1
|
Goodsmith N, Cohen AN, Pedersen ER, Evans E, Young AS, Hamilton AB. Predictors of Functioning and Recovery Among Men and Women Veterans with Schizophrenia. Community Ment Health J 2023; 59:110-121. [PMID: 35643881 DOI: 10.1007/s10597-022-00979-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 04/29/2022] [Indexed: 01/07/2023]
Abstract
Gender differences may play a role in functional outcomes for individuals with schizophrenia. To better understand differences, an exploratory secondary analysis was conducted using data from a large, multi-site study of individuals with schizophrenia in treatment at Veterans Affairs medical centers. Participants completed surveys at baseline (n = 801; 734 men, 67 women) to assess demographics, symptoms, social supports, and recovery; and one year (n = 662; 604 men, 58 women) to assess quality of life and functioning. Hierarchical linear regressions examined interactions of baseline factors with functioning and quality of life. Women and men did not differ significantly in baseline social support, psychiatric symptoms, or recovery. Female gender predicted higher occupational functioning, while social functioning in men was inversely related to baseline symptom severity. Being married predicted higher quality of life for women, but not men. These findings may inform gender tailoring of services for schizophrenia.
Collapse
Affiliation(s)
- Nichole Goodsmith
- VA Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation, & Policy, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd (206), Los Angeles, CA, 90073, USA.
- VA Desert Pacific Mental Illness Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd (210A), Los Angeles, CA, 90073, USA.
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, 760 Westwood Plaza, Los Angeles, CA, 90095, USA.
| | - Amy N Cohen
- American Psychiatric Association, 800 Maine Avenue, S.W., Suite 900, Washington, DC, 20024, USA
| | - Eric R Pedersen
- Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Elizabeth Evans
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, 311 Arnold House, 715 North Pleasant Street, Amherst, MA, 01003, USA
| | - Alexander S Young
- VA Desert Pacific Mental Illness Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd (210A), Los Angeles, CA, 90073, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, 760 Westwood Plaza, Los Angeles, CA, 90095, USA
| | - Alison B Hamilton
- VA Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation, & Policy, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd (206), Los Angeles, CA, 90073, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, 760 Westwood Plaza, Los Angeles, CA, 90095, USA
| |
Collapse
|
2
|
Khare C, Mueser KT, McGurk SR. The relationship between cognitive functioning, age and employment in people with severe mental illnesses in an urban area in India: A longitudinal study. Schizophr Res Cogn 2022; 29:100255. [PMID: 35542828 PMCID: PMC9079721 DOI: 10.1016/j.scog.2022.100255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 04/25/2022] [Accepted: 04/25/2022] [Indexed: 11/16/2022]
Abstract
Although there is substantial evidence of the association between cognitive impairment and work in people with severe mental illnesses (SMI) in developed countries, less is known about this relationship in developing countries such as India. Studies showing higher rates of employment in people with SMI in developing countries than developed ones raise the question of whether cognitive functioning is related to work status and characteristics of work (e.g., wages earned). We conducted a one-year follow-up study to investigate the relationship between employment and cognitive functioning, assessed with the Montreal Cognitive Assessment (MoCA), in 150 participants with SMI (92% schizophrenia) living in an urban area and receiving psychiatric outpatient treatment at a public hospital in India. The MoCA had good internal reliability and test-retest reliability over the one-year period. Better cognitive functioning was associated with younger age, shorter duration of illness, higher education, and male gender. Both younger and older participants with higher cognitive functioning at baseline were more likely to be employed at baseline and one year later. Work status at baseline and one year follow-up was consistently related to executive functions among younger participants, and to attention among older participants, suggesting changes over the course of illness in the importance of specific cognitive domains for achieving satisfactory work performance. The findings suggest that cognitive functioning is associated with employment in people with SMI in India. Attention to impaired cognitive functioning may be critical to improving employment outcomes in this population.
Collapse
Affiliation(s)
- Chitra Khare
- College of Health and Rehabilitation Sciences, Sargent College, Boston University, 635 Commonwealth Ave., Boston, MA 02215, USA
- Center for Psychiatric Rehabilitation, Boston University, 940 Commonwealth Ave. West, Boston, MA 02215, USA
| | - Kim T. Mueser
- Center for Psychiatric Rehabilitation, Boston University, 940 Commonwealth Ave. West, Boston, MA 02215, USA
- Department of Occupational Therapy, Boston University, Boston, MA 02215, USA
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Susan R. McGurk
- Center for Psychiatric Rehabilitation, Boston University, 940 Commonwealth Ave. West, Boston, MA 02215, USA
- Department of Occupational Therapy, Boston University, Boston, MA 02215, USA
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| |
Collapse
|
3
|
Mourgues C, Hammer A, Fisher V, Kafadar E, Quagan B, Bien C, Jaeger H, Thomas R, Sibarium E, Negreira AM, Sarisik E, Polisetty V, Nur Eken H, Imtiaz A, Niles H, Sheldon AD, Powers AR. Measuring Voluntary Control Over Hallucinations: The Yale Control Over Perceptual Experiences (COPE) Scales. Schizophr Bull 2022; 48:673-683. [PMID: 35089361 PMCID: PMC9077437 DOI: 10.1093/schbul/sbab144] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Auditory verbal hallucinations (AVH) frequently cause significant distress and dysfunction, and may be unresponsive to conventional treatments. Some voice-hearers report an ability to fully control the onset and offset of their AVH, making them significantly less disruptive. Measuring and understanding these abilities may lead to novel interventions to enhance control over AVH. Fifty-two voice-hearers participated in the pilot study. 318 participants with frequent AVH participated in the validation study. A pool of 59 items was developed by a diverse team including voice-hearers and clinicians. After the pilot study, 35 items were retained. Factorial structure was assessed with exploratory (EFA, n = 148) and confirmatory (CFA, n = 170) factor analyses. Reliability and convergent validity were assessed using a comprehensive battery of validated phenomenological and clinical scales. CFA on the final 18 items supported two factors for a Methods of Control Scale (5 items each, average ω = .87), and one factor for a Degree of Control Scale (8 items, average ω = .95). Correlation with clinical measures supported convergent validity. Degree of control was associated with positive clinical outcomes in voice-hearers both with and without a psychosis-spectrum diagnosis. Degree of control also varied with quality of life independently of symptom severity and AVH content. The Yale control over perceptual experiences (COPE) Scales robustly measure voice-hearers' control over AVH and exhibit sound psychometric properties. Results demonstrate that the capacity to voluntarily control AVH is independently associated with positive clinical outcomes. Reliable measurement of control over AVH will enable future development of interventions meant to bolster that control.
Collapse
Affiliation(s)
| | | | | | - Eren Kafadar
- Yale University School of Medicine, New Haven, CT,USA
| | | | - Claire Bien
- Yale University School of Medicine, New Haven, CT,USA
| | - Hale Jaeger
- Yale University School of Medicine, New Haven, CT,USA
| | - Rigi Thomas
- Southwest College of Naturopathic Medicine, Tempe, AZ, USA
| | - Ely Sibarium
- Yale University School of Medicine, New Haven, CT,USA
| | | | - Elif Sarisik
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Vasishta Polisetty
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Hatice Nur Eken
- School of Medicine, Vanderbilt University, Nashville, TN, USA
| | - Ayyub Imtiaz
- Faculty of Medicine, Health Sciences Center, Kuwait University, Kuwait City, Kuwait
| | - Halsey Niles
- Yale University School of Medicine, New Haven, CT,USA
| | | | | |
Collapse
|
4
|
Pearse E, Bucci S, Raphael J, Berry K. The relationship between attachment and functioning for people with serious mental illness: a systematic review. Nord J Psychiatry 2020; 74:545-557. [PMID: 32692588 DOI: 10.1080/08039488.2020.1767687] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
AIMS Functional impairment is a hallmark feature of severe mental health problems (SMI). Attachment theory is a key psychological theory of interpersonal functioning and difficulties in attachment are common in SMI and may help explain functioning problems in SMI. This systematic review aimed to synthesise and critically appraise existing literature exploring associations between adult attachment style and functioning in SMI samples. METHOD Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines we systematically searched five databases using strings of terms relating to both attachment and social functioning. Inclusion criteria were samples diagnosed with SMI and validated measure tools. RESULTS Ten studies met inclusion criteria. Considerable heterogeneity was found across studies in relation to construct measurement, sample size, and gender distribution. However, as predicted there was some evidence to suggest that secure attachment is associated with better functioning, and insecure attachment (specifically anxious style) is associated with impairments in functioning. CONCLUSION Findings highlight the importance of considering attachment in relation to functional outcome when working with people with SMI, particularly when assessing, formulating, and delivering psychological interventions.
Collapse
Affiliation(s)
- Elisabeth Pearse
- Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Sandra Bucci
- Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Jessica Raphael
- Research and Development, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Katherine Berry
- Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
| |
Collapse
|
5
|
Diagnostic stability in children and adolescents with bipolar disorder, a nationwide register-based study. Int J Bipolar Disord 2020; 8:14. [PMID: 32372109 PMCID: PMC7200954 DOI: 10.1186/s40345-020-0179-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 01/22/2020] [Indexed: 01/06/2023] Open
Abstract
Background Diagnostic stability of bipolar disorder (BD) in children and adolescents, beyond the first contact has been investigated sparsely. The aim of this study was to investigate the diagnostic stability of BD in children and adolescents using over two decades of nationwide register-based data, and to examine factors associated with change from BD to schizophrenia (ICD-10: F20.x), schizoaffective disorder (ICD-10: F25.x) or other primary psychotic disorders (ICD-10 F23.x–24.x and F28.x–29.x). Methods Danish register-based data for all incident BD patients diagnosed prior to age 18 years, between January 1st 1995 and December 31st 2014 (N = 519). We graphically illustrated diagnostic change at different follow-up times and studied variables associated with diagnostic change after 3-year follow-up using Poisson regression with robust standard error estimates. Results The diagnosis of incident BD was relatively stable. The diagnosis did not change for 93% of those followed for at least 6 months, and remained unchanged for 86% and 73% of those followed at least 3 years and 10 years, respectively. In patients followed for at least 3 years after index BD (N = 478), the risk of diagnostic change was 61% higher in males versus females. The risk of diagnostic change for patients diagnosed during hospitalization was 74% higher compared to patients diagnosed at outpatient clinics/emergency rooms. The risk of diagnostic change for patients abusing substances other than alcohol and cannabis was 173% higher compared to patients not abusing such substances. The risk of diagnostic change for patients previously diagnosed with schizophrenia or related diagnosis was 257% higher compared to patients not having been diagnosed with such diagnosis previously, while the risk of diagnostic change in offspring of parents with schizophrenia or related diagnosis was 126% higher compared to patients who did not have parents diagnosed with such disorders. Conclusion Overall, the stability of the BD diagnosis in the Danish nationwide healthcare registers was high. Factors associated with risk of diagnostic change within 3 years of the initial diagnosis were being male, diagnosis given during hospitalization, substance abuse other than alcohol and cannabis, and a prior diagnosis of schizophrenia or related diagnosis in the patient or in their parents.
