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Kubota R, Ikezawa S, Oi H, Oba MS, Izumi S, Tsuno R, Adachi L, Miwa M, Toya S, Nishizato Y, Haga D, Iwane T, Nakagome K. Valuable interaction with cognitive remediation and optimal antipsychotics for recovery in schizophrenia (VICTORY-S): study protocol for an interventional, open-label, randomized comparison of combined treatment with cognitive remediation and lurasidone or paliperidone. Front Psychiatry 2024; 14:1331356. [PMID: 38380376 PMCID: PMC10877376 DOI: 10.3389/fpsyt.2023.1331356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 12/22/2023] [Indexed: 02/22/2024] Open
Abstract
Background Cognitive impairment, a core feature of schizophrenia, is associated with poor outcomes. Pharmacotherapy and psychosocial treatment, when used alone, have inadequate effect sizes for cognitive impairment, leading to recent interest in combination interventions. A previous study examined the additive effect of cognitive remediation on lurasidone in patients with schizophrenia, which was negative. Although improvement in cognitive function was suggested for lurasidone, it was inconclusive because there was no antipsychotic control in the study. To clarify whether lurasidone has a meaningful impact on cognitive function in combination with cognitive remediation, we use paliperidone as a control antipsychotic in this study. We hypothesize that combination with lurasidone will improve cognitive and social function to a greater extent than paliperidone. Methods The valuable interaction with cognitive remediation and optimal antipsychotics for recovery in schizophrenia study is a multicenter, interventional, open-label, rater-blind, randomized comparison study, comparing the effect of lurasidone plus cognitive remediation with that of paliperidone plus cognitive remediation in patients with schizophrenia. The Neuropsychological Educational Approach to Remediation (NEAR) is used for cognitive remediation. Eligible patients will be randomized 1:1 to receive lurasidone or paliperidone combined with NEAR (6 weeks antipsychotic alone followed by 24 weeks combination antipsychotic plus NEAR). The primary endpoint is the change from baseline in the tablet-based Brief Assessment of Cognition in Schizophrenia composite T-score at the end of the NEAR combination treatment period. Secondary endpoints will include change from baseline in social function, schizophrenia symptoms, and quality of life at the end of the NEAR combination treatment period. Furthermore, change from baseline to the end of the pharmacotherapy period and change from the end of the pharmacotherapy period to the end of the NEAR combination treatment period will be assessed for all endpoints. Safety will also be evaluated. Discussion Achievement of adequate cognitive function is central to supporting social function, which is a key treatment goal for patients with schizophrenia. We think this study will fill in the gaps of the previous study and provide useful information regarding treatment decisions for patients with schizophrenia. Clinical trial registration Japan Registry of Clinical Trials ID, jRCTs031200338.
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Affiliation(s)
- Ryotaro Kubota
- Department of Forensic Psychiatry, National Center of Neurology and Psychiatry Hospital, Tokyo, Japan
| | - Satoru Ikezawa
- Department of Psychiatry, National Center of Neurology and Psychiatry Hospital, Tokyo, Japan
- Department of Psychiatry, International University of Health and Welfare Mita Hospital, Tokyo, Japan
| | - Hideki Oi
- Department of Clinical Data Science, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Mari S Oba
- Department of Clinical Data Science, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Shoki Izumi
- Department of Clinical Data Science, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Ryoko Tsuno
- Department of Clinical Data Science, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Leona Adachi
- Department of Psychiatry, National Center of Neurology and Psychiatry Hospital, Tokyo, Japan
| | - Mako Miwa
- Department of Psychiatry, National Center of Neurology and Psychiatry Hospital, Tokyo, Japan
| | - Shunji Toya
- CNS Group, Medical Science, Sumitomo Pharma Co., Ltd., Tokyo, Japan
| | - Yohei Nishizato
- CNS Group, Medical Science, Sumitomo Pharma Co., Ltd., Tokyo, Japan
| | | | | | - Kazuyuki Nakagome
- Department of Psychiatry, National Center of Neurology and Psychiatry Hospital, Tokyo, Japan
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Murphy SM, Flores AT, Wojtalik JA, Keshavan MS, Eack SM. Symptom contributors to quality of life in schizophrenia: Exploratory factor and network analyses. Schizophr Res 2024; 264:494-501. [PMID: 38281419 PMCID: PMC11005863 DOI: 10.1016/j.schres.2024.01.028] [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: 07/14/2023] [Revised: 01/18/2024] [Accepted: 01/20/2024] [Indexed: 01/30/2024]
Abstract
Individuals with schizophrenia and other associated disorders experience significant disturbance to their quality of life (QoL) due to a multitude of co-occurring symptoms. Popular evidence-based practices (EBPs) devote significant effort to reduce positive symptomatology in order to prevent relapse, while emerging research posits that other symptoms (cognitive deficits, negative and affective symptoms) are more indicative of QoL disturbance. This study sought to examine the impact of symptom constructs on QoL and attempt to infer directionality of influence via network analysis. A total of 102 recovery phase adult outpatients with schizophrenia spectrum disorders were assessed on positive, negative, and affective symptomatology, in addition to QoL and cognitive abilities. Exploratory factor analysis and network analysis were performed to identify associations and infer directed influence between symptom constructs, and a directed acyclic graph was constructed to observe associations between symptom domains and QoL. Factor analysis results indicated that individual measures align with their respective symptom constructs. Strong factor correlations were found between QoL and the negative and affective symptom constructs, with weaker associations found between positive symptoms and cognition. Visualization of the network structure illustrated QoL as the central cluster of the network, and examination of the weighted edges found the strongest connectivity between QoL, negative symptomatology, and affective symptoms. More severe negative and affective symptoms were most directly linked with poorer QoL and may prove to be integral in attaining positive outcomes in schizophrenia treatment. Incorporation of psychosocial treatments in addition to pharmacotherapy may prove effective in targeting negative and affective symptoms.
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Affiliation(s)
- Samuel M Murphy
- School of Social Work, University of Pittsburgh, United States of America; Department of Psychiatry, University of Pittsburgh School of Medicine, United States of America.
| | - Ana T Flores
- School of Social Work, University of Pittsburgh, United States of America; Department of Psychiatry, University of Pittsburgh School of Medicine, United States of America
| | - Jessica A Wojtalik
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, United States of America
| | - Matcheri S Keshavan
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Massachusetts Mental Health Center Division of Public Psychiatry, United States of America
| | - Shaun M Eack
- School of Social Work, University of Pittsburgh, United States of America; Department of Psychiatry, University of Pittsburgh School of Medicine, United States of America
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Kang Z, Qin Y, Sun Y, Lu Z, Sun Y, Chen H, Feng X, Zhang Y, Guo H, Yan H, Yue W. Multigenetic Pharmacogenomics-Guided Treatment vs Treatment As Usual Among Hospitalized Men With Schizophrenia: A Randomized Clinical Trial. JAMA Netw Open 2023; 6:e2335518. [PMID: 37801319 PMCID: PMC10559185 DOI: 10.1001/jamanetworkopen.2023.35518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 08/19/2023] [Indexed: 10/07/2023] Open
Abstract
Importance Limited evidence supports multigenetic pharmacogenomics-guided treatment (MPGT) in schizophrenia. Objective To evaluate the clinical effectiveness of MPGT in schizophrenia in a randomized clinical trial (RCT). Design, Setting, and Participants This RCT was conducted from March 2020 to March 2022. Male Chinese Han inpatients aged 18 to 60 years diagnosed with schizophrenia with a Positive and Negative Symptom Scale (PANSS) score of 60 or more from 2 selected study hospitals were included. Patients and raters were masked to MPGT or treatment as usual (TAU) randomization. Interventions Participants were randomly assigned in a 1:1 ratio to receive either MPGT or TAU for 12 weeks. Main Outcomes and Measures The primary efficacy outcome was the percentage change in PANSS total scores (range, 30 to 210) from baseline to week 6 analyzed by a modified intention-to-treat mixed model for repeated measures. The secondary outcome included response and symptomatic remission rates. Results A total of 210 participants (mean [SD] age, 29.2 [8.8] years) were enrolled and analyzed, with 113 assigned to MPGT and 97 to TAU. Compared with those randomized to TAU, participants randomized to MPGT demonstrated a significantly higher percentage change in PANSS score (74.2% vs 64.9%; adjusted mean difference, 9.2 percentage points; 95% CI, 4.4-14.1 percentage points; P < .001) and a higher response rate (93 of 113 [82.3%] vs 63 of 97 [64.9%]; adjusted odds ratio, 2.48; 95% CI, 1.28-4.80; P = .01) at the end of week 6. Conclusions and Relevance In this RCT of MPGT, MPGT was more effective than TAU in treating patients with schizophrenia. These findings suggest that multigenetic pharmacogenomic testing could serve as an effective tool to guide the treatment of schizophrenia. Trial Registration Chinese Clinical Trial Registry Identifier: ChiCTR2000029671.
