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Jeong JH, Kim J, Kang N, Ahn YM, Kim YS, Lee D, Kim SH. Modeling the Determinants of Subjective Well-Being in Schizophrenia. Schizophr Bull 2024:sbae156. [PMID: 39255414 DOI: 10.1093/schbul/sbae156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/12/2024]
Abstract
BACKGROUND The ultimate goal of successful schizophrenia treatment is not just to alleviate psychotic symptoms, but also to reduce distress and achieve subjective well-being (SWB). We aimed to identify the determinants of SWB and their interrelationships in schizophrenia. METHODS Data were obtained from 637 patients with schizophrenia enrolled in multicenter, open-label, non-comparative clinical trials. The SWB under the Neuroleptic Treatment Scale (SWN) was utilized; a cut-off score of 80 indicated a high level of SWB at baseline and 6 months. Various machine learning (ML) algorithms were employed to identify the determinants of SWB. Furthermore, network analysis and structural equation modeling (SEM) were conducted to explore detailed relationship patterns. RESULTS The random forest (RF) model had the highest area under the curve (AUC) of 0.794 at baseline. Obsessive-compulsive symptoms (OCS) had the most significant impact on high levels of SWB, followed by somatization, cognitive deficits, and depression. The network analysis demonstrated robust connections among the SWB, OCS, and somatization. SEM analysis revealed that OCS exerted the strongest direct effect on SWB, and also an indirect effect via the mediation of depression. Furthermore, the contribution of OCS at baseline to SWB was maintained 6 months later. CONCLUSIONS OCS, somatization, cognition, and depression, rather than psychotic symptoms, exerted significant impacts on SWB in schizophrenia. Notably, OCS exhibited the most significant contribution not only to the current state of well-being but also to follow-up SWB, implying that OCS was predictive of SWB. The findings demonstrated that OCS management is critical for the treatment of schizophrenia.
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Affiliation(s)
- Jae Hoon Jeong
- Department of Psychiatry, Nowon Eulji University Hospital, Seoul, Republic of Korea
| | - Jayoun Kim
- Department of Clinical Epidemiology, Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Nuree Kang
- Department of Psychiatry, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Yong Min Ahn
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yong Sik Kim
- Department of Psychiatry, Nowon Eulji University Hospital, Seoul, Republic of Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Donghwan Lee
- Department of Statistics, Ewha Womans University, Seoul, Republic of Korea
| | - Se Hyun Kim
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
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Aunjitsakul W, Jongbowonwiwat K, Lambe S, Freeman D, McLeod HJ, Gumley A. Exploring stigma, shame, and safety behaviours in social anxiety and paranoia amongst people diagnosed with schizophrenia. Behav Cogn Psychother 2024:1-15. [PMID: 39205504 DOI: 10.1017/s1352465824000225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
BACKGROUND Social anxiety and paranoia are connected by a shared suspicion framework. Based on cognitive-behavioural approaches, there is evidence for treating social anxiety and psychosis. However, mechanisms underlying the relationship between social anxiety and paranoia remain unclear. AIMS To investigate mediators between social anxiety and paranoia in schizophrenia such as negative social appraisals (i.e. stigma or shame; Hypothesis 1), and safety behaviours (i.e. anxious avoidance or in situ safety behaviours; Hypothesis 2). METHOD A cross-sectional study was conducted among Asian out-patients with schizophrenia (January-April 2020). Data on social anxiety, paranoia, depression, shame, stigma, anxious avoidance, and in situ behaviours were collected. Associations between social anxiety and paranoia were investigated using linear regressions. Mediation analysis via 10,000 bias-corrected bootstrap samples with 95% confidence intervals (CI) was used to test the indirect effects (ab) of mediators. RESULTS Participants (n=113, 59.3% male) with a mean age of 44.2 years were recruited. A linear relationship between social anxiety and paranoia was found. In multiple mediation analyses (co-varying for depression), stigma and shame (Hypothesis 1) did not show any significant indirect effects with ab=.004 (95%CI=-.013, .031) and -.003 (-.023, .017), respectively, whereas in situ behaviours (Hypothesis 2) showed a significant effect with ab=.110 (.038, .201) through the social anxiety-paranoia relationship. CONCLUSIONS Social anxiety and paranoia are positively correlated. In situ safety behaviours fully mediated the social anxiety and paranoia relationship. Targeted interventions focusing on safety behaviours could help reduce paranoia in psychosis. Symptom severity should be measured to help characterise the participants' characteristics.
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Affiliation(s)
- Warut Aunjitsakul
- Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Kreuwan Jongbowonwiwat
- Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Sinead Lambe
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Daniel Freeman
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Hamish J McLeod
- School of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Andrew Gumley
- School of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
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Totzek JF, Chakravarty MM, Joober R, Malla A, Shah JL, Raucher-Chéné D, Young AL, Hernaus D, Lepage M, Lavigne KM. Longitudinal inference of multiscale markers in psychosis: from hippocampal centrality to functional outcome. Mol Psychiatry 2024:10.1038/s41380-024-02549-x. [PMID: 38605172 DOI: 10.1038/s41380-024-02549-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 03/28/2024] [Accepted: 04/02/2024] [Indexed: 04/13/2024]
Abstract
Multiscale neuroscience conceptualizes mental illness as arising from aberrant interactions across and within multiple biopsychosocial scales. We leverage this framework to propose a multiscale disease progression model of psychosis, in which hippocampal-cortical dysconnectivity precedes impairments in episodic memory and social cognition, which lead to more severe negative symptoms and lower functional outcome. As psychosis represents a heterogeneous collection of biological and behavioral alterations that evolve over time, we further predict this disease progression for a subtype of the patient sample, with other patients showing normal-range performance on all variables. We sampled data from two cross-sectional datasets of first- and multi-episode psychosis, resulting in a sample of 163 patients and 119 non-clinical controls. To address our proposed disease progression model and evaluate potential heterogeneity, we applied a machine-learning algorithm, SuStaIn, to the patient data. SuStaIn uniquely integrates clustering and disease progression modeling and identified three patient subtypes. Subtype 0 showed normal-range performance on all variables. In comparison, Subtype 1 showed lower episodic memory, social cognition, functional outcome, and higher negative symptoms, while Subtype 2 showed lower hippocampal-cortical connectivity and episodic memory. Subtype 1 deteriorated from episodic memory to social cognition, negative symptoms, functional outcome to bilateral hippocampal-cortical dysconnectivity, while Subtype 2 deteriorated from bilateral hippocampal-cortical dysconnectivity to episodic memory and social cognition, functional outcome to negative symptoms. This first application of SuStaIn in a multiscale psychiatric model provides distinct disease trajectories of hippocampal-cortical connectivity, which might underlie the heterogeneous behavioral manifestations of psychosis.
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Affiliation(s)
- Jana F Totzek
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Douglas Research Centre, Montreal, QC, Canada
- Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - M Mallar Chakravarty
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Douglas Research Centre, Montreal, QC, Canada
- Department of Biological and Biomedical Engineering, McGill University, Montreal, QC, Canada
| | - Ridha Joober
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Douglas Research Centre, Montreal, QC, Canada
| | - Ashok Malla
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Douglas Research Centre, Montreal, QC, Canada
| | - Jai L Shah
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Douglas Research Centre, Montreal, QC, Canada
| | - Delphine Raucher-Chéné
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Douglas Research Centre, Montreal, QC, Canada
| | - Alexandra L Young
- Department of Computer Science, University College London, London, United Kingdom
| | - Dennis Hernaus
- Department of Psychiatry & Neuropsychology, School for Mental Health and NeuroScience MHeNS, Maastricht University, Maastricht, The Netherlands
| | - Martin Lepage
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Douglas Research Centre, Montreal, QC, Canada
| | - Katie M Lavigne
- Department of Psychiatry, McGill University, Montreal, QC, Canada.
- Douglas Research Centre, Montreal, QC, Canada.
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Kayaoğlu K, Ay E. Examination of internalized stigma, quality of life, and happiness in patients with schizophrenia. J Ment Health 2024; 33:101-109. [PMID: 37975570 DOI: 10.1080/09638237.2023.2278096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 08/25/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Happiness in patients with schizophrenia is a neglected concept that needs to be developed. Determining the relationship between internalized stigma, quality of life, and happiness, which is important for the prognosis of schizophrenia, will reveal why it is necessary to focus on activities that will increase happiness in patients with schizophrenia. AIM This study aimed to compare the levels of internalized stigma, quality of life, and happiness in patients with schizophrenia. METHODS A descriptive and correlational research design was used. The research population consisted of patients who applied to the psychiatry outpatient clinic of a hospital in eastern Turkey during the research period and were diagnosed with schizophrenia according to the DSM-5 diagnostic criteria; 87 voluntary patients who agreed to participate in the study constituted the research sample. A personal information form, the Internalized Stigma of Mental Illness Scale (ISMI), the World Health Organization Quality-of-Life Scale (WHOQOL-BREF), and the Subjective Happiness Scale (SHS) were used for data collection. RESULTS According to the patients' ISMI, WHOQOL-BREF-TR, and SHS scores, patients perceived internalized stigma above the moderate level in all sub-dimensions. In general, their quality of life was moderate (the highest mean score was on the national environment domain and the lowest mean score was on the social domain); the mean SHS score was 13.02 ± 5.53. There was a strong and negative correlation between the mean SHS score and the total ISMI score and a strong and positive correlation between SHS and the physical, mental, social, and national environment domains of WHOQOL-BREF-TR. CONCLUSIONS It was determined that the mean internal stigma score of the patients decreased and their mean quality of life score increased as their mean subjective happiness score increased. It is recommended clinical studies be carried out to increase happiness in patients with schizophrenia.