Collapse
|
6
|
Thorup A, Albert N, Bertelsen M, Petersen L, Jeppesen P, Le Quack P, Krarup G, Jørgensen P, Nordentoft M. Gender differences in first-episode psychosis at 5-year follow-up – two different courses of disease? Results from the OPUS study at 5-year follow-up. Eur Psychiatry 2020; 29:44-51. [DOI: 10.1016/j.eurpsy.2012.11.005] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Revised: 11/14/2012] [Accepted: 11/23/2012] [Indexed: 10/27/2022] Open
Abstract
AbstractObjectiveGender differences in psychosis have been investigated, and the results have contributed to a better understanding of the disease, but many questions are unanswered. In clinical terms, women and men with psychosis differ in terms of access to social support, tendency of substance abuse, level of functioning and symptom patterns. We aimed to investigate how gender differences at onset of psychosis develop during the first 5 years of treatment.MethodA total of 578 patients with a first-episode psychosis in the schizophrenia spectrum were included in the Danish OPUS trial – a randomized clinical trial comparing 2 years of intensive early-intervention programme with standard treatment. All patients were assessed with validated instruments at inclusion, and after 2 and 5 years. Data were analysed for significant gender differences.ResultsMales have significantly higher levels of negative symptoms at all times, and are more likely to live alone and suffer from substance abuse. Females reach higher levels of social functioning at follow-up, and show a greater tendency to be employed or in education than males. Markedly more women than men live with children. More women than men reach a state of recovery and are more compliant with medication.ConclusionThere are significant gender differences at 2- and 5-year follow-up in this large cohort of first-episode psychotic patients. Males and females show different symptomatology and different levels of social functioning.
Collapse
|
7
|
Dama M, Veru F, Schmitz N, Shah J, Iyer S, Joober R, Malla A. Sex Differences in Clinical and Functional Outcomes among Patients Treated in an Early Intervention Service for Psychotic Disorders: An Observational Study. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2019; 64:708-717. [PMID: 31189340 PMCID: PMC6783666 DOI: 10.1177/0706743719854069] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE It has been shown that men with a longstanding psychotic disorder have worse clinical and functional outcomes than women. Our objectives were to examine whether these sex differences are also present among patients treated in an early intervention service (EIS) for psychosis and to determine if these differences are related to risk factors other than sex. METHOD Patients (N = 569) were assessed for demographic/clinical characteristics at entry and for symptoms/functioning over 2 years of treatment. Clinical outcomes included remission of positive, negative, and total symptoms. Functional outcomes included good functioning and functional remission. Logistic regression models examined the relationship between sex and outcomes after 1 and 2 years of treatment while controlling for the influence of other risk factors. RESULTS Men reported to be less educated and have a longer duration of untreated psychosis, poorer childhood and early adolescent premorbid functioning, higher rates of substance abuse/dependence disorders, greater severity of baseline negative symptoms, and poorer baseline social/occupational functioning than women. Women were more likely to achieve symptom remission than men after 2 years of treatment (negative odds ratio [OR], 1.69; 95% confidence interval [CI], 1.02 to 2.78; total OR, 1.79; 95% CI, 1.08 to 2.98). Women were also more likely than men to exhibit good functioning (OR, 1.61; 95% CI, 1.04 to 2.49) after 1 but not after 2 years of treatment. These results did not persist after controlling for other risk factors that could confound these associations (i.e., childhood premorbid functioning and age at onset of psychosis). CONCLUSIONS Sex differences seen in outcomes among patients treated in an EIS for psychosis may be largely influenced by the disparity of other risk factors that exist between the 2 sexes.
Collapse
Affiliation(s)
- Manish Dama
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Quebec
| | - Franz Veru
- Department of Psychiatry, McGill University, Montreal, Quebec
| | - Norbert Schmitz
- Department of Psychiatry, McGill University, Montreal, Quebec
| | - Jai Shah
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Quebec.,Department of Psychiatry, McGill University, Montreal, Quebec
| | - Srividya Iyer
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Quebec.,Department of Psychiatry, McGill University, Montreal, Quebec
| | - Ridha Joober
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Quebec.,Department of Psychiatry, McGill University, Montreal, Quebec
| | - Ashok Malla
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Quebec.,Department of Psychiatry, McGill University, Montreal, Quebec
| |
Collapse
|
8
|
Domenech C, Bernasconi C, Moneta MV, Nordstroem AL, Cristobal-Narvaez P, Vorstenbosch E, Cobo J, Ochoa S, Haro JM. Health-related quality of life associated with different symptoms in women and in men who suffer from schizophrenia. Arch Womens Ment Health 2019; 22:357-365. [PMID: 30088146 DOI: 10.1007/s00737-018-0896-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 07/24/2018] [Indexed: 11/29/2022]
Abstract
Health-related quality of life (HRQoL) in patients with schizophrenia is related to the severity of psychiatric symptoms. The objective of this study is to analyze whether the symptoms that influence HRQoL are similar in women and men. Data were part of the Pattern study, an international observational investigation which collected data from 1379 outpatients with schizophrenia. Patients were evaluated with the Mini International Neuropsychiatric Inventory, the Clinical Global Impression-Schizophrenia, and the Positive and Negative Syndrome Scale (PANSS), and reported their quality of life using the Schizophrenia Quality of Life Scale (SQLS), the Short Form-36 (SF-36), and the EuroQol-5 Dimension (EQ-5D). Men reported higher HRQoL on all scales. PANSS total score was 80.6 (SD 23.6) for women and 77.9 (SD 22.1) for men. In women, a higher PANSS negative score and a higher PANSS affective score were associated with a lower SQLS score. In men, a higher PANSS positive score and a higher PANSS affective score were associated with a lower SQLS score. The same pattern appeared with EQ-VAS and EQ-5D tariff. In women, greater age and higher PANSS affective score were associated with a lower SF-36 mental component score. In men, higher PANSS affective, positive, and cognitive scores were associated with a lower SF-36 mental component score. This study shows that HRQoL is influenced by different psychiatric symptoms in women and men. This may have significant implications when deciding the main treatment target in patients with schizophrenia.ClinicalTrials.gov Identifier: https://clinicaltrials.gov/ct2/show/NCT01634542.
Collapse
Affiliation(s)
- Cristina Domenech
- Universitat de Barcelona, Barcelona, Spain.,Parc Sanitari Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Catalonia, Spain
| | | | - Maria Victoria Moneta
- Parc Sanitari Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica en Red, CIBERSAM, Madrid, Spain
| | | | - Paula Cristobal-Narvaez
- Parc Sanitari Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica en Red, CIBERSAM, Madrid, Spain
| | - Ellen Vorstenbosch
- Parc Sanitari Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Catalonia, Spain
| | - Jesus Cobo
- Corporació Sanitària Parc Taulí, Hospital Universitari - UAB Sabadell, Barcelona, Catalonia, Spain
| | - Susana Ochoa
- Parc Sanitari Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica en Red, CIBERSAM, Madrid, Spain
| | - Josep Maria Haro
- Universitat de Barcelona, Barcelona, Spain. .,Parc Sanitari Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Catalonia, Spain. .,Centro de Investigación Biomédica en Red, CIBERSAM, Madrid, Spain.
| |
Collapse
|
9
|
Cannabis use in male and female first episode of non-affective psychosis patients: Long-term clinical, neuropsychological and functional differences. PLoS One 2017; 12:e0183613. [PMID: 28832666 PMCID: PMC5568402 DOI: 10.1371/journal.pone.0183613] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 08/08/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Numerous studies show the existence of a high prevalence of cannabis use among patients with psychosis. However, the differences between men and women who debut with a first episode of psychosis (FEP) regarding cannabis use have not been largely explored. The aim of this study was to identify the specific sex factors and differences in clinical evolution associated with cannabis use. METHOD Sociodemographic characteristics at baseline were considered in our sample of FEP patients to find differences depending on sex and the use of cannabis. Clinical, functional and neurocognitive variables at baseline, 1-year, and 3-years follow-up were also explored. RESULTS A total of 549 patients, of whom 43% (N = 236) were cannabis users, 79% (N = 186) male and 21% (N = 50) female, were included in the study. There was a clear relationship between being male and being a user of cannabis (OR = 5.6). Cannabis users were younger at illness onset. Longitudinal analysis showed that women significantly improved in all three dimensions of psychotic symptoms, both in the subgroup of cannabis users and in the non-users subgroup. Conversely, subgroups of men did not show improvement in the negative dimension. In cognitive function, only men presented a significant time by group interaction in processing speed, showing a greater improvement in the subgroup of cannabis users. CONCLUSION Despite knowing that there is a relationship between cannabis use and psychosis, due to the high prevalence of cannabis use among male FEP patients, the results showed that there were very few differences in clinical and neurocognitive outcomes between men and women who used cannabis at the start of treatment compared to those who did not.
Collapse
|
10
|
Savill M, Orfanos S, Bentall R, Reininghaus U, Wykes T, Priebe S. The impact of gender on treatment effectiveness of body psychotherapy for negative symptoms of schizophrenia: A secondary analysis of the NESS trial data. Psychiatry Res 2017; 247:73-78. [PMID: 27871030 PMCID: PMC5191935 DOI: 10.1016/j.psychres.2016.11.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 11/14/2016] [Indexed: 11/25/2022]
Abstract
Despite promising findings from small-scale studies suggesting that body psychotherapy may be an effective treatment for negative symptoms, these results were not replicated in a recent multisite trial. In this trial a far smaller proportion of women were recruited relative to earlier studies, which may be an issue given the gender mix of the sample evaluated has been found to affect trial outcomes in schizophrenia. Using data from our multisite trial, the interaction between gender and treatment allocation as a predictor of outcomes was examined in 275 participants (72 women and 203 men) randomised to either a body psychotherapy or Pilates group. Negative symptoms were found to significantly reduce in women randomised to the body psychotherapy condition in comparison to Pilates, while no such effect was detected in men. Consistent with the smaller trials, this improvement was found to relate predominantly to expressive deficits. These findings suggest that body psychotherapy may be an effective treatment for negative symptoms in women. These findings emphasise the importance of sample characteristics in determining trial outcome in psychological treatment studies.