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Affiliation(s)
- Zhewei Kang
- Institute of Mental Health, Peking University Sixth Hospital, Beijing, China
- National Clinical Research Center for Mental Disorders, Peking University Sixth Hospital, Beijing, China
- NHC Key Laboratory of Mental Health, Research Unit of Diagnosis and Treatment of Mood Cognitive Disorder, Chinese Academy of Medical Sciences, Beijing, China
| | - Ying Qin
- The Second People’s Hospital of Guizhou Province, Guiyang, China
| | - Yutao Sun
- Tangshan Mental Health Center, Tangshan Fifth Hospital, Tangshan, China
| | - Zhe Lu
- Institute of Mental Health, Peking University Sixth Hospital, Beijing, China
- National Clinical Research Center for Mental Disorders, Peking University Sixth Hospital, Beijing, China
- NHC Key Laboratory of Mental Health, Research Unit of Diagnosis and Treatment of Mood Cognitive Disorder, Chinese Academy of Medical Sciences, Beijing, China
| | - Yaoyao Sun
- Institute of Mental Health, Peking University Sixth Hospital, Beijing, China
- National Clinical Research Center for Mental Disorders, Peking University Sixth Hospital, Beijing, China
- NHC Key Laboratory of Mental Health, Research Unit of Diagnosis and Treatment of Mood Cognitive Disorder, Chinese Academy of Medical Sciences, Beijing, China
| | - Huan Chen
- Shantou University Mental Health Center, Shantou, China
| | - Xiaoyang Feng
- Institute of Mental Health, Peking University Sixth Hospital, Beijing, China
- National Clinical Research Center for Mental Disorders, Peking University Sixth Hospital, Beijing, China
- NHC Key Laboratory of Mental Health, Research Unit of Diagnosis and Treatment of Mood Cognitive Disorder, Chinese Academy of Medical Sciences, Beijing, China
| | - Yuyanan Zhang
- Institute of Mental Health, Peking University Sixth Hospital, Beijing, China
- National Clinical Research Center for Mental Disorders, Peking University Sixth Hospital, Beijing, China
- NHC Key Laboratory of Mental Health, Research Unit of Diagnosis and Treatment of Mood Cognitive Disorder, Chinese Academy of Medical Sciences, Beijing, China
| | - Hua Guo
- Zhumadian Second People’s Hospital, Zhumadian, China
| | - Hao Yan
- Institute of Mental Health, Peking University Sixth Hospital, Beijing, China
- National Clinical Research Center for Mental Disorders, Peking University Sixth Hospital, Beijing, China
- NHC Key Laboratory of Mental Health, Research Unit of Diagnosis and Treatment of Mood Cognitive Disorder, Chinese Academy of Medical Sciences, Beijing, China
| | - Weihua Yue
- Institute of Mental Health, Peking University Sixth Hospital, Beijing, China
- National Clinical Research Center for Mental Disorders, Peking University Sixth Hospital, Beijing, China
- NHC Key Laboratory of Mental Health, Research Unit of Diagnosis and Treatment of Mood Cognitive Disorder, Chinese Academy of Medical Sciences, Beijing, China
- PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, China
- Chinese Institute for Brain Research, Beijing, China
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Zhu R, Zhou Y, Wei S, Wang W, Wang D, Wang L, Zhang XY. Insomnia in Chinese patients with chronic schizophrenia: prevalence, clinical correlates and relationship with cognitive impairment. Sleep Breath 2023; 27:1977-1983. [PMID: 36522602 DOI: 10.1007/s11325-022-02762-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 11/23/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE Insomnia is a major public health concern that often occurs in patients with schizophrenia, complicating the treatment and prognosis of patients. This study aimed to investigate the prevalence of insomnia and its relationship with cognitive function in Chinese patients with chronic schizophrenia. METHODS We recruited patients with schizophrenia and collected their clinical and demographic data. Insomnia data were collected through a self-reported questionnaire consisting of three questions. The positive and negative syndrome scale (PANSS) was used to measure psychopathological symptoms, while the repeatable battery for the assessment of neuropsychological status (RBANS) was used to measure cognitive performance. RESULTS Of 957 Chinese patients with chronic schizophrenia 20.2% reported having insomnia (193/957). Male patients (107/630, 17.0%) had a lower rate of insomnia than female patients (86/327, 26.3%) (x2 = 11.60, p = 0.001). Patients with insomnia exhibited significantly higher PANSS total score and positive symptom, negative symptom, and general psychopathology scores, but significantly lower RBANS total score, language, attention and delayed memory scores compared to patients without insomnia (all p < 0.05). Logistic regression analysis showed that female sex, high PANSS total score and the use of diazepam were independently associated with insomnia (all p < 0.05). CONCLUSIONS Insomnia is relatively common in Chinese patients with chronic schizophrenia. Some demographic data and clinical symptoms are associated with insomnia. Patients with schizophrenia and insomnia perform poorly on cognition tests suggesting that insomnia and cognitive function are closely related in patients with schizophrenia.
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Affiliation(s)
- Rongrong Zhu
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, 16 Lincui Road, Chaoyang District, Beijing, 100101, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Yongjie Zhou
- Department of Psychiatric Rehabilitation, Shenzhen Kangning Hospital, Shenzhen, China
| | - Shuochi Wei
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, 16 Lincui Road, Chaoyang District, Beijing, 100101, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Wenjia Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, 16 Lincui Road, Chaoyang District, Beijing, 100101, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Dongmei Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, 16 Lincui Road, Chaoyang District, Beijing, 100101, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Li Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, 16 Lincui Road, Chaoyang District, Beijing, 100101, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Xiang-Yang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, 16 Lincui Road, Chaoyang District, Beijing, 100101, China.
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.
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Attepe Özden S, Tekindal M, Tekindal MA. Quality of Life of people with Schizophrenia: A meta-analysis. Int J Soc Psychiatry 2023; 69:1444-1452. [PMID: 37029492 DOI: 10.1177/00207640231164019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/09/2023]
Abstract
BACKGROUND Schizophrenia is a severe, chronic mental disorder that causes many psychosocial problems. In order to reveal these problems, it is necessary to measure the quality of life of people with schizophrenia. AIM The aim of this meta-analysis is to compare the quality of life of people with schizophrenia and healthy subjects. METHODS Literature search was conducted in the Web of Science Core Collection database including the dates of January 2000 and March 2021. The systematic search provided 464 potentially relevant studies. The final sample consisted of 18 studies. RESULTS The results of using a random effects model for analysis indicated that schizophrenia subjects showed considerably lower quality of life scores compared to healthy controls. CONCLUSION Determining the quality of people with schizophrenia will help us to create effective psychosocial intervention programs.
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Affiliation(s)
| | - Melike Tekindal
- Department of Social Work, İzmir Katip Çelebi University, İzmir, Turkey
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Long-acting Injectable Antipsychotics during the COVID-19 pandemic in schizophrenia: An observational study in a real-world clinical setting. Psychiatry Res 2022; 317:114878. [PMID: 36206591 PMCID: PMC9526678 DOI: 10.1016/j.psychres.2022.114878] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 09/24/2022] [Accepted: 09/30/2022] [Indexed: 01/05/2023]
Abstract
The COVID-19 pandemic is having an important impact on the practice of mental health services and on schizophrenia patients, and heterogeneous and conflicting findings are being reported on the reduction of long-acting injectable (LAI) antipsychotics use. Aims of the study were to assess the total number of patients treated with LAI, the start of novel LAI and the discontinuation of LAI treatments, analyzing register data of the first year of the pandemic, 2020, compared to a pre-pandemic reference year, 2019. Data from two outpatient centers were retrieved, for a total of 236 participants in 2020: no significant differences were observed comparing 2020 and 2019 when considering the total number of patients on LAI treatment (p = 0.890) and the number of dropouts (p = 0.262); however, a significant reduction in the start of LAI was observed (p = 0.022). In 2020, second generation LAI were more prescribed than first generation LAI (p = 0.040) while no difference was observed in 2019 (p = 0.191). These findings attest the efficacy of measures adopted in mental health services to face the consequences of COVID-19 and shed further light on the impact of the pandemic on the clinical practice of mental health services and on the continuity of care of people with schizophrenia.
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WHODAS 2.0: Associations of functional disability with sex, age, and length of care in outpatients with schizophrenia-spectrum disorders. Psychiatry Res 2022; 313:114583. [PMID: 35533470 DOI: 10.1016/j.psychres.2022.114583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 04/10/2022] [Accepted: 04/27/2022] [Indexed: 11/22/2022]
Abstract
Schizophrenia is a disabling mental disorder that is associated with impairments in both social and occupational functioning. Few studies, however, have explored functional domains of disability and its associations with age, sex, and length of care. As part of a hospital quality improvement initiative, data were collected on outpatients' age, sex, length of care, and levels of disability (using the WHODAS 2.0; N=180; M=45.72; 68% male). Mean disability summary and domain scores were compared with population norms from international samples and two published studies in schizophrenia. A series of three-way ANOVAs and post-hoc tests evaluated differences in levels of disability based on age, sex, and length of care categories. Sample mean summary scores were comparable to published studies in schizophrenia (M=24.81; SD=17.37; 85th percentile). Statistically significant main effects of sex and age on summary and domain-specific scores were found, whereas length of care was not significant. A statistically significant three-way interaction of sex x length of care x age was found for summary and mobility scores. Findings provide support for the reliability and validity of the WHODAS 2.0 in outpatients with schizophrenia. Although causal inferences cannot be made, findings show that age and sex are important factors to consider in addressing disability.