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Affiliation(s)
- Kübra Kayaoğlu
- Department of Psychiatric Nursing, Faculty of Health Sciences, Malatya Turgut Ozal University, Malatya, Turkey
| | - Eda Ay
- Department of Psychiatric Nursing, Faculty of Nursing, Atatürk University, Erzurum, Turkey
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Migliorini C, Harvey C, Hou C, Wang S, Wang F, Huang ZH. Subjective quality of life and schizophrenia: results from a large cohort study based in Chinese primary care. BMC Psychiatry 2024; 24:86. [PMID: 38297269 PMCID: PMC10832280 DOI: 10.1186/s12888-024-05558-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 01/24/2024] [Indexed: 02/02/2024] Open
Abstract
INTRODUCTION Much confusion exists between health-related QoL (HRQoL) scales and subjective QoL (SQoL) scales. One method to avoid confusion is use of a single question that asks What is your quality of life? or similar. This study explored the relationship between biopsychosocial factors and high SQoL, SQoL stability, and factors associated with improving SQoL. METHOD We conducted a large cohort study of community-dwelling Chinese adults with schizophrenia, with two data points (2015-2016 (N = 742), 2017-2018 (N = 491)). Demographic and clinically related items and a comprehensive suite of published measures were collected. Direct logistic regressions were used to explore links between biopsychosocial factors and high SQoL and Improvement in SQoL across time. RESULTS Sample at Baseline: Male = 62.3%; Med age = 38.5 years; Med Age at illness onset = 24 years; SQoL Mode = neither poor nor good. Three independent variables predicted high SQoL at T1. Contemporary age and the presence of clinically relevant symptoms had a negative relationship with high SQoL; insight had a positive relationship with high SQoL. SQoL changed significantly across time with a modest effect size. Age at illness onset was the single independent variable linked to improving SQoL favoring being older at the time of illness onset. DISCUSSION/CONCLUSIONS SQoL can be high and changeable. While symptomology and illness insight may affect SQoL self-appraisals at single points in time, only age of illness onset was connected with improving SQoL. Thus, public health measures to delay illness onset are important. In addition, care about the distinction between HRQoL and SQoL in study design and choice of measures is necessary and will depend on the purpose and context.
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Affiliation(s)
- Christine Migliorini
- Psychosocial Research Centre, Department of Psychiatry, The University of Melbourne, Grattan St, Parkville, Victoria, 3010, Australia.
- Division of Mental Health, North West Area Mental Health, Melbourne, VIC, Australia.
- NorthWestern Mental Health, Royal Melbourne Hospital, Melbourne, VIC, Australia.
| | - Carol Harvey
- Psychosocial Research Centre, Department of Psychiatry, The University of Melbourne, Grattan St, Parkville, Victoria, 3010, Australia
- Division of Mental Health, North West Area Mental Health, Melbourne, VIC, Australia
| | - Cailan Hou
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences, Southern Medical University, Huifu West Road Yuexiu District, Guangdong, China
| | - Shibin Wang
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences, Southern Medical University, Huifu West Road Yuexiu District, Guangdong, China
| | - Fei Wang
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences, Southern Medical University, Huifu West Road Yuexiu District, Guangdong, China
| | - Zhuo-Hui Huang
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences, Southern Medical University, Huifu West Road Yuexiu District, Guangdong, China
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ÖZCAN TOZOĞLU E. Toplum Ruh Sağlığı Merkezlerinde Vaka Yöneticiliği Yapılan Şizofreni Hastaları Daha Mutlu mu? PSIKIYATRIDE GUNCEL YAKLASIMLAR - CURRENT APPROACHES IN PSYCHIATRY 2023. [DOI: 10.18863/pgy.1207947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
Şizofreni hastaları için iyileşmeden bahsedilirken belirtilerin olmaması ile yetinilmiş ve mutluluk kavramı genelde göz ardı edilmiştir. Çalışmamızda toplum ruh sağlığı merkezi (TRSM) tarafından takip edilip vaka yöneticisi olan şizofreni hastaları ile sadece poliklinik takibi yapılan remisyondaki şizofreni hastalarının mutluluk düzeylerini ve bu mutluluğu etkilediği düşünülen duygu dışavurumu, hastanın algıladığı destek düzeyi ve yaşam niteliğini karşılaştırmayı amaçladık. En az 1 yıldır düzenli TRSM takibi yapılan ve vaka yöneticisi (VY) olan (n:100) ve poliklinik takibi yapılan en az 3 aydır remisyonda olan (n:100) şizofreni hastaları çalışmaya alındı. Her iki gruba Öznel Mutluluk Ölçeği (ÖMÖ), Algılanan Elde Edilebilir Destek Ölçeği (AEEDÖ), Yaşam Niteliği Ölçeği (YNÖ), Duygu Dışavurum Düzeyi Ölçeği (DDDÖ) uygulandı. ÖMÖ, AEEDÖ, DDDÖ, YNÖ puanları VY olan grupta istatistiki olarak anlamlı farklıydı. Duygu Dışavurum Düzeyini gösteren alt ölçekler ile ÖMÖ puanları arasında negatif korelasyon saptandı. YNÖ ve AEEDÖ puanları ile ÖMÖ puanları arasında ise pozitif korelasyon saptandı. VY olması durumunda AEEDÖ puanlarının ÖMÖ puanları üzerinde aracı bir etkisi olduğu; YNÖ puanlarının aracı bir etkisi olmadığı saptandı. DDDÖ alt ölçekleri olan müdahalecilik, duygusal tepki ve hoşgörü/beklenti düzeylerinin ÖMÖ puanları üzerinde aracı bir etkiye sahip olduğu; hastalığa karşı tutum düzeylerinin aracı etkiye sahip olmadığı saptandı. Şizofreni hastaları için iyileşmeden bahsederken genelde mutluluk göz ardı edilen bir kavramdır. Çalışmamızda TRSM hizmeti kapsamındaki vaka yöneticiliğinin etkisini değerlendirdik ve şizofreni hastalarının mutluluğuna olumlu etkisi olduğunu saptadık.
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Affiliation(s)
- Elif ÖZCAN TOZOĞLU
- SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, ERZURUM BÖLGE SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ, DAHİLİ TIP BİLİMLERİ BÖLÜMÜ
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Agarwal SM, Dissanayake J, Agid O, Bowie C, Brierley N, Chintoh A, De Luca V, Diaconescu A, Gerretsen P, Graff-Guerrero A, Hawco C, Herman Y, Hill S, Hum K, Husain MO, Kennedy JL, Kiang M, Kidd S, Kozloff N, Maslej M, Mueller DJ, Naeem F, Neufeld N, Remington G, Rotenberg M, Selby P, Siddiqui I, Szacun-Shimizu K, Tiwari AK, Thirunavukkarasu S, Wang W, Yu J, Zai CC, Zipursky R, Hahn M, Foussias G. Characterization and prediction of individual functional outcome trajectories in schizophrenia spectrum disorders (PREDICTS study): Study protocol. PLoS One 2023; 18:e0288354. [PMID: 37733693 PMCID: PMC10513234 DOI: 10.1371/journal.pone.0288354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 06/23/2023] [Indexed: 09/23/2023] Open
Abstract
Schizophrenia spectrum disorders (SSDs) are associated with significant functional impairments, disability, and low rates of personal recovery, along with tremendous economic costs linked primarily to lost productivity and premature mortality. Efforts to delineate the contributors to disability in SSDs have highlighted prominent roles for a diverse range of symptoms, physical health conditions, substance use disorders, neurobiological changes, and social factors. These findings have provided valuable advances in knowledge and helped define broad patterns of illness and outcomes across SSDs. Unsurprisingly, there have also been conflicting findings for many of these determinants that reflect the heterogeneous population of individuals with SSDs and the challenges of conceptualizing and treating SSDs as a unitary categorical construct. Presently it is not possible to identify the functional course on an individual level that would enable a personalized approach to treatment to alter the individual's functional trajectory and mitigate the ensuing disability they would otherwise experience. To address this ongoing challenge, this study aims to conduct a longitudinal multimodal investigation of a large cohort of individuals with SSDs in order to establish discrete trajectories of personal recovery, disability, and community functioning, as well as the antecedents and predictors of these trajectories. This investigation will also provide the foundation for the co-design and testing of personalized interventions that alter these functional trajectories and improve outcomes for people with SSDs.
