The Social Occupational Functioning Scale (SOFS): a brief measure of functional status in persons with schizophrenia

Effectiveness of Virtual - Compensatory Cognitive Training (V-CCT) for improving cognition in persons with schizophrenia - a multi- centre randomized controlled trial

BACKGROUND

Cognitive deficits are the core component in persons with schizophrenia which impacts their socio-occupational functioning. Also, cognitive deficits cause significant impairment with the person's quality of life [3]. Hence, targeting such a pivotal aspect in persons with schizophrenia through suitable interventions is very important. Developed countries have designed various cognitive remediation programs using computers involving high-end software which cannot be generalized to low-resource settings, like India, due to various factors including sociocultural factors, educational standards, and living standards of the patient population. Compensatory cognitive training (CCT) was developed to be "brief, practical, low-tech" and found to be effective in the west [9]. As there are no structured cognitive intervention modules in India, we have adapted the English CCT manual to be used for an urban population in Chennai, India. CCT was found to be feasible in face-to-face group sessions in our setting [12] and is found to be feasible and acceptable as virtual one-one intervention (unpublished data). Therefore, this study aims to evaluate the effectiveness of V-CCT in enhancing cognition and socio-occupational functioning.

METHODS

The proposed study will be a multicenter assessor-blinded randomized controlled trial at two clinical sites in Chennai, India. The preparatory phase of the study would include translation of the manual to the local language, recruitment and training of research assistants, and pilot testing using the translated manual. The second phase will be the main randomized controlled trial (RCT), during which a total of 160 persons diagnosed with schizophrenia will be recruited from both sites. After obtaining informed consent, baseline assessments will be conducted on cognition, functioning, self-esteem, and quality of life. Participants will be randomly assigned to either the virtual CCT group or the control group using a computer-generated randomization table. End-line assessments will be conducted 6 weeks after the baseline by research assistants who are blinded to the randomization post-intervention.

DISCUSSION

If V-CCT is found to be effective, it will be available for use in Tamil for persons with schizophrenia, and it will have an effect on their functioning, quality of life, and self-esteem.

TRIAL REGISTRATION

The study is registered under Clinical trial registry-India (CTRI), and the registration number is CTRI/2024/04/065267. Registered on April 2024.

Efficacy of a Culturally Adapted Emotion Recognition Training Program in Improving Facial Emotion Recognition in Persons with Schizophrenia

Background

Facial emotion recognition (FER) deficits are being considered as core features of social cognitive deficits in schizophrenia, associated with socio-occupational dysfunction. Social cognition intervention programs have been shown to improve these deficits; however, there are no such intervention strategies in India. In this study, we aim to examine the efficacy of Training of Affect Recognition - Indian Version (TAR-IV) to enhance the FER abilities of people with schizophrenia.

Methods

In an open-label experimental design, 36 participants with schizophrenia underwent 12 sessions of TAR-IV as an add-on to treatment as usual (TAU), while 29 participants with schizophrenia continued TAU (pharmacological treatment with or without occupational therapy and vocational rehabilitation services). Clinical and functional assessments were done using the positive and negative syndrome scale (PANSS) and socio-occupational functioning scale. Emotion recognition abilities were assessed on the tool for recognition of emotions in neuropsychiatric disorders at baseline, post-intervention, and follow-up (two to three months post-intervention).

Results

The intervention group showed significant improvements in FER (P = .001) and socio-occupational functioning (P = .008) after receiving the TAR-IV, which remained significant at two months follow-up. A lower age of onset and poorer neurocognitive function at baseline predicted greater changes in emotion recognition ability following the intervention.

Conclusions

This study demonstrated the efficacy of TAR-IV, the Indian adaptation of social cognition intervention, in improving emotion recognition abilities and socio-occupational functioning in patients with schizophrenia. These findings need to be replicated in randomized controlled trials.

Sleep and socio-occupational functioning in adults with serious mental illness: A systematic review

Sleep is a crucial factor influencing mental health and quality of life. Individuals with serious mental illness (SMI) often experience significant sleep problems. This can further exacerbate their symptoms and impact their socio-occupational functioning (SOF) (the extent to which a person is able to engage in 'self-care and activities of daily living, communication, interpersonal relations, instrumental living skills, and work'). Despite the well-established bidirectional relationship between sleep and mental health, the specific association between sleep and SOF in the context of SMI remains underexplored. A systematic review was conducted. Comprehensive searches in PubMed and PsycNet yielded 832 results. After applying inclusion criteria, 24 studies were included in the narrative synthesis. Study characteristics and key findings were extracted for analysis. Collectively, studies investigated sleep quality, satisfaction, duration, disturbance, specific disorders, and objectively-recorded sleep parameters across various study designs. Studies included a total population of 10,938, utilising a range of sleep and SOF outcome measures. Nearly all studies indicated that worsened sleep was associated with reduced SOF in SMI populations. The review supports the potential role of improved sleep as a route to improved SOF in SMI populations. This has clear implications for research and clinical care for patients with SMI.

Effect of Long-Term Tai Chi Therapy on the Immune-Inflammatory Pathway in Patients with Schizophrenia with Antipsychotic-Stabilized

The primary objective of this study was to explore the influence of prolonged (24 weeks) supplementary Tai Chi therapy on cognitive capabilities and immune-inflammatory pathways in subjects diagnosed with schizophrenia. A total of 90 individuals who have been clinically diagnosed with schizophrenia were assigned to two treatment groups, namely the Tai Chi treatment (TT) group and the routine treatment (RT) group. Following a 24-week duration of intervention, the data obtained from 32 patients in the TT group and 30 patients in the RT group were meticulously analyzed. At the commencement of the investigation and upon completion of the 24-week intervention, blood samples were gathered, and clinical evaluations were executed. In plasma, the identification of nine cytokines (IL-10, IFN-γ, IL-5, GM-CSF, TNF-α, IL-13, IL-4, IL-2, and IL-12) was conducted using the multiple primer suspension chip method. The clinical evaluations encompassed CGI, WHOQUOL-BREF, SOFS, PSS, BPRS, SAPS, SANS, and RBANS. In comparison to the RT group, the patients in the TT group demonstrated decreased levels of TNF-α and IL-5 (P < 0.05). Moreover, they encountered more pronounced advancements in SAPS, SANS, PSS, SOFS, and RBANS scores (P < 0.05). Additionally, a positive connection was detected between the plasma TNF-α level in the TT group and both the SANS score and the SPFS score (P < 0.05). Tai Chi has been shown to improve clinical symptoms in patients with schizophrenia as an add-on therapy, potentially through its effects on immunomodulatory pathways.

Protocol-based assessment and management of first episode psychosis: Comparison of short and medium-term outcomes in psychopathology, quality of life, functioning and family burden across two sites in India

BACKGROUND

Standard assessment and management protocols exist for first episode psychosis (FEP) in high income countries. Due to cultural and resource differences, these need to be modified for application in low-and middle-income countries.

AIMS

To assess the applicability of standard assessment and management protocols across two cohorts of FEP patients in North and South India by examining trajectories of psychopathology, functioning, quality of life and family burden in both.

METHOD

FEP patients at two sites (108 at AIIMS, North India, and 115 at SCARF, South India) were assessed using structured instruments at baseline, 3, 6 and 12 months. Standard management protocols consisted of treatment with antipsychotics and psychoeducation for patients and their families. Generalised estimating equation (GEE) modelling was carried out to test for changes in outcomes both across and between sites at follow-up.

RESULTS

There was an overall significant improvement in both cohorts for psychopathology and other outcome measures. The trajectories of improvement differed between the two sites with steeper improvement in non-affective psychosis in the first three months at SCARF, and affective symptoms in the first three months at AIIMS. The reduction in family burden and improvement in quality of life were greater at AIIMS than at SCARF during the first three months.

CONCLUSIONS

Despite variations in cultural contexts and norms, it is possible to implement FEP standard assessment and management protocols in North and South India. Preliminary findings indicate that FEP services lead to significant improvements in psychopathology, functioning, quality of life, and family burden within these contexts.

Clinical effects of a yoga-based intervention for patients with schizophrenia - A six-month randomized controlled trial

BACKGROUND

Yoga has shown promise as an add-on therapy for patients with schizophrenia. However, most studies have been short-term, with methodological limitations.

METHODS

We conducted a six-month parallel-group randomized-controlled trial (with rater blinding) to evaluate the effectiveness of a yoga-based intervention in improving symptoms and quality of life in patients with schizophrenia. We recruited 110 patients from an urban tertiary hospital and a semi-urban community centre who met DSM 5 criteria for schizophrenia and were on stable medication for at least six weeks. Participants were randomly assigned to either yoga add-on therapy (YT) or treatment-as-usual (TAU) groups. Clinical assessments were conducted at baseline and at one, three and six months. The primary outcome was changes in positive/negative symptom scores and secondary outcomes included changes in quality of life, perceived stress and socio-occupational functioning.

RESULTS

Intention to treat analysis with a longitudinal mixed model approach revealed a significant group-by-time interaction with the YT group showing medium effect improvements in negative symptoms (η2p = 0.06) and small effect improvements in positive symptoms (η2p = 0.012), WHOQOL-BREF quality of life [psychological well-being (η2p = 0.015) and environmental health (η2p = 0.048)] when compared to TAU. The patients successfully learned and performed yoga practices without reporting any significant adverse effects.

