, The First Clinical Medical College, Shanxi Medical University, Shanxi, 030000, China.
| | - Junhan Wang
- Key Laboratory of Learning and Cognition, School of Psychology, Capital Normal University, Beijing, 100037, China.
| | - Fangfang Shangguan
- Key Laboratory of Learning and Cognition, School of Psychology, Capital Normal University, Beijing, 100037, China.
| | - Xiang-Yang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, 100101, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, 100101, China.
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Ercan Doğu S, Örsel S. The relationship between psychopathology, occupational balance, and quality of life among people with schizophrenia. Aust Occup Ther J 2022. [PMID: 36562348 DOI: 10.1111/1440-1630.12855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 11/18/2022] [Accepted: 11/28/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE There is an increased risk of occupational imbalance and poor quality of life (QoL) if one has schizophrenia. Although evidence suggests a relationship between psychopathology and QoL, the association of occupational balance (OB) with QoL in schizophrenia is unclear. This study aimed to investigate the associations among psychopathology, occupational balance, and QoL in schizophrenia. METHODS This was a cross-sectional study carried out in a Community Mental Health Center (CMHC). Ninety-five individuals aged 18 years or older with the diagnosis of schizophrenia participated in the study. All participants completed a sociodemographic form, Positive and Negative Syndrome Scale (PANSS), Calgary Depression Scale in Schizophrenia (CDSS), Occupational Balance Questionnaire-11 Turkish Version (OBQ11-T), and the World Health Organisation Quality of Life Assessment Instrument (WHOQOL-100-TR). Relationships among clinical and depressive symptoms, OB, and QoL variables were examined through correlation analysis, and then multiple linear regression analysis was performed to determine the variables that have influences on QOL. RESULTS The study participants had low OB scores and the lowest mean in the WHOQOL-social relationships subscale. WHOQOL-overall QoL score demonstrated a moderate negative correlation with the PANSS-total score and PANSS-general psychopathology subscale score (r = -0.422, r = -0.463, P < 0.001) and a mild negative correlation with the CDSS-total score (r = -0.390, P < 0.001). OBQ11-T total score showed a moderate positive correlation with the WHOQOL-overall score (r = 0.549; P < 0.001). Findings from the multiple linear regression analysis revealed that OBQ11-T (β = -0.467, P = 0.000) and PANSS-general psychopathology (β = -0.221, P = 0.045) were significant predictors of the overall QoL, explaining 48% of the variance in the overall QoL (adjusted R2 = .43, P < 0.001). CONCLUSION Our study findings showed that OB and general psychopathology are determinants that should be considered in improving the QoL in individuals with schizophrenia. Thereby, addressing the symptoms of general psychopathology and occupational factors to improve the QoL may be achieved with the incorporation of occupation-based programmes to routine treatment. However, further research is required.
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Affiliation(s)
- Selma Ercan Doğu
- Hamidiye Faculty of Health Sciences, Department of Occupational Therapy, University of Health Sciences, Istanbul, Turkey
| | - Sibel Örsel
- Department of Psychiatry, University of Health Sciences Diskapi Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
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Cai Y, Gong W, He W, He H, Hughes JP, Simoni J, Xiao S, Gloyd S, Lin M, Deng X, Liang Z, Dai B, Liao J, Hao Y, Xu DR. Residual Effect of Texting to Promote Medication Adherence for Villagers with Schizophrenia in China: 18-Month Follow-up Survey After the Randomized Controlled Trial Discontinuation. JMIR Mhealth Uhealth 2022; 10:e33628. [PMID: 35438649 PMCID: PMC9066323 DOI: 10.2196/33628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 01/12/2022] [Accepted: 02/02/2022] [Indexed: 11/13/2022] Open
Abstract
Background
Reducing the treatment gap for mental health in low- and middle-income countries is a high priority. Even with treatment, adherence to antipsychotics is rather low. Our integrated intervention package significantly improved medication adherence within 6 months for villagers with schizophrenia in resource-poor communities in rural China. However, considering the resource constraint, we need to test whether the effect of those behavior-shaping interventions may be maintained even after the suspension of the intervention.
Objective
The aim of this study is to explore the primary outcome of adherence and other outcomes at an 18-month follow-up after the intervention had been suspended.
Methods
In a 6-month randomized trial, 277 villagers with schizophrenia were randomized to receive either a government community mental health program (686 Program) or the 686 Program plus Lay health supporters, e-platform, award, and integration (LEAN), which included health supporters for medication or care supervision, e-platform access for sending mobile SMS text messaging reminders and education message, a token gift for positive behavior changes (eg, continuing taking medicine), and integrating the e-platform with the existing 686 Program. After the 6-month intervention, both groups received only the 686 Program for 18 months (phase 2). Outcomes at both phases included antipsychotic medication adherence, functioning, symptoms, number of rehospitalization, suicide, and violent behaviors. The adherence and functioning were assessed at the home visit by trained assessors. We calculated the adherence in the past 30 days by counting the percentage of dosages taken from November to December 2018 by unannounced home-based pill counts. The functioning was assessed using the World Health Organization Disability Assessment Schedule 2.0. The symptoms were evaluated using the Clinical Global Impression–Schizophrenia during their visits to the 686 Program psychiatrists. Other outcomes were routinely collected in the 686 Program system. We used intention-to-treat analysis, and missing data were dealt with using multiple imputation. The generalized estimating equation model was used to assess program effects on adherence, functioning, and symptoms.
Results
In phase 1, antipsychotic adherence and rehospitalization incidence improved significantly. However, in phase 2, the difference of the mean of antipsychotic adherence (adjusted mean difference 0.05, 95% CI −0.06 to 0.16; P=.41; Cohen d effect size=0.11) and rehospitalization incidence (relative risk 0.65, 95% CI 0.32-1.33; P=.24; number needed to treat 21.83, 95% CI 8.30-34.69) was no longer statistically significant, and there was no improvement in other outcomes in either phase (P≥.05).
Conclusions
The simple community-based LEAN intervention could not continually improve adherence and reduce the rehospitalization of people with schizophrenia. Our study inclined to suggest that prompts for medication may be necessary to maintain medication adherence for people with schizophrenia, although we cannot definitively exclude other alternative interpretations.
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Affiliation(s)
- Yiyuan Cai
- Department of Epidemiology and Health Statistic, School of Public Health, Guizhou Medical University, Guiyang, China
| | - Wenjie Gong
- HER Team and Department of Maternal and Child Health, Xiangya School of Public Health, Central South University, Changsha, China
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, United States
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Wenjun He
- Center for World Health Organization (WHO) Studies and Department of Health Management, School of Health Management of Southern Medical University, Guangzhou, China
- Acacia Labs, Institute for Global Health and Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Hua He
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
| | - James P Hughes
- Department of Biostatistics, University of Washington, Seattle, WA, United States
| | - Jane Simoni
- Department of Psychology, University of Washington, Seattle, WA, United States
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Shuiyuan Xiao
- Xiangya School of Public Health, Central South University, Changsha, China
| | - Stephen Gloyd
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Meijuan Lin
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong Special Administrative Region, China
| | - Xinlei Deng
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Zichao Liang
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Bofeng Dai
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Jing Liao
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Yuantao Hao
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Dong Roman Xu
- Center for World Health Organization (WHO) Studies and Department of Health Management, School of Health Management of Southern Medical University, Guangzhou, China
- Acacia Labs, Institute for Global Health and Dermatology Hospital, Southern Medical University, Guangzhou, China
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Ayalew M, Reta Y, Defar S. Predictors of unrecognised comorbid depression in patients with schizophrenia at Amanuel mental specialized hospital, Ethiopia: a cross-sectional study. BMJ Open 2021; 11:e049026. [PMID: 34556512 PMCID: PMC8461692 DOI: 10.1136/bmjopen-2021-049026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The occurrence of depression in patients with schizophrenia (PWS) increases the risk of relapse, frequency and duration of hospitalisation, and decreases social and occupational functioning. OBJECTIVE This study aimed to assess prevalence of unrecognised comorbid depression and its determinants in PWS. METHOD A cross-sectional study was conducted from 1 to 30 March 2019 at Amanuel mental specialized hospital among 300 PWS. The 9-item Calgary Depression Scale for Schizophrenia was used to assess comorbid depression. Logistic regression was used to determine the association between outcome and explanatory variables. Statistical significance was declared at p value <0.05 with 95% CI. RESULTS The prevalence of unrecognised comorbid depression was found to be 30.3%. Living alone (adjusted OR (AOR)=3.49, 95% CI=0.45 to 8.36), having poor (AOR=4.43, 95% CI=1.45 to 13.58) and moderate (AOR=4.45, 95% CI=1.30 to 15.22) social support, non-adherence to medication (AOR=3.82, 95% CI=1.70 to 8.55), presenting with current negative symptoms such as asocialia (AOR=4.33, 95% CI=1.98 to 9.45) and loss of personal motivation (AOR=3.46, 95% CI=1.53 to 7.84), and having suicidal behaviour (AOR=6.83, 95% CI=3.24 to 14.41) were the significant predictors of comorbid depression in PWS. CONCLUSION This study revealed considerably a high prevalence of unrecognised comorbid depression among PWS. Therefore, clinicians consider timely screening and treating of comorbid depression in PWS.