Collapse
Affiliation(s)
- Mark Savill
- Department of Psychiatry, Weill Institute for Neurosciences, University of California San Francisco, Box 0984 266, 401 Parnassus Avenue, LP-255, San Francisco, CA 94143, USA.
| | - Stavros Orfanos
- Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, Queen Mary University of London, UK
| | | | - Ulrich Reininghaus
- MHeNS School for Mental Health and Neuroscience, Maastricht University, The Netherlands
| | - Til Wykes
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, Queen Mary University of London, UK
| |
Collapse
|
11
|
Petkari E, Mayoral F, Moreno-Küstner B. Gender matters in schizophrenia-spectrum disorders: Results from a healthcare users epidemiological study in Malaga, Spain. Compr Psychiatry 2017; 72:136-143. [PMID: 27816847 DOI: 10.1016/j.comppsych.2016.09.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 09/28/2016] [Accepted: 09/30/2016] [Indexed: 10/20/2022] Open
Abstract
PURPOSE Women suffering from schizophrenia-spectrum disorders may differ from men in clinical course and outcome. Still, those differences can only be portrayed accurately by means of studies that derive information from multiple sources. One such study was performed in a well-defined area supported by a Mental Health Clinical Management Unit in Malaga, Spain. METHODS Data from 1640 patients (1048 men and 592 women) that were in contact with services during 2008 were examined for the purpose of the present analysis. Gender differences in sociodemographic and clinical characteristics and the role of gender for explaining clinical characteristics (diagnosis, disease severity and service use) beyond potential sociodemographic confounders were explored. RESULTS The chi-squared analysis results revealed that in comparison to men, women were older, married or widowed/divorced and living as housewives with their families in cities. Genders also differed across diagnoses, with men being at higher risk for suffering from paranoid schizophrenia, while women being at higher risk for persistent delusional, acute/transitory and schizoaffective disorders. Furthermore, men had greater disease severity and higher chances to visit the mental health rehabilitation unit (MHRU). Further regression analyses revealed that after controlling for confounders, gender differences remained significant across diagnoses and severity. However, they lost their significance under the influence of marital, living and occupational status when predicting the use of MHRU. CONCLUSION Results confirm the existence of gender differences and highlight the importance of other factors for designing effective psychosocial services that are tailor-made to the patients' needs.
Collapse
Affiliation(s)
- Eleni Petkari
- Department of Psychology, School of Humanities and Social Sciences, European University of Cyprus, Nicosia, Cyprus; Department of Psychology, School of Science and Technology, Middlesex University Dubai, Dubai, United Arab Emirates; International Maristan Network.
| | - Fermín Mayoral
- Regional Hospital of Malaga, Spain, Galvez Ginachero Avenue s/n, Malaga 29009, Spain; Biomedicine Institute of Malaga-IBIMA, Avda Jorge Luis Borges, 15, 3,3ª, Malaga, 29019, Spain; International Maristan Network.
| | - Berta Moreno-Küstner
- Biomedicine Institute of Malaga-IBIMA, Avda Jorge Luis Borges, 15, 3,3ª, Malaga, 29019, Spain; Department of Personality, Assessment and Psychological Treatment, University of Malaga, Campus Teatinos s/n, Malaga 18071, Spain; Andalusian Psychosocial Research Group-GAP, Malaga, Spain; International Maristan Network.
| |
Collapse
|
12
|
Butjosa A, Gómez-Benito J, Huerta-Ramos E, Del Cacho N, Barajas A, Baños I, Usall J, Dolz M, Sánchez B, Carlson J, Maria Haro J, Ochoa S. Incidence of stressful life events and influence of sociodemographic and clinical variables on the onset of first-episode psychosis. Psychiatry Res 2016; 245:108-115. [PMID: 27541345 DOI: 10.1016/j.psychres.2016.08.030] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 08/04/2016] [Accepted: 08/08/2016] [Indexed: 01/01/2023]
Abstract
This study presents a quantitative analysis of the incidence of stressful life events (SLEs) and the variables gender, age at onset, family history and psychotic symptoms in patients with first-episode psychosis (FEP). A descriptive, cross-sectional methodology was used to interview 68 patients with FEP between 13 and 47 years of age. The Psychiatric Epidemiology Research Interview Life Events Scale collected one-year period prior to onset of FEP - used to analyse the subcategories academic, work, love and marriage, children, residence, legal affairs, finances and social activities-, Positive and Negative Syndrome Scale, and Clinical Global Impression-Schizophrenia scale were used to assess the relevance of certain SLEs during adolescence. Age at onset showed a significant negative correlation with the categories academic and social activities. By contrast, it showed a positive correlation with work and children. A significant relationship was found between paternal family history and social activities and between maternal family history and academic and love and marriage. Finally, an inverse relationship was observed between negative symptoms and the categories children and finance. Depressive symptoms were significantly correlated with the category academic. Our results show the importance of SLEs during adolescence and suggest that there is a clear need to develop preventive actions that promote effective strategies for dealing with the accumulation of psychosocial stress.
Collapse
Affiliation(s)
- Anna Butjosa
- Parc Sanitari Sant Joan de Déu, Teaching, Research & Innovation Unit, CIBERSAM, Sant Boi de Llobregat, Barcelona, Spain; Sant Joan de Déu Research Foundation, CIBERSAM, Esplugues de Llobregat, Barcelona, Spain; Department of Personality, Evaluation and Psychological Treatment, Faculty of Psychology, University of Barcelona, Spain.
| | - Juana Gómez-Benito
- Department of Personality, Evaluation and Psychological Treatment, Faculty of Psychology, University of Barcelona, Spain; Institute for Brain, Cognition, and Behaviour (IR3C), University of Barcelona, Spain
| | - Elena Huerta-Ramos
- Parc Sanitari Sant Joan de Déu, Teaching, Research & Innovation Unit, CIBERSAM, Sant Boi de Llobregat, Barcelona, Spain; Sant Joan de Déu Research Foundation, CIBERSAM, Esplugues de Llobregat, Barcelona, Spain
| | - Núria Del Cacho
- Parc Sanitari Sant Joan de Déu, Teaching, Research & Innovation Unit, CIBERSAM, Sant Boi de Llobregat, Barcelona, Spain; Sant Joan de Déu Research Foundation, CIBERSAM, Esplugues de Llobregat, Barcelona, Spain
| | - Ana Barajas
- Parc Sanitari Sant Joan de Déu, Teaching, Research & Innovation Unit, CIBERSAM, Sant Boi de Llobregat, Barcelona, Spain; Sant Joan de Déu Research Foundation, CIBERSAM, Esplugues de Llobregat, Barcelona, Spain; Hospital Sant Joan de Déu, Acute Unit, CIBERSAM, Esplugues de Llobregat, Barcelona, Spain; Centro de Higiene Mental de Les Corts Research Unit, Barcelona, Spain
| | - Iris Baños
- Parc Sanitari Sant Joan de Déu, Teaching, Research & Innovation Unit, CIBERSAM, Sant Boi de Llobregat, Barcelona, Spain; Sant Joan de Déu Research Foundation, CIBERSAM, Esplugues de Llobregat, Barcelona, Spain
| | - Judith Usall
- Parc Sanitari Sant Joan de Déu, Teaching, Research & Innovation Unit, CIBERSAM, Sant Boi de Llobregat, Barcelona, Spain
| | - Montserrat Dolz
- Hospital Sant Joan de Déu, Acute Unit, CIBERSAM, Esplugues de Llobregat, Barcelona, Spain
| | - Bernardo Sánchez
- Hospital Sant Joan de Déu, Acute Unit, CIBERSAM, Esplugues de Llobregat, Barcelona, Spain
| | - Janina Carlson
- Parc Sanitari Sant Joan de Déu, Teaching, Research & Innovation Unit, CIBERSAM, Sant Boi de Llobregat, Barcelona, Spain; Sant Joan de Déu Research Foundation, CIBERSAM, Esplugues de Llobregat, Barcelona, Spain; Hospital Sant Joan de Déu, Acute Unit, CIBERSAM, Esplugues de Llobregat, Barcelona, Spain
| | - Josep Maria Haro
- Parc Sanitari Sant Joan de Déu, Teaching, Research & Innovation Unit, CIBERSAM, Sant Boi de Llobregat, Barcelona, Spain
| | | | - Susana Ochoa
- Parc Sanitari Sant Joan de Déu, Teaching, Research & Innovation Unit, CIBERSAM, Sant Boi de Llobregat, Barcelona, Spain
| |
Collapse
|
13
|
Cobo J, Nieto L, Ochoa S, Pousa E, Usall J, Baños I, González B, Ruiz I, Ruiz AI. Insight and gender in schizophrenia and other psychoses. Psychiatry Res 2016; 243:268-77. [PMID: 27423634 DOI: 10.1016/j.psychres.2016.04.089] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 12/30/2015] [Accepted: 04/25/2016] [Indexed: 12/24/2022]
Abstract
This study aimed to evaluate gender differences in the deficit of insight in psychosis and determine influences of clinical, functional, and sociodemographic variables. A multicenter sample of 401 adult patients with schizophrenia and other psychotic disorders who agreed to participate was evaluated in four centers of the metropolitan area of Barcelona (Catalonia). Psychopathological assessment was performed using the Positive and Negative Syndrome Scale Lindenmayers' Factors. Insight and its dimensions were assessed by means of the Scale of Unawareness of Mental Disorder. Significant differences were apparent neither between men and women in the three dimensions of insight, nor in the total awareness, nor in the total attribution subscales. However, statistically significant differences were found in awareness and attribution of particular symptoms. Women showed a worse awareness of thought disorder and alogia and a higher misattribution of apathy. Higher cognitive and positive symptoms, early stage of the illness, and having been married explained deficits of insight dimensions in women. In men, other variables such as lower functioning, higher age, other psychosis diagnosis, and, to a lower extent, higher scores in cognitive, positive, and excitative symptoms, explained deficits of insight dimensions. These data could help to design gender-specific preventive and therapeutic strategies.