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Healthcare resource utilization and quality of life by cognitive impairment in patients with schizophrenia. Schizophr Res Cogn 2022; 28:100233. [PMID: 35004189 PMCID: PMC8715204 DOI: 10.1016/j.scog.2021.100233] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/13/2021] [Accepted: 12/13/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The objective was to investigate the association between cognitive impairment and healthcare resource utilization (HCRU) and quality of life (QoL) among patients with schizophrenia. METHODS Data from the Adelphi Schizophrenia Disease Specific Programme™, a point-in-time survey of physicians and their patients, were collected in the United States between July-October 2019. Psychiatrists reported on patient cognitive function, HCRU, housing circumstances and employment status for their next 10 consulting adult patients with schizophrenia. Patients were classified as having no/mild or moderate/severe cognitive impairment and asked to complete a QoL questionnaire voluntarily. Multiple regression analysis estimated the association between severity of cognitive impairment and patient outcomes adjusting for patient demographics and clinical characteristics. RESULTS Psychiatrists (n=124) reported on 651 and 484 patients with no/mild and moderate/severe cognitive impairment, respectively. Moderate/severe vs. no/mild cognitive impairment was associated with greater odds of hospitalization related to schizophrenia relapse within the last 12 months (adjusted odds ratio [aOR] [95% CI] = 2.23 [1.53-3.24]) and being unemployed due to disability (aOR = 2.39 [1.65-3.45]). Patients with moderate/severe vs. no/mild cognitive impairment had worse average QoL (EuroQoL 5-dimension [EQ-5D] Health Index: difference = -0.09 [-0.13 to -0.04]; EQ-5D Visual Analogue Scale: difference = -7.0 [-13.0 to -1.0]) and overall life satisfaction (Quality of Life Enjoyment and Satisfaction Questionnaire-Short Form: difference = -8.4 [-14.1 to -2.8]). CONCLUSIONS Moderate/severe cognitive impairment among patients with schizophrenia was associated with worse patient outcomes including greater risk of hospitalizations related to schizophrenia relapse. Treatment to improve cognitive function could benefit the large proportion of patients with schizophrenia who suffer from cognitive impairment.
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Ehrminger M, Roux P, Urbach M, André M, Aouizerate B, Berna F, Bohec AL, Capdevielle D, Chéreau I, Clauss J, Dubertret C, Dubreucq J, Fond G, Honciuc RM, Lançon C, Laouamri H, Leigner S, Mallet J, Misdrahi D, Pignon B, Rey R, Schürhoff F, Passerieux C, Brunet-Gouet E. The puzzle of quality of life in schizophrenia: putting the pieces together with the FACE-SZ cohort. Psychol Med 2022; 52:1501-1508. [PMID: 32962773 DOI: 10.1017/s0033291720003311] [Citation(s) in RCA: 6] [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: 11/05/2022]
Abstract
BACKGROUND The determinants of quality of life (QoL) in schizophrenia are largely debated, mainly due to methodological discrepancies and divergence about the concepts concerned. As most studies have investigated bi- or tri-variate models, a multivariate model accounting for simultaneous potential mediations is necessary to have a comprehensive view of the determinants of QOL. We sought to estimate the associations between cognitive reserve, cognition, functioning, insight, depression, schizophrenic symptoms, and QoL in schizophrenia and their potential mediation relationships. METHODS We used structural equation modeling with mediation analyses to test a model based on existing literature in a sample of 776 patients with schizophrenia from the FondaMental Foundation FACE-SZ cohort. RESULTS Our model showed a good fit to the data. We found better functioning to be positively associated with a better QoL, whereas better cognition, better insight, higher levels of depression, and schizophrenic symptoms were associated with a lower QoL in our sample. Cognitive reserve is not directly linked to QoL, but indirectly in a negative manner via cognition. We confirm the negative relationship between cognition and subjective QoL which was previously evidenced by other studies; moreover, this relationship seems to be robust as it survived in our multivariate model. It was not explained by insight as some suggested, thus the mechanism at stake remains to be explained. CONCLUSION The pathways to subjective QoL in schizophrenia are complex and the determinants largely influence each other. Longitudinal studies are warranted to confirm these cross-sectional findings.
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Affiliation(s)
- Mickael Ehrminger
- University Paris Saclay - UVSQ, Health Sciences department, EA 4047 HANDIReSP, Laboratory for clinical and public health research on psychological, cognitive and motor disability, Versailles, France
- University Department of Adult Psychiatry and Addictology, Versailles Hospital, Le Chesnay, France
- University Paris Saclay, 'PsyDev' Team, CESP, Inserm, Villejuif, France
- Fondation Fondamental, Créteil, France
| | - Paul Roux
- University Paris Saclay - UVSQ, Health Sciences department, EA 4047 HANDIReSP, Laboratory for clinical and public health research on psychological, cognitive and motor disability, Versailles, France
- University Department of Adult Psychiatry and Addictology, Versailles Hospital, Le Chesnay, France
- University Paris Saclay, 'PsyDev' Team, CESP, Inserm, Villejuif, France
- Fondation Fondamental, Créteil, France
| | - Mathieu Urbach
- University Department of Adult Psychiatry and Addictology, Versailles Hospital, Le Chesnay, France
- Fondation Fondamental, Créteil, France
| | - Myrtille André
- Fondation Fondamental, Créteil, France
- University Department of Adult Psychiatry, La Colombière Hospital, Montpellier, France
| | - Bruno Aouizerate
- Fondation Fondamental, Créteil, France
- Department of Adult Psychiatry, Charles Perrens Hospital, Bordeaux, France
- University of Bordeaux, Laboratory of Nutrition and Integrative Neurobiology (UMR INRA 1286), France
| | - Fabrice Berna
- Fondation Fondamental, Créteil, France
- Department of Psychiatry, University Hospitals of Strasbourg, Strasbourg, France
- University of Strasbourg, INSERM U1114, Strasbourg, France
| | - Anne-Lise Bohec
- Fondation Fondamental, Créteil, France
- University Claude Bernard Lyon 1, INSERM U1028, CNRS UMR5292, Lyon Center for Research in Neuroscience, PSYR2 Team, Le Vinatier Hospital, Bron, France
| | - Delphine Capdevielle
- Fondation Fondamental, Créteil, France
- University of Montpellier, PSNREC, Neuropsychiatry: Epidemiological and Clinical Research, INSERM, Montpellier, France
| | - Isabelle Chéreau
- Fondation Fondamental, Créteil, France
- Department of Psychiatry, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Julie Clauss
- Fondation Fondamental, Créteil, France
- Department of Psychiatry, University Hospitals of Strasbourg, Strasbourg, France
- University of Strasbourg, INSERM U1114, Strasbourg, France
| | - Caroline Dubertret
- Fondation Fondamental, Créteil, France
- Department of Psychiatry, Louis Mourier Hospital, Colombes, France
- University Paris Descartes, INSERM UMR1266, Institute of Psychiatry and Neuroscience of Paris, Paris, France
- University Paris Diderot, School of Medicine, Sorbonne Paris Cité, Paris, France
| | - Julien Dubreucq
- Fondation Fondamental, Créteil, France
- Psychosocial Rehabilitation Reference Centre, Alpes-Isère Hospital, Grenoble, France
| | - Guillaume Fond
- Fondation Fondamental, Créteil, France
- Department of Public Health, La Conception University Hospital, Marseille, France
- School of medicine, University of Aix-Marseille, EA 3279, Marseille, France
| | - Roxana-Mihaela Honciuc
- Fondation Fondamental, Créteil, France
- Department of Psychiatry, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Christophe Lançon
- Fondation Fondamental, Créteil, France
- School of medicine, University of Aix-Marseille, EA 3279, Marseille, France
- Department of Psychiatry, Sainte Marguerite University Hospital, Marseille, France
| | | | - Sylvain Leigner
- Fondation Fondamental, Créteil, France
- Psychosocial Rehabilitation Reference Centre, Alpes-Isère Hospital, Grenoble, France
| | - Jasmina Mallet
- Fondation Fondamental, Créteil, France
- Department of Psychiatry, Louis Mourier Hospital, Colombes, France
- University Paris Descartes, INSERM UMR1266, Institute of Psychiatry and Neuroscience of Paris, Paris, France
- University Paris Diderot, School of Medicine, Sorbonne Paris Cité, Paris, France
| | - David Misdrahi
- Fondation Fondamental, Créteil, France
- Department of Adult Psychiatry, Charles Perrens Hospital, Bordeaux, France
- University of Bordeaux, CNRS UMR 5287-INCIA, Bordeaux, France
| | - Baptiste Pignon
- Fondation Fondamental, Créteil, France
- INSERM U955, Translational Psychiatry Team, DHU Pe-PSY, Mondor University Hospital, Créteil, France
- School of medicine, University of Paris-Est, Créteil, France
| | - Romain Rey
- Fondation Fondamental, Créteil, France
- University Claude Bernard Lyon 1, INSERM U1028, CNRS UMR5292, Lyon Center for Research in Neuroscience, PSYR2 Team, Le Vinatier Hospital, Bron, France
| | - Franck Schürhoff
- Fondation Fondamental, Créteil, France
- INSERM U955, Translational Psychiatry Team, DHU Pe-PSY, Mondor University Hospital, Créteil, France
- School of medicine, University of Paris-Est, Créteil, France
| | - Christine Passerieux
- University Paris Saclay - UVSQ, Health Sciences department, EA 4047 HANDIReSP, Laboratory for clinical and public health research on psychological, cognitive and motor disability, Versailles, France
- University Department of Adult Psychiatry and Addictology, Versailles Hospital, Le Chesnay, France
- University Paris Saclay, 'PsyDev' Team, CESP, Inserm, Villejuif, France
- Fondation Fondamental, Créteil, France
| | - Eric Brunet-Gouet
- University Paris Saclay - UVSQ, Health Sciences department, EA 4047 HANDIReSP, Laboratory for clinical and public health research on psychological, cognitive and motor disability, Versailles, France
- University Department of Adult Psychiatry and Addictology, Versailles Hospital, Le Chesnay, France
- University Paris Saclay, 'PsyDev' Team, CESP, Inserm, Villejuif, France
- Fondation Fondamental, Créteil, France
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10
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Jiménez-López E, Villanueva-Romero CM, Sánchez-Morla EM, Martínez-Vizcaíno V, Ortiz M, Rodriguez-Jimenez R, Vieta E, Santos JL. Neurocognition, functional outcome, and quality of life in remitted and non-remitted schizophrenia: A comparison with euthymic bipolar I disorder and a control group. Schizophr Res 2022; 240:81-91. [PMID: 34991042 DOI: 10.1016/j.schres.2021.12.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 12/20/2021] [Accepted: 12/24/2021] [Indexed: 11/28/2022]
Abstract
There are discrepancies about if the severity of the symptomatology in schizophrenia is related to neurocognitive performance, functional outcome, and quality of life (QoL). Also, there are controversial data about the comparison between euthymic bipolar patients and different subgroups of schizophrenia in neurocognition, functioning, and QoL level. The present study aimed to compare the neurocognitive performance, functional outcome, and QoL of remitted and non-remitted patients with SC with respect to a group of euthymic patients with BD, and a control group. It included 655 subjects: 98 patients with schizophrenia in remission (SC-R), 184 non-remitted patients with schizophrenia (SC-NR), 117 euthymic patients with bipolar I disorder (BD), and 256 healthy subjects. A comprehensive clinical, neurocognitive (six cognitive domains), functional, and QoL assessment was carried out. Remission criteria of Andreasen were used to classify schizophrenia patients as remitted or non-remitted. Compared with control subjects all groups of patients showed impaired neurocognitive performance, functioning and QoL. SC-R patients had an intermediate functioning between control subjects and SC-NR, all at a neurocognitive, functional, or QoL level. There were no significant differences between SC-R and BD. These results suggest that reaching clinical remission is essential to achieve a better level of psychosocial functioning, and QoL. Likewise, the results of this study suggest that euthymic patients with bipolar disorder and patients with schizophrenia in remission are comparable at the neurocognitive and functional levels, which might have implications in the pathophysiology of both disorders.