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Affiliation(s)
- Mohammed Ayalew
- School of Nursing, Hawassa University College of Medicine and Health Sciences, Hawassa, Ethiopia
| | - Yared Reta
- School of Nursing, Hawassa University College of Medicine and Health Sciences, Hawassa, Ethiopia
| | - Semira Defar
- Department Midwifery, Hawassa University College of Medicine and Health Sciences, Hawassa, Ethiopia
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Pietrini F, Tatini L, Santarelli G, Brugnolo D, Squillace M, Bozza B, Ballerini A, Ricca V, D'Anna G. Self- and caregiver-perceived disability, subjective well-being, quality of life and psychopathology improvement in long-acting antipsychotic treatments: a 2-year follow-up study. Int J Psychiatry Clin Pract 2021; 25:307-315. [PMID: 34057873 DOI: 10.1080/13651501.2021.1912358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Switching to long-acting injectable (LAI) antipsychotic maintenance treatment (AMT) represents a valuable strategy for schizophrenia. In a recovery-oriented approach, patient-reported outcomes (PROs) such as perceived disability, subjective well-being, and quality of life cannot be neglected. METHODS Forty clinically stable outpatients with schizophrenia treated with oral second-generation antipsychotics were enrolled at the time of switching to the equivalent dose of LAI. 35 subjects completed this 2-year longitudinal, prospective, open-label, observational study. Patients were assessed at baseline, after 1 year, and after 2 years of LAI-AMT, using psychometric scales (Positive And Negative Syndrome Scale, PANSS; Young Mania Rating Scale, YMRS; Montgomery-Åsberg Depression Rating Scale, MADRS), PROs (Subjective Well-Being under Neuroleptics short form, SWN-K; Short Form-36 health survey, SF-36; 12-item World Health Organisation Disability Assessment Schedule, WHODAS 2.0), and caregiver-reported outcomes (12-item WHODAS 2.0). RESULTS No psychotic relapses were observed. Psychopathology measures (PANSS total and subscales - excluding negative symptoms), mood symptoms (YMRS, MADRS), perceived disability (patient- and caregiver-administered WHODAS 2.0), subjective well-being (SWN-K), and quality of life (SF-36) showed a concomitant amelioration after 1 year, without further significant variations. DISCUSSION Switching to LAI-AMT may decrease perceived impairment, and increase subjective well-being and quality of life in clinically stable outpatients with schizophrenia.HighlightsLAI treatment may improve outcomes by reducing psychopathology levels and relapses.In a recovery-oriented approach, patient-reported outcomes cannot be neglected.LAI antipsychotics may optimise the subjective experience of treatment.Switching to LAI therapy may result in a reduction in perceived disability.There is a significant correlation between proxy- and patient-reported disability.
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Affiliation(s)
- Francesco Pietrini
- Department of Mental Health and Addictions, Central Tuscany NHS Trust, Florence, Italy
| | - Lorenzo Tatini
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Gabriele Santarelli
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Dario Brugnolo
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Marco Squillace
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Bernardo Bozza
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Andrea Ballerini
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Valdo Ricca
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Giulio D'Anna
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
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Association of depressive symptoms with cognitive impairment in patients with never-treated first-episode schizophrenia: Analysis of the Depression in Schizophrenia in China (DISC) study. Gen Hosp Psychiatry 2021; 71:108-113. [PMID: 34000518 DOI: 10.1016/j.genhosppsych.2021.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/25/2021] [Accepted: 04/29/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Depressive symptoms and cognitive dysfunction are common in patients with schizophrenia and depressive disorder. This study aimed at exploring whether and how depressive symptoms were correlated with neuro-cognitive impairment in patients with never-treated first-episode (NTFE) schizophrenia. METHODS The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) was administered to 79 patients and 80 healthy controls to assess neuropsychological function. For all patients, the 17-item Hamilton Depression Rating Scale (HAMD-17) was adopted to evaluate depressive symptoms, and the Positive and Negative Syndrome Scale (PANSS) was utilized to assess psychopathological symptoms. RESULTS Thirty-nine patients (49.37%) met the criteria for comorbid depressive symptoms. The RBANS total and the four index scores in the patients were significantly lower than those in the healthy controls. Further, compared with patients without depressive symptoms, patients with depressive symptoms scored lower in attention index, but higher in PANSS general psychopathology and total scores. The HAMD-17 total score was significantly correlated with attention, PANSS total, and PANSS general psychopathology scores. Moreover, multiple regression analysis identified education and HAMD-17 score as the contributors to attention. CONCLUSION Our results suggest that the rate of depressive symptoms in NTFE schizophrenia is high, which is correlated with neuro-cognitive impairment, especially attention and psychopathology.
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Cai Y, Gong W, He H, Hughes JP, Simoni J, Xiao S, Gloyd S, Lin M, Deng X, Liang Z, He W, Dai B, Liao J, Hao Y, Xu DR. Mobile Texting and Lay Health Supporters to Improve Schizophrenia Care in a Resource-Poor Community in Rural China (LEAN Trial): Randomized Controlled Trial Extended Implementation. J Med Internet Res 2020; 22:e22631. [PMID: 33258788 PMCID: PMC7738261 DOI: 10.2196/22631] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 09/23/2020] [Accepted: 10/29/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Schizophrenia is a severe and disabling condition that presents a dire health equity challenge. Our initial 6-month trial (previously reported) using mobile texting and lay health supporters, called LEAN, significantly improved medication adherence from 0.48 to 0.61 (adjusted mean 0.11, 95% CI 0.03 to 0.20, P=.007) for adults with schizophrenia living in a resource-poor village in rural China. OBJECTIVE We explored the effectiveness of our texting program in improving participants' medication adherence, functioning, and symptoms in an extended implementation of the intervention after its initial phase. METHODS In an approximated stepped-wedge wait-list design randomized controlled trial, 277 community-dwelling villagers with schizophrenia were assigned 1:1 in phase 1 into intervention and wait-list control groups. The intervention group received (1) lay health supporters (medication or care supervisors), (2) e-platform (mobile-texting reminders and education message) access, (3) a token gift for positive behavioral changes, and (4) integration with the existing government community-mental health program (the 686 Program) while the wait-listed control group initially only received the 686 Program. Subsequently (in the extended period), both groups received the LEAN intervention plus the 686 Program. The primary outcome was antipsychotic medication adherence (percentage of dosages taken over the past month assessed by unannounced home-based pill counts). The secondary outcomes were symptoms measured during visits to 686 Program psychiatrists using the Clinical Global Impression scale for schizophrenia and functioning measured by trained student assessors using the World Health Organization Disability Assessment Schedule 2.0. Other outcomes included data routinely collected in the 686 Program system (refill records, rehospitalization due to schizophrenia, death for any reason, suicide, wandering, and violent behaviors). We used intention-to-treat analysis and missing data were imputed. A generalized estimating equation model was used to assess program effects on antipsychotics medication adherence, symptoms, and functioning. RESULTS Antipsychotics medication adherence improved from 0.48 in the control period to 0.58 in the extended intervention period (adjusted mean difference 0.11, 95% CI 0.04 to 0.19; P=.004). We also noted an improvement in symptoms (adjusted mean difference -0.26, 95% CI -0.50 to -0.02; P=.04; Cohen d effect size 0.20) and a reduction in rehospitalization (0.37, 95% CI 0.18 to 0.76; P=.007; number-needed-to-treat 8.05, 95% CI 4.61 to 21.41). There was no improvement in functioning (adjusted mean difference 0.02, 95% CI -0.01 to 0.06; P=.18; Cohen d effect size 0.04). CONCLUSIONS In an extended implementation, our intervention featuring mobile texting messages and lay health workers in a resource-poor community setting was more effective than the 686 Program alone in improving medication adherence, improving symptoms, and reducing rehospitalization. TRIAL REGISTRATION Chinese Clinical Trial Registry; ChiCTR-ICR-15006053 https://tinyurl.com/y5hk8vng.