DISCUSSION

Our findings suggest that yoga-based intervention may be a valuable adjuvant therapy for medication-stabilized patients with schizophrenia, especially in ameliorating negative symptoms and enhancing quality of life. Future controlled trials, including active physical interventions, are crucial to validate yoga's efficacy, optimize clinical use, and elucidate underlying mechanisms.

Effects of yoga on clinical symptoms, quality of life and social functioning in patients with schizophrenia: A systematic review and meta-analysis

BACKGROUND

Yoga is gradually being explored as a potential complementary intervention in addition to psychiatric drugs for schizophrenia. However, there are conflicts on the efficacy of yoga for schizophrenia. This meta-analysis was aimed to evaluate the association of yoga intervention with reductions on clinical symptoms and improvements in quality of life (QoL) as well as social functioning among schizophrenia.

METHOD

Systematic literature search was undertaken to identify all RCTs that compared yoga with active or passive controls for patients with schizophrenia from inception to July 2023. The outcomes were measurements of positive symptoms, negative symptoms, QoL and social functioning. Random-effects models were performed to calculate the effect sizes in the standardized mean differences reporting as Hedges' s g statistic.

RESULTS

19 studies enrolling 1274 participants with schizophrenia were included. Yoga had a medium effect on positive symptoms in the short term (Hedges's g = 0.31) and small effect in the long term (Hedges's g = 0.18). Medium significant effects were also found on negative symptoms in both the short term (Hedges's g = 0.44) and the long term (Hedges's g = 0.35). Yoga had a significant impact on improving both total QoL (Hedges's g = 0.34) and social functioning (Hedges's g = 0.45) with medium effect sizes.

CONCLUSIONS

Yoga was associated with significant reductions on negative and positive symptoms, and significant improvements in QoL as well as social functioning in patients with schizophrenia. Future research should explore the long-term efficacy of yoga for schizophrenia, encompassing more diverse populations.

Supported employment interventions for workplace mental health of persons with mental disabilities in low-to-middle income countries: A scoping review

OBJECTIVE

To review the evidence of supported employment interventions in low-to-middle income countries, documents their impact for persons with mental disorders in the open labour market and well as support decision making for its wider implementation in the workplace.

DESIGN

The scoping review is conducted following guidelines in the Arksey and O'Malley (2005) Framework.

DATA SOURCES AND ELIGIBILITY

Eleven databases which are PubMed, Scopus, Academic Search Premier, the Cumulative Index to Nursing and Allied Health Literature, Africa-Wide Information, Humanities International Complete, Web of Science, PsychInfo, SocINDEX, Open Grey and Sabinet were searched for articles published between January 2006 and January 2022. Both peer-reviewed articles and grey literature were eligible if they were on supported employment interventions in low-to-middle income countries. Only articles published in English were included.

STUDY APPRAISAL AND SYNTHESIS

Articles were screened at title, abstract and full article levels by two independent teams with the use of Rayyan software. Deductive thematic analysis was used to synthesize evidence on the supported employment interventions implemented in LMICs, capturing evidence of their outcomes for persons with mental disabilities securing competitive work.

RESULTS

The search yielded 7347 records and after screening by title and abstract, 188 studies were eligible for full article screening. Eight studies were included in this scoping review. Thematic descriptions of the findings were based on the availability of supported employment interventions within the context, the type of supported employment interventions as well as mental health and vocational outcomes in the workplace.

CONCLUSIONS

There is limited evidence of supported employment interventions in low-to-middle income countries despite the promising potential it has as an intervention to address mental health problems in the workplace and facilitate work participation by persons with mental disabilities.

Effects of a six-month yoga intervention on the immune-inflammatory pathway in antipsychotic-stabilized schizophrenia patients: A randomized controlled trial

BACKGROUND

Schizophrenia is a complex neuropsychiatric disorder for which several etiopathological theories have been proposed, one of the prominent ones being immune dysfunction. Recent studies on yoga as an add-on therapy have shown improvement in negative symptoms, cognition, and quality of life in schizophrenia patients. However, the biological mechanism/s of action of yoga in schizophrenia are not clear. The current study was aimed at exploring the effects of long-term (6 months) add-on yoga therapy on the immune inflammatory pathway in schizophrenia patients.

METHODS

Sixty schizophrenia patients were randomized to add-on yoga therapy (YT=30) and treatment-as-usual (TAU=30) groups of which 21 patients in YT and 20 in TAU group completed the study. Blood samples and clinical assessments were obtained at baseline and at the end of 6 months. The plasma levels of nine cytokines (IL-2, IL-4, IL-5, IL-10, IL-12(p70), IL-13, GM-CSF, IFN-γ, and TNF-α) were quantified using multiplex suspension array. The clinical assessments included SAPS, SANS, BPRS, PSS, CGI, SOFS and WHOQUOL-BREF.

RESULTS

Patients in the yoga group showed significant reductions in plasma TNF-α (Z = 2.99, p = 0.003) and IL-5 levels (Z = 2.20, p = 0.03) and greater clinical improvements in SAPS, SANS, PSS, and SOFS scores as compared to TAU group. Further, plasma TNF-α levels exhibited a positive correlation with negative symptoms (r_s =0.45, p = 0.02) and socio-occupational functioning (r_s =0.61, p = 0.002) in the YT group.

CONCLUSIONS

The findings of the study suggest that improvements in schizophrenia psychopathology with yoga interventions are associated with immuno-modulatory effects.

Psychotic symptoms and neurocognition among patients with major depressive disorder: A chained mediation model of depressive symptoms and socio-occupational functioning

BACKGROUND

Depressive symptom and psychotic symptom have been identified as risk factors for impaired socio-occupational functioning in patients with major depressive disorder (MDD), while neurocognitive functioning is considered to be a potential protective factor against socio-occupational functioning. Nevertheless, little is known about the complex relationship among these factors in patients with MDD. The purpose of this research was to explore whether the relationship between depressive symptom severity and social-occupational functioning is mediated by neurocognitive functioning and psychotic symptom severity in MDD patients.

METHODS

A total of 659 eligible MDD patients included male and female, and their depressive symptoms and psychotic symptoms at baseline were assessed by the 17-item Hamilton Depression Scale (HAMD-17) and The Brief Psychiatric Rating Scale (BPRS) respectively. Cognitive domains were assessed by the MATRICS Consensus Cognitive Battery (MCCB), and subjective and objective functioning were measured by the Global Assessment of Functioning (GAF).

LIMITATION

The analysis is cross-sectional, which limits causal inference.

RESULT

(1) The correlation between depressive symptoms and thought disturbance was positive (r = 0.125, p = 0.001), whereas the correlations with visual learning and memory (r = -0.146, p < 0.001) and socio-occupational functioning (r = -0.175, p < 0.001) were negative. (2) Depressive symptoms mainly affect the socio-occupational functioning of MDD patients via three indirect effects: the single mediating effect of psychotic symptoms and neurocognitive functioning, and the chain mediating effect of psychotic symptoms and neurocognitive functioning.

CONCLUSIONS

The results suggest that the relationship between depressive symptom severity and socio-occupational functioning in MDD patients is partially mediated by psychotic symptom severity and neurocognitive functioning.

Association of clinical factors with socio-occupational functioning among individuals with schizophrenia

Background

Schizophrenia is assumed to be developing into a marked disability affecting performances in educational and vocational fields for both males and females. It is a psychiatric disorder that has been proven to be associated with poor occupational skills and functioning. This research aimed at studying the clinical correlates of socio-occupational functioning skills of persons with schizophrenia as per the ICD-10, DCR criteria.

Materials and Methods

The is a cross-sectional descriptive study that included 200 participants diagnosed with schizophrenia, in which sociode mographic and clinical data sheet and Socio-occupational Functioning Scale (SOFS) by Saraswat et al. were used.

Results

Mean age of the participants was 34 years, with onset of illness being 24 years of age. The results indicated significant correlation at 0.05 level between the total score of SOFS and age of onset and duration of illness.

Conclusion

It can be concluded that for a better treatment outcome in a disorder like schizophrenia, bio-psychosocial model of treatment is necessary.

A Mixed-Methods Outcomes Evaluation Protocol for a Co-Produced Psychoeducation Workshop Series on Recovery from Psychosis

Co-production in mental health is a relatively new approach to designing and delivering mental health services, which involves collaboration amongst professionals, persons in recovery, and their caregivers to provide services. The aim of this protocol paper is to detail the implementation and evaluation of a co-produced workshop series named Broken Crayons. Collaborating with an early intervention program for first-episode psychosis, the study team and peer volunteers generated a co-production framework based on their experience of co-producing 11 workshops. This paper also outlines a protocol to evaluate Broken Crayons, a psychoeducation workshop series co-created and co-delivered by mental health professionals, persons in recovery, and their caregivers. Indicators on personal recovery, mental wellbeing, community integration, etc., are included as outcomes. Two-tailed, paired t-tests will be used to compare pre- and post-workshop survey data. Focus group discussions will also be conducted to gather subjective experiences of participants of the Broken Crayons workshops. Cost-savings of co-production by Recovery Colleges are discussed. The implications of using co-production to foster citizenry in persons living with first-episode psychosis are discussed in the context of social causation and social drift theories. Taken together, we argued that co-production is not just a passing trend, but a moral imperative for inclusive and equitable mental health service design and delivery.