Collapse
Affiliation(s)
- Jesus Cobo
- Mental Health Department, Corporació Sanitària Parc Taulí, Hospital Universitari - UAB Sabadell, Barcelona, Catalonia, Spain; Department of Psychiatry and Forensic Medicine. Universitat Autònoma de Barcelona Bellaterra, Barcelona, Catalonia, Spain; Research Workgroup on Womens' Mental Health, Catalan Society of Psychiatry & Mental Health Barcelona, Catalonia, Spain.
| | - Lourdes Nieto
- Research Workgroup on Womens' Mental Health, Catalan Society of Psychiatry & Mental Health Barcelona, Catalonia, Spain; Department of Research, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, Mexico
| | - Susana Ochoa
- Research Workgroup on Womens' Mental Health, Catalan Society of Psychiatry & Mental Health Barcelona, Catalonia, Spain; Research and Development Unit, Parc Sanitari San Joan de Dèu - CIBERSAM Sant Boi de Llobregat, Barcelona, Catalonia, Spain
| | - Esther Pousa
- Mental Health Department, Corporació Sanitària Parc Taulí, Hospital Universitari - UAB Sabadell, Barcelona, Catalonia, Spain; Institut de Neuropsiquiatria i Addiccions, Hospital del Mar Barcelona, Catalonia, Spain
| | - Judith Usall
- Research Workgroup on Womens' Mental Health, Catalan Society of Psychiatry & Mental Health Barcelona, Catalonia, Spain; Research and Development Unit, Parc Sanitari San Joan de Dèu - CIBERSAM Sant Boi de Llobregat, Barcelona, Catalonia, Spain
| | - Iris Baños
- Research and Development Unit, Parc Sanitari San Joan de Dèu - CIBERSAM Sant Boi de Llobregat, Barcelona, Catalonia, Spain
| | - Beatriz González
- Mental Health Department, Hospital Benito Menni Sant Boi de Llobregat, Barcelona, Catalonia, Spain
| | - Isabel Ruiz
- Department of Health and Clinical Psychology - Research Unit. Universitat Autònoma de Barcelona Bellaterra, Barcelona, Catalonia, Spain
| | | | - Ada I Ruiz
- Research Workgroup on Womens' Mental Health, Catalan Society of Psychiatry & Mental Health Barcelona, Catalonia, Spain; Institut de Neuropsiquiatria i Addiccions, Hospital del Mar Barcelona, Catalonia, Spain; IMIM - Hospital del Mar Medical Research Institut Barcelona, Catalonia, Spain
| |
Collapse
|
14
|
Influence of cognition, premorbid adjustment and psychotic symptoms on psycho-social functioning in first-episode psychosis. Psychiatry Res 2016; 242:157-162. [PMID: 27280526 DOI: 10.1016/j.psychres.2016.04.121] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 03/22/2016] [Accepted: 04/30/2016] [Indexed: 01/12/2023]
Abstract
OBJECTIVE The aim of this study is to evaluate the relationship between psycho-social functioning and symptoms, cognitive function, and premorbid adjustment, in patients with a first-episode psychosis. METHOD Clinical data were obtained from 90 patients, who were assessed with the Disability Assessment Scale (DAS-sv), the Positive and Negative Syndrome Scale (PANSS), the Premorbid Adjustment Scale (PAS-S) and with a battery of cognitive tests including Trail Making Tests A and B (TMTA- B), Continous Performance Test (CPT), some subscales of the Wechler Adult Intelligence Scale (WAIS), and the Verbal Learning Test España-Complutense (TAVEC). RESULTS The results of the study suggest that psycho-social functioning in first-episode psychosis is significantly related to: positive, negative, excitative, affective and disorganized symptoms, social premorbid adjustment, cognitive flexibility, working memory, short term and long term memory. Of these, those which best explained psycho-social functioning are the positive and excitative symptoms, premorbid adjustment, flexibility and memory. CONCLUSIONS These findings highlight the importance early intervention on cognitive and clinical variables to help provide a better psycho-social functioning in people with a first-episode of psychosis.
Collapse
|
15
|
Affective empathy in schizophrenia: a meta-analysis. Schizophr Res 2016; 175:109-117. [PMID: 27094715 DOI: 10.1016/j.schres.2016.03.037] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 03/24/2016] [Accepted: 03/30/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND Affective empathy, or the emotional response one has to the experiences or emotional states of others, contributes to relationship-maintaining behaviors and is key in fostering social connections, yet no work has synthesized the body of literature for people with schizophrenia. The aim of the present meta-analysis was to determine the extent to which those diagnosed with schizophrenia experience deficits in affective empathy. METHODS A literature search was conducted of studies examining empathy. Data were analyzed using a random effects meta-analytic model with Hedges' g standardized mean difference effect size. RESULTS Individuals with schizophrenia exhibited significant, medium deficits in affective empathy (k=37). Measurement type moderated the affective empathy deficit such that performance-based measures showed larger schizophrenia group deficits than self-report measures. CONCLUSION Consistent, significant deficits in affective empathy were found comparing people with schizophrenia to healthy controls, especially when using performance-based assessments. The medium effect suggests an important role for empathy in the realm of social cognitive research, and points to the need for further investigation of measurement techniques and associations with functional outcomes.
Collapse
|
16
|
Usall J, Huerta-Ramos E, Labad J, Cobo J, Núñez C, Creus M, Parés GG, Cuadras D, Franco J, Miquel E, Reyes JC, Roca M. Raloxifene as an Adjunctive Treatment for Postmenopausal Women With Schizophrenia: A 24-Week Double-Blind, Randomized, Parallel, Placebo-Controlled Trial. Schizophr Bull 2016; 42:309-17. [PMID: 26591005 PMCID: PMC4753610 DOI: 10.1093/schbul/sbv149] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
UNLABELLED The potential therapeutic utility of estrogens in schizophrenia is increasingly being recognized. Raloxifene, a selective estrogen receptor modulator, appears to act similarly to estrogens on dopamine and serotonin brain systems. One previous trial by our team found that raloxifene was useful to improve negative, positive, and general psychopathological symptoms, without having the negative side effects of estrogens. In this study, we assess the utility of raloxifene in treating negative and other psychotic symptoms in postmenopausal women with schizophrenia exhibiting prominent negative symptoms. This was a 24-week, randomized, parallel, double-blind, placebo-controlled study. Patients were recruited from the inpatient and outpatient departments of Parc Sanitari Sant Joan de Déu, Hospital Universitari Institut Pere Mata, and Corporació Sanitària Parc Taulí. Seventy postmenopausal women with schizophrenia (DSM-IV) were randomized to either adjunctive raloxifene (38 women) or adjunctive placebo (32 women). Psychopathological symptoms were assessed at baseline and at weeks 4, 12, and 24 with the Positive and Negative Syndrome Scale (PANSS) and the Scale for the Assessment of Negative Symptoms (SANS). The addition of raloxifene (60 mg/d) to regular antipsychotic treatment significantly reduced negative (P = .027), general (P = .003), and total symptomatology (P = .005) measured with the PANSS during the 24-week trial, as compared to women receiving placebo. Also Alogia SANSS subscale improved more in the raloxifene (P = .048) than the placebo group. In conclusion, raloxifene improved negative and general psychopathological symptoms, compared with antipsychotic medication alone, in postmenopausal women with schizophrenia. These data replicate our previous results with a larger sample and a longer follow-up. TRIAL REGISTRATION NCT01573637.
Collapse
Affiliation(s)
| | | | | | - Jesús Cobo
- Catalan Group in Women’s Mental Health Research (GTRDSM), Barcelona, Spain;,Corporació Sanitària i Universitària Parc Taulí, Psychiatry Department, Sabadell, Spain
| | - Christian Núñez
- Parc Sanitari Sant Joan de Déu, Research and Development Unit, Sant Boi de Llobregat, Spain
| | - Marta Creus
- Hospital Universitari Institut Pere Mata, IISPV, Universitat Rovira i Virgili, Psychiatry Department, Reus, Spain
| | - Gemma García Parés
- Catalan Group in Women’s Mental Health Research (GTRDSM), Barcelona, Spain;,Corporació Sanitària i Universitària Parc Taulí, Psychiatry Department, Sabadell, Spain;,CAP EAE SALUT MENTAL, Andorra
| | - Daniel Cuadras
- Parc Sanitari Sant Joan de Déu, Research and Development Unit, Sant Boi de Llobregat, Spain
| | - José Franco
- Instituto de Salud Carlos III, Centro de Investigación en Red de Salud Mental (CIBERSAM), Madrid, Spain;,Hospital Universitari Institut Pere Mata, IISPV, Universitat Rovira i Virgili, Psychiatry Department, Reus, Spain
| | - Eva Miquel
- Parc Sanitari Sant Joan de Déu, Research and Development Unit, Sant Boi de Llobregat, Spain
| | - Julio César Reyes
- Instituto de Salud Carlos III, Centro de Investigación en Red de Salud Mental (CIBERSAM), Madrid, Spain;,Hospital Universitari Institut Pere Mata, IISPV, Universitat Rovira i Virgili, Psychiatry Department, Reus, Spain
| | - Mercedes Roca
- Parc Sanitari Sant Joan de Déu, Research and Development Unit, Sant Boi de Llobregat, Spain
| | | |
Collapse
|
17
|
Novick D, Montgomery W, Treuer T, Moneta MV, Haro JM. Sex differences in the course of schizophrenia across diverse regions of the world. Neuropsychiatr Dis Treat 2016; 12:2927-2939. [PMID: 27881918 PMCID: PMC5115683 DOI: 10.2147/ndt.s101151] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
This study explores sex differences in the outcomes of patients with schizophrenia (clinical/functional remission and recovery) across diverse regions of the world (Northern Europe, Southern Europe, Central and Eastern Europe, Latin America, East Asia, and North Africa and the Middle East). Data (n=16,380 for this post hoc analysis) were taken from the World-Schizophrenia Health Outcomes Study. In most regions, females had a later age at first service contact for schizophrenia, a lower level of overall/negative symptom severity, lower rates of alcohol/substance abuse and paid employment, and higher percentages of having a spouse/partner and independent living. Overall, females had slightly higher rates of clinical remission (58.0% vs 51.8%), functional remission (22.8% vs 16.0%), and recovery (16.5% vs 16.0%) at 36 months (P<0.001 for all). This pattern was consistently observed in Southern Europe and Northern Europe even after controlling for baseline sex differences, but not in other regions. In Central and Eastern Europe, rates of clinical remission were higher in females at 36 months, but those of functional remission and recovery were similar between males and females. The opposite was observed for Latin America. In East Asia, sex differences were rarely observed for these outcomes. Finally, in North Africa and the Middle East, sex differences in these outcomes were pronounced only in regression analyses. These regional variations shed light on the importance of psychosocial and cultural factors and their effects on sex in the prognosis of schizophrenia.