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Affiliation(s)
- Yiyuan Cai
- School of Public Health, Sun Yat-sen University, Guangzhou, China
- School of Public Health, Guizhou Medical University, Guiyang, China
| | - Wenjie Gong
- Xiangya School of Public Health, Central South University, Changsha, China
| | - Hua He
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
| | - James P Hughes
- Department of Biostatistics, University of Washington, Seattle, WA, United States
| | - Jane Simoni
- Department of Psychology, University of Washington, Seattle, WA, United States
| | - Shuiyuan Xiao
- Xiangya School of Public Health, Central South University, Changsha, China
| | - Stephen Gloyd
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Meijuan Lin
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Xinlei Deng
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Zichao Liang
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Wenjun He
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Bofeng Dai
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Jing Liao
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Yuantao Hao
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Dong Roman Xu
- Acacia Lab for Health Systems Strengthening and Department of Health Management, School of Health Management, Southern Medical University, Guangzhou, China
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B N S, Grover S. Depression in schizophrenia: Prevalence and its impact on quality of life, disability, and functioning. Asian J Psychiatr 2020; 54:102425. [PMID: 33271709 DOI: 10.1016/j.ajp.2020.102425] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 09/07/2020] [Accepted: 09/12/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Limited information is available on the prevalence of depression and its correlates in patients with schizophrenia in clinical remission. This study aims to understand the prevalence of depression in patients with schizophrenia currently in clinical remission and evaluate the impact of depression on the functioning, disability, and quality of life. METHODOLOGY 250 participants diagnosed with schizophrenia, currently in clinical remission, were recruited by convenient sampling and assessed on the Calgary Depression Scale for Schizophrenia (CDSS). Participants were also assessed on positive and negative syndrome scale (PANSS), Global Assessment of Functioning Scale, Indian Disability Evaluation and Assessment Scale, and World Health Organization Quality of Life - Bref Version. RESULTS As per CDSS, the prevalence of mild depression (≥ 5) and significant depression (≥ 7) were 27.6 % and 18.8 % respectively. The presence of significant depression was associated higher level of residual psychopathology on PANSS (in general psychopathology score, prosocial score and total score), poor functioning, higher level of disability in the domain of interpersonal activities, higher prevalence of physical comorbidity and poor quality of life compared to those without significant depression. CONCLUSIONS Around one-fifth of patients with schizophrenia have significant depression during the phase of clinical remission. It has a negative impact on functioning, is associated with a higher level of disability in the domain of interpersonal activities, and poor quality of life compared to those without significant depression. Hence, addressing depression should be an integral part of schizophrenia management in clinical remission to improve the overall outcome of patients with schizophrenia.
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Affiliation(s)
- Subodh B N
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| | - Sandeep Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Kim SJ, Jung DU, Moon JJ, Jeon DW, Seo YS, Jung SS, Lee YC, Kim JE, Kim YS. Relationship between disability self-awareness and cognitive and daily living function in schizophrenia. SCHIZOPHRENIA RESEARCH-COGNITION 2020; 23:100192. [PMID: 33294392 PMCID: PMC7689331 DOI: 10.1016/j.scog.2020.100192] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 11/09/2020] [Accepted: 11/15/2020] [Indexed: 11/04/2022]
Abstract
We investigated the relationship between disability self-awareness and cognitive and daily living functions in 49 patients with schizophrenia. The World Health Organization Disability Assessment Schedule 2.0 (WHODAS) self-report was used to identify patient-rated global function. A clinician-rated measure of global function was obtained using the Personal and Social Performance Scale (PSP); disability self-awareness was calculated using two global function scores. The Positive and Negative Syndrome Scale (PANSS) and the Calgary Depression Scale for Schizophrenia (CDSS) were used to evaluate clinical symptoms, while the MATRICS consensus cognitive battery (MCCB) and the UCSD Performance-based Skills Assessment (UPSA) were applied to assess cognitive and daily living functionality, respectively. The WHODAS scores correlated significantly with the MCCB verbal learning, visual learning, and social cognition domains, and with the UPSA communication domain. The PSP correlated significantly with all MCCB and UPSA domains. Disability self-awareness demonstrated positive correlation with most domains of MCCB and UPSA. The findings of this study indicate that the lower the cognitive and daily living function in patients with schizophrenia, the more positively they perceive their own disability. Patients with schizophrenia may have diverse functional disabilities. Function assessment comprises clinician evaluation and patient self-reports. Disability self-awareness was determined using self-report and clinician evaluation. Its relation with cognitive and daily living functions was evaluated in this study. These functions were found to be directly proportional to disability self-awareness.
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Affiliation(s)
- Sung-Jin Kim
- Department of Psychiatry, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Do-Un Jung
- Department of Psychiatry, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Jung-Joon Moon
- Department of Psychiatry, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Dong-Wook Jeon
- Department of Psychiatry, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Young-Soo Seo
- Department of Psychiatry, Sharing and Happiness Hospital, Busan, Republic of Korea
| | - Sung-Soo Jung
- Department of Psychiatry, Sharing and Happiness Hospital, Busan, Republic of Korea
| | - Yoo-Chul Lee
- Department of Psychiatry, Busan Metropolitan Mental Hospital, Busan, Republic of Korea
| | - Jeong-Eun Kim
- Department of Psychiatry, Busan Metropolitan Mental Hospital, Busan, Republic of Korea
| | - Yeon-Sue Kim
- Department of Psychiatry, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
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Chang CC, Beckstead JW, Lo SC, Yang CY. Depressive symptoms and quality of life in people with a diagnosis of schizophrenia: An exploratory study of the potential mediating role of health-promoting lifestyles. Perspect Psychiatr Care 2020; 56:939-948. [PMID: 32314381 DOI: 10.1111/ppc.12516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/23/2020] [Accepted: 04/07/2020] [Indexed: 01/09/2023] Open
Abstract
PURPOSE To examine health-promoting lifestyles mediates the relationship between depressive symptoms and quality of life (QOL) in people with schizophrenia. DESIGN AND METHODS A cross-sectional exploratory study design was conducted. Two-hundred and seventy-three participants were administered demographic data, health-promoting lifestyle profile, Beck Depression Inventory II, and World Health Organization Quality of Life-BREF. The Hayes PROCESS macro was employed to analyze data. FINDINGS The results showed self-actualization fully mediated the environmental domain of QOL, physical health, psychological health, and social relationships domains were partial mediation. PRACTICE IMPLICATIONS This study recommends that professionals reinforce persons' self-actualization when the QOL is affected by depressive symptoms in people with schizophrenia.