Cerebral, Psychosocial, Family Functioning and Disability of Persons with Schizophrenia

The human brain is the most cognitively capable of mammalian brains, endowed as it is with an overdeveloped cerebral cortex that, in parallel, renders it vulnerable to mental disorders. Schizophrenia is the expression of the dysregulation of the neuronal activity of cortical and subcortical regions due to modifications in the levels of the various neurotransmitters, especially of dopamine, with a reciprocal, intimate relationship among genes with environmental and psychosocial factors. If the dopaminergic system increases the function prefrontal cortex will be reduced: this is the main reason of social, occupational and familiar disruption. The present article describes the function of the brain in schizophrenia and its relation with anatomical, physiological, and genetic changes, in addition to identifying, psychosocial and family factors that can be determinant in the functionality of the patient. A review of national and international bibliography was conducted bearing in mind the following variables: functioning at the cerebral level; psychosocial functioning, familial functioning, disability, and functionality in persons with schizophrenia. Due to the variety of the issues included in this review, it can be concluded that schizophrenia is the product of a complex array of symptoms, deficits and disabilities. It was identified that there is a reciprocal confluence of diverse genetic, psychosocial, familial, environmental, educative, and social factors which affect the functionality of persons with this disorder. The latter makes it necessary to study the patient taking into consideration all of these components in an integral manner.

Comparison of Marital and Sexual Functioning of the Spouses of Patients with Schizophrenia and Depressive Disorders

Aim:

This study assessed the various aspects of marital functioning among the spouses of patients with schizophrenia and recurrent depressive disorder (RDD).

Methodology:

Spouses were assessed on Dyadic Adjustment Scale (DAS), Marital Forgiveness Scale, Quality Marriage Index, New Sexual Satisfaction Scale, and Arizona Sexual Experience Questionnaire.

Results:

Compared to the spouses of patients with RDD, spouses of patients with schizophrenia reported poor marital adjustment (in the consensus and satisfaction domains of DAS), lower quality of marriage, and significantly lower sexual satisfaction. Spouses did not differ significantly on account of marital forgiveness and prevalence of sexual dysfunction. Higher age of onset of schizophrenia in the patients was associated with better quality of marriage as assessed by using quality of marriage scale, better consensus, and satisfaction as per the DAS. Higher residual psychopathology and poor socio-occupational functioning in patients with schizophrenia were associated with poor marital adjustment and sexual satisfaction.

Conclusion:

To conclude, the present study depicts that the spouses of patients with schizophrenia have poorer marital adjustment and sexual satisfaction, in comparison to the spouses of patients with RDD.

Multimodal versus unimodal auditory hallucinations in clinical practice: Clinical characteristics and treatment outcomes

Psychological treatments for hallucinations typically target auditory verbal hallucinations (AVH) but neglect the influence of hallucinations in other sensory modalities. This study compared the baseline clinical characteristics and therapeutic outcomes (following brief Coping Strategy Enhancement) of adult clients (N = 100) with multimodal or unimodal (auditory) hallucinations attending an outpatient service for distressing AVH. The results showed that 72.1% of clients reported multimodal hallucinations in the past month. Group comparisons of most baseline clinical characteristics (AVH features, beliefs about AVH, number of traumatic events, personal and social functioning, negative affect) were non-significant. However, in the subgroup (N = 65) reporting ongoing effects of traumatic events, those with multimodal hallucinations reported significantly higher posttraumatic stress symptoms (d = 0.62). Notably, both multimodal and unimodal hallucination groups showed improvement in AVH distress and frequency post-treatment, but group differences in treatment outcomes were not significant. These findings, in a naturalistic service setting, confirm that multimodal hallucinations are common in people seeking help for distressing AVH and may be associated with higher levels of posttraumatic stress symptoms. Importantly, they also suggest that psychological therapy may be suitable and effective for clients experiencing AVH - irrespective of the presence of hallucinations in other sensory modalities.

Effectiveness of clozapine on quality of life and functioning in patients with treatment-resistant schizophrenia

BACKGROUND

Although it is well known that treatment with clozapine is associated with improvement in core symptoms of schizophrenia, little information is available about its impact on other outcome variables. Accordingly, this study aimed to evaluate the short term (3 months) effectiveness of clozapine in patients with treatment-resistant schizophrenia (TRS) in terms of quality of life, disability, and level of functioning.

METHODS

This naturalistic follow-up study evaluated 52 participants at the baseline and three months (±1 week) after initiation of clozapine (prospective assessment) on Positive and Negative Syndrome Scale for schizophrenia, Calgary Depression Scale for Schizophrenia, Yale-Brown Obsessive-Compulsive Scale Checklist and Scale, Clinical Global Impression (CGI) scale, Beck Cognitive Insight Scale (BCIS), Scale to Assess Unawareness of Mental Disorders (SUMD), Social Occupational Functioning Scale - SOFS, Functioning Assessment Short Test (FAST), Indian Disability Evaluation and Assessment Scale (IDEAS), World Health Organisation Quality Of Life-BREF (WHOQOL-BREF) and Self-report Quality of Life Measure for people with schizophrenia.

RESULTS

Treatment with clozapine led to significant improvement in the quality of life, functioning, and disability; reduction in psychopathology (positive, negative, general psychology, depression), the severity of illness, compulsive behavior, and improvement in insight including cognitive insight.

CONCLUSIONS

Treatment with clozapine leads to improvement in core symptoms of schizophrenia and is also associated with significant improvement in the quality of life, functioning, and disability.

Specialised early intervention teams (extended time) for recent-onset psychosis

BACKGROUND

Psychosis is an illness characterised by the presence of hallucinations and delusions that can cause distress or a marked change in an individual's behaviour (e.g. social withdrawal, flat or blunted effect). A first episode of psychosis (FEP) is the first time someone experiences these symptoms that can occur at any age, but the condition is most common in late adolescence and early adulthood. This review is concerned with FEP and the early stages of a psychosis, referred to throughout this review as 'recent-onset psychosis.' Specialised early intervention (SEI) teams are community mental health teams that specifically treat people who are experiencing, or have experienced, a recent-onset psychosis. SEI teams provide a range of treatments including medication, psychotherapy, psychoeducation, educational and employment support, augmented by assertive contact with the service user and small caseloads. Treatment is time limited, usually offered for two to three years, after which service users are either discharged to primary care or transferred to a standard adult community mental health team. Evidence suggests that once SEI treatment ends, improvements may not be sustained, bringing uncertainty about the optimal duration of SEI to ensure the best long-term outcomes. Extending SEI has been proposed as a way of providing continued intensive treatment and continuity of care, of usually up to five years, in order to a) sustain the positive initial outcomes of SEI; and b) improve the long-term trajectory of the illness.

OBJECTIVES

To compare extended SEI teams with treatment as usual (TAU) for people with recent-onset psychosis. To compare extended SEI teams with standard SEI teams followed by TAU (standard SEI + TAU) for people with recent-onset psychosis.

SEARCH METHODS

On 3 October 2018 and 22 October 2019, we searched Cochrane Schizophrenia's study-based register of trials, including registries of clinical trials.

SELECTION CRITERIA

We selected all randomised controlled trials (RCTs) comparing extended SEI with TAU for people with recent-onset psychosis and all RCTs comparing extended SEI with standard SEI + TAU for people with recent-onset psychosis. We entered trials meeting these criteria and reporting usable data as included studies.

DATA COLLECTION AND ANALYSIS

We independently inspected citations, selected studies, extracted data and appraised study quality. For binary outcomes we calculated the risk ratios (RRs) and their 95% confidence intervals (CIs). For continuous outcomes we calculated the mean difference (MD) and their 95% CIs, or if assessment measures differed for the same construct, we calculated the standardised mean difference (SMD) with 95% CIs. We assessed risk of bias for included studies and created a 'Summary of findings' table using the GRADE approach.