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Affiliation(s)
- Sri Mahavir Agarwal
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
- Temerty Faculty Institute of Medical Science, University of Toronto, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Banting and Best Diabetes Centre (BBDC), University of Toronto, Toronto, Canada
| | - Joel Dissanayake
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Ofer Agid
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Christopher Bowie
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Noah Brierley
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Araba Chintoh
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Vincenzo De Luca
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Andreea Diaconescu
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Philip Gerretsen
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Ariel Graff-Guerrero
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Colin Hawco
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Yarissa Herman
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Sean Hill
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Kathryn Hum
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Muhammad Omair Husain
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - James L. Kennedy
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Michael Kiang
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Sean Kidd
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Nicole Kozloff
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Marta Maslej
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Daniel J. Mueller
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Farooq Naeem
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Nicholas Neufeld
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Gary Remington
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Martin Rotenberg
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Peter Selby
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Ishraq Siddiqui
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Kate Szacun-Shimizu
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Arun K. Tiwari
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | | | - Wei Wang
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Joanna Yu
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Clement C. Zai
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Robert Zipursky
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Margaret Hahn
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
- Temerty Faculty Institute of Medical Science, University of Toronto, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Banting and Best Diabetes Centre (BBDC), University of Toronto, Toronto, Canada
| | - George Foussias
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
- Temerty Faculty Institute of Medical Science, University of Toronto, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
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Happiness and Mental Disorders. Healthcare (Basel) 2022; 10:healthcare10091781. [PMID: 36141393 PMCID: PMC9499168 DOI: 10.3390/healthcare10091781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/04/2022] [Accepted: 09/08/2022] [Indexed: 11/21/2022] Open
Abstract
The research object is the approach the meaning of happiness for people with severe mental illness (SMI) under follow-up in a mental health unit in Tenerife. The research aims to improve the care they receive. This qualitative, phenomenological study uses convenience and intentional sampling. Questions were administered to a focus group consisting of 4 women and 1 man, aged 35–69, and 16 individual interviews were conducted with 8 women and 8 men, aged 20–62. The interviews were audio-recorded, with prior consent, transcribed verbatim, coded, and analyzed using QSR N-Vivo Release 1.4.1 (851), Spain. Happiness has three dimensions: personal, interpersonal–relational, and temporal. The personal dimension includes personality, positive emotions, health, motivations for establishing personal goals, and engaging in activities. The interpersonal–relational dimension includes family support; social support and relationships; social and occupational functioning; overcoming deaths, breakups, or job losses; and the absence of stigma on mental illness. The temporal dimension establishes that happiness can be comprised of either a set of happy moments or a continuous state of happiness that varies throughout life. Based on the results of this research, it could be proposed that future research should focus on the effectiveness of nursing interventions, addressing the life goals of people with mental disorders, and the pursuit of their happiness.
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Krzyzanowski DJ, Wu S, Carnovale M, Agarwal SM, Remington G, Goghari V. Trait Anhedonia in Schizophrenia: A Systematic Review and Comparative Meta-analysis. Schizophr Bull 2021; 48:335-346. [PMID: 34891171 PMCID: PMC8886586 DOI: 10.1093/schbul/sbab136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Anhedonia, the reduced capacity to experience pleasure, has long been considered a prominent feature of schizophrenia spectrum disorders. Many domain-specific conceptualizations of anhedonia and pleasure capacity have been developed, and there currently exist a variety of self-report assessment tools that purport to assess these various domains. The current systematic review and meta-analysis (PROSPERO: CRD42020156169) aimed to quantify overall and domain-specific self-reported anhedonia in people with schizophrenia compared to nonpsychiatric controls. We performed a literature search of PsycINFO, MEDLINE, and Embase databases for dissertations and peer-reviewed articles published in English prior to June 2021. Studies employing a psychometrically validated self-report measure of anhedonia, pleasure experience or affect in people with schizophrenia, schizoaffective, or schizophreniform disorders; studies utilizing at least one clearly defined healthy or community control group for comparison; and studies providing sufficient data to calculate effect sizes were included in this review. Random and mixed effects meta-analyses, meta-regressions, and subgroup comparisons were run across domains of anhedonia to explore weighted mean effect sizes and their associated moderators. In total, 146 studies met inclusion criteria, yielding 390 Hedges' g effect sizes from the included comparisons. People with schizophrenia reported moderate-to-large elevations in overall and domain-specific anhedonia. A sensitivity analysis accounting for high risk of bias studies did not significantly impact results. Lastly, patient sex, education, negative symptom severity, antipsychotic class, and trait negative affect differentially moderated effect sizes across domains of anhedonia. Despite the heterogeneity inherent in schizophrenia spectrum disorders, self-reported anhedonia is ubiquitously reported across self-report measures in this population.
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Affiliation(s)
- Daniel J Krzyzanowski
- Department of Psychology, University of Toronto Scarborough, Toronto, ON, Canada,Graduate Department of Psychological Clinical Science, University of Toronto, Toronto, ON, Canada,Centre for Addiction and Mental Health, Toronto, ON, Canada,To whom correspondence should be addressed; Graduate Department of Psychological Clinical Science, University of Toronto Scarborough, 1265 Military Trail, Toronto, ON, Canada M1C 1A4; tel: +1(416) 535 8501 Ext. 36092, e-mail:
| | - Sally Wu
- Centre for Addiction and Mental Health, Toronto, ON, Canada,Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Michael Carnovale
- Department of Psychology, University of Toronto Scarborough, Toronto, ON, Canada,Graduate Department of Psychological Clinical Science, University of Toronto, Toronto, ON, Canada
| | - Sri Mahavir Agarwal
- Centre for Addiction and Mental Health, Toronto, ON, Canada,Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Gary Remington
- Graduate Department of Psychological Clinical Science, University of Toronto, Toronto, ON, Canada,Centre for Addiction and Mental Health, Toronto, ON, Canada,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Vina Goghari
- Department of Psychology, University of Toronto Scarborough, Toronto, ON, Canada,Graduate Department of Psychological Clinical Science, University of Toronto, Toronto, ON, Canada,Centre for Addiction and Mental Health, Toronto, ON, Canada,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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10
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Liao Z, Allott K, Anderson JFI, Killackey E, Cotton SM. Quality of life in first episode psychosis: a cluster analytic approach. Qual Life Res 2021; 31:1807-1817. [PMID: 34661805 DOI: 10.1007/s11136-021-03014-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE Quality of life is increasingly recognised as an important outcome for young people with first episode psychosis (FEP). The first aim was to determine whether distinct homogenous subgroups of young people with FEP could be delineated based on profiles on quality of life domains (Physical Health, Psychological, Social relationships and Environmental). The second aim was to examine the discriminant validity of these subgroups with respect to demographic, functioning and clinical features of FEP. METHOD Quality of life, demographic characteristics, clinical characteristics, cognition and functioning were assessed in 145 people with FEP. Cluster analysis using Ward's methods and Squared Euclidean Distance with a k-means verification were employed to identify subgroups with homogenous quality of life profiles. The clusters were externally validated using multinomial logistic regressions. RESULTS Three distinct quality of life profiles were identified: one with good quality of life across all domains (30%), one with poor quality of life particularly in Psychological and Social relationships domains (28%), and one 'intermediate' group with comparatively low Psychological quality of life (42%). Depression, semantic verbal fluency, social inclusion and social/occupational functioning showed associations with group membership. CONCLUSION Our results suggest the potential of maintaining relatively good quality of life despite the experience of FEP. Future research on interventions to improve quality of life may consider the potential of addressing depression, social inclusion and social/occupational functioning.
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Affiliation(s)
- Z Liao
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, 3010, Australia
| | - K Allott
- Orygen, Parkville, Melbourne, VIC, 3052, Australia.,Centre for Youth Mental Health, The University of Melbourne, Locked Bag 10 (35 Poplar Road), Parkville, Melbourne, VIC, 3052, Australia
| | - J F I Anderson
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, 3010, Australia
| | - E Killackey
- Orygen, Parkville, Melbourne, VIC, 3052, Australia.,Centre for Youth Mental Health, The University of Melbourne, Locked Bag 10 (35 Poplar Road), Parkville, Melbourne, VIC, 3052, Australia
| | - S M Cotton
- Orygen, Parkville, Melbourne, VIC, 3052, Australia. .,Centre for Youth Mental Health, The University of Melbourne, Locked Bag 10 (35 Poplar Road), Parkville, Melbourne, VIC, 3052, Australia.
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11
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Functioning and Happiness in People with Schizophrenia: Analyzing the Role of Cognitive Impairment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147706. [PMID: 34300155 PMCID: PMC8303973 DOI: 10.3390/ijerph18147706] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 07/13/2021] [Accepted: 07/17/2021] [Indexed: 01/07/2023]
Abstract
Schizophrenia is associated with marked functional impairment and low levels of subjective happiness. The aim of the current study was to evaluate the relationship between subjective happiness and functioning in patients with schizophrenia, while considering the role of cognitive functioning. Methods: In total, 69 schizophrenia patients and 87 matched healthy controls participated in the study. Patients’ clinical status was assessed, and a series of self-report questionnaires were administered to both patients and healthy controls to measure subjective happiness, satisfaction with life, well-being, functioning, and cognitive impairment. A multiple linear regression model identified significant predictors of subjective happiness and related constructs. Results: Schizophrenia participants endorsed lower levels of happiness and well-being, and higher perceived stress compared to healthy controls. In schizophrenia patients, there was an inverse and significant correlation (r = −0.435; p = 0.013) between subjective happiness and functioning in a subgroup of patients without cognitive impairment. This correlation was not significant (r = −0.175; p = 0.300) in the subgroup with cognitive impairment. When controlling for other clinical variables (by multiple lineal regression), the severity of symptoms and level of insight failed to demonstrate significant relationships with happiness; meanwhile, perceived stress and some specific cognitive dominions (as verbal learning and processing speed) were associated with satisfaction of life of the patients. Conclusions: The relationship between subjective happiness and functioning in schizophrenia patients was influenced by level of cognitive impairment. Findings from this study suggest that rehabilitation programs may improve recovery outcomes with a focus on subjective happiness and functioning, especially in patients with cognitive impairment. Future research is needed to better understand the complex interplay between subjective happiness, functioning, and cognitive impairment in patients with schizophrenia.