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Affiliation(s)
- Chia-Chi Chang
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan.,Department of Nursing, School of Nursing, National Yang-Ming University, Taipei, Taiwan
| | - Jason W Beckstead
- Department of Epidemiology & Biostatistics, College of Public Health, University of South Florida, Tampa, Florida
| | - Su-Chen Lo
- Department of Nursing, Bali Psychiatric Center, Ministry of Health and Welfare, New Taipei City, Taiwan
| | - Chiu-Yueh Yang
- Department of Nursing, School of Nursing, National Yang-Ming University, Taipei, Taiwan
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11
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Ahuir M, Crosas JM, Estrada F, Zabala W, Pérez-Muñoz S, González-Fernández A, Tost M, Aguayo R, Montalvo I, Miñano MJ, Gago E, Pàmias M, Monreal JA, Palao D, Labad J. Cognitive biases are associated with clinical and functional variables in psychosis: A comparison across schizophrenia, early psychosis and healthy individuals. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2020; 14:4-15. [PMID: 32950409 DOI: 10.1016/j.rpsm.2020.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 06/18/2020] [Accepted: 07/04/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE We investigated the presence of cognitive biases in people with a recent-onset psychosis (ROP), schizophrenia and healthy adolescents and explored potential associations between these biases and psychopathology. METHODS Three groups were studied: schizophrenia (N=63), ROP (N=43) and healthy adolescents (N=45). Cognitive biases were assessed with the Cognitive Biases Questionnaire for Psychosis (CBQ). Positive, negative and depressive symptoms were assessed with the PANSS and Calgary Depression Scale (ROP; schizophrenia) and with the CAPE-42 (healthy adolescents). Cannabis use was registered. The association between CBQ and psychopathology scales was tested with multiple linear regression analyses. RESULTS People with schizophrenia reported more cognitive biases (46.1±9.0) than ROP (40±5.9), without statistically significant differences when compared to healthy adolescents (43.7±7.3). Cognitive biases were significantly associated with positive symptoms in both healthy adolescents (Standardized β=0.365, p=0.018) and people with psychotic disorders (β=0.258, p=0.011). Cognitive biases were significantly associated with depressive symptoms in healthy adolescents (β=0.359, p=0.019) but in patients with psychotic disorders a significant interaction between schizophrenia diagnosis and CBQ was found (β=1.804, p=0.011), which suggests that the pattern differs between ROP and schizophrenia groups (positive association only found in the schizophrenia group). Concerning CBQ domains, jumping to conclusions was associated with positive and depressive symptoms in people with schizophrenia and with cannabis use in ROP individuals. Dichotomous thinking was associated with positive and depressive symptoms in all groups. CONCLUSIONS Cognitive biases contribute to the expression of positive and depressive symptoms in both people with psychotic disorders and healthy individuals.
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Affiliation(s)
- Maribel Ahuir
- Department of Mental Health, Parc Taulí Hospital Universitari, I3PT, Sabadell, Barcelona, Spain; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona (UAB), Cerdanyola del Vallès, Barcelona, Spain; Psychiatry and Clinical Psychology Service, Institute of Neuroscience, Hospital Clínic de Barcelona, IDIBAPS, Barcelona, Spain
| | - Josep Maria Crosas
- Department of Mental Health, Parc Taulí Hospital Universitari, I3PT, Sabadell, Barcelona, Spain
| | - Francesc Estrada
- Department of Mental Health, Parc Taulí Hospital Universitari, I3PT, Sabadell, Barcelona, Spain
| | - Wanda Zabala
- Department of Mental Health, Parc Taulí Hospital Universitari, I3PT, Sabadell, Barcelona, Spain
| | - Sara Pérez-Muñoz
- Department of Mental Health, Parc Taulí Hospital Universitari, I3PT, Sabadell, Barcelona, Spain
| | - Alba González-Fernández
- Department of Mental Health, Parc Taulí Hospital Universitari, I3PT, Sabadell, Barcelona, Spain
| | - Meritxell Tost
- Department of Mental Health, Parc Taulí Hospital Universitari, I3PT, Sabadell, Barcelona, Spain; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona (UAB), Cerdanyola del Vallès, Barcelona, Spain
| | - Raquel Aguayo
- Department of Mental Health, Parc Taulí Hospital Universitari, I3PT, Sabadell, Barcelona, Spain
| | - Itziar Montalvo
- Department of Mental Health, Parc Taulí Hospital Universitari, I3PT, Sabadell, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
| | - Maria José Miñano
- Department of Mental Health, Parc Taulí Hospital Universitari, I3PT, Sabadell, Barcelona, Spain
| | - Estefania Gago
- Department of Mental Health, Parc Taulí Hospital Universitari, I3PT, Sabadell, Barcelona, Spain; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona (UAB), Cerdanyola del Vallès, Barcelona, Spain
| | - Montserrat Pàmias
- Department of Mental Health, Parc Taulí Hospital Universitari, I3PT, Sabadell, Barcelona, Spain; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona (UAB), Cerdanyola del Vallès, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
| | - José Antonio Monreal
- Department of Mental Health, Parc Taulí Hospital Universitari, I3PT, Sabadell, Barcelona, Spain; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona (UAB), Cerdanyola del Vallès, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
| | - Diego Palao
- Department of Mental Health, Parc Taulí Hospital Universitari, I3PT, Sabadell, Barcelona, Spain; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona (UAB), Cerdanyola del Vallès, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
| | - Javier Labad
- Department of Mental Health, Parc Taulí Hospital Universitari, I3PT, Sabadell, Barcelona, Spain; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona (UAB), Cerdanyola del Vallès, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain; Department of Mental Health, Consorci Sanitari del Maresme, Mataró, Barcelona, Spain.
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12
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Elegbede VI, Obadeji A, Adebowale TO, Oluwole LO. Comparative assessment of quality of life of patients with schizophrenia attending a community psychiatric centre and a psychiatric hospital. Ghana Med J 2019; 53:92-99. [PMID: 31481804 PMCID: PMC6697764 DOI: 10.4314/gmj.v53i2.3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Over the past few decades, there has been an emphasis on the de-institutionalisation of psychiatric care with a focus on community care. With Quality of Life (QoL) as an outcome measure, this study compared the QoL of patients with schizophrenia attending a psychiatric hospital and a community psychiatric centre. DESIGN This was a cross-sectional study in two psychiatric facilities. METHODS Data were obtained through a socio-demographic and clinical questionnaire; the QoL was assessed with the WHOQOL-BREF and patient satisfaction with care with CPOSS. Total and domain scores of WHOQOL-BREF for each group were calculated and compared with each other and other group characteristics. Diagnosis of schizophrenia was based on ICD-10. RESULTS Participants from the two centres did not differ significantly on any of the socio-demographic characteristics measured. Similarly, there was no significant difference in their overall mean WHOQOL-BREF scores as well as the mean WHOQOL-BREF of domain scores. However, the married and females from both centres significantly had higher mean WHOQOL-BREF scores than their male counterparts. Patients in remission for more than two years or those on a single type of medication (either oral or depot preparation) from both centres significantly had higher mean WHOQOL-BREF score compared with those who had less than two years of remission or on both oral and depot preparations. CONCLUSION Overall QoL of patients managed at the two centres was comparable, with similar socio-demographic as well as clinical variables influencing QoL. This suggests that patients with schizophrenia can be well managed at community psychiatric centres. FUNDING None declared.
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Affiliation(s)
| | - Adetunji Obadeji
- Department of Psychiatry, Ekiti State University Teaching Hospital, Ado-Ekiti, Ekiti State, Nigeria
| | - Timothy O Adebowale
- Department of Clinical services, Neuropsychiatric Hospital, Aro, Abeokuta, Ogun State, Nigeria
| | - Lateef O Oluwole
- Department of Psychiatry, Ekiti State University Teaching Hospital, Ado-Ekiti, Ekiti State, Nigeria
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13
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Sagayadevan V, Lee SP, Ong C, Abdin E, Chong SA, Subramaniam M. Quality of Life across Mental Disorders in Psychiatric Outpatients. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2018. [DOI: 10.47102/annals-acadmedsg.v47n7p243] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Introduction: Literature has shown that individuals with various psychiatric disorders experience a lower quality of life (QoL). However, few have examined QoL across disorders. The current study explored differences in QoL and symptom severity across 4 psychiatric diagnostic groups: anxiety disorders (including obsessive compulsive disorder [OCD]), depressive disorders, schizophrenia, and pathological gambling. Materials and Methods: Data analysed was from a previous study that examined the prevalence of hoarding symptoms among outpatients (n = 500) in a tertiary psychiatric hospital in Singapore. Measures utilised included the Beck Anxiety Inventory (BAI), Beck Depression Inventory-II (BDI-II) and Quality of Life Enjoyment and Satisfaction Questionnaire-Short Form (Q-LES-Q-SF). Sociodemographic information and details on type and number of comorbidities were also collected. Results: The depressive disorder group had the highest level of depressive and anxiety symptoms and the lowest QoL whereas; the schizophrenia group had the lowest level of depressive symptoms and the highest QoL. Age and employment status were the only sociodemographic correlates which were significantly associated with QoL. After controlling for sociodemographic factors, only the type of mental disorder was found to have a significant effect in explaining BAI, BDI-II and Q-LES-Q-SF. Conclusion: Findings offer insight in terms of the burden associated with the various disorders.