Collapse
Affiliation(s)
| | | | - Tamas Treuer
- Eli Lilly and Company, Neuroscience Research, Budapest, Hungary
| | - Maria Victoria Moneta
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Barcelona, Spain
| | - Josep Maria Haro
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Barcelona, Spain
| |
Collapse
|
18
|
Enhancing assertive community treatment with cognitive behavioral social skills training for schizophrenia: study protocol for a randomized controlled trial. Trials 2015; 16:438. [PMID: 26424639 PMCID: PMC4590698 DOI: 10.1186/s13063-015-0967-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 09/17/2015] [Indexed: 01/05/2023] Open
Abstract
Background Schizophrenia leads to profound disability in everyday functioning (e.g., difficulty finding and maintaining employment, housing, and personal relationships). Medications can effectively reduce positive symptoms (e.g., hallucinations and delusions), but they do not meaningfully improve daily life functioning. Psychosocial evidence-based practices (EBPs) improve functioning, but these EBPs are not available to most people with schizophrenia. The field must close the research and service delivery gap by adapting EBPs for schizophrenia to facilitate widespread implementation in community settings. Our hybrid effectiveness and implementation study represents an initiative to bridge this divide. In this study we will test whether an existing EBP (i.e., Cognitive Behavioral Social Skills Training (CBSST)) modified to work in practice settings (i.e., Assertive Community Treatment (ACT) teams) commonly available to persons with schizophrenia results in better consumer outcomes. We will also identify key factors relevant to developing future CBSST implementation strategies. Methods/Design For the effectiveness study component, persons with schizophrenia will be recruited from existing publicly funded ACT teams operating in community settings. Participants will be randomized to one of the 2 treatments (ACT alone or ACT + Adapted CBSST) and followed longitudinally for 18 months with assessments every 18 weeks after baseline (5 in total). The primary outcome domain is psychosocial functioning (e.g., everyday living skills and activities related to employment, education, and housing) as measured by self-report, testing, and observation. Additional outcome domains of interest include mediators of change in functioning, symptoms, and quality of services. Primary analyses will be conducted using linear mixed-effects models for continuous data. The implementation study component consists of a structured, mixed qualitative-quantitative methodology (i.e., Concept Mapping) to characterize and assess the implementation experience from multiple stakeholder perspectives in order to inform future implementation initiatives. Discussion Adapting CBSST to fit into the ACT service delivery context found throughout the United States creates an opportunity to substantially increase the number of persons with schizophrenia who could have access to and benefit from EBPs. As part of the implementation learning process training materials and treatment workbooks have been revised to promote easier use of CBSST in the context of brief community-based ACT visits. Trial registration ClinicalTrials.gov NCT02254733. Date of registration: 25 April 2014.
Collapse
|
19
|
Abstract
BACKGROUND An increasing number of studies identifies the duration of illness (DI) as an important predictor of outcome in patients affected by major psychoses (MP). The aim of the present paper was to revise medical literature about DI and its effects on MP, focusing in particular on the relationship between DI and outcome with particular reference to treatment response, suicidal risk, cognitive impairment and social functioning. METHODS A search in the main database sources has been performed to obtain a comprehensive overview. Studies with different methodologies (open and double-blinded) have been included, while papers considering other variables such as duration of untreated episode/illness were excluded. MP included the diagnoses of schizophrenia, bipolar disorder and major depressive disorder. RESULTS Available data show that DI influences treatment response, suicidal risk and loss of social functioning in schizophrenic patients, while results are more controversial with regard to cognitive impairment. In bipolar disorder, a long DI has been associated with less treatment response, more suicidal risk and cognitive impairment, but more data are needed to draw definitive conclusions. Finally, studies, regarding DI of illness and its predictive value of outcome in major depressive disorder show contradictory results. CONCLUSIONS DI appears a negative outcome factor particularly for schizophrenia, while with regard to mood disorders, more data are needed to draw definitive sound conclusions.
Collapse
Affiliation(s)
- Alfredo Carlo Altamura
- Alfredo C Altamura, Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico , Via F. Sforza 35, 20122, Milan , Italy
| | | | | |
Collapse
|
20
|
Grover S, Avasthi A, Shah S, Lakdawala B, Chakraborty K, Nebhinani N, Kallivayalil RA, Dalal PK, Sinha V, Khairkar P, Mukerjee DG, Thara R, Behere P, Chauhan N, Thirunavukarasu M, Malhotra S. Indian Psychiatric Society multicentric study on assessment of health-care needs of patients with severe mental illnesses as perceived by their family caregivers and health-care providers. Indian J Psychiatry 2015; 57:181-9. [PMID: 26124525 PMCID: PMC4462788 DOI: 10.4103/0019-5545.158185] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
AIM To study the health-care needs of the patients with severe mental disorders as perceived by their family caregivers and the treating psychiatrists. MATERIALS AND METHODS Caregivers of patients with severe mental disorders and their treating psychiatrists were assessed using Camberwell Assessment of Need-Research Version (CAN-R) scale and indigenously designed Supplementary Assessment of Needs Scale (SNAS). RESULTS The study included 1494 patients recruited from 15 centers. The mean needs as per the CAN-R, perceived by the caregivers were 7.8 and treating psychiatrists were 8.1. About one-third of needs were unmet. On SNAS, both caregivers and treating psychiatrists reported a mean of 7.9 needs, of which more than half were unmet as per the caregivers. As per the treating psychiatrists, 45.5% of the needs as assessed on SNAS were unmet. There was a high level of correlation between needs perceived by the patients, caregivers and the treating psychiatrists. On CAN-R, main domains of needs as reported by the caregivers were those of money, relief of psychological distress, information about the illness and treatment, welfare benefits, transport, company and food. As per the treating psychiatrists, the most common total needs identified were those of relief of psychological distress, welfare benefits, information about the illness and treatment, money, transport, company self-care and physical health. The most common domains of needs as assessed on SNAS as per the caregivers were those of free treatment, medical reimbursement, psychoeducation, financial help, social support, insurance, more time from the clinicians and travel concession. The treating psychiatrists identified dealing with caregiver's stress as the most common need. CONCLUSIONS According to the family caregivers and treating psychiatrists, about one-third of the needs of the patients as assessed using CAN-R and about half of the needs as assessed using SNAS are unmet.
Collapse
Affiliation(s)
- Sandeep Grover
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajit Avasthi
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sandip Shah
- Department of Psychiatry, SBKS MI and RC, Sumandeep Vidyapeeth, Pipaira, Vadodara, Gujarat, India
| | - Bhavesh Lakdawala
- Department of Psychiatry, B. J. Medical College and Civil Hospital, Ahmedabad, Gujarat, India
| | - Kaustav Chakraborty
- Department of Psychiatry, College of Medicine and J.N.M. Hospital, Kalyani, India
| | | | - Roy A Kallivayalil
- Department of Psychiatry, Pushpagiri Institute of Medical Sciences, Tiruvalla, Kerala, India
| | - Pranob K Dalal
- Department of Psychiatry, KGMU, Lucknow, Uttar Pradesh, India
| | - Vishal Sinha
- Department of Psychiatry, S. N. Medical College, Agra, Uttar Pradesh, India
| | - Praveen Khairkar
- Department of Psychiatry, Mahatma Gandhi Institute of Medical Sciences, Sevagram, India
| | - Divya G Mukerjee
- Department of Psychiatry, R. G. Kar Medical College, Kolkata, West Bengal, India
| | - R Thara
- Schizophrenia Research Foundation (SCARF), Chennai, India
| | - Prakash Behere
- Department of Psychiatry, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India
| | | | - M Thirunavukarasu
- Department of Psychiatry, SRM Medical College Hospital and Research Centre, Chennai, Tamil Nadu, India
| | | |
Collapse
|
21
|
Gender differences in individuals at high-risk of psychosis: a comprehensive literature review. ScientificWorldJournal 2015; 2015:430735. [PMID: 25685840 PMCID: PMC4312997 DOI: 10.1155/2015/430735] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 12/07/2014] [Accepted: 12/08/2014] [Indexed: 01/29/2023] Open
Abstract
Introduction. To date, few studies have focused on the characterization of clinical phenomenology regarding gender in population at high-risk of psychosis. This paper is an attempt to summarize the findings found in the scientific literature regarding gender differences in high-risk populations, taking into account parameters studied in populations with schizophrenia and other psychotic disorders, such as incidence, clinical expression, duration of untreated illness (DUI), social functioning, and cognitive impairment prior to full-blown psychosis development. Method. Studies were systematically searched in PubMed. Studies using gender variable as a control variable were excluded. 12 studies met inclusion criteria. Results. Most of the studies found a differential pattern between women and men as regards clinical, social, and cognitive variables in the prodromal phase, with worse performance in men except in cognitive functioning (more severe negative symptoms, worse social functioning, and longer DUI in men). Similar conversion rates over time were found between men and women. Conclusions. Many of the studies analyzed suggest that differences between men and women in the expression of psychosis extend across a continuum, from the subclinical forms of illness to the debut of psychosis. However, the small number of studies and their significant methodological and clinical limitations do not allow for firm conclusions.
Collapse
|
22
|
Grover S, Avasthi A, Shah S, Lakdawala B, Chakraborty K, Nebhinani N, Kallivayalil RA, Dalal PK, Sinha V, Khairkar P, Mukerjee DG, Thara R, Behere P, Chauhan N, Thirunavukarasu M, Malhotra S. Indian Psychiatric Society multicentric study on assessment of health-care needs of patients with severe mental illnesses. Indian J Psychiatry 2015; 57:43-50. [PMID: 25657456 PMCID: PMC4314916 DOI: 10.4103/0019-5545.148520] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
AIM To assess the health-care needs of the patients with severe mental disorders. MATERIALS AND METHODS Patients with the diagnosis of a severe mental disorder (schizophrenia and related psychotic disorders, bipolar disorder, recurrent depressive disorder, major depressive disorder and obsessive compulsive disorder) were assessed using Camberwell Assessment of Need-Research version (CAN-R) Scale and indigenously designed Supplementary Needs Assessment Scale (SNAS). RESULTS The study included 1494 patients recruited from 15 centers. The most common diagnostic group was that of affective disorders (55.3%), followed by psychotic disorders (37.6%). The mean number of total needs as perceived by the patients was 7.6 on the CAN-R. About two-third of the needs as assessed on CAN-R were met, and one-third were unmet. On CAN-R, main domains of needs as reported by patients were those of money, welfare benefits, transport, information about the illness and treatment, relief of psychological distress, company, household skills and intimate relationships. On SNAS, the mean number of total needs as perceived by the patients was 7.6 of which 4.1 were met needs. The most common domains of needs as assessed on SNAS were those of financial help, medical reimbursement, psychoeducation, free treatment, certification of mental illness, flexible work/job timings, addressing the caregiver stress and legal aid. CONCLUSION About two-third of the needs, of the patients with severe mental disorders are met as assessed using CAN-R. However, higher percentages of unmet needs are identified on SNAS. In view of the commonly reported needs, a change in the orientation of services offered to people with mental disorders is very much called for. At the government level, desired policies must be formulated to support the patients with mental disorders.