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12
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Krzyzanowski D, Agid O, Goghari V, Remington G. Cognitive discrepancies, motivation and subjective well-being in people with schizophrenia. SCHIZOPHRENIA RESEARCH-COGNITION 2021; 26:100205. [PMID: 34258238 PMCID: PMC8259292 DOI: 10.1016/j.scog.2021.100205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/23/2021] [Accepted: 06/24/2021] [Indexed: 01/07/2023]
Abstract
Research indicates that people with schizophrenia often achieve similar levels of subjective well-being (SWB) compared to healthy controls despite prominent symptomatology and significant functional difficulties. Furthermore, compared to healthy controls, young-adult people with schizophrenia differ in the relative importance they place on values, or guiding life principles, associated with educational and occupational success (openness to change), suggesting that changing motivations may contribute to SWB and the apparent motivational deficits commonly reported in this population. The current study sought to better understand these relationships in middle-aged people with schizophrenia or schizoaffective disorder (n=29) versus a relatively healthy group of community controls (n=23). Participants completed measures of SWB and values. They also completed a cognitive battery and interviews concerned with mental and physical health. Patients reported similar levels of SWB compared to controls in the context of significant cognitive, social and vocational difficulties. Moreover, living consistently with values (valued living) predicted SWB in both groups. Lastly, internalized mental illness stigma was negatively associated with openness to change in the patient group. While encouraging from an emotional resiliency perspective, SWB and valued living in people with schizophrenia may hinder motivation towards treatment goals that could otherwise improve functional outcomes in this population. Patients with schizophrenia reported similar levels of SWB compared to community controls. Living consistently with values (i.e., valued living) predicted SWB in both groups. Internalized mental illness stigma was negatively associated with openness to change values in the patient group. Changing motivations may contribute to the apparent motivational deficits commonly reported in people with schizophrenia.
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Affiliation(s)
- Daniel Krzyzanowski
- University of Toronto Scarborough, Graduate Department of Psychological Clinical Science, 1265 Military Trail, Toronto, ON M1C 1A4, Canada.,Centre for Addiction and Mental Health, 1000 Queen St W, Toronto, ON M6J 1H1, Canada
| | - Ofer Agid
- University of Toronto Scarborough, Graduate Department of Psychological Clinical Science, 1265 Military Trail, Toronto, ON M1C 1A4, Canada.,Department of Psychiatry, University of Toronto, 27 King's College Cir, Toronto ON M5S, Canada.,Centre for Addiction and Mental Health, 1000 Queen St W, Toronto, ON M6J 1H1, Canada
| | - Vina Goghari
- University of Toronto Scarborough, Graduate Department of Psychological Clinical Science, 1265 Military Trail, Toronto, ON M1C 1A4, Canada.,Centre for Addiction and Mental Health, 1000 Queen St W, Toronto, ON M6J 1H1, Canada
| | - Gary Remington
- University of Toronto Scarborough, Graduate Department of Psychological Clinical Science, 1265 Military Trail, Toronto, ON M1C 1A4, Canada.,Department of Psychiatry, University of Toronto, 27 King's College Cir, Toronto ON M5S, Canada.,Centre for Addiction and Mental Health, 1000 Queen St W, Toronto, ON M6J 1H1, Canada
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13
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Aunjitsakul W, McGuire N, McLeod HJ, Gumley A. Candidate Factors Maintaining Social Anxiety in the Context of Psychotic Experiences: A Systematic Review. Schizophr Bull 2021; 47:1218-1242. [PMID: 33778868 PMCID: PMC8379542 DOI: 10.1093/schbul/sbab026] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Social anxiety is common in psychosis and associated with impaired functioning, poorer quality of life, and higher symptom severity. This study systematically reviewed factors maintaining social anxiety in people with attenuated, transient, or persistent psychotic experiences. Other correlates of social anxiety were also examined. MEDLINE, Embase, CENTRAL, and PsycINFO were searched for relevant literature up to October 19, 2020. Forty-eight articles were eligible for narrative synthesis: 38 cross-sectional studies, 8 prospective studies, 1 uncontrolled trial, and 1 qualitative study. From 12060 participants, the majority was general population (n = 8771), followed by psychosis samples (n = 2532) and those at high risk of psychosis (n = 757). The methodological quality and risk of bias were assessed using the Mixed Methods Appraisal Tool. Ninety percent of studies were rated as high to very-high quality. Poorer quality studies typically failed to adequately control for confounds and provided insufficient information on the measurement validity and reliability. Prominent psychological factors maintaining social anxiety included self-perceptions of stigma and shame. Common correlates of social anxiety included poorer functioning and lower quality of life. In conclusion, stigma and shame could be targeted as a causal mechanism in future interventional studies. The integration of findings from this review lead us to propose a new theoretical model to guide future intervention research.
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Affiliation(s)
- Warut Aunjitsakul
- Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand,Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK,To whom correspondence should be addressed; Glasgow Institute of Health and Wellbeing, Glasgow Mental Health Research Facility, University of Glasgow, Fleming Pavilion, West of Scotland Science Park (Todd Campus), Glasgow, G20 0XA, UK; tel: 0141-330-4852, e-mail:
| | - Nicola McGuire
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Hamish J McLeod
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Andrew Gumley
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
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14
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Does the Psychiatrist's Use of Subjective Well-Being Measurement in People with Schizophrenia Provide a Better Alignment with the Patient's Well-Being Perception than Clinical Judgement Alone? ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 48:768-779. [PMID: 33728557 DOI: 10.1007/s10488-021-01127-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2021] [Indexed: 10/21/2022]
Abstract
To examine the agreement between patient and psychiatrist ratings of subjective well-being in people with schizophrenia using three well-being measurements: Satisfaction with Life, Subjective Happiness, and Subjective Well-being under Neuroleptic Treatment (SWN), including the SWN-subscale, and to investigate whether the psychiatrist's judgement or the psychiatrist-rated SWN is better at defining patient well-being. Patients with schizophrenia (n = 150) completed the three well-being measurements, then met psychiatrists, and their well-being was judged as either 'poor' or 'adequate' via the usual clinical assessment before being assessed again by the psychiatrist using the same measurements. Intra-class correlation was used to analyze the absolute agreement between 'patient-rated' and 'psychiatrist-rated' scores. Agreements on 'adequate' well-being status between patient-rated SWN (≥ 80; gold standard), psychiatrist-rated SWN, and psychiatrist's judgement were calculated using Kappa coefficients. We also calculated the sensitivity and specificity of the psychiatrist's judgement and the psychiatrist-rated SWN to define adequate well-being. SWN showed the strongest absolute agreement between patient-psychiatrist ratings (ICC = 0.7, p = 0.005), with physical functioning yielding the highest and self-control the lowest coefficients. The psychiatrist-rated SWN showed a better Kappa coefficient (0.4, p < 0.001) than the psychiatrist's judgement. Clinical judgement showed a 67% sensitivity and a 64% specificity, whereas the psychiatrist-rated SWN (score 93, AUC 81.4%) showed a 74% sensitivity and a 74% specificity for well-being prediction. The use of SWN by psychiatrists yielded a better alignment of well-being than the psychiatrist's judgement alone. The SWN subscale could help fill the gap between clinician and patient views on well-being. Psychiatrists should upskill in assessing patient wellbeing for appropriate treatment provision.
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15
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Caballero R, Valiente C, Espinosa R. The perception of well-being: Do people with severe psychiatric conditions and their therapists put themselves in each other’s shoes? JOURNAL OF POSITIVE PSYCHOLOGY 2021. [DOI: 10.1080/17439760.2021.1871943] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Rocío Caballero
- Department of Psychology, Complutense University of Madrid, Madrid, Spain
| | - Carmen Valiente
- Department of Psychology, Complutense University of Madrid, Madrid, Spain
| | - Regina Espinosa
- Department of Psychology, Camilo José Cela University of Madrid, Madrid, Spain
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16
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Rekhi G, Ang MS, Lee J. Association between negative symptom domains and happiness in schizophrenia. Gen Hosp Psychiatry 2021; 68:83-89. [PMID: 33412469 DOI: 10.1016/j.genhosppsych.2020.12.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 12/22/2020] [Accepted: 12/24/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The study aimed to examine the association between levels of self-reported happiness and different domains and subdomains of negative symptoms (NS), as well as symptomatic remission in schizophrenia. METHODS 274 individuals with schizophrenia were assessed on the Subjective Happiness Scale (SHS), Positive and Negative Syndrome Scale and Clinical Assessment Interview for Negative Symptoms (CAINS). Multiple linear regressions were used to examine the association between levels of happiness and increasingly specific CAINS NS domains and subdomains, as well as symptomatic remission. RESULTS 177 (64.6%) participants rated themselves as happy. NS, specifically motivation and pleasure related to social activities (MAP Social) (B=-0.402, t=-4.805, p<0.001), and depressive symptoms (B=-0.760, t=-7.102, p<0.001) were significantly associated with levels of happiness. Individuals in symptomatic remission rated themselves happier than those who were not in remission (mean composite SHS: 5.10 [SD=1.18] versus 4.61 [SD=1.16], p=0.002). CONCLUSIONS In this largest study on happiness in schizophrenia, we found that the MAP domain of NS, MAP social subdomain and depressive symptoms were significantly associated with levels of happiness. Additionally, individuals in symptomatic remission rated themselves happier than those who were not in remission. Symptom management remains important in the holistic care plan for individuals with schizophrenia.