Key words: Anxiety, Comorbid, Depression, Symptom severity
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Affiliation(s)
| | - Siau Pheng Lee
- Research Division, Institute of Mental Health, Singapore
| | - Clarissa Ong
- Research Division, Institute of Mental Health, Singapore
| | | | - Siow Ann Chong
- Research Division, Institute of Mental Health, Singapore
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Widschwendter CG, Kemmler G, Rettenbacher MA, Yalcin-Siedentopf N, Hofer A. Subjective well-being, drug attitude, and changes in symptomatology in chronic schizophrenia patients starting treatment with new-generation antipsychotic medication. BMC Psychiatry 2018; 18:212. [PMID: 29954366 PMCID: PMC6022409 DOI: 10.1186/s12888-018-1791-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 06/12/2018] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Non-adherence to medication remains a major challenge in the long-term management of patients with schizophrenia. Next to lack of insight into the illness, adverse effects of antipsychotic drugs, cognitive deficits, poor therapeutic alliance, reduced quality of life, missing social support, and negative attitudes toward medication are predictors of non-adherence. This study examined potential correlations between attitudes toward antipsychotic drug therapy, subjective well-being, and symptom change in patients with chronic schizophrenia. METHODS 30 patients with schizophrenia starting monotherapy with a new-generation antipsychotic were included into the study. The Drug Attitude Inventory (DAI) and the Subjective Well-being under Neuroleptic Treatment Scale, short form (SWN-K), were administered after 2, 4, and 12 weeks of treatment. At the same points in time and at baseline, psychopathological symptoms were rated by means of the Positive and Negative Syndrome Scale (PANSS), and functioning was assessed by means of the Global Assessment of Functioning Scale (GAF). Antipsychotic induced side effects were evaluated by using the Udvalg for Kliniske Undersogelser (UKU) Side Effect Rating Scale. RESULTS Study participants had a mean age of 37.5 ± 9.7 years, baseline symptoms were mild. The PANSS total score improved significantly from baseline to weeks 4 (p = .003) and 12 (p = .001), respectively. Neither the DAI total score nor the SWN-K total score changed significantly over the course of time. The severity of symptoms was not correlated with drug attitude at any time point but was negatively correlated with wellbeing at weeks 2 (r = -.419, p = .021) and 4 (r = -.441, p = .015). There was no significant correlation between DAI and SWN-K total scores at any time point. CONCLUSIONS Next to showing that the DAI and the SWN-K measure different aspects of subjective experiences during antipsychotic treatment these findings emphasize the use of both instruments to optimize adherence to medication.
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Affiliation(s)
- Christian G. Widschwendter
- 0000 0000 8853 2677grid.5361.1Medical University Innsbruck, Department of Psychiatry,Psychotherapy, and Psychosomatics. Division of Psychiatry I, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Georg Kemmler
- 0000 0000 8853 2677grid.5361.1Medical University Innsbruck, Department of Psychiatry,Psychotherapy, and Psychosomatics. Division of Psychiatry I, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Maria A. Rettenbacher
- 0000 0000 8853 2677grid.5361.1Medical University Innsbruck, Department of Psychiatry,Psychotherapy, and Psychosomatics. Division of Psychiatry I, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Nursen Yalcin-Siedentopf
- 0000 0000 8853 2677grid.5361.1Medical University Innsbruck, Department of Psychiatry,Psychotherapy, and Psychosomatics. Division of Psychiatry I, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Alex Hofer
- 0000 0000 8853 2677grid.5361.1Medical University Innsbruck, Department of Psychiatry,Psychotherapy, and Psychosomatics. Division of Psychiatry I, Anichstrasse 35, 6020 Innsbruck, Austria
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15
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Dai J, Du X, Yin G, Zhang Y, Xia H, Li X, Cassidy R, Tong Q, Chen D, Teixeira AL, Zheng Y, Ning Y, Soares JC, He MX, Zhang XY. Prevalence, demographic and clinical features of comorbid depressive symptoms in drug naïve patients with schizophrenia presenting with first episode psychosis. Schizophr Res 2018; 193:182-187. [PMID: 28651908 DOI: 10.1016/j.schres.2017.06.029] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Revised: 06/17/2017] [Accepted: 06/18/2017] [Indexed: 01/04/2023]
Abstract
Depressive symptoms are common in first episode schizophrenia. However, the prevalence and its associations of comorbid depressive symptoms with clinical variables are less well characterized in Chinese Han patients with schizophrenia. In this cross-sectional study, we recruited 240 first-episode and drug naïve (FEDN) inpatients with schizophrenia. All patients were rated on the 17-item Hamilton Depression Rating Scale (HAMD-17) to measure depressive symptoms, and also on the Positive and Negative Syndrome Scale (PANSS) for psychopathology. Our results showed that 131 patients had a total score of 8 or more points on HAMD-17, making the prevalence of comorbid depressive symptoms 54.6%. Fewer women (48.1%, 62 of 129) than men (62.2%, 69 of 111) had comorbid depressive symptoms. Compared to those patients without depressive symptoms, those with depressive symptoms showed higher PANSS total, general psychopathology, cognitive factor and negative symptom scores (all p<0.05). Further stepwise multiple logistic regression analysis indicated that the PANSS general psychopathology, the PANSS total score and gender (all p<0.05) remained significantly associated with depressive symptoms. In addition, correlation analysis showed significant correlations between HAMD total score and the following parameters: the PANSS general psychopathology, total score, and cognitive factor (Bonferroni corrected p's<0.05). Our results suggest that depressive symptoms occur with high prevalence in FEND schizophrenia in a Chinese Han population, and show association with general psychopathology, as well as with cognitive impairment.
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Affiliation(s)
- Jing Dai
- The Fourth People's Hospital of Chengdu, Chengdu Mental Health Center, Chengdu, China
| | - Xiangdong Du
- Suzhou Psychiatric Hospital, The Affiliated Guangji Hospital of Soochow University, Jiangsu, China
| | - Guangzhong Yin
- Suzhou Psychiatric Hospital, The Affiliated Guangji Hospital of Soochow University, Jiangsu, China
| | - Yingyang Zhang
- Suzhou Psychiatric Hospital, The Affiliated Guangji Hospital of Soochow University, Jiangsu, China
| | - Haishen Xia
- Hefei Fourth People's Hospital, Anhui Mental Health Center, Hefei, China
| | - Xiaosi Li
- Hefei Fourth People's Hospital, Anhui Mental Health Center, Hefei, China
| | - Rylan Cassidy
- Brown Foundation Institute of Molecular Medicine for the Prevention of Human Diseases of McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Qingchun Tong
- Brown Foundation Institute of Molecular Medicine for the Prevention of Human Diseases of McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Dachun Chen
- Psychiatry Research Center, Beijing HuiLongGuan Hospital, Peking University, Beijing, China
| | - Antonio Lucio Teixeira
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Yingjun Zheng
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Yuping Ning
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Jair C Soares
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Man-Xi He
- The Fourth People's Hospital of Chengdu, Chengdu Mental Health Center, Chengdu, China.
| | - Xiang Yang Zhang
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.