Collapse
Affiliation(s)
- Sandeep Grover
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajit Avasthi
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sandip Shah
- Department of Psychiatry, SBKS MI and RC, Sumandeep Vidyapeeth, Pipaira, Vadodara, Gujarat, India
| | - Bhavesh Lakdawala
- Department of Psychiatry, B.J. Medical College and Civil Hospital, Ahmedabad, Gujarat, India
| | - Kaustav Chakraborty
- Department of Psychiatry, College of Medicine and J.N.M. Hospital, Kalyani, India
| | | | | | - Pranob K Dalal
- Department of Psychiatry, KGMU, Lucknow, Uttar Pradesh, India
| | - Vishal Sinha
- Department of Psychiatry, S. N. Medical College, Agra, Uttar Pradesh, India
| | - Praveen Khairkar
- Department of Psychiatry, Mahatma Gandhi Institute of Medical Sciences, Sevagram, India
| | - Divya G Mukerjee
- Department of Psychiatry, R. G. Kar Medical College, Kolkata, West Bengal, India
| | - R Thara
- Schizophrenia Research Foundation (SCARF), Chennai, India
| | - Prakash Behere
- Department of Psychiatry, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India
| | | | - M Thirunavukarasu
- Department of Psychiatry, SRM Medical College Hospital and Research Centre, Chennai, Tamil Nadu, India
| | | |
Collapse
|
23
|
Roldán-Merino J, Lluch-Canut T, Menarguez-Alcaina M, Foix-Sanjuan A, Haro Abad JM. Psychometric evaluation of a new instrument in Spanish to measure self-care requisites in patients with schizophrenia. Perspect Psychiatr Care 2014; 50:93-101. [PMID: 24689490 DOI: 10.1111/ppc.12026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Revised: 03/06/2013] [Accepted: 04/10/2013] [Indexed: 11/28/2022] Open
Abstract
PURPOSE The purpose of this study was to develop and validate a new instrument in Spanish designed to measure self-care requisites in patients with schizophrenia treated in the community. DESIGN AND METHODS The first phase was conducted to develop the questionnaire through a panel of experts and evaluate for content validity. Psychometric evaluation was then conducted with a consecutive sample of 341 patients. FINDINGS The scale demonstrated good internal consistency and stability over time. The discriminant and convergent validity was satisfactory. The confirmatory factor analysis showed that the theoretical model fits the self-care requisites proposed by Orem's nursing theory from which it originated. PRACTICE IMPLICATIONS This scale is a valid and reliable instrument for use in clinical practice, guiding the nurse in developing the most appropriate care plan for each patient.
Collapse
Affiliation(s)
- Juan Roldán-Merino
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain; Campus Docent Sant Joan de Déu-Fundació Privada, School of Nursing, University of Barcelona, Esplugues de Llobregat, Barcelona, Spain; CIBERSAM (Centro de Investigación Biomédica en Red de Salud Mental), Sant Boi de Llobregat, Barcelona, Spain
| | | | | | | | | | | |
Collapse
|
24
|
|
25
|
Erol A, Putgul G, Kosger F, Ersoy B. Facial emotion recognition in schizophrenia: the impact of gender. Psychiatry Investig 2013; 10:69-74. [PMID: 23482852 PMCID: PMC3590433 DOI: 10.4306/pi.2013.10.1.69] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Revised: 09/20/2012] [Accepted: 10/10/2012] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Previous studies reported gender differences for facial emotion recognition in healthy people, with women performing better than men. Few studies that examined gender differences for facial emotion recognition in schizophrenia brought out inconsistent findings. The aim of this study is to investigate gender differences for facial emotion identification and discrimination abilities in patients with schizophrenia. METHODS 35 female and 35 male patients with schizophrenia, along with 35 female and 35 male healthy controls were included in the study. All the subjects were evaluated with Facial Emotion Identification Test (FEIT), Facial Emotion Discrimination Test (FEDT), and Benton Facial Recognition Test (BFRT). Patients' psychopathological symptoms were rated by means of the Positive and Negative Syndrome Scale (PANSS). RESULTS Male patients performed significantly worse than female patients on FEIT total, and negative scores. Male controls performed significantly worse than female controls on FEIT total and negative scores. On all tasks, female patients performed comparable with controls. Male patients performed significantly worse than controls on FEIT, and FEDT. CONCLUSION Women with schizophrenia outperformed men for facial emotion recognition ability in a pattern that is similar with the healthy controls. It could be claimed that male patients with schizophrenia need special consideration for emotion perception deficits.
Collapse
Affiliation(s)
- Almıla Erol
- Clinic of Psychiatry, Ataturk Education and Research Hospital, Izmir, Turkey
| | - Gulperi Putgul
- Clinic of Psychiatry, Menemen State Hospital, Izmir, Turkey
| | - Ferdi Kosger
- Clinic of Psychiatry, Eskisehir State Hospital, Eskisehir, Turkey
| | - Bilal Ersoy
- Clinic of Psychiatry, Karabuk State Hospital, Karabuk, Turkey
| |
Collapse
|
26
|
Ochoa S, Usall J, Cobo J, Labad X, Kulkarni J. Gender differences in schizophrenia and first-episode psychosis: a comprehensive literature review. SCHIZOPHRENIA RESEARCH AND TREATMENT 2012; 2012:916198. [PMID: 22966451 PMCID: PMC3420456 DOI: 10.1155/2012/916198] [Citation(s) in RCA: 330] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Revised: 01/19/2012] [Accepted: 01/31/2012] [Indexed: 12/20/2022]
Abstract
Recent studies have begun to look at gender differences in schizophrenia and first-episode psychosis in an attempt to explain the heterogeneity of the illness. However, a number of uncertainties remain. This paper tries to summarize the most important findings in gender differences in schizophrenia and first-psychosis episodes. Several studies indicate that the incidence of schizophrenia is higher in men. Most of the studies found the age of onset to be earlier in men than in women. Findings on symptoms are less conclusive, with some authors suggesting that men suffer more negative symptoms while women have more affective symptoms. Premorbid functioning and social functioning seem to be better in females than males. However, cognitive functioning remains an issue, with lack of consensus on differences in neuropsychological profile between women and men. Substance abuse is more common in men than women with schizophrenia and first-episode psychosis. In terms of the disease course, women have better remission and lower relapse rates. Lastly, there is no evidence of specific gender differences in familial risk and obstetric complications. Overall, gender differences have been found in a number of variables, and further study in this area could help provide useful information with a view to improving our care of these patients.
Collapse
Affiliation(s)
- Susana Ochoa
- Research and Developmental Unit of Parc Sanitari Sant Joan de Déu, CIBERSAM. GTRDSM, Sant Boi de Llobregat, 08330 Barcelona, Spain
| | - Judith Usall
- Research and Developmental Unit of Parc Sanitari Sant Joan de Déu, CIBERSAM. GTRDSM, Sant Boi de Llobregat, 08330 Barcelona, Spain
| | - Jesús Cobo
- Department of Mental Health, Corporació Parc Sanitari Taulí, GTRDSM, Sabadell, 08830 Barcelona, Spain
| | - Xavier Labad
- Department of Mental Health, Institut de Psiquiatria Pere Mata, GTRDSM, Reus, Tarragona, Spain
| | - Jayashri Kulkarni
- Monash Alfred Psychiatry Research Centre (MAPrc), “We Mend Minds,” Old Baker Building, The Alfred Commercial Road, Melbourne, VIC 3004, Australia
| |
Collapse
|
27
|
Bertani M, Lasalvia A, Bonetto C, Tosato S, Cristofalo D, Bissoli S, De Santi K, Mazzoncini R, Lazzarotto L, Santi M, Sale A, Scalabrin D, Abate M, Tansella M, Rugger M. The influence of gender on clinical and social characteristics of patients at psychosis onset: A report from the Psychosis Incident Cohort Outcome Study (PICOS). Psychol Med 2012; 42:769-780. [PMID: 21995856 DOI: 10.1017/s0033291711001991] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND. This paper examined the hypothesis that males with first-episode psychosis (FEP) experience lower pre-morbid adjustment, greater social disability and more self-perceived needs at illness onset than females(by controlling for duration of untreated psychosis, diagnosis, age and symptoms at onset). Results disconfirming this hypothesis were thought to suggest the potentially mediating role of social context in determining the impact of symptoms and disability on the everyday lives of male patients in the early phase of psychosis. METHOD. A large epidemiologically representative cohort of FEP patients (n=517) was assessed within the Psychosis Incident Cohort Outcome Study (PICOS) framework – a multi-site research project examining incident cases of psychosis in Italy's Veneto region. RESULTS. Despite poorer pre-morbid functioning and higher social disability at illness onset, males reported fewer unmet needs in the functioning domain than females did. An analysis of help provided by informal care givers showed that males received more help from their families than females did. This finding led us to disconfirm the second part of the hypothesis and suggest that the impact of poorer social performance and unmet needs on everyday life observed in male patients might be hampered by higher tolerance and more support within the family context.CONCLUSIONS. These findings shed new light on rarely investigated sociocultural and contextual factors that may account for the observed discrepancy between social disability and needs for care in FEP patients. They also point to a need for further research on gender differences, with the ultimate aim of delivering gender-sensitive effective mental health care.