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Affiliation(s)
- Gurpreet Rekhi
- Research Division, Institute of Mental Health, Singapore.
| | - Mei San Ang
- Research Division, Institute of Mental Health, Singapore
| | - Jimmy Lee
- Research Division, Institute of Mental Health, Singapore; North Region & Department of Psychosis, Institute of Mental Health, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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17
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Crespo-Facorro B, Such P, Nylander AG, Madera J, Resemann HK, Worthington E, O'Connor M, Drane E, Steeves S, Newton R. The burden of disease in early schizophrenia - a systematic literature review. Curr Med Res Opin 2021; 37:109-121. [PMID: 33095689 DOI: 10.1080/03007995.2020.1841618] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Schizophrenia is a heterogeneous disorder with a burden that can vary greatly depending on the severity and the duration. Previous research has suggested that patients in the earlier stages of schizophrenia (typically first-episode schizophrenia) benefit from effective early treatment, however, a comprehensive review of the burden specifically in this population has not been undertaken. A systematic literature review was therefore conducted to characterize the clinical, economic, and humanistic burden, as reported in naturalistic studies of schizophrenia populations specifically at an early stage of disease in comparison with healthy controls, patients with chronic schizophrenia, and patients with other psychiatric disorders. METHODS AND MATERIALS Searches were conducted in MEDLINE, MEDLINE In-Process, Embase, PsycINFO, and EconLit databases for records published between January 2005 and April 2019, and of relevant conference abstracts published between January 2014 and May 2019. Data were extracted from relevant publications and subjected to qualitative evaluation. RESULTS Fifty-two publications were identified for inclusion and revealed a considerable burden for early schizophrenia with regards to mortality, psychiatric comorbidities such as substance abuse and depression, poor social functioning, and unemployment. Comparisons with chronic schizophrenia suggested a greater burden with longer disease duration, while comparisons with other psychiatric disorders were inconclusive. This review uncovered various gaps in the available literature, including limited or no data on incarcerations, caregiver burden, and costs associated with early schizophrenia. CONCLUSIONS Overall, the burden of schizophrenia is apparent even in the early stages of the disease, although further research is required to quantify the burden with chronic schizophrenia and other psychiatric disorders.
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Affiliation(s)
- Benedicto Crespo-Facorro
- Department of Medicine & Psychiatry, University Hospital Virgen del Rocio, IBiS, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Sevilla, Spain
| | | | | | - Jessica Madera
- Global Medical Affairs, Otsuka Pharmaceutical Development & Commercialization, Inc, Princeton, NJ, USA
| | | | | | | | - Emma Drane
- Costello Medical Consulting Ltd, Cambridge, UK
| | | | - Richard Newton
- Peninsula Health, Monash University, Frankston, Victoria, Australia
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18
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Ouyang P, Sun W, Wang C. Well-being loss in informal care for the elderly people: Empirical study from China national baseline CHARLS. Asia Pac Psychiatry 2019; 11:e12336. [PMID: 30238701 DOI: 10.1111/appy.12336] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 08/02/2018] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Well-being is an important component of health, while informal care plays a vital role in daily care of the elderly. However, the effects of informal care on the well-being of the elderly remain unclear. This study was aimed to estimate such effects, in which well-being was measured by 2 subjective indicators: happiness and life satisfaction. METHODS Potential endogeneity was purified using instrumental variables. Data were collected from national baseline China Health and Retirement Longitudinal Study (CHARLS). RESULTS Receiving informal care would decrease the elderly's happiness score and life satisfaction score significantly. The health produced from informal care cannot offset the health depreciation caused by aging. DISCUSSION To improve the well-being of the elderly, caregivers have more to do and policymakers can design designated care policies based on our results.
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Affiliation(s)
- Peng Ouyang
- School of Management, Harbin Institute of Technology, Harbin, China
| | - Wenjun Sun
- School of Management, Harbin Institute of Technology, Harbin, China
| | - Chunlan Wang
- School of Management, Harbin Institute of Technology, Harbin, China
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19
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Siddiqui I, Remington G, Fervaha G, Fletcher PJ, Voineskos AN, Saperia S, Zakzanis KK, Foussias G. Objective investigation of activity preference in schizophrenia: A pilot study. Psychiatry Res 2018; 267:551-559. [PMID: 29980136 DOI: 10.1016/j.psychres.2018.05.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 03/23/2018] [Accepted: 05/15/2018] [Indexed: 11/29/2022]
Abstract
Amotivation and reduced goal-directed activity engagement are prominent features of schizophrenia. Previous investigations of patients' activities have relied on accounts of daily living activities, rather than objective measures. This study used wireless motion capture to objectively evaluate activity preference when individuals are provided an explicit choice between an active versus passive engagement option. Twenty outpatients with schizophrenia and twenty matched healthy controls completed the Activity Preference Task, in which participants play a motion-based game (active) or watch a film (passive), and were administered clinical and cognitive assessments. Schizophrenia participants' duration, intensity, and persistence of active engagement were associated with apathy and community functioning. No group differences emerged from comparisons of task measures; however, exploratory cluster analysis identified a distinct subgroup of schizophrenia patients with reduced engagement and increased apathy compared to other patients and controls. The Task provides a means of quantifying activity engagement, which may be particularly valuable given the lack of objective measures for intrinsically motivated behaviours. Our initial findings suggest that schizophrenia patients as a group are equally inclined as healthy individuals towards actively engaging activities when presented an explicit choice, but such provision may be insufficient for initiation and maintenance of functional behaviours among amotivated patients.
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Affiliation(s)
- Ishraq Siddiqui
- Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College St., Toronto, Ontario M5T 1R8, Canada.; Institute of Medical Science, Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Circle, Toronto, Ontario M5S 1A8, Canada..
| | - Gary Remington
- Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College St., Toronto, Ontario M5T 1R8, Canada.; Institute of Medical Science, Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Circle, Toronto, Ontario M5S 1A8, Canada.; Department of Psychiatry, University of Toronto, 250 College St., Toronto, Ontario M5T 1R8, Canada
| | - Gagan Fervaha
- Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College St., Toronto, Ontario M5T 1R8, Canada.; Institute of Medical Science, Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Circle, Toronto, Ontario M5S 1A8, Canada
| | - Paul J Fletcher
- Department of Psychiatry, University of Toronto, 250 College St., Toronto, Ontario M5T 1R8, Canada; Preclinical Research and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College St., Toronto, Ontario M5T 1R8, Canada; Department of Psychology, University of Toronto, Sidney Smith Hall, 100 St. George St., Toronto, Ontario M5S 3G3, Canada
| | - Aristotle N Voineskos
- Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College St., Toronto, Ontario M5T 1R8, Canada.; Institute of Medical Science, Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Circle, Toronto, Ontario M5S 1A8, Canada.; Department of Psychiatry, University of Toronto, 250 College St., Toronto, Ontario M5T 1R8, Canada
| | - Sarah Saperia
- Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College St., Toronto, Ontario M5T 1R8, Canada
| | - Konstantine K Zakzanis
- Department of Psychology, University of Toronto Scarborough, 1265 Military Trail, Toronto, Ontario M1C 1A4, Canada
| | - George Foussias
- Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College St., Toronto, Ontario M5T 1R8, Canada.; Institute of Medical Science, Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Circle, Toronto, Ontario M5S 1A8, Canada.; Department of Psychiatry, University of Toronto, 250 College St., Toronto, Ontario M5T 1R8, Canada
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20
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Eglit GM, Palmer BW, Jeste DV. Overview of measurement-based positive psychiatry. Nord J Psychiatry 2018; 72:396-403. [PMID: 30744516 PMCID: PMC6373474 DOI: 10.1080/08039488.2018.1459834] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 03/27/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND Psychiatry has traditionally focused on studying psychopathology and treating mental illnesses to relieve symptoms and prevent relapse. Positive psychiatry seeks to expand the scope of psychiatry to broader aspects of mental health and well-being among individuals with or without mental illnesses. Positive psychosocial factors such as well-being, resilience, optimism, wisdom, and social support are central to positive psychiatry. AIM To summarize the emerging science of positive psychiatry, emphasizing the use of measures of positive characteristics and outcomes relevant to mental health. METHODS Overview of recent research in positive psychiatry, focusing on measurements. RESULTS Positive psychosocial factors are associated with better mental and physical health in diverse populations. Among individuals with serious mental illnesses, levels of these factors vary considerably, but positive psychiatry interventions can improve well-being and rates of recovery in at least subsets of the patients. A number of measures of positive factors and outcomes are available; most of them are based on self-reports, which have advantages as well as limitations. CONCLUSIONS Positive psychiatry has the potential to improve the health and well-being of individuals with or without mental illnesses. Further research is needed to provide clinicians and investigators with a full tool-box of validated measures for positive psychosocial factors and outcomes. These measures should be subjected to rigorous psychometric evaluation across populations to help clarify mechanisms underlying positive factors, evaluate their longitudinal trajectories, and examine the impact of interventions on health and well-being over the lifespan in different clinical groups.