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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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Anderson JP, Icten Z, Alas V, Benson C, Joshi K. Comparison and predictors of treatment adherence and remission among patients with schizophrenia treated with paliperidone palmitate or atypical oral antipsychotics in community behavioral health organizations. BMC Psychiatry 2017; 17:346. [PMID: 29047368 PMCID: PMC5648472 DOI: 10.1186/s12888-017-1507-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 10/09/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Nonadherence to antipsychotic treatment increases the likelihood of relapse and progressive symptomatology in patients with schizophrenia. Atypical long-acting injectables, including paliperidone palmitate (PP), may increase adherence and improve symptoms. This study compared and assessed predictors of treatment patterns and symptom remission among schizophrenia patients treated with PP versus atypical oral antipsychotic therapy (OAT) in community behavioral health organizations (CBHOs). METHODS This retrospective cohort analysis evaluated 763 patients with schizophrenia and new (PP-N; N = 174) or continuing (PP-C; N = 308) users of PP, or new users of OAT (N = 281) at enrollment in the REACH-OUT study (2010-2013). Treatment outcomes assessed at 1 year were discontinuation, and adherence, measured by proportion of days covered (PDC) or medication possession ratio (MPR). Remission status was assessed using the Structured Clinical Interview for Symptoms of Remission (SCI-SR). A machine learning platform, Reverse Engineering and Forward Simulation (REFS™), was used to identify predictors of study outcomes. Multivariate Cox and generalized linear regressions estimated the adjusted hazard ratios (HRs) or odds ratios (ORs) with 95% confidence intervals. RESULTS Among PP-N users, 27% discontinued their initial treatment regimen versus 51% (p < 0.001) of OAT users. PP-N (vs OAT; HR = 0.49 [0.31-0.76]) users and males (HR = 0.65 [0.46-0.92]) had significantly lower rates of discontinuation. Relative to OAT, PP-N had a 36% [31%-42%] higher MPR and a 10-fold increased achievement of PDC ≥80% (OR = 10.46 [5.72-19.76]). PP users were significantly more likely to achieve remission in follow-up (PP-N vs OAT: OR = 2.65 [1.39-5.05]; PP-C vs OAT: OR = 1.83 [1.03-3.25]). CONCLUSIONS Relative to OAT, PP was associated with improved adherence, less frequent treatment discontinuation, and improved symptom remission in this CBHO study population.
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Affiliation(s)
| | - Zeynep Icten
- GNS Healthcare, 196 Broadway, Cambridge, MA 02139-1902 USA
| | - Veronica Alas
- GNS Healthcare, 196 Broadway, Cambridge, MA 02139-1902 USA
| | - Carmela Benson
- Janssen Scientific Affairs, 1125 Trenton Harbourton Rd, Titusville, NJ 08560 USA
| | - Kruti Joshi
- Janssen Scientific Affairs, 1125 Trenton Harbourton Rd, Titusville, NJ 08560 USA
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18
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Personal resources and depression in schizophrenia: The role of self-esteem, resilience and internalized stigma. Psychiatry Res 2017; 256:359-364. [PMID: 28686933 DOI: 10.1016/j.psychres.2017.06.079] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 05/03/2017] [Accepted: 06/25/2017] [Indexed: 11/22/2022]
Abstract
Depression in schizophrenia represents a challenge from a diagnostic, psychopathological and therapeutic perspective. The objective of this study is to test the hypothesis that resilience and self-stigma affect depression severity and to evaluate the strength of their relations in 921 patients with schizophrenia. A structural equation model was tested where depression is hypothesized as affected by resilience, internalized stigma, gender and negative symptoms, with the latter two variables used as exogenous covariates and the former two as mediators. The analysis reveals that low resilience, high negative symptoms, female gender were directly associated with depression severity, and internalized stigma acted only as a mediator between avolition and resilience, with similar magnitude. The cross-sectional study design and the variable selection limit the generalizability of the study results. The model supports a complex interaction between personal resources and negative symptoms in predicting depression in schizophrenia. The clinical implication of these findings is that personal resources could be a significant target of psychosocial treatments.
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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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Federici S, Bracalenti M, Meloni F, Luciano JV. World Health Organization disability assessment schedule 2.0: An international systematic review. Disabil Rehabil 2016; 39:2347-2380. [PMID: 27820966 DOI: 10.1080/09638288.2016.1223177] [Citation(s) in RCA: 218] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE This systematic review examines research and practical applications of the World Health Organization Disability Assessment Schedule (WHODAS 2.0) as a basis for establishing specific criteria for evaluating relevant international scientific literature. The aims were to establish the extent of international dissemination and use of WHODAS 2.0 and analyze psychometric research on its various translations and adaptations. In particular, we wanted to highlight which psychometric features have been investigated, focusing on the factor structure, reliability, and validity of this instrument. METHOD Following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) methodology, we conducted a search for publications focused on "whodas" using the ProQuest, PubMed, and Google Scholar electronic databases. RESULTS We identified 810 studies from 94 countries published between 1999 and 2015. WHODAS 2.0 has been translated into 47 languages and dialects and used in 27 areas of research (40% in psychiatry). CONCLUSIONS The growing number of studies indicates increasing interest in the WHODAS 2.0 for assessing individual functioning and disability in different settings and individual health conditions. The WHODAS 2.0 shows strong correlations with several other measures of activity limitations; probably due to the fact that it shares the same disability latent variable with them. Implications for Rehabilitation WHODAS 2.0 seems to be a valid, reliable self-report instrument for the assessment of disability. The increasing interest in use of the WHODAS 2.0 extends to rehabilitation and life sciences rather than being limited to psychiatry. WHODAS 2.0 is suitable for assessing health status and disability in a variety of settings and populations. A critical issue for rehabilitation is that a single "minimal clinically important .difference" score for the WHODAS 2.0 has not yet been established.
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Affiliation(s)
- Stefano Federici
- a Department of Philosophy, Social & Human Sciences and Education , University of Perugia , Perugia , Italy
| | - Marco Bracalenti
- a Department of Philosophy, Social & Human Sciences and Education , University of Perugia , Perugia , Italy
| | - Fabio Meloni
- a Department of Philosophy, Social & Human Sciences and Education , University of Perugia , Perugia , Italy
| | - Juan V Luciano
- b Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan De Déu , St. Boi De Llobregat , Spain.,c Primary Care Prevention and Health Promotion Research Network (RedIAPP) , Madrid , Spain
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Rossell SL, Francis PS, Galletly C, Harris A, Siskind D, Berk M, Bozaoglu K, Dark F, Dean O, Liu D, Meyer D, Neill E, Phillipou A, Sarris J, Castle DJ. N-acetylcysteine (NAC) in schizophrenia resistant to clozapine: a double blind randomised placebo controlled trial targeting negative symptoms. BMC Psychiatry 2016; 16:320. [PMID: 27629871 PMCID: PMC5024434 DOI: 10.1186/s12888-016-1030-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 09/06/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Clozapine is an effective treatment for a proportion of people with schizophrenia (SZ) who are resistant to the beneficial effects of other antipsychotic drugs. However, anything from 40-60 % of people on clozapine experience residual symptoms even on adequate doses of the medication, and thus could be considered 'clozapine resistant'. Agents that could work alongside clozapine to improve efficacy whilst not increasing the adverse effect burden are both desired and necessary to improve the lives of individuals with clozapine-resistant SZ. N-Acetylcysteine (NAC) is one such possible agent. Previous research from our research group provided promising pilot data suggesting the efficacy of NAC in this patient population. The aim of the study reported here is to expand this work by conducting a large scale clinical trial of NAC in the treatment of clozapine-resistant SZ. METHODS This study is an investigator initiated, multi-site, randomised, placebo-controlled trial. It aims to include 168 patients with clozapine-resistant SZ, divided into an intervention group (NAC) and a control group (placebo). Participants in the intervention group will receive 2 g daily of NAC. The primary outcome measures will be the negative symptom scores of the Positive and Negative Syndrome Scale (PANSS). Secondary outcome measures will include: changes in quality of life (QoL) as measured by the Lancashire Quality of Life Profile (LQoLP) and cognitive functioning as measured by the total score on the MATRICS. Additionally we will examine peripheral and cortical glutathione (GSH) concentrations as process outcomes. DISCUSSION This large scale clinical trial will investigate the efficacy of NAC as an adjunctive medication to clozapine. This trial, if successful, will establish a cheap, safe and easy-to-use agent (NAC) as a 'go to' adjunct in patients that are only partly responsive to clozapine. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registration Number: Current Randomised Controlled Trial ACTRN12615001273572 . The date of registration 23 November 2015.