MAIN RESULTS

We included three RCTs, with a total 780 participants, aged 16 to 35 years. All participants met the criteria for schizophrenia spectrum disorders or affective psychoses. No trials compared extended SEI with TAU. All three trials randomly allocated people approximately two years into standard SEI to either extended SEI or standard SEI + TAU. The certainty of evidence for outcomes varied from low to very low. Our primary outcomes were recovery and disengagement from mental health services. No trials reported on recovery, and we used remission as a proxy. Three trials reported on remission, with the point estimate suggesting a 13% increase in remission in favour of extended SEI, but this included wide confidence intervals (CIs) and a very uncertain estimate of no benefit (RR 1.13, 95% CI 0.97 to 1.31; 3 trials, 780 participants; very low-certainty evidence). Two trials provided data on disengagement from services with evidence that extended SEI care may result in fewer disengagements from mental health treatment (15%) in comparison to standard SEI + TAU (34%) (RR 0.45, 95% CI 0.27 to 0.75; 2 trials, 380 participants; low-certainty evidence). There may be no evidence of a difference in rates of psychiatric hospital admission (RR 1.55, 95% CI 0.68 to 3.52; 1 trial, 160 participants; low-certainty evidence), or the number of days spent in a psychiatric hospital (MD -2.70, 95% CI -8.30 to 2.90; 1 trial, 400 participants; low-certainty evidence). One trial found uncertain evidence regarding lower global psychotic symptoms in extended SEI in comparison to standard SEI + TAU (MD -1.90, 95% CI -3.28 to -0.52; 1 trial, 156 participants; very low-certainty evidence). It was uncertain whether the use of extended SEI over standard SEI + TAU resulted in fewer deaths due to all-cause mortality, as so few deaths were recorded in trials (RR 0.38, 95% CI 0.09 to 1.64; 3 trials, 780 participants; low-certainty evidence). Very uncertain evidence suggests that using extended SEI instead of standard SEI + TAU may not improve global functioning (SMD 0.23, 95% CI -0.29 to 0.76; 2 trials, 560 participants; very low-certainty evidence). There was low risk of bias in all three trials for random sequence generation, allocation concealment and other biases. All three trials had high risk of bias for blinding of participants and personnel due to the nature of the intervention. For the risk of bias for blinding of outcome assessments and incomplete outcome data there was at least one trial with high or unclear risk of bias.

AUTHORS' CONCLUSIONS

There may be preliminary evidence of benefit from extending SEI team care for treating people experiencing psychosis, with fewer people disengaging from mental health services. Evidence regarding other outcomes was uncertain. The certainty of evidence for the measured outcomes was low or very low. Further, suitably powered studies that use a consistent approach to outcome selection are needed, but with only one further ongoing trial, there is unlikely to be any definitive conclusion for the effectiveness of extended SEI for at least the next few years.

The role of dopamine dysregulation and evidence for the transdiagnostic nature of elevated dopamine synthesis in psychosis: a positron emission tomography (PET) study comparing schizophrenia, delusional disorder, and other psychotic disorders

There have been few studies performed to examine the pathophysiological differences between different types of psychosis, such as between delusional disorder (DD) and schizophrenia (SZ). Notably, despite the different clinical characteristics of DD and schizophrenia (SZ), antipsychotics are deemed equally effective pharmaceutical treatments for both conditions. In this context, dopamine dysregulation may be transdiagnostic of the pathophysiology of psychotic disorders such as DD and SZ. In this study, an examination is made of the dopamine synthesis capacity (DSC) of patients with SZ, DD, other psychotic disorders, and the DSC of healthy subjects. Fifty-four subjects were recruited to the study, comprising 35 subjects with first-episode psychosis (11 DD, 12 SZ, 12 other psychotic disorders) and 19 healthy controls. All received an ¹⁸F-DOPA positron emission tomography (PET)/magnetic resonance (MR) scan to measure DSC (K^occ;30-60 value) within 1 month of starting antipsychotic treatment. Clinical assessments were also made, which included Positive and Negative Syndrome Scale (PANSS) measurements. The mean K^occ;30-60 was significantly greater in the caudate region of subjects in the DD group (ES = 0.83, corrected p = 0.048), the SZ group (ES = 1.40, corrected p = 0.003) and the other psychotic disorder group (ES = 1.34, corrected p = 0.0045), compared to that of the control group. These data indicate that DD, SZ, and other psychotic disorders have similar dysregulated mechanisms of dopamine synthesis, which supports the utility of abnormal dopamine synthesis in transdiagnoses of these psychotic conditions.

Social cognition in patients with first episode of psychosis in remission

AIM

The present study aimed to compare the social cognition (SC) deficits in patients with first-episode psychosis (FEP) and healthy controls and evaluate the association of SC deficits with socio-occupational functioning, insight, quality of life, and stigma.

METHODS

This study included 30 patients with FEP in remission phase and 26 healthy controls matched for age, gender, education, and intelligent quotient. SC was assessed on the domains of theory of mind (ToM), social perception, and attributional bias.

RESULTS

Compared to healthy controls, patients with FEP had significantly higher deficits in the domains of second-order ToM (unpaired t = 4.447, P < 0.001) and Faux Pas Composite Index (unpaired t = 2.824, P = 0.007). In the correlation analysis, higher age of patients with FEP was significantly associated with more externalizing bias (Pearson's correlation coefficient = 0.38, P = 0.039) and those with lower level of education had more social cognitive deficits in the domains of Faux Pas Composite Index (Pearson's correlation coefficient = 0.43, P = 0.018), Social Perception Index (Pearson's correlation coefficient = 0.38, P = 0.04), and Nonsocial Perception Index (Pearson's correlation coefficient = 0.5, P = 0.005). Duration of untreated psychosis was associated with higher deficits in the first-order ToM (Pearson's correlation coefficient = -0.38, P = 0.04) and Externalizing Bias Index (Pearson's correlation coefficient = -0.49, P = 0.006). Longer duration of treatment was associated with higher impairment in first-order ToM index (Pearson's correlation coefficient = -0.42, P = 0.02). General psychopathology and total Positive and Negative Syndrome Scale total score correlated significantly with externalizing bias, with a higher level of psychopathology associated with more severe deficits in this domain. There was no correlation of SC with the quality of life, cognitive insight, and stigma (except for occasional correlation of stereotype endorsement and externalizing bias).

CONCLUSION

The present study suggests that compared to healthy controls, patients with FEP have impairment in the domains of second-order ToM and Faux Pas Composite Index. However, social cognitive deficits have only a few correlations with various psychosocial outcomes of FEP.

Supported employment programme for persons with severe mental disorders in India: A feasibility study

BACKGROUND

A number of persons with severe mental illnesses are unable to prepare for, find or keep a job due to factors linked to their illness as well as psychosocial issues.

AIM

To test the feasibility of a supported employment programme to help persons with severe mental disorders obtain and sustain employment.

METHODS

A supported employment programme was developed for persons with severe mental disorders with components of (a) assessment of vocational potential, (b) vocational counselling, (c) networking and liaison with prospective employers, (d) job-related training and placement and (e) continued support for 6 months. Job placement status, social occupational functioning and disability (quantitative data) and benefits of enrolling in the employment programme (qualitative data) were assessed.

RESULTS

A total of 40 employers were liaised with for providing job placement and reasonable accommodation. Out of 63 participants recruited into the study, 32 (50.8%) participants were placed in competitive jobs, placement was actively attempted for 17 (27.0%) participants, 7 (11.1%) were referred for skill training and 7 (11.1%) dropped out from the study. The disability score significantly reduced and socio-occupational functioning significantly improved in those who were placed over a period of 6 months.

CONCLUSION

The supported employment programme was found to be feasible as it showed good placement rates and improvement in socio-occupational functioning and disability scores.

Psychiatric hospital reform in low-income and middle-income countries Structured Individualised inTervention And Recovery (SITAR): a two-arm pragmatic randomised controlled trial study protocol

INTRODUCTION

Low-income and middle-income settings like India have large treatment gaps in mental healthcare. People with severe mental disorders face impediments to their clinical and functional recovery, and have large unmet needs. The infrastructure and standards of care are poor in colonial period psychiatric hospitals, with no clear pathways to discharge and successfully integrate recovered individuals into the community. Our aim is to study the impact of psychiatric hospital reform on individual patient outcomes in a psychiatric hospital in India.

METHODS AND ANALYSIS

Structured Individualised inTervention And Recovery (SITAR) is a two-arm pragmatic randomised controlled trial, focusing on patients aged 18-60 years with a hospital stay of 12-120 months and a primary diagnosis of psychosis. It tests the effectiveness of structural and process reform with and without an individually tailored recovery plan on patient outcomes of disability (primary outcome WHO Disability Assessment Scale), symptom severity, social and occupational functioning and quality of life. A computer-generated permuted block randomisation schedule will allocate recruited subjects to the two study arms. We aim to recruit 100 people into each trial arm. Baseline and outcome measures will be undertaken by trained researchers independent to the case managers providing the individual intervention. A health economic analysis will determine the costing of implementing the individually tailored recovery plan.

ETHICS AND DISSEMINATION

The study will provide answers to important questions around the nature and process of reforms in institutional care that promote recovery while being cognizant of protecting human rights, and dignity. Ethical approval for SITAR was obtained from a registered ethics committee in India (Institutional Ethics Committee VikasAnvesh Foundation, VAF/2018-19/012 dated 6 December 2018) and the University of Warwick's Biomedical and Scientific Research Ethics Committee (REGO-2019-2332, dated 21 March 2019), and registered on the Central Trial Registry of India (CTRI/2019/01/017267). Trial results will be published in accordance to CONSORT guidelines.

Measurement based care in schizophrenia-Feasibility in routine clinical practice

Measurement based care (MBC) implies the utilization of structured objective scales/batteries in the assessment and monitoring of an illness. Patients with schizophrenia with heterogeneous presentation would potentially benefit better through MBC. Time constraints and additional work burden are frequently cited as barriers in implementing objective assessments. In this selective review, the authors discuss the available standard scales for assessment in schizophrenia, the advantages and disadvantages in implementing MBC and a feasible approach to overcome the barriers by adapting shorter versions of structured scales.