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Affiliation(s)
- Graham M.L. Eglit
- Department of Psychiatry, University of California San Diego, La Jolla, CA USA
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA USA
| | - Barton W. Palmer
- Department of Psychiatry, University of California San Diego, La Jolla, CA USA
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA USA
- Veterans Affairs San Diego Healthcare System, San D). St. Paul, Minnesotaiego, CA USA
| | - Dilip V. Jeste
- Department of Psychiatry, University of California San Diego, La Jolla, CA USA
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA USA
- Department of Neurosciences, University of California San Diego, La Jolla, CA USA
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21
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Attention-deficit/hyperactivity disorder symptoms and happiness among adults in the general population. Psychiatry Res 2018; 265:317-323. [PMID: 29778053 DOI: 10.1016/j.psychres.2018.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 03/13/2018] [Accepted: 05/01/2018] [Indexed: 01/10/2023]
Abstract
Despite an increasing focus on the role of mood and emotions in attention-deficit/hyperactivity disorder (ADHD), as yet, there has been comparatively little research on positive emotions. To address this research gap, the current study examined the association between ADHD symptoms and happiness using data from the 2007 Adult Psychiatric Morbidity Survey. The analytic sample comprised 7274 adults aged 18 and above residing in private households in England. Information was collected on ADHD symptoms using the Adult ADHD Self-Report Scale (ASRS) Screener, while happiness was assessed with a single (3-point) measure. Multivariable ordinal logistic regression analysis and a mediation analysis were performed to examine associations. Greater ADHD symptom severity was associated with higher odds for feeling less happy. Mood instability (percentage mediated 37.1%), anxiety disorder (35.6%) and depression (29.9%) were all important mediators of the association between ADHD and happiness. Given that happiness has been linked to a number of beneficial outcomes, the results of this study highlight the importance of diagnosing ADHD in adults and also of screening for and treating any comorbid psychiatric disorders in these individuals.
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22
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Edmonds EC, Martin AS, Palmer BW, Eyler LT, Rana BK, Jeste DV. Positive mental health in schizophrenia and healthy comparison groups: relationships with overall health and biomarkers. Aging Ment Health 2018; 22:354-362. [PMID: 27834490 DOI: 10.1080/13607863.2016.1251572] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Positive psychological factors (PPFs) have been reported to have a significant impact on health in the general population. However, little is known about the relationship of these factors with mental and physical health in schizophrenia. METHOD One hundred and thirty-five outpatients with schizophrenia and 127 healthy comparison subjects (HCs), aged 26-65 years, were evaluated with scales of resilience, optimism, happiness, and perceived stress. Measures of mental and physical health were also obtained. Regression analyses examined associations of a PPF composite with health variables. RESULTS Relative to the HCs, the schizophrenia group had lower levels of PPFs. However, there was considerable heterogeneity, with over one-third of schizophrenia participants having values within the 'normative' range. The PPF composite was positively related to mental and physical health variables and with biomarkers of inflammation and insulin resistance. The relationship between PPFs and mental health was particularly strong for individuals with schizophrenia. CONCLUSION A sizable minority of adults with chronic schizophrenia have levels of resilience, optimism, happiness, and perceived stress similar to HCs. Psychosocial interventions to enhance PPFs should be tested in patients with serious mental illnesses, with the goal of improving their mental health (beyond controlling symptoms of psychosis) and their physical health.
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Affiliation(s)
- Emily C Edmonds
- a Department of Psychiatry , University of California San Diego , La Jolla , CA , USA
| | - Averria Sirkin Martin
- a Department of Psychiatry , University of California San Diego , La Jolla , CA , USA.,b Sam and Rose Stein Institute for Research on Aging, University of California San Diego , La Jolla , CA , USA
| | - Barton W Palmer
- a Department of Psychiatry , University of California San Diego , La Jolla , CA , USA.,b Sam and Rose Stein Institute for Research on Aging, University of California San Diego , La Jolla , CA , USA.,c VA San Diego Healthcare System , San Diego , CA , USA
| | - Lisa T Eyler
- a Department of Psychiatry , University of California San Diego , La Jolla , CA , USA.,b Sam and Rose Stein Institute for Research on Aging, University of California San Diego , La Jolla , CA , USA
| | - Brinda K Rana
- a Department of Psychiatry , University of California San Diego , La Jolla , CA , USA.,b Sam and Rose Stein Institute for Research on Aging, University of California San Diego , La Jolla , CA , USA
| | - Dilip V Jeste
- a Department of Psychiatry , University of California San Diego , La Jolla , CA , USA.,b Sam and Rose Stein Institute for Research on Aging, University of California San Diego , La Jolla , CA , USA.,d Department of Neurosciences , University of California San Diego , La Jolla , CA , USA
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Investigating the predictors of happiness, life satisfaction and success in schizophrenia. Compr Psychiatry 2018; 81:42-47. [PMID: 29245017 DOI: 10.1016/j.comppsych.2017.11.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 10/20/2017] [Accepted: 11/20/2017] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Previous studies have suggested that, despite marked functional impairments, remitted first episode patients with schizophrenia report levels of well-being that are comparable to healthy controls. The aim of the current study was to specifically evaluate self-reported happiness, life satisfaction and success in individuals with schizophrenia beyond their first-episode of psychosis, and to investigate the impact of symptoms and functioning on these subjective experiences. METHODS Fifty-one schizophrenia patients and 56 matched healthy controls participated in the study. Factor scores were computed to compare happiness and life satisfaction and success (LSS) between groups. Hierarchical multiple regression analyses were conducted to investigate the predictive value of symptoms and functional impairments on patients' subjective reports of happiness and LSS. RESULTS Schizophrenia participants endorsed lower levels of LSS compared to healthy controls, with no significant group differences in self-reported happiness. For patients with schizophrenia, motivation deficits and depressive symptoms predicted reductions in both happiness and LSS. CONCLUSIONS Patients with schizophrenia do not report significant reductions in their subjective experience of happiness, but do endorse lower levels of life satisfaction and success. Further, the absence of a robust link between poor functioning and lower happiness or LSS serves to reaffirm the notion that functional status does not dictate whether an individual with schizophrenia experiences a sense of happiness, satisfaction or success in life.
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Ohta M, Nakataki M, Takeda T, Numata S, Tominaga T, Kameoka N, Kubo H, Kinoshita M, Matsuura K, Otomo M, Takeichi N, Harada M, Ohmori T. Structural equation modeling approach between salience network dysfunction, depressed mood, and subjective quality of life in schizophrenia: an ICA resting-state fMRI study. Neuropsychiatr Dis Treat 2018; 14:1585-1597. [PMID: 29942132 PMCID: PMC6007191 DOI: 10.2147/ndt.s163132] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
PURPOSE Quality of life (QOL) is an important clinical outcome for patients with schizophrenia, and recent studies have focused on subjective QOL. We evaluated the causal relationship between psychosocial aspect of subjective QOL, symptoms, cognitive functions, and salience network (SN) dysfunction in schizophrenia using structural equation modeling (SEM). PATIENTS AND METHODS We performed a cross-sectional study of 21 patients with symptomatically stabilized schizophrenia and 21 age-, sex-, and education level-matched healthy controls who underwent resting-state functional magnetic resonance imaging. We evaluated SN dysfunction in schizophrenia using independent component analysis (ICA). We rated participant psychopathology using the Positive and Negative Syndrome Scale (PANSS), the Brief Assessment of Cognition in Schizophrenia (BACS), and the Calgary Depression Scale for Schizophrenia (CDSS). We rated psychosocial aspect of subjective QOL using the Schizophrenia Quality of Life Scale (SQLS) psychosocial subscale. We applied SEM to examine the relationships between SN dysfunction, PANSS positive and negative scores, CDSS total scores, BACS composite scores, and SQLS psychosocial subscale scores. RESULTS In second-level analysis after group ICA, patient group had significant lower right pallidum functional connectivity (FC) within the SN than the controls did (Montreal Neurological Institute [MNI] [x y z] = [22 -2 -6]) (p = 0.027, family-wise error [FWE] corrected). In SEM, we obtained a good fit for an SEM model in which SN dysfunction causes depressed mood, which in turn determines psychosocial aspect of subjective QOL (chi-squared p = 0.9, root mean square error of approximation (RMSEA) < 0.001, comparative fit index [CFI] = 1.00, and standardized root mean square residual [SRMR]= 0.020). CONCLUSION We found a continuous process by which SN dysfunction causes depressed moods that determine psychosocial aspect of subjective QOL in schizophrenia. This is the first report that offers a unified explanation of functional neuroimaging, symptoms, and outcomes. Future studies combining neuroimaging techniques and clinical assessments would elucidate schizophrenia's pathogenesis.