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Affiliation(s)
- Susan L. Rossell
- Centre for Mental Health, Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne, VIC Australia
- St Vincent’s Mental Health Service, St Vincent’s Hospital, Melbourne, VIC Australia
- Monash Alfred Psychiatry Research Centre and The Voices Clinic, The Alfred, Melbourne, VIC Australia
| | - Paul S. Francis
- Centre for Chemistry and Biotechnology, School of Life & Environmental Sciences, Deakin University, Geelong, VIC Australia
| | - Cherrie Galletly
- Psychiatry Department, University of Adelaide, Adelaide, South Australia Australia
- Northern Adelaide Health Local Network, Adelaide, South Australia Australia
| | - Anthony Harris
- Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, NSW Australia
- Brain Dynamics Centre, The Westmead Institute for Medical Research, University of Sydney, Sydney, NSW Australia
| | - Dan Siskind
- School of Medicine, University of Queensland, Brisbane, QLD Australia
| | - Michael Berk
- IMPACT Strategic Research Centre, Barwon Health, Deakin University, Geelong, VIC Australia
| | - Kiymet Bozaoglu
- Baker IDI Heart & Diabetes Institute, Melbourne, VIC Australia
| | - Frances Dark
- Metro South Addiction and Mental Health Service, Brisbane, QLD Australia
| | - Olivia Dean
- IMPACT Strategic Research Centre, Barwon Health, Deakin University, Geelong, VIC Australia
| | - Dennis Liu
- Psychiatry Department, University of Adelaide, Adelaide, South Australia Australia
- Northern Adelaide Health Local Network, Adelaide, South Australia Australia
| | - Denny Meyer
- Centre for Mental Health, Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne, VIC Australia
- Department of Statistics, Data Science and Epidemiology, Swinburne University of Technology, Melbourne, VIC Australia
| | - Erica Neill
- St Vincent’s Mental Health Service, St Vincent’s Hospital, Melbourne, VIC Australia
| | - Andrea Phillipou
- St Vincent’s Mental Health Service, St Vincent’s Hospital, Melbourne, VIC Australia
| | - Jerome Sarris
- ARCADIA Mental Health Research Group, Professorial Unit, The Melbourne Clinic, Department of Psychiatry, The University of Melbourne, Melbourne, VIC Australia
- Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, VIC Australia
| | - David J. Castle
- St Vincent’s Mental Health Service, St Vincent’s Hospital, Melbourne, VIC Australia
- Department of Psychiatry, University of Melbourne, Melbourne, VIC Australia
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Tan EJ, Rossell SL. Comparing how co-morbid depression affects individual domains of functioning and life satisfaction in schizophrenia. Compr Psychiatry 2016; 66:53-8. [PMID: 26995236 DOI: 10.1016/j.comppsych.2015.12.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 12/29/2015] [Accepted: 12/30/2015] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Depression in schizophrenia is often associated with reduced life satisfaction. Yet, it is not clear how depression influences different functioning domains. The relative impact across objective and subjective quality of life (QOL) has also not been clearly compared. This study sought to examine the differences in individual QOL indicators between schizophrenia patients with and without co-morbid depression. This was completed separately for objective and subjective QOL. METHOD 57 patients with schizophrenia/schizoaffective disorder were classified into groups with (DP: N=31, M=45.81, SD=10.29) and without depression (NDP: N=26, M=40.54, SD=11.00) using MADRS scores. Objective and subjective QOL was assessed using Lehman's (1988) QOL Interview using five domains: daily activities and functioning, family relations, social relations, safety and health. z-scores were created for these domains (objective and subjective) based on responses from 44 healthy controls (M=39.80, SD=13.94). RESULTS Objectively, DP patients had significantly reduced social interaction frequency compared to HCs. Subjectively, DP patients had significantly poorer scores than HCs on all five domains, and additionally reported poorer satisfaction with daily activities and health compared with the NDP group. CONCLUSIONS Presence of depression in schizophrenia results in reduced self-reported life satisfaction across a broad spectrum of QOL domains. Objectively, depression resulted in decreased interactions with friends and peers, i.e. greater social isolation. The findings support the need to continue developing and implementing peer support groups in schizophrenia, a challenging task especially in the face of depression. More broadly, the assessment of depression in other illnesses is recommended.
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Affiliation(s)
- Eric Josiah Tan
- Monash Alfred Psychiatry research centre, Monash University Central Clinical School, and The Alfred Hospital, Melbourne, Australia; Brain and Psychological Sciences Research Centre, Swinburne University of Technology, Hawthorn, Australia.
| | - Susan Lee Rossell
- Monash Alfred Psychiatry research centre, Monash University Central Clinical School, and The Alfred Hospital, Melbourne, Australia; Brain and Psychological Sciences Research Centre, Swinburne University of Technology, Hawthorn, Australia
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Abedi Shargh N, Rostami B, Kosari B, Toosi Z, Majelan GA. Study of Relationship Between Depression and Quality of Life in Patients With Chronic Schizophrenia. Glob J Health Sci 2015; 8:224-9. [PMID: 26493412 PMCID: PMC4803983 DOI: 10.5539/gjhs.v8n3p224] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 04/03/2015] [Indexed: 11/16/2022] Open
Abstract
Depression is among the personality traits of schizophrenic patients, which results from psychotic features or is a consequence of a period of psychosis. Depression in schizophrenic patients is one of the important factors affecting their quality of life. The study population of this descriptive and analytic study consists of patients with chronic schizophrenia in Zahedan in 2014. The sample included 60 patients who simultaneously suffered from depression and were selected using random sampling (30 males and 30 females). The research instruments included the Schizophrenia Quality of Life Scale (SQLS) and the Beck Depression Inventory (the inventory was filled out by the tester). In order to form a statistics analysis, we used Pearson correlation and regression multivariate. Investigating the study hypotheses showed that there was a negative correlation between the high level of depression and low quality of life. the relationship between depression and the quality of life subscales showed that in women, the variable of symptoms and complications was a significant predictor; however, the other two variables (energy and motivation and psychosocial) were not significant predictors. In case of men, psychosocial variable was a significant predictor; however, the other two variables (energy and motivation and symptoms and complications) were not significant predictors. In general, depression on these patients makes discontent of life on them; therefore, elimination of their depression on their treatment is necessary.
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Affiliation(s)
- Najme Abedi Shargh
- MSc of Clinical Psychology, Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran.
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Karow A, Wittmann L, Schöttle D, Schäfer I, Lambert M. The assessment of quality of life in clinical practice in patients with schizophrenia. DIALOGUES IN CLINICAL NEUROSCIENCE 2015. [PMID: 25152657 PMCID: PMC4140512 DOI: 10.31887/dcns.2014.16.2/akarow] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of the present article is to review QoL scales used in studies investigating patients with schizophrenia over the past 5 years, and to summarize the results of QoL assessment in clinical practice in these patients. Literature available from January 2009 to December 2013 was identified in a PubMed search using the key words "quality of life" and "schizophrenia" and in a cross-reference search for articles that were particularly relevant. A total of n=432 studies used 35 different standardized generic and specific QoL scales in patients with schizophrenia. Affective symptoms were major obstacles for QoL improvement in patients with schizophrenia. Though positive symptoms, negative symptoms, and cognitive functioning may be seen as largely independent parameters from subjective QoL, especially in cross-sectional trials, long-term studies confirmed a critical impact of early QoL improvement on long-term symptomatic and functional remission, as well as of early symptomatic response on long-term QoL. Results of the present review suggest that QoL is a valid and useful outcome criterion in patients with schizophrenia. As such, it should be consistently applied in clinical trials. Understanding the relationship between symptoms and functioning with QoL is important because interventions that focus on symptoms of psychosis or functioning alone may fail to improve subjective QoL to the same level. However, the lack of consensus on QoL scales hampers research on its predictive validity. Future research needs to find a consensus on the concept and measures of QoL and to test whether QoL predicts better outcomes with respect to remission and recovery under consideration of different treatment approaches in patients with schizophrenia.