Social functioning and health-related quality of life trajectories in people with epilepsy after epilepsy surgery

OBJECTIVE

An improvement in quality of life (QoL) over time after epilepsy surgery has been demonstrated in people with epilepsy; however, social functioning has been less investigated. We conducted this study to examine whether postsurgical improvement is parallel between QoL and social functioning in patients with epilepsy.

METHODS

We retrospectively reviewed patients who underwent epilepsy surgery. All participants completed a comprehensive neuropsychological assessment, the Quality of Life in Epilepsy Inventory (QOLIE-89) questionnaire, and the Social and Occupational Functioning Scale for Epilepsy (SOFSE) before surgery and at 3 months, 6 months, and 1 year after surgery. Demographic and epilepsy-related information was also collected. Generalized estimating equations with identity links were used to model the QOLIE-89 and SOFSE over time and possible associated factors. A p < 0.05 was considered statistically significant.

RESULTS

A total of 76 patients, including 36 males and 43 females aged 18 to 62 years were collected. Both total QOLIE-89 and overall SOFSE improved over time after epilepsy surgery (adjusted p value < 0.001 and 0.002, respectively, with Bonferroni's correction). Total QOLIE-89 improved 3 months after surgery, while overall SOFSE showed no significant improvement until 6 months after surgery. The presurgical Full-Scale Intelligence Quotient (FSIQ) of the Wechsler Adult Intelligence Scale-III and years of education were significantly associated with time-dependent improvement for both total QOLIE-89 and overall SOFSE (p value < 0.001). At one year after surgery, overall SOFSE and total QOLIE-89 scores were significantly higher in the seizure-free group than in the nonseizure-free group (p value = 0.040 and 0.032, respectively).

CONCLUSION

Social functioning significantly improved in people with epilepsy after surgery as QoL, but it took more time to exhibit improvement. People with better FSIQ and more years of education had better improvement in social functioning over time. The early intervention of rehabilitation programs after epilepsy surgery might be necessary to facilitate the improvement in social functioning.

Cross-cultural adaptation and psychometric properties of the Chinese version of the Functional Remission of General Schizophrenia (FROGS) scale and the four-item version (mini-FROGS) among people with schizophrenia

OBJECTIVE

This study was designed to verify the cross-cultural psychometric properties of the Functional Remission of General Schizophrenia (FROGS) scale and the four-item version (mini-FROGS) in Chinese schizophrenic individuals.

METHODS

Item clustering analysis was used to show the clustering relationship among items. Confirmatory factor analysis (CFA) was used to test the structural validity of the scale. The Global Assessment of Functioning (GAF) was used as a criterion to test convergent validity. The receiver operating characteristic curve (ROC) and the area under the ROC curve (ROC-AUC) were calculated to test the sensitivity and specificity of FROGS and mini-FROGS for functional assessment. Fifty participants were randomly selected for retest at two-month intervals.

RESULTS

A total of 228 schizophrenia individuals were enrolled in our study. The results of the item clustering analysis and CFA supported the 3-factor structure of the original scale, and all items, except for the item "absence of antisocial or violent", showed good psychometric characteristics. The correlated coefficients between FROGS and mini-FROGS with the GAF were excellent (FROGS: r = 0.74, p＜0.01; mini-FROGS: r = 0.65, p＜0.01). The retest showed that the scale had good stability and validity over time (ICC = 0.856; 95% CI = 0.701∼0.941). Both mini-FROGS and FROGS had good sensitivity and specificity for the measurement of social function (mini-FROGS: ROC-AUC = 84.3% (76.9%-91.6%), and FROGS: ROC-AUC = 89.2% (83.0%-95.4%)), and there was no difference between the two versions of ROC-AUC (P = 0.154).

CONCLUSION

The results of our study showed that the Chinese version of FROGS and mini-FROGS had good psychometric properties for assessing the social function of people with schizophrenia in China. In particular, the mini-FROGS version was better used in the clinical setting because of its convenience and efficiency.

Validation of a four items version of the Functional Remission of General Schizophrenia scale (the mini-FROGS) to capture the functional benefits of clinical remission

Objectives

We previously developed the Functional Remission Of General Schizophrenia (FROGS) scale demonstrating first, reliable assessment in a cross-sectional study and second, good time-stability. The purpose of the present analysis was to propose a shorter version (mini-FROGS), more compatible with the limited time available in a psychiatric visit, focusing on the functional domains that have higher likelihood of being improved with higher and/or longer symptomatic remission in different cultural backgrounds.

Methods

We used multiple regressions to find the most informative items explaining increased length of symptomatic remission, using prospective data from a national observational multicenter survey. Then, the mini-FROGS was used in different European countries to test its between-center reliability, compared to other scales.

Results

Four domains were retained as capturing the maximum of symptomatic remission, namely (1) travel and communication, (2) management of illness and treatment, (3) self-esteem and sense of independence and (4) respect of biological rhythms. First, the mini-FROG was evaluated in 443 French patients with clinical remission and 22 without, and 12/18 months later in 140 patients still in clinical remission and 23 in relapse. In Europe, 295 schizophrenia patients were assessed with the mini-FROGS and other scales devoted to functional remission, allowing comparisons. The mini-FROGS showed good correlations with other scales in different countries and demonstrated good psychometric properties.

Conclusion

These results give evidence that a 4 items-only version of the FROGS scale may be useful to assess important aspects of functional remission, tightly linked to the length of clinical remission.

Social cognitive endophenotypes in schizophrenia: A study comparing first episode schizophrenia patients and, individuals at clinical- and familial- 'at-risk' for psychosis

Impairments in specific domains of social cognition have been suggested as possible endophenotypes for schizophrenia and clinical markers for accurate identification of 'at-risk' (AR) states. Aim of the present study was to find out whether performance on social cognition tasks will distinguish 'clinical at-risk (CAR)' and 'familial at-risk (FAR)' individuals from remitted first episode schizophrenia (FES) patients and healthy controls. Fifty in each of these four groups were included for analysis. Schizophrenia psychopathology in FES group was assessed using the Positive and Negative Syndrome Scale (PANSS). Theory of mind (ToM; first and second order (SOT and FOT), and faux pas composite (FPC)), attributional bias (AB) and social perception (SP) were assessed using the Social Cognition Rating Tool in Indian Setting (SOCRATIS). Facial emotion recognition task was used to assess emotional-expression recognition (ER). Significant differences in ToM, SP and ER between the four groups were found, even after controlling for performance on various neurocognitive tasks. ToM and SP were identified to follow an endophenotype pattern. While, both ToM and SP classified FES from healthy with large accuracy rates, SP, specifically, distinguished at-risk from disease groups. None of the social cognitive domains accurately classified familial at-risk from clinical at-risk groups. We conclude that social cognitive measures may be used as reliable endophenotype markers for schizophrenia and its sub-domains may be used for valid identification of AR individuals.

Yoga and schizophrenia-a comprehensive assessment of neuroplasticity: Protocol for a single blind randomized controlled study of yoga in schizophrenia

INTRODUCTION

Schizophrenia is one of the most severe mental disorders with a prevalence of about 1% and a leading cause of disability among young adults. Pharmacotherapy is the mainstay in the management of schizophrenia. However, even with the best of medication, several problems like refractoriness, negative symptoms, frequent relapses, and cognitive impairments persist.

METHODS

This is a randomized-controlled clinical study including patients from an urban tertiary hospital and a semi-urban community center, with a between-group, repeated-measures, longitudinal design. This study will recruit 160 patients with DSM 5 diagnosis of schizophrenia who are on stable medication for a minimum of 6 weeks; they will be randomly assigned into 2 arms viz., yoga therapy (YT), and treatment-as-usual (TAU) with 80 patients in each arm. Participants will undergo Clinical, Laboratory, and Radiological assessments at baseline and at intervals of 1 month, 3 months, and 6 months from the baseline. It is hypothesized that yoga will improve psychopathology and emotion processing, increase serum brain derived neurotrophic factor (BDNF) and plasma oxytocin levels and effect changes in cerebral activation in areas of the brain associated with schizophrenia.

DISCUSSION

This study aims to measure the efficacy of a Yoga-based intervention as an adjunct in patients with schizophrenia as well as the mechanisms of these effects.

TRIAL REGISTRATION

Registered retrospectively with Clinical Trial Registry - India (CTRI) with registration number CTRI/2017/08/009219.

Evaluating the "C" and "B" in brief cognitive behaviour therapy for distressing voices in routine clinical practice in an uncontrolled study

Brief and single-symptom forms of cognitive behaviour therapy (CBT) for distressing voices may increase access to evidence-based psychological therapy and transcend diagnostic barriers. The current study evaluated the "C" and "B" in CBT for distressing voices in a transdiagnostic voices clinic. The B module (component of therapy) sought to enhance coping with voices, and the C module evaluated the accuracy of negative beliefs about the self and voices. The aims of the study were to investigate (a) whether modules B and/or C led to significant and clinically meaningful improvements on the primary outcome of voice-related distress, and (b) if changes in beliefs about self and voices (proposed change mechanisms) underpinned changes in voice distress across module C. Each module consisted of four sessions, individually tailored yet manualized, and designed with ease of staff training and delivery in mind. Assessment measures were administered at baseline (T1), post-module B (T2), and post-module C (T3). The results (N = 62) showed statistically significant medium-sized pre- and post-effects for voice-related distress from T1 to T2 and from T2 to T3, with large effects from T1 to T3. Just over half of the clients reported clinically meaningful improvements from T1 to T3. Neither beliefs about self nor voices were found to mediate improvements in voice distress during module C. The findings from this study suggest that both the B and C in CBT for voices can contribute to positive outcomes within routine clinical practice.