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Affiliation(s)
- Estela Jiménez-López
- Department of Psychiatry, Hospital Virgen de La Luz, Cuenca, Spain; Universidad de Castilla-La Mancha. Health and Social Research Center, Cuenca, Spain; Neurobiological Research Group. Institute of Technology, Universidad de Castilla-La Mancha, Cuenca, Spain; CIBERSAM (Biomedical Research Networking Centre in Mental Health), Spain
| | | | - Eva María Sánchez-Morla
- CIBERSAM (Biomedical Research Networking Centre in Mental Health), Spain; Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; School of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain; CogPsy-Group, Universidad Complutense de Madrid (UCM), Spain.
| | - Vicente Martínez-Vizcaíno
- Universidad de Castilla-La Mancha. Health and Social Research Center, Cuenca, Spain; Universidad Autónoma de Chile. Facultad de Ciencias de la Salud, Talca, Chile
| | - M Ortiz
- Interdisciplinary Center for Security, Reliability and Trust (SnT), University of Luxembourg, 1855 Luxembourg, Luxembourg
| | - Roberto Rodriguez-Jimenez
- CIBERSAM (Biomedical Research Networking Centre in Mental Health), Spain; Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; School of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain; CogPsy-Group, Universidad Complutense de Madrid (UCM), Spain
| | - Eduard Vieta
- CIBERSAM (Biomedical Research Networking Centre in Mental Health), Spain; Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - José Luis Santos
- Department of Psychiatry, Hospital Virgen de La Luz, Cuenca, Spain; Neurobiological Research Group. Institute of Technology, Universidad de Castilla-La Mancha, Cuenca, Spain; CIBERSAM (Biomedical Research Networking Centre in Mental Health), Spain
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11
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Zhdanava M, Starr HL, Totev TI, Lefebvre P, Shah A, Sheng K, Pilon D. Impact of COVID-19 Pandemic on Prescribing of Long-Acting Injectable Antipsychotics for Schizophrenia: Results from a United States Prescriber Survey. Neuropsychiatr Dis Treat 2022; 18:2003-2019. [PMID: 36101838 PMCID: PMC9464453 DOI: 10.2147/ndt.s379985] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 08/26/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To describe changes due to the COVID-19 pandemic in the prescribing of long-acting antipsychotics (LAI) for schizophrenia, patient outcomes, and patient and healthcare provider (HCP) attitudes regarding COVID-19 vaccination in the United States (US). METHODS An anonymous online survey was administered to US-based LAI prescribers with a psychiatry specialty in May 2021. Information on prescriber and clinical practice characteristics, LAI prescribing, patient outcomes, and attitudes toward COVID-19 vaccination was collected and described. RESULTS Of the 401 LAI prescribers meeting survey criteria, 64.6% reported that LAI prescribing remained unchanged (increase: 19.2%, decrease: 14.0%). The majority did not switch patients from LAIs to oral antipsychotics (OAP; 63.3%) or to LAI formulations with lower frequency of administration (68.1%); most prescribers switched the same number of patients from OAPs to LAIs during the pandemic as in previous practice (65.1%). Half of LAI prescribers (50.1%) reported antipsychotic adherence as unchanged among most patients; 44.6% reported symptom control/relapse frequency as unchanged. Most prescribers believed their patients with schizophrenia should be prioritized for COVID-19 vaccination (74.1%) and encouraged all patients to obtain a COVID-19 vaccine (84.0%). However, 64.1% of prescribers reported hesitancy among some patients about vaccines' safety; 51.4% reported that some patients were willing to be vaccinated despite the hesitancy, 48.6% indicated that some patients perceived COVID-19 vaccines as safe, effective, and important. CONCLUSION LAI prescribing and prescriber-reported antipsychotic adherence in patients with schizophrenia remained largely unchanged approximately one year after the start of COVID-19. Focused efforts to overcome patients' COVID-19 vaccine hesitancy are warranted.
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Affiliation(s)
| | - H Lynn Starr
- Janssen Scientific Affairs, LLC, Titusville, NJ, USA
| | | | | | - Aditi Shah
- Analysis Group, Inc., Montréal, QC, Canada
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12
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Vita A, Gaebel W, Mucci A, Sachs G, Barlati S, Giordano GM, Nibbio G, Nordentoft M, Wykes T, Galderisi S. European Psychiatric Association guidance on treatment of cognitive impairment in schizophrenia. Eur Psychiatry 2022; 65:e57. [PMID: 36059103 PMCID: PMC9532218 DOI: 10.1192/j.eurpsy.2022.2315] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background Although cognitive impairment is a core symptom of schizophrenia related to poorer outcomes in different functional domains, it still remains a major therapeutic challenge. To date, no comprehensive treatment guidelines for cognitive impairment in schizophrenia are implemented. Methods The aim of the present guidance paper is to provide a comprehensive meta-review of the current available evidence-based treatments for cognitive impairment in schizophrenia. The guidance is structured into three sections: pharmacological treatment, psychosocial interventions, and somatic treatments. Results Based on the reviewed evidence, this European Psychiatric Association guidance recommends an appropriate pharmacological management as a fundamental starting point in the treatment of cognitive impairment in schizophrenia. In particular, second-generation antipsychotics are recommended for their favorable cognitive profile compared to first-generation antipsychotics, although no clear superiority of a single second-generation antipsychotic has currently been found. Anticholinergic and benzodiazepine burdens should be kept to a minimum, considering the negative impact on cognitive functioning. Among psychosocial interventions, cognitive remediation and physical exercise are recommended for the treatment of cognitive impairment in schizophrenia. Noninvasive brain stimulation techniques could be taken into account as add-on therapy. Conclusions Overall, there is definitive progress in the field, but further research is needed to develop specific treatments for cognitive impairment in schizophrenia. The dissemination of this guidance paper may promote the development of shared guidelines concerning the treatment of cognitive functions in schizophrenia, with the purpose to improve the quality of care and to achieve recovery in this population.
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13
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Eickhoff S, Franzen L, Korda A, Rogg H, Trulley VN, Borgwardt S, Avram M. The Basal Forebrain Cholinergic Nuclei and Their Relevance to Schizophrenia and Other Psychotic Disorders. Front Psychiatry 2022; 13:909961. [PMID: 35873225 PMCID: PMC9299093 DOI: 10.3389/fpsyt.2022.909961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 06/14/2022] [Indexed: 11/29/2022] Open
Abstract
The basal forebrain cholinergic nuclei (BFCN) provide the main cholinergic input to prefrontal cortices, the hippocampi, and amygdala. These structures are highly relevant for the regulation and maintenance of many cognitive functions, such as attention and memory. In vivo neuroimaging studies reported alterations of the cholinergic system in psychotic disorders. Particularly, a downregulation of nicotinic and muscarinic acetylcholine receptors has been found. Crucially, such alterations in neurotransmission have been associated with cognitive impairments and positive and negative symptoms. Recent pharmacological studies support these findings, as they demonstrated an association between the manipulation of cholinergic transmission and an attenuation in symptom severity. Targeting acetylcholine receptors has therefore become a focus for the development of novel psychopharmacological drugs. However, many open questions remain. For instance, it remains elusive what causes such alterations in neurotransmission. While evidence supports the idea that BFCN structural integrity is altered in schizophrenia, it remains to be determined whether this is also present in other psychotic disorders. Furthermore, it is unclear when throughout the course of the disorder these alterations make their appearance and whether they reflect changes in the BFCN alone or rather aberrant interactions between the BFCN and other brain areas. In this review, the specific role of the BFCN and their projections are discussed from a neuroimaging perspective and with a focus on psychotic disorders alongside future directions. These directions set the stage for the development of new treatment targets for psychotic disorders.