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Affiliation(s)
- Anne Karow
- Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Linus Wittmann
- Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Daniel Schöttle
- Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ingo Schäfer
- Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Lambert
- Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Abstract
PURPOSE The study reported here aimed to evaluate both biological and psychosocial factors as predictors for quality of life as well as to examine the associations between the factors and quality of life in individuals with schizophrenia. METHODS Eighty individuals with schizophrenia were recruited to the study. The Thai version of the World Health Organization Quality of Life-BREF was utilized to measure the quality of life. The five Marder subscales of the Positive and Negative Syndrome Scale were applied. Other tools for measurement included the Calgary Depression Scale for Schizophrenia and six social support deficits (SSDs). Pearson/Spearman correlation coefficients and the independent t-test were used for the statistical analysis to determine the associations of variables and the overall quality of life and the four domain scores. A multiple linear regression analysis of the overall quality of life and four domain scores was applied to determine their predictors. RESULTS The Positive and Negative Syndrome Scale total score, positive symptoms, negative symptoms, disorganized thought, and anxiety/depression showed a significant correlation with the overall quality of life and most of the four domain scores. Depression, SSDs, and adverse drug events showed a significant correlation with a poorer overall quality of life. The multiple linear regression model revealed that negative symptoms, depression, and seeing a relative less often than once per week were predictors for the overall quality of life (adjusted R (2)=0.472). Negative symptoms were also found to be the main factors predicting a decrease in the four domains of quality of life - physical health, psychological, social relationships, and environment. CONCLUSION Negative symptoms, depression, and poor contact with relatives were the foremost predictors of poor quality of life in individuals with schizophrenia. Positive symptoms, negative symptoms, disorganized thought, anxiety/depression, SSDs, and adverse events were also found to be correlated with quality of life.
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Affiliation(s)
- Sirijit Suttajit
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Sutrak Pilakanta
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Speech disturbances and quality of life in schizophrenia: differential impacts on functioning and life satisfaction. Compr Psychiatry 2014; 55:693-8. [PMID: 24315617 DOI: 10.1016/j.comppsych.2013.10.016] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 10/28/2013] [Accepted: 10/31/2013] [Indexed: 12/11/2022] Open
Abstract
Speech disturbances in schizophrenia impact on the individual's communicative ability. Although they are considered a core feature of schizophrenia, comparatively little work has been done to examine their impact on the life experiences of patients. This study aimed to examine the relationship between schizophrenia speech disturbances, including those traditionally known as formal thought disorder (TD), and quality of life (QoL). It assessed effects on functioning (objective QoL) and satisfaction (subjective QoL) concurrently, while controlling for the influence of neurocognition and depression. Fifty-four patients with schizophrenia/schizoaffective disorder were administered the MATRICS Consensus Cognitive Battery (MCCB), the PANSS, MADRS (with separate ratings for negative TD [verbal underproductivity] and positive TD [verbal disorganisation and pressured speech]) and Lehman's QOLI assessing both objective and subjective QoL. Ratings of positive and negative TD, depression, and general neurocognition were entered into hierarchical regressions to explore their relationship with both life functioning and satisfaction. Verbal underproductivity was a significant predictor of objective QoL, while pressured speech had a trend association with subjective QoL. This suggests a differential relationship between speech disturbances and QoL. Verbal underproductivity seems to affect daily functioning and relations with others, while pressured speech is predictive of satisfaction with life. The impact of verbal underproductivity on QoL suggests it to be an important target for rehabilitation in schizophrenia.
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Prevalence of depression in schizophrenic patients evaluated by the Calgary Depression Scale in Shebin El-Kom, Menoufiya. MIDDLE EAST CURRENT PSYCHIATRY 2013. [DOI: 10.1097/01.xme.0000433781.14841.77] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Guilera G, Gómez-Benito J, Pino O, Rojo JE, Cuesta MJ, Martínez-Arán A, Safont G, Tabarés-Seisdedos R, Vieta E, Bernardo M, Crespo-Facorro B, Franco M, Rejas J. Utility of the World Health Organization Disability Assessment Schedule II in schizophrenia. Schizophr Res 2012; 138:240-7. [PMID: 22521724 DOI: 10.1016/j.schres.2012.03.031] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Revised: 03/12/2012] [Accepted: 03/24/2012] [Indexed: 02/05/2023]
Abstract
AIM The World Health Organization Disability Assessment Schedule II (WHODAS II) was developed for assessing disability. This study provides data on the validity and utility of the Spanish version of the WHODAS II in a large sample of patients with schizophrenia. METHODS The sample included 352 patients with a schizophrenia spectrum disorder. They completed a comprehensive assessment battery including measures of psychopathology, functionality and quality-of-life. A sub-sample of 36 patients was retested after six months to assess its temporal stability. RESULTS Participation in society (6.3%) and Life activities (4.0%) were the domains with the highest percentage of missing data. The internal consistency (Cronbach's alpha) of the total scale was 0.94, and the test-retest stability reached an intraclass correlation coefficient of 0.92. It became apparent that the six primary factor models represent a better fit with reality than other competing models. Relationships between the WHODAS and measures of symptomatology, social and work-related functionality, and quality-of-life were in the expected direction and the scale was ultimately found to be able to differentiate among patients with different degrees of disease severity and different work status. CONCLUSIONS Assessment of disability using appropriate tools is a crucial aspect in the context of mental health and, in this regard, the Spanish version of the WHODAS II shows ample evidence of validity in patients with schizophrenia. The most important contribution of this study is that it is the first analyzing the Spanish version of the WHODAS II (36-item version) in a large sample of patients with schizophrenia.
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Affiliation(s)
- Georgina Guilera
- Department of Methodology, Faculty of Psychology, University of Barcelona, Barcelona, Spain
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Fountoulakis KN, Lekka E, Kouidi E, Chouvarda I, Deligiannis A, Maglaveras N. Development of the Global Disability Scale (Glo.Di.S): preliminary results. Ann Gen Psychiatry 2012; 11:14. [PMID: 22594786 PMCID: PMC3434028 DOI: 10.1186/1744-859x-11-14] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Accepted: 04/24/2012] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The assessment of functioning and disability is an important part of the clinical evaluation, since it measures disease burden and reflects the effectiveness of therapeutic planning and interventions. The aim of the current study was to develop such a self-report instrument on the basis of a review of the literature, and compatible with the WHO approach. MATERIAL AND METHODS The review of the literature led to the development of the Global Disability Scale (Glo.Di.S) with 25 items assessing different aspects of disability. The study sample included 728 persons from vulnerable populations (homeless, jobless, very low income, single parent families etc.; (29.12% males and 70.88% females; aged 55.96 ± 15.22 years). The protocol included also the STAI and the CES-D. The statistical analysis included factor analysis item analysis and ANCOVA. RESULTS The factor analysis revealed the presence of 4 factors explaining 71% of total variance (Everyday functioning, Social and interpersonal functioning, Severity and Mental disability). Chronbach's alpha for the whole scale was 0.95 and for subscales were 0.74-0.94. DISCUSSION The results of the current study suggest that the Glo.Di.S. has the potential to serve as a reliable and valid tool for assessing functioning and disability. Further research is needed to prove that it could be useful across countries, populations and diseases, and whether it provides data that are culturally meaningful and comparable. It can be used in surveys and in clinical research settings and it can generate information of use in evaluating health needs and the effectiveness of interventions to reduce disability and improve health.
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Affiliation(s)
- Konstantinos N Fountoulakis
- Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Pylaia 55535, Greece.
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