The Social Functioning Scale for Alzheimer's Disease: A Short Informant-based Measure of Functional Status in Patients with Alzheimer's Disease in Taiwan

OBJECTIVE

Evaluating social-functioning impairments in patients with Alzheimer's disease (AD) objectively is essential for clinical service. However, the existing instruments lack representative content, consensus on purposes of use, and adequate scoring systems and samples. This study was thus to develop a social functioning scale for patients: the Social Functioning Scale for Alzheimer's Disease (SFSAD).

METHOD

Questionnaires were analyzed from 142 AD patients, 30 patients with amnestic mild cognitive impairment (aMCI), and 50 normal controls.

RESULTS

Based on the literature review and experts' opinions, the final scale includes 20 items in four subscales. The SFSAD showed high internal consistency coefficients (Cronbach's α = .97) and test-retest reliability (r = .99) coefficients. The content validity was desirable, and the criterion-related validity was demonstrated by a significant association with the MMSE, the IADL, and the Barthel ADL. The discriminant validity of the scale was also demonstrated as the level of social-functioning impairment was significantly related to the degree of dementia, and for construct validity, our findings supported the structure of the four-factor hypothesized model.

CONCLUSIONS

The SFSAD is thus a practical, psychometrically sound, and easy-to-administer measure to evaluate social functioning of AD and aMCI in brisk clinical settings.

Social Media and Social Functioning in Psychosis: A Systematic Review

BACKGROUND

Individuals with psychosis are heavy consumers of social media. It is unknown to what degree measures of social functioning include measures of online social activity.

OBJECTIVE

To examine the inclusion of social media activity in measures of social functioning in psychosis and ultrahigh risk (UHR) for psychosis.

METHODS

Two independent authors conducted a search using the following electronic databases: Epistemonikos, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, MEDLINE, Embase, and PsycINFO. The included articles were required to meet all of the following criteria: (1) an empirical study published in the English language in a peer-reviewed journal; (2) the study included a measure of objective or subjective offline (ie, non-Web-mediated contact) and/or online social functioning (ie, Web-mediated contact); (3) the social functioning measure had to be used in samples meeting criteria (ie, Diagnostic and Statistical Manual of Mental Disorders or International Classification of Diseases) for a psychotic disorder or UHR for psychosis; and (4) the study was published between January 2004 and February 2019. Facebook was launched as the first large-scale social media platform in 2004 and, therefore, it is highly improbable that studies conducted prior to 2004 would have included measures of social media activity.

RESULTS

The electronic search resulted in 11,844 distinct articles. Full-text evaluation was conducted on 719 articles, of which 597 articles met inclusion criteria. A total of 58 social functioning measures were identified. With some exceptions, reports on reliability and validity were scarce, and only one measure integrated social media social activity.

CONCLUSIONS

The ecological validity of social functioning measures is challenged by the lack of assessment of social media activity, as it fails to reflect an important aspect of the current social reality of persons with psychosis. Measures should be revised to include social media activity and thus avoid the clinical consequences of inadequate assessment of social functioning.

TRIAL REGISTRATION

International Prospective Register of Systematic Reviews (PROSPERO) CRD42017058514; http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42017058514.

A comparative study of childhood/adolescent and adult onset schizophrenia: does the neurocognitive and psychosocial outcome differ?

AIMS & OBJECTIVES

The present study aimed to evaluate the neurocognitive functioning and psychosocial outcome (in terms of social functioning, disability and internalized stigma) in patients with schizophrenia with childhood/adolescent onset (age of onset ≤18 years) and adult onset (>18years) schizophrenia and to evaluate the effect of neurocognitive impairment on the outcome variables in patients with youth and adult onset schizophrenia.

METHODOLOGY

34 patients with youth onset schizophrenia (Group-I) and 56 patients with adult onset schizophrenia (Group-II), who were currently in clinical remission were assessed on a comprehensive neurocognitive battery,Positive and Negative syndrome Scale (PANSS), Global Assessment of Functioning Scale (GAF), Indian Disability Evaluation and Assessment Scale (IDEAS),Social and Occupational Functioning Assessment Scale (SOFS) and Internalised Stigma of Mental Illness Scale (ISMIS).

RESULTS

On neurocognitive domains (after adjusting for co-variates) significant differences were noted between the two groups in terms of processing speed (TMT-A; I > II; p-value -0.009), verbal fluency (COWA;I < II;p-value-0.001) and cognitive flexibility (TMT-B; I > II; p -0.031). Compared to patients with adult onset schizophrenia, patients with childhood & adolescent onset schizophrenia had significantly higher PANSS negative score, higher disability in all domains of IDEAS, poorer socio-occupational functioning, low global functioning and reported more stigma in the domains of alienation and discrimination.In patients with childhood & adolescent onset schizophrenia, higher deficits in the processing speed and verbal fluency were associated with significantly lower socio-occupational functioning and higher disability; higher executive dysfunction was associated with higher internalized stigma. Among patients with adult onset schizophrenia, higher disability was related to executive dysfunction only and higher stigma was associated with poor cognitive processing, selective attention and poor executive functioning.

CONCLUSIONS

The present study suggests that compared to adult onset schizophrenia, patients with childhood & adolescent onset schizophrenia have more deficits in neurocognition, have higher level of disability, poorer socio-occupational functioning and have higher level of self-stigma.

Mediating effect of neurocognition between severity of symptoms and social-occupational function in anxious depression

BACKGROUND

Major depressive disorder (MDD) is associated with neurocognitive impairment and reduced social-occupational function. However, neurocognition and social-occupational function in patients with anxious depression have been under-investigated. An increasing number of studies have demonstrated that neurocognition plays an important role in social-occupational function. The objective of this study was to investigate the association of severity of symptoms, neurocognition and social-occupational function in patients with anxious depression.

METHOD

Using a cross-sectional design, 214 patients with MDD were recruited consecutively and evaluated using the 17-item Hamilton Depression Rating scale (HAMD-17), the MATRICS Consensus Cognitive Battery (MCCB) and the Global Assessment of Functioning (GAF).

RESULT

The prevalence of anxious depression in MDD patients was 64.5%. Compared to non-anxious subjects, the anxious group had more severe symptoms. Moreover, in the anxious group, social-occupational function was associated with several domains of symptoms and neurocognition, while social-occupational function was associated with only one aspect of depressive symptoms (cognitive disturbance) in the non-anxious group. In addition, there was a mediating effect of neurocognition on the association between the severity of symptoms and social-occupational function in the anxious group.

LIMITATIONS

The major limitation of the present study is the use of a cross-sectional design that is unable to illuminate causal relationships.

CONCLUSION

Our results suggest that the severity of symptoms is negatively associated with neurocognition and social-occupational function and that neurocognition is positively associated with social-occupational function in patients with anxious depression.

Occupational therapy delivered by specialists versus non-specialists for people with schizophrenia

BACKGROUND

Schizophrenia is a severe mental health condition that is characterised by positive symptoms, such as hallucinations and delusions; negative symptoms, such as flattened affect, thought disorder (disrupted speech), and lack of motivation; and cognitive symptoms, such as problems with memory and attention. Schizophrenia can occur as an isolated episode, or as a recurring cycle of remission and relapse, and is associated with impairment in psychosocial and occupational functioning.Although antipsychotic drugs are the main treatment for people with schizophrenia, in most countries mental health services usually provide a range of add-on interventions, including occupational therapy. This is a complex intervention designed to support and enable continued participation in daily life through engagement in activities and occupations meaningful to the individual. Occupational therapists are professionals trained to deliver therapy where the emphasis is on improving occupational function and participation rather than treating symptoms, and uses a wide range of methods based on the needs of individuals. However, similar interventions may also be delivered by staff not trained as occupational therapists.

OBJECTIVES

To examine the effects of occupational therapy delivered by occupational therapists compared to occupational therapy delivered by any other person for people with schizophrenia.

SEARCH METHODS

We searched the Cochrane Schizophrenia Group's Study-Based Register of Trials (including trial registers) on 4 November 2016 and 26 July 2018.

SELECTION CRITERIA

All randomised controlled trials evaluating the functional or clinical outcomes of occupational therapy, or both, for people with schizophrenia delivered by occupational therapists compared with occupational therapy for people with schizophrenia delivered by anyone other than occupational therapists.

DATA COLLECTION AND ANALYSIS

Review authors independently inspected citations, selected studies, extracted data, and appraised study quality.

MAIN RESULTS

The search yielded 1633 records. Of these, we retrieved 17 full-text reports (14 studies) for further scrutiny, which we subsequently excluded as they did not meet our inclusion criteria.