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Affiliation(s)
- Sofia Eickhoff
- Translational Psychiatry, Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Leon Franzen
- Translational Psychiatry, Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Alexandra Korda
- Translational Psychiatry, Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Helena Rogg
- Translational Psychiatry, Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Valerie-Noelle Trulley
- Translational Psychiatry, Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Stefan Borgwardt
- Translational Psychiatry, Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Mihai Avram
- Translational Psychiatry, Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
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14
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Giordano GM, Brando F, Pezzella P, De Angelis M, Mucci A, Galderisi S. Factors influencing the outcome of integrated therapy approach in schizophrenia: A narrative review of the literature. Front Psychiatry 2022; 13:970210. [PMID: 36117655 PMCID: PMC9476599 DOI: 10.3389/fpsyt.2022.970210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 08/11/2022] [Indexed: 12/03/2022] Open
Abstract
The integration of pharmacotherapy with psychosocial interventions has an important role to play in the improvement of functional outcome of subjects with schizophrenia (SCZ), in all stages of the disorder. It is essential for the adequate management of unmet therapeutic needs, such as negative symptoms and cognitive dysfunctions which account for most of the functional impairment of subjects with SCZ and do not respond to available antipsychotics. Enhancing the knowledge on factors involved in the effectiveness of integrated treatment plans is an important step forward for SCZ care. This review aims to identify factors that might influence the impact of integrated treatments on functional outcome. Most studies on the impact of psychosocial treatments on functional outcome of subjects with SCZ did not control for the effect of prescribed antipsychotics or concomitant medications. However, several factors relevant to ongoing pharmacological treatment might influence the outcome of integrated therapy, with an impact on the adherence to treatment (e.g., therapeutic alliance and polypharmacotherapy) or on illness-related factors addressed by the psychosocial interventions (e.g., cognitive dysfunctions or motivational deficits). Indirect evidence suggests that treatment integration should consider the possible detrimental effects of different antipsychotics or concomitant medications on cognitive functions, as well as on secondary negative symptoms. Cognitive dysfunctions can interfere with participation to an integrated treatment plan and can be worsened by extrapyramidal or metabolic side effects of antipsychotics, or concomitant treatment with anticholinergics or benzodiazepines. Secondary negative symptoms, due to positive symptoms, sedation, extrapyramidal side effects or untreated depression, might cause early drop-out and poor adherence to treatment. Researchers and clinicians should examine all the above-mentioned factors and implement appropriate and personalized integrated treatments to improve the outcome of SCZ.
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Affiliation(s)
| | | | | | | | - Armida Mucci
- University of Campania Luigi Vanvitelli, Naples, Italy
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15
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Zhu R, Wang D, Wei G, Wang J, Zhou H, Xu H, Wang W, Wei S, Chen D, Xiu M, Wang L, Zhang XY. Association of negative symptoms with cognitive impairment in Chinese Han patients with chronic schizophrenia. Int J Psychiatry Clin Pract 2021; 25:292-298. [PMID: 33879034 DOI: 10.1080/13651501.2021.1912357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Cognitive impairment is an essential feature of schizophrenia; however, the relationship between clinical psychiatric symptoms with cognitive impairment is still unclear. Therefore, we aimed to assess cognitive deficits and the relationship between clinical symptoms and cognitive function in patients with chronic schizophrenia, which provide a reference guide for psychiatrists. METHODS We compared the cognitive function in 312 schizophrenia inpatients and 397 healthy controls by using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). The positive and negative symptom scale (PANSS) was used to assess the clinical symptoms of the patients. RESULTS Analysis of covariance showed that the RBANS total and four index scores (all p < 0.001) were significantly lower in patients than healthy controls. After Bonferroni correction, Pearson correlation analysis showed that there was a significant negative association between PANSS negative symptom subscale and RBANS total score and all 5 domain scores (all p < 0.01). Further regression analysis showed that negative symptoms, age, age of onset, and antipsychotic dose were important independent predictors of cognitive deficits. CONCLUSIONS Our findings suggest that patients with chronic schizophrenia exhibit cognitive deficits compared with healthy people. Negative symptoms and some clinical variables are associated with cognitive impairment in patients with schizophrenia.KEYPOINTSThis study indicates that patients with chronic schizophrenia have extensive cognitive impairment shown on RBANS except for the visuospatial/constructional domain.Cognitive impairment in patients is associated with age, negative symptoms, age of onset, and antipsychotic dose.There is a significant negative association between cognitive deficits and negative symptoms in patients with chronic schizophrenia.The results of this study need to be confirmed in future studies with longitudinal designs with a large and sex-balanced sample in first-episode drug naïve patients with schizophrenia.
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Affiliation(s)
- Rongrong Zhu
- Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Dongmei Wang
- Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Gaoxia Wei
- Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Jiesi Wang
- Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Huixia Zhou
- Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Hang Xu
- Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Wenjia Wang
- Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Shuochi Wei
- Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Dachun Chen
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, China
| | - Meihong Xiu
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, China
| | - Li Wang
- Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Xiang Yang Zhang
- Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
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16
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Pietrini F, Tatini L, Santarelli G, Brugnolo D, Squillace M, Bozza B, Ballerini A, Ricca V, D'Anna G. Self- and caregiver-perceived disability, subjective well-being, quality of life and psychopathology improvement in long-acting antipsychotic treatments: a 2-year follow-up study. Int J Psychiatry Clin Pract 2021; 25:307-315. [PMID: 34057873 DOI: 10.1080/13651501.2021.1912358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Switching to long-acting injectable (LAI) antipsychotic maintenance treatment (AMT) represents a valuable strategy for schizophrenia. In a recovery-oriented approach, patient-reported outcomes (PROs) such as perceived disability, subjective well-being, and quality of life cannot be neglected. METHODS Forty clinically stable outpatients with schizophrenia treated with oral second-generation antipsychotics were enrolled at the time of switching to the equivalent dose of LAI. 35 subjects completed this 2-year longitudinal, prospective, open-label, observational study. Patients were assessed at baseline, after 1 year, and after 2 years of LAI-AMT, using psychometric scales (Positive And Negative Syndrome Scale, PANSS; Young Mania Rating Scale, YMRS; Montgomery-Åsberg Depression Rating Scale, MADRS), PROs (Subjective Well-Being under Neuroleptics short form, SWN-K; Short Form-36 health survey, SF-36; 12-item World Health Organisation Disability Assessment Schedule, WHODAS 2.0), and caregiver-reported outcomes (12-item WHODAS 2.0). RESULTS No psychotic relapses were observed. Psychopathology measures (PANSS total and subscales - excluding negative symptoms), mood symptoms (YMRS, MADRS), perceived disability (patient- and caregiver-administered WHODAS 2.0), subjective well-being (SWN-K), and quality of life (SF-36) showed a concomitant amelioration after 1 year, without further significant variations. DISCUSSION Switching to LAI-AMT may decrease perceived impairment, and increase subjective well-being and quality of life in clinically stable outpatients with schizophrenia.HighlightsLAI treatment may improve outcomes by reducing psychopathology levels and relapses.In a recovery-oriented approach, patient-reported outcomes cannot be neglected.LAI antipsychotics may optimise the subjective experience of treatment.Switching to LAI therapy may result in a reduction in perceived disability.There is a significant correlation between proxy- and patient-reported disability.
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Affiliation(s)
- Francesco Pietrini
- Department of Mental Health and Addictions, Central Tuscany NHS Trust, Florence, Italy
| | - Lorenzo Tatini
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Gabriele Santarelli
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Dario Brugnolo
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Marco Squillace
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Bernardo Bozza
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Andrea Ballerini
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Valdo Ricca
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Giulio D'Anna
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
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17
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Brunet-Gouet E, Decaix-Tisserand C, Urbach M, Bazin N, Aouizerate B, Brunel L, Capdevielle D, Chereau I, Dubertret C, Dubreucq J, Fond G, Lançon C, Leignier S, Mallet J, Misdrahi D, Pires S, Schneider P, Schurhoff F, Yazbek H, Zinetti-Bertschy A, Passerieux C, Roux P. Outcome prediction with a social cognitive battery: a multicenter longitudinal study. NPJ SCHIZOPHRENIA 2021; 7:30. [PMID: 34039999 PMCID: PMC8155046 DOI: 10.1038/s41537-021-00160-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 03/29/2021] [Indexed: 11/08/2022]
Abstract
The interest in social cognition in schizophrenia is justified by the relationship between deficits in these skills and negative functional outcomes. Although assessment batteries have already been described, there is no consensus about which measures are useful in predicting patient functioning or quality of life (QoL). We investigated a set of five measures of recognition of facial emotions, theory of mind (ToM), and empathy in a cohort of 143 patients with schizophrenia or schizoaffective disorder at inclusion and, amongst whom 79 were reassessed 1 year later. The distribution was satisfactory for the TREF (Facial Emotion Recognition Task), V-SIR (Versailles-Situational Intention Reading), and QCAE (Questionnaire of Cognitive and Affective Empathy). Internal consistency was satisfactory for the TREF, V-SIR, V-Comics (Versailles Intention Attribution Task), and QCAE. Sensitivity to change was acceptable for the TREF. The TREF and V-SIR showed a cross-sectional relationship with functioning beyond the clinical symptoms of schizophrenia but not beyond neurocognition. Moreover, the TREF and V-SIR at inclusion could not predict functioning one year later, whereas most neurocognitive and clinical dimensions at inclusion could. Finally, only affective QCAE showed a significant cross-sectional, but not longitudinal, association with QoL. In conclusion, the TREF had satisfactory psychometric properties and showed a cross-sectional, but not longitudinal, association with objective outcome measures, thus appearing to be reliable in clinical practice and research. The V-SIR also showed promising psychometric properties, despite a possible weakness to detect change. However, these measures should be interpreted within the context of the good predictive power of the neurocognitive and clinical status on the outcome.
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Affiliation(s)
- Eric Brunet-Gouet
- FondaMental Foundation, Créteil, France.
- Department of Adult Psychiatry, Centre Hospitalier de Versailles, Le Chesnay, France.