Collapse
Affiliation(s)
- M Bertani
- Department of Public Health and Community Medicine, Section of Psychiatry and Clinical Psychology, University of Verona, Verona, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Segarra R, Ojeda N, Zabala A, García J, Catalán A, Eguíluz JI, Gutiérrez M. Similarities in early course among men and women with a first episode of schizophrenia and schizophreniform disorder. Eur Arch Psychiatry Clin Neurosci 2012; 262:95-105. [PMID: 21614663 DOI: 10.1007/s00406-011-0218-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Accepted: 05/10/2011] [Indexed: 11/30/2022]
Abstract
The aims of this study were to analyze the presence of gender differences in the phenotypic expression of schizophrenia at the onset of illness and to explore whether these differences determine clinical and functional outcome 2 years after the initiation of treatment. Data from 231 first-episode-psychosis non-substance-dependent patients (156 men and 75 women) participating in a large-scale naturalistic open-label trial with risperidone were recorded at inclusion and months 1, 6, 12, and 24. Men presented a significant earlier age of onset (24.89 years vs. 29.01 years in women), poorer premorbid functioning, and a higher presence of prodromal and baseline negative symptoms. Women were more frequently married or lived with their partner and children and more frequently presented acute stress during the year previous to onset than men. No other significant clinical or functional differences were detected at baseline. The mean dose of antipsychotic treatment was similar for both genders during the study, and no significant differences in UKU scores were found. The number of hospitalizations was similar between groups, and adherence was more frequent among women. At the 2-year follow-up, both groups obtained significant improvements in outcome measures: PANSS, CGI severity, and GAF scores. Significant gender * time interactions were detected for negative and general PANSS subscales, with the improvement being more pronounced for men. However, no differences were detected for the mean scores obtained during the study in any outcome measure, and the final profile was similar for men and women. Our results suggest that although the initial presentation of schizophrenia can differ according to gender, these differences are not sufficient enough to determine differentiated outcome 2 years after the initiation of treatment in non-substance-dependent patients. The influence of gender on the early course of schizophrenia does not seem to be clinically or functionally decisive in this population.
Collapse
Affiliation(s)
- Rafael Segarra
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Vizcaya, Spain
| | | | | | | | | | | | | |
Collapse
|
29
|
Vila-Rodriguez F, Ochoa S, Autonell J, Usall J, Haro JM. Complex interaction between symptoms, social factors, and gender in social functioning in a community-dwelling sample of schizophrenia. Psychiatr Q 2011; 82:261-74. [PMID: 21301960 DOI: 10.1007/s11126-011-9168-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Social functioning (SF) is the ultimate target aimed in treatment plans in schizophrenia, thus it is critical to know what are the factors that determine SF. Gender is a well-established variable influencing SF, yet it is not known how social variables and symptoms interact in schizophrenia patients. Furthermore, it remains unclear whether the interaction between social variables and symptoms is different in men compared to women. Our aim is to test whether social variables are better predictors of SF in community-dwelled individuals with schizophrenia, and whether men and women differ in how symptoms and social variables interact to impact SF. Community-dwelling individuals with schizophrenia (N = 231) were randomly selected from a register. Participants were assessed with symptom measures (PANSS), performance-based social scale (LSP), objective social and demographic variables. Stratification by gender and stepwise multivariate regression analyses by gender were used to find the best-fitting models that predict SF in both gender. Men had poorer SF than women in spite of showing similar symptom scores. On stepwise regression analyses, gender was the main variable explaining SF, with a significant contribution by disorganized and excitatory symptoms. Age of onset made a less marked, yet significant, contribution to explain SF. When the sample was stratified by gender, disorganized symptoms and 'Income' variable entered the model and accounted for a 30.8% of the SF variance in women. On the other hand, positive and disorganized symptoms entered the model and accounted for a 36.1% of the SF variance in men. Community-dwelling men and women with schizophrenia differ in the constellation of variables associated with SF. Symptom scores still account for most of the variance in SF in both genders.
Collapse
Affiliation(s)
- F Vila-Rodriguez
- Department of Psychiatry, BC Mental Health and Addiction Research Institute, University of British Columbia, 3rd Floor-938 West 28th Ave., CFRI Building, Vancouver, BC, V5Z 4H4, Canada.
| | | | | | | | | |
Collapse
|
30
|
Petkari E, Salazar-Montes AM, Kallert TW, Priebe S, Fiorillo A, Raboch J, Onchev G, Karastergiou A, Nawka A, Dembinskas A, Kiejna A, Kjellin L, Torres-González F, Cervilla JA. Acute psychopathology as a predictor of global functioning in patients with ICD-10 non-affective psychosis: a prospective study in 11 European countries. Schizophr Res 2011; 131:105-11. [PMID: 21624822 DOI: 10.1016/j.schres.2011.05.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2010] [Revised: 05/03/2011] [Accepted: 05/15/2011] [Indexed: 10/18/2022]
Abstract
This prospective analysis aimed to study the influence of psychopathological dimensions on the global functioning of persons suffering from psychotic disorders, taking into account the role of a broad range of potential confounders. A large international cohort (n=1888) with ICD-10 non-affective psychosis was evaluated both at baseline during a hospital admission and three months after discharge. Trained interviewers administered a global functioning scale (GAF) and a psychopathological scale (BPRS) at baseline and follow-up). Baseline BPRS psychopathological dimensions were extracted using Principal Component Analysis. Results of multiple linear regression analyses demonstrated that affective symptoms (depressive or manic) prospectively predict a better global functioning, whilst agitation/cognitive symptoms determined poorer global functioning. Other predictors showing an independent effect on better global functioning were medication compliance, country of residence, female gender, married or coupled status, younger age and having a diagnosis of schizoaffective disorder rather than schizophrenia or other ICD-10 psychosis. A predicting model for global functioning in patients with psychosis is provided, showing that assessment of affective and agitation/cognitive symptoms should be emphasised during admission as they can be more informative than positive/negative symptoms in prospectively planning follow-up care that is geared towards a better functional recovery.
Collapse
Affiliation(s)
- Eleni Petkari
- CIBERSAM, Section of Psychiatry and Medical Psychology, Institute of Neurosciences, Faculty of Medicine, University of Granada, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Kleinhaus K, Harlap S, Perrin M, Manor O, Weiser M, Lichtenberg P, Malaspina D. Age, sex and first treatment of schizophrenia in a population cohort. J Psychiatr Res 2011; 45:136-41. [PMID: 20541769 PMCID: PMC2945697 DOI: 10.1016/j.jpsychires.2010.05.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2010] [Revised: 05/04/2010] [Accepted: 05/07/2010] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Schizophrenia affects men more than women, but this may not be true at all ages. This study examines the incidence of first hospitalization for treatment of schizophrenia in each sex over different ages. METHODS We compared the incidence of first admission for treatment in a cohort of 46,388 males and 43,680 females followed from birth until ages 29-41, using life tables and proportional hazards methods. RESULTS Life table estimates of cumulative incidence by age 40 were 1.44% in males and 0.86% in females. For over all ages the relative risk (RR) in males was 1.6 (95% confidence limits=1.4-1.8) compared with females. Before age 17 there was no significant difference between the sexes (RR=0.86, 0.56-1.3). Excess risk in males was observed only from age 17 (RR=1.7, 1.4-1.9). There was no evidence of the incidence in females catching up with that in males, during the 30s. CONCLUSION In this population, there was a significant change, over age, in the relative incidence of first hospitalization for schizophrenia between the sexes; the excess incidence in males first developed at age 17.
Collapse
Affiliation(s)
- K Kleinhaus
- New York University School of Medicine, Department of Psychiatry, New York, NY, United States.
| | - S Harlap
- Department of Psychiatry, New York University School of Medicine, New York, U.S.A
| | - M Perrin
- Department of Psychiatry, New York University School of Medicine, New York, U.S.A
| | - O Manor
- Hebrew University-Hadassah Braun School of Public Health, Jerusalem, Israel
| | - M Weiser
- Department of Psychiatry, Sheba Medical Center, Tel Hashomer, Israel, Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - P Lichtenberg
- Herzog Hospital and Hadassah Medical School of the Hebrew University of Jerusalem, Israel
| | - D Malaspina
- Department of Psychiatry, New York University School of Medicine, New York, U.S.A
| |
Collapse
|
32
|
Mueser KT, Pratt SI, Bartels SJ, Swain K, Forester B, Cather C, Feldman J. Randomized trial of social rehabilitation and integrated health care for older people with severe mental illness. J Consult Clin Psychol 2010; 78:561-73. [PMID: 20658812 DOI: 10.1037/a0019629] [Citation(s) in RCA: 114] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The Helping Older People Experience Success (HOPES) program was developed to improve psychosocial functioning and reduce long-term medical burden in older people with severe mental illness (SMI) living in the community. HOPES includes 1 year of intensive skills training and health management, followed by a 1-year maintenance phase. METHOD To evaluate effects of HOPES on social skills and psychosocial functioning, we conducted a randomized controlled trial with 183 older adults with SMI (58% schizophrenia spectrum) age 50 and older at 3 sites who were assigned to HOPES or treatment as usual with blinded follow-up assessments at baseline and 1- and 2-year follow-up. RESULTS Retention in the HOPES program was high (80%). Intent-to-treat analyses showed significant improvements for older adults assigned to HOPES compared to treatment as usual in performance measures of social skill, psychosocial and community functioning, negative symptoms, and self-efficacy, with effect sizes in the moderate (.37-.63) range. Exploratory analyses indicated that men improved more than women in the HOPES program, whereas benefit from the program was not related to psychiatric diagnosis, age, or baseline levels of cognitive functioning, psychosocial functioning, or social skill. CONCLUSIONS The results support the feasibility of engaging older adults with SMI in the HOPES program, an intensive psychiatric rehabilitation intervention that incorporates skills training and medical case management, and improves psychosocial functioning in this population. Further research is needed to better understand gender differences in benefit from the HOPES program.
Collapse
Affiliation(s)
- Kim T Mueser
- Department of Psychiatry, Dartmouth Psychiatric Research Center, Dartmouth Medical School, 105 Pleasant Street, Concord, NH 03301, USA.
| | | | | | | | | | | | | |
Collapse
|
33
|
Kulhara P, Avasthi A, Grover S, Sharan P, Sharma P, Malhotra S, Gill S. Needs of Indian schizophrenia patients: an exploratory study from India. Soc Psychiatry Psychiatr Epidemiol 2010; 45:809-18. [PMID: 19707701 DOI: 10.1007/s00127-009-0126-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2009] [Accepted: 08/12/2009] [Indexed: 12/30/2022]
Abstract
BACKGROUND Although there are many studies from the West, no study has evaluated the needs of schizophrenia patients in Indian setting. METHODOLOGY 100 consecutive patients of schizophrenia were assessed on Camberwell Assessment of Needs questionnaire. Same questionnaire was also administered to the caregiver to assess their perception about the needs of the patients. RESULTS Patients and their caregivers reported 8.12 and 7.13 needs, respectively, more than two-third of which were unmet. The most commonly reported needs by both patients and their caregivers were need for welfare benefits. Besides the welfare benefits, the four most common areas in which patients had needs and required help were-psychotic symptoms, psychological distress, information about the condition and money, whereas four most commonly reported area of needs reported by the caregivers were psychological distress, money, company and intimate relationships. Help provided by the government or non-governmental organizations was negligible. CONCLUSIONS Most of needs of schizophrenia patients are unmet.