AUTHORS' CONCLUSIONS

Currently there are no randomised controlled trials comparing delivery of occupational therapy for people diagnosed with schizophrenia by occupational therapists with delivery of similar interventions by anyone other than occupational therapists. Research studies employing methodologically robust trial designs are needed to establish whether or not there are better outcomes for people with a diagnosis of schizophrenia with occupational therapy that is delivered by trained occupational therapists.

Facial emotion recognition, socio-occupational functioning and expressed emotions in schizophrenia versus bipolar disorder

Facial emotion recognition deficits have been consistently demonstrated in patients with severe mental disorders. Expressed emotion is found to be an important predictor of relapse. However, the relationship between facial emotion recognition abilities and expressed emotions and its influence on socio-occupational functioning in schizophrenia versus bipolar disorder has not been studied. In this study we examined 91 patients with schizophrenia and 71 with bipolar disorder for psychopathology, socio occupational functioning and emotion recognition abilities. Primary caregivers of 62 patients with schizophrenia and 49 with bipolar disorder were assessed on Family Attitude Questionnaire to assess their expressed emotions. Patients of schizophrenia and bipolar disorder performed similarly on the emotion recognition task. Patients with schizophrenia group experienced higher critical comments and had a poorer socio-occupational functioning as compared to patients with bipolar disorder. Poorer socio-occupational functioning in patients with schizophrenia was significantly associated with greater dissatisfaction in their caregivers. In patients with bipolar disorder, poorer emotion recognition scores significantly correlated with poorer adaptive living skills and greater hostility and dissatisfaction in their caregivers. The findings of our study suggest that emotion recognition abilities in patients with bipolar disorder are associated with negative expressed emotions leading to problems in adaptive living skills.

Schizophrenia outcome measures in the wider international community

Background

Outcome of schizophrenia has been described as favourable in low-and middle-income countries. Recently, researchers have questioned these findings

Aims

To examine the outcome studies carried out in different countries specifically looking atthose from low-and middle-income countries

Methods

Long-term course and outcome studies in schizophrenia were reviewed

Results

A wide variety of outcome measures are used. The most frequent are clinical symptoms, hospitalisation and mortality (direct indicators), and social/ occupational functioning, marriage, social support and burden of care (indirect indicators). Areas such as cognitive function, duration of untreated psychosis, quality of life and effect of medication have not been widely studied in low-and middle-income countries

Conclusions

The outcome of schizophrenia appears to be better in low-and middle-income countries. A host of sociocultural factors have been cited as contributing to this but future research should aim to understand this better outcome. There is a need for more culture-specific instruments to measure outcomes

Social cognition of patients with schizophrenia across the phases of illness - A longitudinal study

AIM

This longitudinal study aimed to evaluate social cognition of patients with schizophrenia at two points, i.e., during the symptomatic phase and clinical remission phase. Additional aim was to evaluate the relationship of social cognition with psychopathology and functional outcome.

METHODOLOGY

Fifty-one patients (N=51) were evaluated on Social Cognition Rating Tools in Indian Setting (SOCRATIS), Positive and Negative Syndrome Scale (PANSS), Global Assessment of Functioning (GAF), Socio-occupational functioning scale (SOFS) and Indian Disability Evaluation and Assessment Scale (IDEAS) during the symptomatic phase of illness. These patients were followed-up longitudinally for achieving clinical remission. Out of the 51 patients, 32 patients underwent second assessment after a mean duration of 143 (SD 34.9) days, while in clinical remission. Data of 111 healthy controls was used for comparison.

RESULTS

Social cognitive deficits were present in both the phases of illness. However, when the baseline and follow-up data was compared, it was evident that the severity of social cognition deficits is lower during the clinical remission phase. Higher levels of social cognitive deficits in both phases of illness are associated with higher socio-occupational dysfunction and higher disability.

CONCLUSION

Present study suggests that impairment in social cognition in patients with schizophrenia is present both in symptomatic and remission phase, with higher level of deficits during the symptomatic phase. Social cognition impairments are associated with poor social and occupational functioning and higher level of disability.

Yoga versus non-standard care for schizophrenia

BACKGROUND

Yoga is an ancient spiritual practice that originated in India and is currently accepted in the Western world as a form of relaxation and exercise. It has been of interest for people with schizophrenia as an alternative or adjunctive treatment.

OBJECTIVES

To systematically assess the effects of yoga versus non-standard care for people with schizophrenia.

SEARCH METHODS

The Information Specialist of the Cochrane Schizophrenia Group searched their specialised Trials Register (latest 30 March 2017), which is based on regular searches of MEDLINE, PubMed, Embase, CINAHL, BIOSIS, AMED, PsycINFO, and registries of clinical trials. We searched the references of all included studies. There are no language, date, document type, or publication status limitations for inclusion of records in the register.

SELECTION CRITERIA

All randomised controlled trials (RCTs) including people with schizophrenia and comparing yoga with non-standard care. We included trials that met our selection criteria and reported useable data.

DATA COLLECTION AND ANALYSIS

The review team independently selected studies, assessed quality, and extracted data. For binary outcomes, we calculated risk ratio (RR) and its 95% confidence interval (CI), on an intention-to-treat basis. For continuous data, we estimated the mean difference (MD) between groups and its 95% CI. We employed a fixed-effect models for analyses. We examined data for heterogeneity (I2 technique), assessed risk of bias for included studies, and created a 'Summary of findings' table for seven main outcomes of interest using GRADE (Grading of Recommendations Assessment, Development and Evaluation).

MAIN RESULTS

We were able to include six studies (586 participants). Non-standard care consisted solely of another type of exercise programme. All outcomes were short term (less than six months). There was a clear difference in the outcome leaving the study early (6 RCTs, n=586, RR 0.64 CI 0.49 to 0.83, medium quality evidence) in favour of the yoga group. There were no clear differences between groups for the remaining outcomes. These included mental state (improvement in Positive and Negative Syndrome Scale, 1 RCT, n=84, RR 0.81 CI 0.62 to 1.07, low quality evidence), social functioning (improvement in Social Occupational Functioning Scale, 1 RCT, n=84, RR 0.90 CI 0.78 to 1.04, low quality evidence), quality of life (mental health) (average change 36-Item Short Form Survey (SF-36) quality-of-life sub-scale, 1 RCT, n=69, MD -5.30 CI -17.78 to 7.18, low quality evidence), physical health, (average change WHOQOL-BREF physical-health sub-scale, 1 RCT, n=69, MD 9.22 CI -0.42 to 18.86, low quality evidence). Only one study reported adverse effects, finding no incidence of adverse events in either treatment group. There were a considerable number of missing outcomes, which included relapse, change in cognition, costs of care, effect on standard care, service intervention, disability, and activities of daily living.

AUTHORS' CONCLUSIONS

We found minimal differences between yoga and non-standard care, the latter consisting of another exercise comparator, which could be broadly considered aerobic exercise. Outcomes were largely based on single studies with limited sample sizes and short-term follow-up. Overall, many outcomes were not reported and evidence presented in this review is of low to moderate quality - too weak to indicate that yoga is superior or inferior to non-standard care control for management of people with schizophrenia.

Relationship of depression with cognitive insight and socio-occupational outcome in patients with schizophrenia

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.

Obsessive Compulsive Symptoms/disorder in patients with schizophrenia: Prevalence, relationship with other symptom dimensions and impact on functioning

The aim of this study was to evaluate the prevalence of comorbid obsessive compulsive symptoms/disorder and its impact on outcome among patients with schizophrenia. 181 patients with schizophrenia were evaluated on Yale-Brown Obsessive-Compulsive Symptom Checklist, Yale-Brown Obsessive-Compulsive Scale, Calgary Depression Scale for Schizophrenia, Positive and Negative Symptom Scale, Social Occupational Functioning Scale, Global Assessment of Functioning Scale and Indian Disability Evaluation and Assessment Scale. Slightly more than one-fourth of patients fulfilled the diagnosis of current (28.2%) and lifetime (29.8%) diagnosis of obsessive compulsive disorder. On Yale Brown Obsessive Compulsive Symptom Checklist, the most common lifetime obsessions were those of contamination (25.4%), followed by obsessions of need for symmetry or exactness (11.6%). The most common compulsions were those of cleaning/washing (27.1%), followed by those of checking (24.3%). Presence of obsessive compulsive symptoms was associated with younger age of onset, higher prevalence of comorbid depression, and current suicidal ideations. Thus, it can be concluded that a significant proportion of patients with schizophrenia have obsessive compulsive symptoms/disorder. Clinicians managing patients of schizophrenia should evaluate the patients thoroughly for presence of comorbid obsessive compulsive symptoms/disorder and must take the same into account while managing the patients.

Concurrent validity of Indian Disability Evaluation and Assessment Scale with sociooccupational functioning scale in patients with schizophrenia

BACKGROUND

The Government of India (GOI) has recommended the use of Indian Disability Evaluation and Assessment Scale (IDEAS) for the assessment and certification of disability in patients with mental illness. Although data are available in terms of internal consistency and construct validity of IDEAS, concurrent validity of IDEAS has rarely been evaluated.