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Affiliation(s)
- Masashi Ohta
- Department of Psychiatry, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Masahito Nakataki
- Department of Psychiatry, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Tomoya Takeda
- Department of Psychiatry, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Shusuke Numata
- Department of Psychiatry, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Takeo Tominaga
- Department of Psychiatry, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Naomi Kameoka
- Department of Psychiatry, Tokushima University Hospital, Tokushima, Japan
| | - Hiroko Kubo
- Department of Psychiatry, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Makoto Kinoshita
- Department of Psychiatry, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Kanae Matsuura
- Department of Psychiatry, Tokushima University Hospital, Tokushima, Japan
| | - Maki Otomo
- Department of Radiology and Radiation Oncology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Naoya Takeichi
- Department of Radiology, Tokushima University Hospital, Tokushima, Japan
| | - Masafumi Harada
- Department of Radiology and Radiation Oncology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Tetsuro Ohmori
- Department of Psychiatry, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
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Characterizing outcome preferences in patients with psychotic disorders: a discrete choice conjoint experiment. Schizophr Res 2017; 185:107-113. [PMID: 28038919 DOI: 10.1016/j.schres.2016.12.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Revised: 12/14/2016] [Accepted: 12/17/2016] [Indexed: 12/13/2022]
Abstract
The majority of individuals with schizophrenia will achieve a remission of psychotic symptoms, but few will meet criteria for recovery. Little is known about what outcomes are important to patients. We carried out a discrete choice experiment to characterize the outcome preferences of patients with psychotic disorders. Participants (N=300) were recruited from two clinics specializing in psychotic disorders. Twelve outcomes were each defined at three levels and incorporated into a computerized survey with 15 choice tasks. Utility values and importance scores were calculated for each outcome level. Latent class analysis was carried out to determine whether participants were distributed into segments with different preferences. Multinomial logistic regression was used to identify predictors of segment membership. Latent class analysis revealed three segments of respondents. The first segment (48%), which we labeled "Achievement-focused," preferred to have a full-time job, to live independently, to be in a long-term relationship, and to have no psychotic symptoms. The second segment (29%), labeled "Stability-focused," preferred to not have a job, to live independently, and to have some ongoing psychotic symptoms. The third segment (23%), labeled "Health-focused," preferred to not have a job, to live in supervised housing, and to have no psychotic symptoms. Segment membership was predicted by education, socioeconomic status, psychotic symptom severity, and work status. This study has revealed that patients with psychotic disorders are distributed between segments with different outcome preferences. New approaches to improve outcomes for patients with psychotic disorders should be informed by a greater understanding of patient preferences and priorities.
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Fervaha G, Agid O, Takeuchi H, Foussias G, Remington G. Life satisfaction and happiness among young adults with schizophrenia. Psychiatry Res 2016; 242:174-179. [PMID: 27288735 DOI: 10.1016/j.psychres.2016.05.046] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 05/29/2016] [Accepted: 05/29/2016] [Indexed: 11/30/2022]
Abstract
People with schizophrenia often experience persistent symptoms and impairments in community functioning; however, despite this, many individuals with the illness report high levels of well-being. We explored the level of subjective well-being in a sample of relatively young outpatients with schizophrenia and matched healthy controls. Seventy-five outpatients with schizophrenia and 72 demographically matched healthy controls, aged 18-35 years, participated in the present study. Subjective well-being was defined as a combination of happiness and satisfaction with life, each of which were measured using validated instruments. Symptom severity, insight, and cognition were also evaluated. People with schizophrenia endorsed significantly lower levels of subjective well-being than healthy controls although, there was substantial overlap in scores, and many participants with schizophrenia endorsed a high level of well-being. Both depressive symptoms and motivational deficits demonstrated significant independent predictive value for determining level of well-being. At a group level, the mean level of happiness and life satisfaction was lower among people with schizophrenia than healthy comparison participants. However, despite this mean difference, there exists marked overlap in individual scores between those with and without schizophrenia, demonstrating that many young people with schizophrenia do, in fact, endorse high levels of subjective well-being.
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Affiliation(s)
- Gagan Fervaha
- Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada.
| | - Ofer Agid
- Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Hiroyoshi Takeuchi
- Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
| | - George Foussias
- Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Gary Remington
- Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
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Duncan MJ, Faulkner G, Remington G, Arbour-Nicitopoulos K. Characterizing the affective responses to an acute bout of moderate-intensity exercise among outpatients with schizophrenia. Psychiatry Res 2016; 237:264-70. [PMID: 26851964 DOI: 10.1016/j.psychres.2016.01.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 11/03/2015] [Accepted: 01/15/2016] [Indexed: 10/22/2022]
Abstract
In addition to offering many physical health benefits, exercise may help improve mental health among individuals with schizophrenia through regulating affect. Therefore, the purpose of this study is to characterize affective responses experienced before, during and after a 10-min bout of exercise versus passive sitting among individuals with schizophrenia. A randomized crossover design compared affect related to feelings of pleasure and arousal at baseline, 6-min into the task, immediately post-task, and 10min post-task to sitting. Thirty participants enroled in the study; 28 participants completed the study. Separate mixed model analyses of variance were conducted for pleasure and arousal, with test order as the between-subject factor, and time and task as within-subject factors. For pleasure, a significant main effect for time and a time x task interaction effect emerged. Post-hoc Bonferroni corrected t-tests (α=.0125) revealed significant differences between pleasure at baseline and both immediately post-task and 10min post-task. No other main effects or interactions emerged. Individuals with schizophrenia derive acute feelings of pleasure from exercise. Thus, exercise may provide a method of regulating affect to improve mental health. Future studies should examine the links between affective responses to health behaviours such as long-term adherence to exercise within this population.
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Affiliation(s)
- Markus J Duncan
- Faculty of Kinesiology & Physical Education, University of Toronto, Toronto, ON, Canada.
| | - Guy Faulkner
- Faculty of Kinesiology & Physical Education, University of Toronto, Toronto, ON, Canada; Schizophrenia Program, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Gary Remington
- Schizophrenia Program, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Agid O, Mcdonald K, Fervaha G, Littrell R, Thoma J, Zipursky RB, Foussias G, Remington G. Values in First-Episode Schizophrenia. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2015; 60:507-14. [PMID: 26720508 PMCID: PMC4679131 DOI: 10.1177/070674371506001106] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 04/01/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Functional impairment continues to represent a major challenge in schizophrenia. Surprisingly, patients with schizophrenia report a level of happiness comparable with control subjects, even in the face of the prominent functional deficits, a finding at odds with evidence indicating a positive relation between happiness and level of functioning. In attempting to reconcile these findings, we chose to examine the issue of values, defined as affectively infused criteria or motivational goals used to select and justify actions, people, and the self, as values are related to both happiness and functioning. METHODS Fifty-six first-episode patients in remission and 56 healthy control subjects completed happiness and values measures. Statistical analyses included correlations, analysis of variance, structural equation modelling, and smallest space analysis. RESULTS Results indicated that patients with schizophrenia placed significantly greater priority on the value dimensions of Tradition (P = 0.02) and Power (P = 0.03), and significantly less priority on Self-direction (P = 0.007) and Stimulation, (P = 0.008). CONCLUSIONS Essentially, people with schizophrenia place more emphasis on the customs and ideas that traditional culture or religion provide in conjunction with a decreased interest in change, which is at odds with the expectations of early adulthood. This value difference could be related to functional deficits. To this point, we have assumed that people hold to the same values that guided them before the illness' onset, but this may not be the case. Our study indicates that values differ in people with schizophrenia, compared with control subjects, even early in the illness and in the face of symptomatic remission.
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Affiliation(s)
- Ofer Agid
- Associate Professor, Department of Psychiatry, University of Toronto, Toronto, Ontario; Staff Psychiatrist and Clinician Scientist,, Complex Mental Illness Program, Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, Ontario
| | - Krysta Mcdonald
- Researcher, Complex Mental Illness Program, Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, Ontario
| | - Gagan Fervaha
- Doctoral Student, Institute of Medical Science, University of Toronto, Toronto, Ontario
| | - Romie Littrell
- Associate Professor, Auckland University of Technology, Auckland, New Zealand
| | - Jessica Thoma
- Psychiatrist, Complex Mental Illness Program, Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, Ontario
| | - Robert B Zipursky
- Professor, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario
| | - George Foussias
- Psychiatrist, Complex Mental Illness Program, Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, Ontario
| | - Gary Remington
- Professor, Department of Psychiatry, Complex Mental Illness Program, Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, Ontario
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Siu CO, Harvey PD, Agid O, Waye M, Brambilla C, Choi WK, Remington G. Insight and subjective measures of quality of life in chronic schizophrenia. SCHIZOPHRENIA RESEARCH-COGNITION 2015; 2:127-132. [PMID: 26973810 PMCID: PMC4788499 DOI: 10.1016/j.scog.2015.05.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Lack of insight is a well-established phenomenon in schizophrenia, and has been associated with reduced rater-assessed functional performance but increased self-reported well-being in previous studies. The objective of this study was to examine factors that might influence insight (as assessed by the Insight and Treatment Attitudes Questionnaire [ITAQ] or PANSS item G12) and subjective quality-of-life (as assessed by Lehman QoL Interview [LQOLI]), using the large National Institute of Mental Health Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) dataset. Uncooperativeness was assessed by PANSS item G8 (“Uncooperativeness”). In the analysis, we found significant moderating effects for insight on the relationships of subjective life satisfaction assessment to symptom severity (as assessed by CGI-S score), objective everyday functioning (as assessed by rater-administered Heinrichs–Carpenter Quality of Life scale), clinically rated uncooperativeness (as assessed by PANSS G8), and discontinuation of treatment for all causes (all P < 0.05 for statistical interaction between insight and subject QoL). Patients with chronic schizophrenia who reported being "pleased" or "delighted" on LQOLI were found to have significantly lower neurocognitive reasoning performance and poorer insight (ITAQ total score). Our findings underscore the importance of reducing cognitive and insight impairments for both treatment compliance and improved functional outcomes.