- DisAP, DevPsy, CESP, Inserm 1018, University Paris Saclay, INSERM, Villejuif, France.
| | - Capucine Decaix-Tisserand
- FondaMental Foundation, Créteil, France
- Department of Adult Psychiatry, Centre Hospitalier de Versailles, Le Chesnay, France
- DisAP, DevPsy, CESP, Inserm 1018, University Paris Saclay, INSERM, Villejuif, France
| | - Mathieu Urbach
- FondaMental Foundation, Créteil, France
- Department of Adult Psychiatry, Centre Hospitalier de Versailles, Le Chesnay, France
- DisAP, DevPsy, CESP, Inserm 1018, University Paris Saclay, INSERM, Villejuif, France
| | - Nadine Bazin
- FondaMental Foundation, Créteil, France
- Department of Adult Psychiatry, Centre Hospitalier de Versailles, Le Chesnay, France
- DisAP, DevPsy, CESP, Inserm 1018, University Paris Saclay, INSERM, Villejuif, France
| | - Bruno Aouizerate
- FondaMental Foundation, Créteil, France
- Department of Adult Psychiatry, Charles Perrens Hospital, Bordeaux, France
- Laboratory of Nutrition and Integrative Neurobiology (UMR INRA 1286), University of Bordeaux, Bordeaux, France
| | - Lore Brunel
- FondaMental Foundation, Créteil, France
- INSERM U955, Translational Psychiatry Team, Creteil, France
- Departement Medico-Universitaire de Psychiatrie et d'Addictologie (DMU ADAPT), Federation Hospitalo-Universitaire de Médecine de Precision (FHU IMPACT), AP-HP, HU Henri Mondor, Creteil, France
| | - Delphine Capdevielle
- FondaMental Foundation, Créteil, France
- University Department of Adult Psychiatry, Hospital La Colombière, CHU Montpellier, Montpellier, France
- INSERM, Univ Montpellier, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France
- University of Montpellier, Montpellier, France
| | - Isabelle Chereau
- FondaMental Foundation, Créteil, France
- CHU Clermont-Ferrand, Service de Psychiatrie B, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Caroline Dubertret
- FondaMental Foundation, Créteil, France
- AP-HP; Department of Psychiatry, Louis Mourier Hospital, Colombes, France
- Inserm UMR1266, Institute of Psychiatry and Neuroscience of Paris, University Paris Descartes, Paris, France
- Sorbonne Paris Cité, Faculté de Médecine, Université Paris Diderot, Paris, France
| | - Julien Dubreucq
- FondaMental Foundation, Créteil, France
- Psychosocial Rehabilitation Reference Centre, Alpes Isère Hospital, Grenoble, France
| | - Guillaume Fond
- FondaMental Foundation, Créteil, France
- La Conception Hospital, AP-HM, Aix-Marseille Univ., School of Medicine-La Timone Medical Campus, EA 3279: CEReSS-Health Service Research and Quality of Life Center, Marseille, France
| | - Christophe Lançon
- FondaMental Foundation, Créteil, France
- Ste Marguerite Hospital, AP-HM, Aix-Marseille Univ., School of Medicine-La Timone Medical Campus, EA 3279: CEReSS-Health Service Research and Quality of Life Center, Marseille, France
| | - Sylvain Leignier
- FondaMental Foundation, Créteil, France
- Psychosocial Rehabilitation Reference Centre, Alpes Isère Hospital, Grenoble, France
| | - Jasmina Mallet
- FondaMental Foundation, Créteil, France
- AP-HP; Department of Psychiatry, Louis Mourier Hospital, Colombes, France
- Inserm UMR1266, Institute of Psychiatry and Neuroscience of Paris, University Paris Descartes, Paris, France
- Sorbonne Paris Cité, Faculté de Médecine, Université Paris Diderot, Paris, France
| | - David Misdrahi
- FondaMental Foundation, Créteil, France
- Department of Adult Psychiatry, Charles Perrens Hospital, Bordeaux, France
| | - Sylvie Pires
- FondaMental Foundation, Créteil, France
- CHU Clermont-Ferrand, Service de Psychiatrie B, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Priscille Schneider
- FondaMental Foundation, Créteil, France
- Department of Psychiatry, University Hospital of Strasbourg, Strasbourg, France
- University of Strasbourg, Strasbourg, France
- Inserm U1114, Strasbourg, France
| | - Franck Schurhoff
- FondaMental Foundation, Créteil, France
- INSERM U955, Translational Psychiatry Team, Creteil, France
- Departement Medico-Universitaire de Psychiatrie et d'Addictologie (DMU ADAPT), Federation Hospitalo-Universitaire de Médecine de Precision (FHU IMPACT), AP-HP, HU Henri Mondor, Creteil, France
| | - Hanan Yazbek
- FondaMental Foundation, Créteil, France
- University Department of Adult Psychiatry, Hospital La Colombière, CHU Montpellier, Montpellier, France
- INSERM, Univ Montpellier, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France
- University of Montpellier, Montpellier, France
| | - Anna Zinetti-Bertschy
- FondaMental Foundation, Créteil, France
- Department of Psychiatry, University Hospital of Strasbourg, Strasbourg, France
- University of Strasbourg, Strasbourg, France
- Inserm U1114, Strasbourg, France
| | - Christine Passerieux
- FondaMental Foundation, Créteil, France
- Department of Adult Psychiatry, Centre Hospitalier de Versailles, Le Chesnay, France
- DisAP, DevPsy, CESP, Inserm 1018, University Paris Saclay, INSERM, Villejuif, France
| | - Paul Roux
- FondaMental Foundation, Créteil, France
- Department of Adult Psychiatry, Centre Hospitalier de Versailles, Le Chesnay, France
- DisAP, DevPsy, CESP, Inserm 1018, University Paris Saclay, INSERM, Villejuif, France
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18
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YENİÇERİ FE, BUDAK M. Sağlıklı Genç Bireylerde Kognitif Görevle Yapılan Egzersizlerin Kognitif Fonksiyonlara, Duygu Durumuna ve Yaşam Kalitesine Etkisi. İSTANBUL GELIŞIM ÜNIVERSITESI SAĞLIK BILIMLERI DERGISI 2020. [DOI: 10.38079/igusabder.753667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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19
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Wang WL, Zhou YQ, Chai NN, Li GH, Liu DW. Mediation and moderation analyses: exploring the complex pathways between hope and quality of life among patients with schizophrenia. BMC Psychiatry 2020; 20:22. [PMID: 31941476 PMCID: PMC6964047 DOI: 10.1186/s12888-020-2436-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 01/08/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The underlying mechanism between hope and quality of life is as yet unknown. We aim to examine the potential mediating effect of depression and resilience and the moderated effect of sex in this well-established association. METHODS Two hundred seven patients diagnosed with schizophrenia were administered a questionnaire battery that measured hope, depression, resilience and QOL. A multiple mediation model was used to examine the mediating effect of resilience and depression on the association between hope and QOL. A subgroup analysis was performed and a moderated mediation model was examined to find and test the moderated effect of sex on the mediation model. We used Mplus to perform moderation and mediation analyses so that the mediators and moderator could function together in the same model. RESULT Sex was the moderator on the direct path between hope and QOL. The relationship between hope and QOL was mediated by resilience and depression in both sexes. When compared with female patients, the effect of hope on QOL was completely mediated by resilience and depression in males. In female patients, the model was partially mediated, and the direct effect of hope on QOL was significantly negatively correlated with the level of hope. CONCLUSION We present a conceptual model containing the mediated effects of resilience and depression and the moderated effect of sex between hope and QOL, which we believe facilitates the understanding of these associations. This model should be useful in the formulation of strategies to improve QOL.
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Affiliation(s)
- Wei-Liang Wang
- grid.410736.70000 0001 2204 9268School of Nursing, Harbin Medical University (Daqing), Daqing, Heilongjiang China
| | - Yu-Qiu Zhou
- School of Nursing, Harbin Medical University (Daqing), Daqing, Heilongjiang, China.
| | - Nan-Nan Chai
- grid.443353.60000 0004 1798 8916School of Nursing, Chifeng University, Chifeng, the Autonomous Region China
| | - Guo-Hua Li
- Chifeng Anding Hospital, Chifeng, the Autonomous Region China
| | - Dong-Wei Liu
- grid.410736.70000 0001 2204 9268School of Nursing, Harbin Medical University (Daqing), Daqing, Heilongjiang China
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20
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Paudel S, Coman D, Freudenreich O. Subjective experience of cognitive difficulties as an important attribute of quality of life among individuals with schizophrenia spectrum disorders. Schizophr Res 2020; 215:476-478. [PMID: 31672382 DOI: 10.1016/j.schres.2019.09.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 09/06/2019] [Accepted: 09/28/2019] [Indexed: 11/30/2022]
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21
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Li Z, Liu L, Lin W, Zhou Y, Zhang G, Du X, Li Y, Tang W, Zhang X. NRG3 contributes to cognitive deficits in chronic patients with schizophrenia. Schizophr Res 2020; 215:134-139. [PMID: 31753594 DOI: 10.1016/j.schres.2019.10.060] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 09/06/2019] [Accepted: 10/30/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Cognitive deficit is a fundamental trait of schizophrenia, but its mecwhanisms remain unknown. The neuregulin 3 (NRG3) gene, involving in neuronal function, has been considered to be associated with schizophrenia and cognition. However, no study has investigated the effects of NRG3 polymorphism on cognitive deficits in a large sample of the patients with schizophrenia. METHODS A total of 1112 schizophrenia patients and 423 controls were recruited and genotyped with NRG3 rs10748842. Among them, 864 patients and 403 controls were assessed for cognition through the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). SHEsis was applied and followed by logistic regression analysis. The models of analyses of covariance (ANCOVA) were constructed to examine the effects of NRG3 rs10748842 on cognitive deficits. RESULTS No differences in NRG3 rs10748842 allele and genotype were found between patients and controls (both p > 0.05). With the exception of Visuospatial/construction, the other RBANS scores were significantly lower in patients compared to controls after adjusting for gender and education (all p < 0.001). Interestingly, we found that NRG3 rs10748842 was associated with cognitive deficit in schizophrenia, showing that patients carrying C allele had lower attention and total scores than those with TT genotype (both p < 0.05). CONCLUSION NRG3 rs10748842 may not confer susceptibility to schizophrenia, but may be more closely associated with cognitive deficit, especially attention performance in chronic schizophrenia.