AIM

The aim was to study the concurrent validity of IDEAS with Global Assessment of Functioning (GAF) and Social and Occupational Functioning Scale (SOFS) in patients with schizophrenia.

MATERIALS AND METHODS

One hundred and seventy-eight consenting patients with schizophrenia in remission were assessed for disability, functioning, and psychopathology using the IDEAS, SOFS, GAF, and Positive and Negative symptom scale (PANSS) respectively.

RESULTS

Mean total PANSS score was 51.3 (standard deviation SD -11.19). Disability (>40%) was present in 84.8% of the sample. All the component scores of IDEAS (self-care, interpersonal activities, communication, and work), total IDEAS score, and Global IDEAS score correlated significantly (P < 0.001) with the three domains of SOFS (adaptive life skills, social appropriateness and communication, and interpersonal relationships) along with the total SOFS score. GAF total score had significant negative correlation (P < 0.001) with all the components of IDEAS, total IDEAS score and global IDEAS score. Higher residual psychopathology was also associated with overall higher disability as assessed by total IDEAS score and Global IDEAS score.

CONCLUSIONS

This study shows that the GOI-modified IDEAS had good concurrent validity with global and sociooccupational functioning as assessed by GAF and SOFS respectively.

World Health Organization disability assessment schedule 2.0: An international systematic review

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.

Development of a Social Skills Assessment Screening Scale for Psychiatric Rehabilitation Settings: A Pilot Study

CONTEXT

Deficits in social skills may present in a range of psychiatric disorders, particularly in the more serious and persistent conditions, and have an influence on functioning across various domains.

AIMS

This pilot study aimed at developing a brief measure, for structured evaluation and screening for social skills deficits, which can be easily integrated into routine clinical practice.

SETTINGS AND DESIGN

The sample consisted of 380 inpatients and their accompanying caregivers, referred to Psychiatric Rehabilitation Services at a tertiary care government psychiatric hospital.

MATERIALS AND METHODS

The evaluation included an Inpatient intake Proforma and the 20-item Social Skills Assessment Screening Scale (SSASS). Disability was assessed using the Indian Disability Evaluation and Assessment Scale (IDEAS) for a subset of 94 inpatients.

STATISTICAL ANALYSIS USED

The analysis included means and standard deviations, frequency and percentages, Cronbach's alpha to assess internal consistency, t-tests to assess differences in social skills deficits between select subgroups, and correlation between SSASS and IDEAS scores.

RESULTS

The results indicated the profile of social skills deficits assessed among the inpatients with varied psychiatric diagnoses. The "psychosis" group exhibited significantly higher deficits than the "mood disorder" group. Results indicated high internal consistency of the SSASS and adequate criterion validity demonstrated by correlations with select IDEAS domains. Modifications were made to the SSASS following the pilot study.

CONCLUSIONS

The SSASS has potential value as a measure for screening and individualised intervention plans for social skills training in mental health and rehabilitation settings. The implications for future work on the psychometric properties and clinical applications are discussed.

Exercise Improves Clinical Symptoms, Quality of Life, Global Functioning, and Depression in Schizophrenia: A Systematic Review and Meta-analysis

BACKGROUND

Physical exercise may be valuable for patients with schizophrenia spectrum disorders as it may have beneficial effect on clinical symptoms, quality of life and cognition.

METHODS

A systematic search was performed using PubMed (Medline), Embase, PsychInfo, and Cochrane Database of Systematic Reviews. Controlled and uncontrolled studies investigating the effect of any type of physical exercise interventions in schizophrenia spectrum disorders were included. Outcome measures were clinical symptoms, quality of life, global functioning, depression or cognition. Meta-analyses were performed using Comprehensive Meta-Analysis software. A random effects model was used to compute overall weighted effect sizes in Hedges' g.

RESULTS

Twenty-nine studies were included, examining 1109 patients. Exercise was superior to control conditions in improving total symptom severity (k = 14, n = 719: Hedges' g = .39, P < .001), positive (k = 15, n = 715: Hedges' g = .32, P < .01), negative (k = 18, n = 854: Hedges' g = .49, P < .001), and general (k = 10, n = 475: Hedges' g = .27, P < .05) symptoms, quality of life (k = 11, n = 770: Hedges' g = .55, P < .001), global functioning (k = 5, n = 342: Hedges' g = .32, P < .01), and depressive symptoms (k = 7, n = 337: Hedges' g = .71, P < .001). Yoga, specifically, improved the cognitive subdomain long-term memory (k = 2, n = 184: Hedges' g = .32, P < .05), while exercise in general or in any other form had no effect on cognition.

CONCLUSION

Physical exercise is a robust add-on treatment for improving clinical symptoms, quality of life, global functioning, and depressive symptoms in patients with schizophrenia. The effect on cognition is not demonstrated, but may be present for yoga.

Yoga versus standard care for schizophrenia

BACKGROUND

Yoga is an ancient spiritual practice that originated in India and is currently accepted in the Western world as a form of relaxation and exercise. It has been of interest for people with schizophrenia to determine its efficacy as an adjunct to standard-care treatment.

OBJECTIVES

To examine the effects of yoga versus standard care for people with schizophrenia.

SEARCH METHODS

We searched the Cochrane Schizophrenia Group Trials Register (November 2012 and January 29, 2015), which is based on regular searches of MEDLINE, PubMed, EMBASE, CINAHL, BIOSIS, AMED, PsycINFO, and registries of clinical trials. We searched the references of all included studies. There were no language, date, document type, or publication status limitations for inclusion of records in the register.

SELECTION CRITERIA

All randomised controlled trials (RCTs) including people with schizophrenia comparing yoga to standard-care control.

DATA COLLECTION AND ANALYSIS

The review team independently selected studies, quality rated these, and extracted data. For binary outcomes, we calculated risk ratio (RR) and its 95% confidence interval (CI), on an intention-to-treat basis. For continuous data, we estimated the mean difference (MD) between groups and its 95% CI. We employed mixed-effect and fixed-effect models for analyses. We examined data for heterogeneity (I(2) technique), assessed risk of bias for included studies, and created 'Summary of findings' tables using GRADE (Grading of Recommendations Assessment, Development and Evaluation).

MAIN RESULTS

We included eight studies in the review. All outcomes were short term (less than six months). There were clear differences in a number of outcomes in favour of the yoga group, although these were based on one study each, with the exception of leaving the study early. These included mental state (improvement in Positive and Negative Syndrome Scale, 1 RCT, n = 83, RR 0.70 CI 0.55 to 0.88, medium-quality evidence), social functioning (improvement in Social Occupational Functioning Scale, 1 RCT, n = 83, RR 0.88 CI 0.77 to 1, medium-quality evidence), quality of life (average change 36-Item Short Form Survey (SF-36) quality-of-life subscale, 1 RCT, n = 60, MD 15.50, 95% CI 4.27 to 26.73, low-quality evidence), and leaving the study early (8 RCTs, n = 457, RR 0.91 CI 0.6 to 1.37, medium-quality evidence). For the outcome of physical health, there was not a clear difference between groups (average change SF-36 physical-health subscale, 1 RCT, n = 60, MD 6.60, 95% CI -2.44 to 15.64, low-quality evidence). Only one study reported adverse effects, finding no incidence of adverse events in either treatment group. This review was subject to a considerable number of missing outcomes, which included global state, change in cognition, costs of care, effect on standard care, service intervention, disability, and activities of daily living.

AUTHORS' CONCLUSIONS

Even though we found some positive evidence in favour of yoga over standard-care control, this should be interpreted cautiously in view of outcomes largely based each on one study with limited sample sizes and short-term follow-up. Overall, many outcomes were not reported and evidence presented in this review is of low to moderate quality - -too weak to indicate that yoga is superior to standard-care control for the management of schizophrenia.

Factors Affecting Well-being and Socio-occupational Functioning in Schizophrenia Patients Following an Acute Exacerbation: A Hospital Based Observational Study

BACKGROUND

Improving functioning levels are an important goal of treatment in schizophrenia. Most studies have described long-term course and outcome in schizophrenia. However, understanding factors influencing functioning in the immediate recovery period following an acute exacerbation may be of important clinical relevance.

AIM

The aim of this study is to assess the factors that influence well-being and socio-occupational functioning following an acute exacerbation in schizophrenia patients.

MATERIALS AND METHODS

The study included 40 patients during the period from June 2013 to June 2014. The possible effect of gender, duration of illness, duration of untreated psychosis, premorbid adjustment, cognitive impairment, facial affect perception and treatment compliance on well-being, and socio-occupational functioning was examined.

RESULTS

About 45% of the individuals experienced below average well-being. On logistic regression analysis poor compliance with medication and poorer cognitive functioning significantly differentiated the patient group with below average well-being from those with an above average well-being. Male gender, poor premorbid adjustment, poor compliance to treatment, poor cognitive functioning, and greater duration of untreated psychosis were found to be associated with a poorer socio-occupational functioning.

CONCLUSION

Clinical interventions focusing on improving cognitive impairment and compliance to treatment could play a role in improving well-being, and socio-occupational functioning in schizophrenia patients following an acute exacerbation.