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Affiliation(s)
| | - Philip D Harvey
- University of Miami Miller School of Medicine, Miami, FL, USA; Research Service, Bruce W. Carter VA Medical Center, Miami, FL, USA
| | - Ofer Agid
- Center for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Mary Waye
- Chinese University of Hong Kong, Shatin, N.T., Hong Kong
| | - Carla Brambilla
- Applied Mathematics and Information Technologies Institute, National Research Council, Milan, Italy
| | | | - Gary Remington
- Center for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, Canada
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Abstract
Optimal outcome in schizophrenia is thought to include remission of symptoms, functional recovery, and improved subjective well-being. The present study examined the characteristics of individuals with schizophrenia who report being satisfied with their life in general. Individuals with schizophrenia who participated in the Clinical Antipsychotic Trial of Intervention Effectiveness study were included in the present analysis. Approximately half of the individuals evaluated reported a high level of life satisfaction, even while many concurrently described themselves as at least moderately ill and experiencing moderate-severe symptoms and manifested severe functional deficits. Of all individuals evaluated, only about 1% experienced what was considered to be optimal outcome. Individuals with schizophrenia are able to experience a high level of life satisfaction, despite experiencing severe illness and functional deficits. Those involved in care should be aware that life satisfaction as an outcome is not necessarily associated with symptom remission and superior functioning.
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Zipursky RB, Agid O. Recovery, not progressive deterioration, should be the expectation in schizophrenia. World Psychiatry 2015; 14:94-6. [PMID: 25655164 PMCID: PMC4329903 DOI: 10.1002/wps.20194] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Robert B Zipursky
- Department of Psychiatry and Behavioural Neurosciences, Michael G. DeGroote School of Medicine, McMaster University, and Schizophrenia and Community Integration Services, St. Joseph's Healthcare HamiltonHamilton, Ontario, Canada
| | - Ofer Agid
- Department of Psychiatry, Faculty of Medicine, University of Toronto, and Complex Mental Illness/Schizophrenia Services, Centre for Addiction and Mental HealthToronto, Ontario, Canada
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Fervaha G, Zakzanis KK, Jeffay E, Graff-Guerrero A, Foussias G, Agid O, Remington G. Amotivation as central to negative schizotypy and their predictive value for happiness. PERSONALITY AND INDIVIDUAL DIFFERENCES 2014. [DOI: 10.1016/j.paid.2014.03.039] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Palmer BW, Martin AS, Depp CA, Glorioso DK, Jeste DV. Wellness within illness: happiness in schizophrenia. Schizophr Res 2014; 159:151-6. [PMID: 25153363 PMCID: PMC4928639 DOI: 10.1016/j.schres.2014.07.027] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 07/18/2014] [Accepted: 07/20/2014] [Indexed: 11/28/2022]
Abstract
Schizophrenia is typically a chronic disorder and among the most severe forms of serious mental illnesses in terms of adverse impact on quality of life. Yet, there have been suggestions that some people with schizophrenia can experience an overall sense of happiness in their lives. We investigated happiness among 72 outpatients with non-remitted chronic schizophrenia with a mean duration of illness of 24.4 years, and 64 healthy comparison subjects (HCs). Despite continued treatment with antipsychotic medications, the individuals with schizophrenia manifested a mild to moderate level of psychopathology. People with schizophrenia reported lower mean levels of happiness than HCs, but there was substantial heterogeneity within the schizophrenia group. Level of happiness in persons with schizophrenia was significantly correlated with higher mental health-related quality of life, and several positive psychosocial factors (lower perceived stress, and higher levels of resilience, optimism, and personal mastery). However, level of happiness was not related to sociodemographic characteristics, duration of illness, severity of positive or negative symptoms, physical function, medical comorbidity, or cognitive functioning. Except for an absence of an association with resilience, the pattern of correlations of happiness with other variables seen among HCs was similar to that in individuals with schizophrenia. Although happiness may be harder to achieve in the context of a serious mental illness, it nonetheless appears to be a viable treatment goal in schizophrenia. Psychotherapies targeting positive coping factors such as resilience, optimism, and personal mastery warrant further investigation.
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Affiliation(s)
- Barton W. Palmer
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA,The University of California, San Diego Center for Healthy Aging and the Stein Institute for Research on Aging, La Jolla, CA, USA,Veterans Affairs San Diego Healthcare System, San Diego, CA, USA,Corresponding author at: University of California, San Diego MC 0993, 9500 Gilman Drive, La Jolla, CA 92093-0993, USA. Tel.: +1 858 246 0765. (B.W. Palmer)
| | - Averria Sirkin Martin
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA,The University of California, San Diego Center for Healthy Aging and the Stein Institute for Research on Aging, La Jolla, CA, USA
| | - Colin A. Depp
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA,The University of California, San Diego Center for Healthy Aging and the Stein Institute for Research on Aging, La Jolla, CA, USA,Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Danielle K. Glorioso
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA,The University of California, San Diego Center for Healthy Aging and the Stein Institute for Research on Aging, La Jolla, CA, USA
| | - Dilip V. Jeste
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA,The University of California, San Diego Center for Healthy Aging and the Stein Institute for Research on Aging, La Jolla, CA, USA,Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA
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Gard DE, Sanchez AH, Cooper K, Fisher M, Garrett C, Vinogradov S. Do people with schizophrenia have difficulty anticipating pleasure, engaging in effortful behavior, or both? JOURNAL OF ABNORMAL PSYCHOLOGY 2014; 123:771-82. [PMID: 25133986 DOI: 10.1037/abn0000005] [Citation(s) in RCA: 101] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Motivation deficits are common in schizophrenia, but little is known about underlying mechanisms, or the specific goals that people with schizophrenia set in daily life. Using neurobiological heuristics of pleasure anticipation and effort assessment, we examined the quality of activities and goals of 47 people with and 41 people without schizophrenia, utilizing ecological momentary assessment. Participants were provided cell phones and called 4 times a day for 7 days, and were asked about their current activities and anticipation of upcoming goals. Activities and goals were later coded by independent raters on pleasure and effort. In line with recent laboratory findings on effort computation deficits in schizophrenia, relative to healthy participants, people with schizophrenia reported engaging in less effortful activities and setting less effortful goals, which were related to patient functioning. In addition, patients showed some inaccuracy in estimating how difficult an effortful goal would be, which in turn was associated with lower neurocognition. In contrast to previous research, people with schizophrenia engaged in activities and set goals that were more pleasure-based, and anticipated goals as being more pleasurable than controls. Thus, this study provided evidence for difficulty with effortful behavior and not anticipation of pleasure. These findings may have psychosocial treatment implications, focusing on effort assessment or effort expenditure. For example, to help people with schizophrenia engage in more meaningful goal pursuits, treatment providers may leverage low-effort pleasurable goals by helping patients to break down larger, more complex goals into smaller, lower-effort steps that are associated with specific pleasurable rewards.
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Affiliation(s)
| | | | | | - Melissa Fisher
- San Francisco Department of Veterans Affairs Medical Center
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Fervaha G, Agid O, Takeuchi H, Foussias G, Remington G. Clinical determinants of life satisfaction in chronic schizophrenia: data from the CATIE study. Schizophr Res 2013; 151:203-8. [PMID: 24183751 DOI: 10.1016/j.schres.2013.10.021] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Revised: 10/16/2013] [Accepted: 10/17/2013] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Quality of life is seen as an important outcome variable for patients with schizophrenia. However, the precise definition of this construct varies and has often been used to define health-related domains. The present study sought to focus on global life satisfaction as a key subjective domain and determine its relationship with clinical variables. METHOD The study sample included 1437 patients with chronic schizophrenia who participated in the Clinical Antipsychotic Trial of Intervention Effectiveness (CATIE) study. Patients were evaluated with a comprehensive battery of assessments capturing symptoms, cognition and medication side effects, among other variables. Life satisfaction was evaluated with a global self-report item. RESULTS Greater depressive symptoms were the most robust indicator of worse life satisfaction. Lower life satisfaction was also associated with poorer psychosocial functioning, greater symptoms of anxiety, apathy and more negative attitudes toward medication. Taken together, these variables explained 20% of the variance in life satisfaction scores. Positive symptoms and other medication side effects also negatively influenced life satisfaction scores. CONCLUSIONS These results affirm that clinical variables have an adverse effect on the overall subjective well-being of patients with schizophrenia. The relatively small amount of variance explained, though, argues for a better understanding of those other variables that contribute to life satisfaction.
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Affiliation(s)
- Gagan Fervaha
- Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada.
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Abstract
PURPOSE OF REVIEW Poor psychosocial functioning in schizophrenia can be conceptualized as an early indicator of chronic neurodevelopmental illness. Alternatively, impaired psychosocial functioning could be the result of social and environmental factors associated with the onset of psychotic illness. We review recent evidence on psychosocial outcome in the early phases of psychotic illness, when young people are less removed from their developmental trajectory, any brain changes may be mutable and there may be greater opportunity for intervention. RECENT FINDINGS In samples with first-episode psychosis, poor premorbid functioning, stable negative symptoms and impaired social cognition and neurocognition may indicate individuals likely to experience poor psychosocial outcome. There is also some evidence of social/environmental predictors of poor outcome. Recent findings from at-risk samples suggest similar patterns, although more research is needed. SUMMARY It is likely that for some patients poor psychosocial outcome is the result of longstanding neurological changes, whereas for others it is related to the secondary consequences of having psychosis. We suggest that measuring psychosocial outcome in the early stages of psychosis is important for our understanding of the cause of schizophrenia, but argue for the importance of the patient's subjective view on their psychosocial recovery.
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