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Affiliation(s)
- Zezhi Li
- Department of Neurology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lihua Liu
- Department of Psychiatry, Qingdao Mental Health Center, Qingdao, China
| | - Wei Lin
- Department of Psychiatry, Qingdao Mental Health Center, Qingdao, China
| | - Yongjie Zhou
- Research Center for Psychological and Health Sciences, China University of Geosciences, Wuhan, China; Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science & Technology, Wuhan, China
| | - Guangya Zhang
- Suzhou Psychiatric Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Xiangdong Du
- Suzhou Psychiatric Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Yi Li
- Research Center for Psychological and Health Sciences, China University of Geosciences, Wuhan, China; Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science & Technology, Wuhan, China
| | - Wei Tang
- The Affiliated Kangning Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China; Wenzhou Medical University Wenzhou, Zhejiang, China.
| | - Xiangyang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, 100101, China.
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22
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Brunet-Gouet E, Urbach M, Ramos V, Ehrminger M, Aouizerate B, Brunel L, Capdevielle D, Chereau I, Dubertret C, Dubreucq J, Fond G, Lançon C, Leignier S, Mallet J, Misdrahi D, Pires S, Schneider P, Schürhoff F, Yazbek H, Zinetti-Bertschy A, Bazin N, Passerieux C, Roux P. Assessing metacognitive and help-seeking strategies in schizophrenia: design and psychometric validation of the Versailles Metacognitive Strategies Evaluation Questionnaire. Clin Rehabil 2019; 34:263-275. [PMID: 31795759 DOI: 10.1177/0269215519888784] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The aim of this study is to design a questionnaire, the Versailles Metacognitive Strategies Evaluation Questionnaire, for assessing the use of metacognitive and help-seeking strategies in three key-domains of impaired daily functioning in schizophrenia. To evaluate its psychometric properties (internal consistency, factor structure, convergent and divergent validity, and stability). DESIGN Development of a questionnaire and psychometric validation procedure in patients with schizophrenia compared with healthy controls. Stability over one year was assessed in the patient group. SETTING Schizophrenia Centers of Expertise (French FondaMental Network). SUBJECTS A total of 141 patients with schizophrenia, among whom 77 participated in the second evaluation; 97 healthy subjects. MAIN MEASURES The Versailles Metacognitive Strategies Evaluation Questionnaire, Positive and Negative Symptoms Scale, Personal and Social Performance Scale, Evaluation of Cognitive Processes involved in Disability in Schizophrenia Scale, Schizophrenia Quality of Life Questionnaire, and Stages of Recovery Instrument. RESULTS From the 36-items version, stepwise exploratory factor analysis (oblimin) produced a 25-items scale which had a 3-factors structure (hygiene concern, social relationships, and hygiene help-seeking). Cronbach's were respectively equal to 0.91, 0.82, and 0.78. One-year stability was good (intra-class correlation coefficient = 0.7). The three factors showed good convergent validity with measures of quality of life (rho = 0.34, P ⩽ 0.001). The first two factors correlated with recovery (N = 34, rho = 0.53, P ⩽ 0.001). On the contrary, the factors exhibited divergent validity, with no significant correlation, with symptoms and cognitive and psychosocial functioning (P > 0.05). Factor structure in healthy controls did not match with that of patients, all items but one were found significantly different among groups. CONCLUSION The Versailles Metacognitive Strategies Evaluation Questionnaire provides a simple and valid means to assess metacognitive strategies in individuals with schizophrenia.
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Affiliation(s)
- Eric Brunet-Gouet
- Fondation FondaMental, Créteil, France.,Department of Adult Psychiatry, Centre Hospitalier de Versailles, Le Chesnay, France.,HandiRESP Laboratory, EA4047, Health Sciences Department Simone Veil, University of Versailles Saint-Quentin-En-Yvelines, Montigny-le-Bretonneux, France
| | - Mathieu Urbach
- Fondation FondaMental, Créteil, France.,Department of Adult Psychiatry, Centre Hospitalier de Versailles, Le Chesnay, France.,HandiRESP Laboratory, EA4047, Health Sciences Department Simone Veil, University of Versailles Saint-Quentin-En-Yvelines, Montigny-le-Bretonneux, France
| | - Veronica Ramos
- Fondation FondaMental, Créteil, France.,Department of Adult Psychiatry, Centre Hospitalier de Versailles, Le Chesnay, France.,HandiRESP Laboratory, EA4047, Health Sciences Department Simone Veil, University of Versailles Saint-Quentin-En-Yvelines, Montigny-le-Bretonneux, France
| | - Mickael Ehrminger
- HandiRESP Laboratory, EA4047, Health Sciences Department Simone Veil, University of Versailles Saint-Quentin-En-Yvelines, Montigny-le-Bretonneux, France
| | - Bruno Aouizerate
- Fondation FondaMental, Créteil, France.,Department of Adult Psychiatry, Charles Perrens Hospital, Bordeaux, France.,University of Bordeaux, CNRS UMR 5287-INCIA, Bordeaux, France
| | - Lore Brunel
- Fondation FondaMental, Créteil, France.,Translational Psychiatry Team, INSERM U955, Creteil, France.,AP-HP Mondor University Hospital, DHU Pe-PSY, Schizophrenia Expert Center, Creteil, France
| | - Delphine Capdevielle
- Fondation FondaMental, Créteil, France.,Inserm U1061, Service Universitaire de Psychiatrie adulte, Hôpital la Colombière, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Isabelle Chereau
- Fondation FondaMental, Créteil, France.,CHU Clermont-Ferrand, Service de psychiatrie B, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Caroline Dubertret
- Fondation FondaMental, Créteil, France.,AP-HP, Department of Psychiatry, Louis Mourier Hospital, Colombes, France.,Inserm U894, Paris, France.,Université Paris Diderot, Sorbonne Paris Cité, Faculté de médecine, Paris, France
| | - Julien Dubreucq
- Fondation FondaMental, Créteil, France.,Psychosocial Rehabilitation Reference Centre, Alpes Isère Hospital, Grenoble, France
| | - Guillaume Fond
- Fondation FondaMental, Créteil, France.,Hopital de la conception, AMU CEReSS u 3729, Marseille, France
| | - Christophe Lançon
- Fondation FondaMental, Créteil, France.,Hopital Sainte-Marguerite, Marseille, France
| | - Sylvain Leignier
- Fondation FondaMental, Créteil, France.,Psychosocial Rehabilitation Reference Centre, Alpes Isère Hospital, Grenoble, France
| | - Jasmina Mallet
- Fondation FondaMental, Créteil, France.,AP-HP, Department of Psychiatry, Louis Mourier Hospital, Colombes, France.,Inserm U894, Paris, France.,Université Paris Diderot, Sorbonne Paris Cité, Faculté de médecine, Paris, France
| | - David Misdrahi
- Fondation FondaMental, Créteil, France.,Department of Adult Psychiatry, Charles Perrens Hospital, Bordeaux, France.,University of Bordeaux, CNRS UMR 5287-INCIA, Bordeaux, France
| | - Sylvie Pires
- Fondation FondaMental, Créteil, France.,CHU Clermont-Ferrand, Service de psychiatrie B, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Priscille Schneider
- Fondation FondaMental, Créteil, France.,Department of Psychiatry, University Hospital of Strasbourg, Strasbourg, France.,University of Strasbourg, Strasbourg, France.,Inserm U1114, Strasbourg, France
| | - Franck Schürhoff
- Fondation FondaMental, Créteil, France.,Translational Psychiatry Team, INSERM U955, Creteil, France.,AP-HP Mondor University Hospital, DHU Pe-PSY, Schizophrenia Expert Center, Creteil, France
| | - Hanan Yazbek
- Fondation FondaMental, Créteil, France.,Inserm U1061, Service Universitaire de Psychiatrie adulte, Hôpital la Colombière, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Anna Zinetti-Bertschy
- Fondation FondaMental, Créteil, France.,Department of Psychiatry, University Hospital of Strasbourg, Strasbourg, France.,University of Strasbourg, Strasbourg, France.,Inserm U1114, Strasbourg, France
| | - Nadine Bazin
- Fondation FondaMental, Créteil, France.,Department of Adult Psychiatry, Centre Hospitalier de Versailles, Le Chesnay, France.,HandiRESP Laboratory, EA4047, Health Sciences Department Simone Veil, University of Versailles Saint-Quentin-En-Yvelines, Montigny-le-Bretonneux, France
| | - Christine Passerieux
- Fondation FondaMental, Créteil, France.,Department of Adult Psychiatry, Centre Hospitalier de Versailles, Le Chesnay, France.,HandiRESP Laboratory, EA4047, Health Sciences Department Simone Veil, University of Versailles Saint-Quentin-En-Yvelines, Montigny-le-Bretonneux, France
| | - Paul Roux
- Fondation FondaMental, Créteil, France.,Department of Adult Psychiatry, Centre Hospitalier de Versailles, Le Chesnay, France.,HandiRESP Laboratory, EA4047, Health Sciences Department Simone Veil, University of Versailles Saint-Quentin-En-Yvelines, Montigny-le-Bretonneux, France
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DeRosse P, Barber AD, Fales CL, Malhotra AK. Deconstructing Avolition: Initiation vs persistence of reward-directed effort. Psychiatry Res 2019; 273:647-652. [PMID: 31207847 PMCID: PMC7864548 DOI: 10.1016/j.psychres.2019.01.073] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 01/23/2019] [Accepted: 01/23/2019] [Indexed: 10/27/2022]
Abstract
Avolition, a decrease in the initiation and persistence of goal-directed behavior, is a critical determinant of disability in patients with schizophrenia. Recent studies have demonstrated that avolition can be modeled using reward-based, behavioral paradigms. These studies suggest that avolition represents a motivational deficit, accounted for by a diminished ability to anticipate pleasurable experiences. Notably, although data suggest that "initiation" and "persistence" of goal-directed behavior may depend on different processes, few studies have sought to distinguish between these two components of avolitional symptoms. Such distinctions could have real consequences for the development and evaluation of interventions designed to ameliorate avolitional symptoms. Thus, the present study examined the relationship between anticipatory pleasure, a key driver of avolition, and both the initiation and persistence of reward-directed, effortful responding during the Effort Expenditures for Rewards Task in 103 healthy participants. We found that anticipatory pleasure was not significantly predictive of the initiation of effortful responding but was significantly predictive of the persistence of effortful responding; most notably when the probabilities of reward and non-reward were equivalent. These data suggest that although deficits in reward processes contribute to the likelihood of persisting in reward-driven behavior, they contribute little to the initiation of such behavior.
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Affiliation(s)
- Pamela DeRosse
- The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department of Psychiatry, Hempstead, NY, USA; The Feinstein Institute for Medical Research, Center for Psychiatric Neuroscience, Manhasset, NY, USA; Division of Psychiatry Research, The Zucker Hillside Hospital, Division of Northwell Health, Glen Oaks, NY, USA.
| | - Anita D Barber
- The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department of Psychiatry, Hempstead, NY, USA; The Feinstein Institute for Medical Research, Center for Psychiatric Neuroscience, Manhasset, NY, USA; Division of Psychiatry Research, The Zucker Hillside Hospital, Division of Northwell Health, Glen Oaks, NY, USA
| | - Christina L Fales
- The Feinstein Institute for Medical Research, Center for Psychiatric Neuroscience, Manhasset, NY, USA; Division of Psychiatry Research, The Zucker Hillside Hospital, Division of Northwell Health, Glen Oaks, NY, USA
| | - Anil K Malhotra
- The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department of Psychiatry, Hempstead, NY, USA; The Feinstein Institute for Medical Research, Center for Psychiatric Neuroscience, Manhasset, NY, USA; Division of Psychiatry Research, The Zucker Hillside Hospital, Division of Northwell Health, Glen Oaks, NY, USA
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24
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Pietrini F, Albert U, Ballerini A, Calò P, Maina G, Pinna F, Vaggi M, Boggian I, Fontana M, Moro C, Carpiniello B. The modern perspective for long-acting injectables antipsychotics in the patient-centered care of schizophrenia. Neuropsychiatr Dis Treat 2019; 15:1045-1060. [PMID: 31118640 PMCID: PMC6503342 DOI: 10.2147/ndt.s199048] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 03/18/2019] [Indexed: 12/31/2022] Open
Abstract
Schizophrenia is a chronic syndrome involving different clinical dimensions, and causes significant disability with a negative impact on the quality of life of patients and their caregivers. Current guidelines for the treatment of schizophrenia focus on maximizing a patient's adaptive functioning and quality of life in a recovery-oriented approach that encourages active collaboration among patients, caregivers, and mental health professionals to design and manage a customized and comprehensive care plan. In the present study, a panel of experts (psychiatrists, psychologists, nurse, and social worker) gathered to review and explore the need for contemporary use of second-generation antipsychotic long-acting injectables (SGA LAIs) in "recovery-oriented" and "patient-centered" care of schizophrenia. Starting from the available data and from sharing personal attitudes and experiences, the panel selected three clinical dimensions considered useful in characterizing each patient: phase of disease, adherence to treatment, and level of functioning. For each clinical dimension, perspectives of patients and caregivers with regard to needs, expectations, and personal experiences were reviewed and the role of SGA LAIs in achieving shared goals examined. The experts concluded that from today's modern perspectives, SGA-LAIs may play an important role in breaking the spiral of desocialization and functional decline in schizophrenia, thus favoring the recovery process.
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Affiliation(s)
- Francesco Pietrini
- Department of Mental Health and Addictions, Central Tuscany NHS Trust, Florence, Italy
| | - Umberto Albert
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Andrea Ballerini
- Department of Health Sciences, Florence University School of Medicine, Florence, Italy
| | - Paola Calò
- Department of Mental Health, Azienda Sanitaria Locale Lecce, Lecce, Italy
| | - Giuseppe Maina
- Rita Levi Montalcini Department of Neuroscience, University of Torino, Torino, Italy
| | - Federica Pinna
- Department of Medical Sciences and Public Health, Unit of Psychiatry, University of Cagliari, Cagliari, Italy
| | - Marco Vaggi
- Department of Mental Health and Drug Addiction ASL 3 Genoa, Azienda Sanitaria 3 Genovese, Genoa, Italy
| | - Ileana Boggian
- Department of Mental Health, Azienda Ulss 9 Scaligera, Legnago, Italy
| | - Maria Fontana
- Department of Mental Health, Azienda Sanitaria Locale Lecce, Lecce, Italy
| | - Cesare Moro
- Department of Mental Health and Addictions, ASST Bergamo Ovest, Treviglio, Italy
| | - Bernardo Carpiniello
- Psychiatric Clinical Unit, University Hospital of Cagliari, Cagliari, Italy.,Department of Medical Sciences and Public Health, Unit of Psychiatry, University of Cagliari, Cagliari, Italy
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25
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[Successful treatment in the day clinic of the Clinic for Psychiatry and Psychotherapy of LMU Munich. Experienced changes from the patients' perspective]. MMW Fortschr Med 2018; 160:6-10. [PMID: 30367439 DOI: 10.1007/s15006-018-1050-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 09/11/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND In the day clinic of the Department of Psychiatry and Psychotherapy of the LMU Munich, a multimodal therapy concept is offered. The goals of treatment are, in addition to the reduction of symptoms, an expansion of everyday life skills and the professional and social reintegration of patients. METHOD The effectiveness of the therapeutic work was evaluated over a period of just under 3 years. Both the therapist and the patients themselves assessed the success of the treatment. RESULTS Subjective measures: The affective (BDI: 17.45 at the beginning vs. 9.38 at the end) and the anxiety symptoms (STAI: 49.51 at the beginning vs. 42.11 at the end) decreased. The quality of life (WHOQOL-Bref: 40.96 at the beginning vs. 62.50 at the end) increased. Performance (COPM: 3.81 at start vs. 6.91 at end) and satisfaction with it (COPM: 3.48 at start vs. 7.08 at end) improved. Physician's judgment: The global assessment of functioning (GAF: start of therapy 54.91 vs. end of therapy 68.14) and the clinical global impression (CGI: start of therapy 4.48 vs. treatment end 3.03) showed an improvement. All results were significant. CONCLUSION The day clinic's treatment concept seems to work comprehensively, both in patients with depressive disorder and in patients with schizophrenic disease.
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26
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Lu L, Zeng LN, Zong QQ, Rao WW, Ng CH, Ungvari GS, Li J, An FR, Xiang YT. Quality of life in Chinese patients with schizophrenia: A meta-analysis. Psychiatry Res 2018; 268:392-399. [PMID: 30125870 DOI: 10.1016/j.psychres.2018.07.003] [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] [Received: 01/23/2018] [Revised: 05/27/2018] [Accepted: 07/04/2018] [Indexed: 12/19/2022]
Abstract
The impact of schizophrenia on quality of life (QOL) is significantly influenced by sociocultural factors. This meta-analysis systematically compared QOL between patients with schizophrenia and healthy controls in China. PubMed, PsycINFO, Embase, Chinese National Knowledge Infrastructure (CNKI), SinoMed and WanFang databases were searched to identify case-control studies. Standardized mean differences (SMDs) and 95% confidence interval (CI) were calculated using random effect models. Eighteen case-control studies comparing QOL between schizophrenia patients (n = 2,425) and healthy controls (n = 2,072) were included in the analyses. Compared with healthy controls, schizophrenia patients had significantly poorer overall QOL [11 studies; SMD:-1.07 (95%CI:-1.44, -0.70), P < 0.001] as well as in the physical, psychological, social and environmental QOL domains. Subgroup analyses revealed that poorer QOL was significantly associated with diagnostic criteria, study location, female gender, older age and inpatient status. Older schizophrenia patients had lower physical and psychological QOL, while inpatients had lower psychological QOL. In conclusion, compared with healthy controls, schizophrenia patients in China have significantly lower QOL.
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Affiliation(s)
- Li Lu
- Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macao, SAR, China
| | - Liang-Nan Zeng
- The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Qian-Qian Zong
- School of Nursing, Capital Medical University, Beijing, China; The National Clinical Research Center for Mental Disorders, China &Center of Depression, Beijing Institute for Brain Disorders & Mood Disorders Center, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Wen-Wang Rao
- Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macao, SAR, China
| | - Chee H Ng
- Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Gabor S Ungvari
- University of Notre Dame Australia & Graylands Hospital, Perth, Australia
| | - Jun Li
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal University, China
| | - Feng-Rong An
- The National Clinical Research Center for Mental Disorders, China &Center of Depression, Beijing Institute for Brain Disorders & Mood Disorders Center, Beijing Anding Hospital, Capital Medical University, Beijing, China.
| | - Yu-Tao Xiang
- Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macao, SAR, China.
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