Collapse
Affiliation(s)
- Parmanand Kulhara
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.
| | | | | | | | | | | | | |
Collapse
|
34
|
Arvidsson H. Gender differences in needs and care of severely mentally ill persons: findings from a Swedish cross-sectional and longitudinal study. Int J Soc Psychiatry 2010; 56:424-35. [PMID: 19628556 DOI: 10.1177/0020764009106631] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND A great amount of research has been done in the area of gender and severe mental illness. However, there is an apparent lack of studies on gender differences concerning needs and care. AIM To analyze differences in needs and care between men and women considered to be severely mentally ill (SMI) after the 1995 Swedish mental health care reform. METHOD In one area of Sweden, surveys were made in 1995/96 and 2006 of persons considered to be SMI. These persons were interviewed and their needs assessed. In a cross-sectional study in 2006, the needs and care of men and women were compared. In a longitudinal study, men and women interviewed in both 1995/96 and 2006 were compared concerning the development of needs and care. RESULTS The structure of needs differed between men and women. Men had more needs concerning functional disability and those needs seemed possible to meet in the existing service structure. Women's needs concerning physical health, information about health and own security, seemed to be more difficult to meet. Only a few gender differences were found in satisfaction with services and service utilization. CONCLUSION It seems urgent to have a gender perspective in a needs-led mental healthcare service.
Collapse
Affiliation(s)
- Hans Arvidsson
- Department of Psychology, University of Gothenburg, Sweden.
| |
Collapse
|
35
|
Thomas P, Wood J, Chandra A, Nimgaonkar VL, Deshpande SN. Differences among Men and Women with Schizophrenia: A Study of US and Indian Samples. Psychiatry Investig 2010; 7:9-16. [PMID: 20396427 PMCID: PMC2848766 DOI: 10.4306/pi.2010.7.1.9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2010] [Revised: 02/23/2010] [Accepted: 02/24/2010] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To test the hypothesis that similar differences in psychopathology are present across cultures among men and women with schizophrenia (SZ). METHODS Sex based differences were tested systematically in two independent samples from the Northeastern USA and North India using the same procedures. The clinical variables were obtained from five interview instruments. RESULTS Among the US participants, the number of significant differences exceeded chance predictions (15/240 variables significant at p<0.02, 6.25%; expected number of significant differences: 5). Similarly, a greater than expected number of variables differed significantly between men and women among the Indian subjects (13/230 differences at p<0.02, 5.65%; expected: 5). One of these variables significantly differed in both samples (lifetime abuse of cannabis). When multivariate analyses were conducted in the combined US and Indian samples sex based differences remained for only four variables: course of the illness, history of inappropriate emotions, marital status and number of children. CONCLUSION Sex based differences in SZ/schizoaffective disorder are present in the USA and India at greater than chance probabilities. The majority of the variables differ across the samples. The biological underpinnings of these variables need further investigation.
Collapse
Affiliation(s)
- Pramod Thomas
- Training Program for Psychiatric Genetics in India, Department of Psychiatry, PGIMER-Dr. Ram Manohar Lohia Hospital, Delhi, India
- Department of Psychiatry, University of Pittsburgh School of Medicine Pittsburgh, PA, USA
| | - Joel Wood
- Department of Psychiatry, University of Pittsburgh School of Medicine Pittsburgh, PA, USA
| | - Abha Chandra
- Department of Statistics, Meerut College, Meerut, UP, USA
| | - Vishwajit L Nimgaonkar
- Department of Psychiatry, University of Pittsburgh School of Medicine Pittsburgh, PA, USA
- Department of Human Genetics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Smita N Deshpande
- Training Program for Psychiatric Genetics in India, Department of Psychiatry, PGIMER-Dr. Ram Manohar Lohia Hospital, Delhi, India
- Department of Psychiatry, PGIMER-Dr. Ram Manohar Lohia Hospital, Delhi, India
| |
Collapse
|
36
|
Cotton SM, Lambert M, Schimmelmann BG, Foley DL, Morley KI, McGorry PD, Conus P. Gender differences in premorbid, entry, treatment, and outcome characteristics in a treated epidemiological sample of 661 patients with first episode psychosis. Schizophr Res 2009; 114:17-24. [PMID: 19635660 DOI: 10.1016/j.schres.2009.07.002] [Citation(s) in RCA: 135] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2009] [Revised: 06/12/2009] [Accepted: 07/04/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Gender differences in psychotic disorder have been observed in terms of illness onset and course; however, past research has been limited by inconsistencies between studies and the lack of epidemiological representative of samples assessed. Thus, the aim of this study was to elucidate gender differences in a treated epidemiological sample of patients with first episode psychosis (FEP). METHODS A medical file audit was used to collect data on premorbid, entry, treatment and 18-month outcome characteristics of 661 FEP consecutive patients treated at the Early Psychosis Prevention and Intervention Centre (EPPIC), Melbourne, Australia. RESULTS Prior to onset of psychosis, females were more likely to have a history of suicide attempts (p=.011) and depression (p=.001). At service entry, females were more likely to have depressive symptoms (p=.007). Conversely, males had marked substance use problems that were evident prior to admission (p<.001) and persisted through treatment (p<.001). At service entry, males also experienced more severe psychopathology (p<.001) and lower levels of functioning (GAF, p=.008; unemployment/not studying p=.004; living with family, p=.003). Treatment non-compliance (p<.001) and frequent hospitalisations (p=.047) were also common for males with FEP. At service discharge males had significantly lower levels of functioning (GAF, p=.008; unemployment/not studying p=.040; living with family, p=.001) compared to females with FEP. CONCLUSIONS Gender differences are evident in illness course of patients with FEP, particularly with respect to past history of psychopathology and functioning at presentation and at service discharge. Strategies to deal with these gender differences need to be considered in early intervention programs.
Collapse
Affiliation(s)
- S M Cotton
- Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Victoria, Australia.
| | | | | | | | | | | | | |
Collapse
|
37
|
Køster A, Lajer M, Lindhardt A, Rosenbaum B. Gender differences in first episode psychosis. Soc Psychiatry Psychiatr Epidemiol 2008; 43:940-6. [PMID: 18574541 DOI: 10.1007/s00127-008-0384-3] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2008] [Accepted: 05/22/2008] [Indexed: 10/22/2022]
Abstract
BACKGROUND In the description of 1 episode schizophrenia patients, female gender is associated with better social function and a higher degree of compliance, while males exhibit more negative symptoms and a higher degree of abuse. The question is raised whether gender specific differences exist which should be taken into consideration in order to provide optimal treatment for the patients. METHODS AND MATERIAL Data from 269 persons (181 men and 88 women), included in the Danish national schizophrenia project (DNS), were registered at inclusion and year 2, and were analyzed according to gender, social functioning, psychopathology, drug consumption and abuse during the course of 2 years treatment. RESULTS Women had longer duration of illness before treatment and exhibited more affective symptoms while men were more socially isolated and had more negative symptoms. Alcohol and drug abuse appeared significantly more among men. Women were comparatively more heavily medicated than men. Social function, PANSS negative, drug consumption, affective symptomatology and abuse improved significantly after 2 years follow-up. CONCLUSION The gender differences demonstrated in the study suggest gender specific treatment interventions in order to provide optimal treatment for both male and female patients.
Collapse
Affiliation(s)
- Anne Køster
- Center of Psychiatry at Rigshospitalet, University of Copenhagen, Faculty of Health Sciences, Copenhagen, Denmark.
| | | | | | | |
Collapse
|
38
|
Bhatia T, Chakraborty S, Thomas P, Naik A, Mazumdar S, Nimgaonkar VL, Deshpande SN. Is familiality associated with downward occupation drift in schizophrenia? Psychiatry Investig 2008; 5:168-74. [PMID: 20046361 PMCID: PMC2796027 DOI: 10.4306/pi.2008.5.3.168] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE Downward occupational drift has been extensively investigated in schizophrenia. It is known that certain illness related factors, such as severity, affect drift, but the impact of familial factors has not been investigated. METHODS Occupation drift was studied among patients with schizophrenia/schizoaffective disorder (SZ/SZA)(n=523) and 130 affected sib pairs (ASPs). Drift was analyzed in relation to familiality as well as demographic and clinical variables. For comparison one proband (one of the affected siblings) from each ASP was selected. Occupation drift was measured in relation to the most responsible job held, and with regard to head of the household (HOH) occupation status. RESULTS There was no significant difference between single affected and ASP probands in terms of occupational drift from the most responsible job (drifted 39.2% and 38% respectively) and with regard to HOH's occupation (drifted 88% and 82.8% respectively). A significant part of the sample remained unemployed in both single affected and ASP samples. Thus, there was no significant impact of familiality on these variables. However, marital status, pattern of severity, age at onset, gender were found to be associated with downward occupation drift in single affected probands while the only significant factor in familial probands was pattern of severity of severity when measuring in terms of downward drift from most responsible job. CONCLUSION Though there is occupation drift in schizophrenia, there is no detectable impact of familial factors. Employment is associated with severity of delete.
Collapse
Affiliation(s)
- Triptish Bhatia
- Training Program for Psychiatric Genetics in India, Dr RML Hospital, New Delhi, India
| | - Satabdi Chakraborty
- Training Program for Psychiatric Genetics in India, Dr RML Hospital, New Delhi, India
| | - Pramod Thomas
- Training Program for Psychiatric Genetics in India, Dr RML Hospital, New Delhi, India
| | - Amina Naik
- Genetic Susceptibility in Schizophrenia, Dr RML Hospital, New Delhi, India
| | - Sati Mazumdar
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, USA
| | | | - Smita N Deshpande
- Training Program for Psychiatric Genetics in India, Dr RML Hospital, New Delhi, India
| |
Collapse
|
39
|
Barceló M, Villalta V, Serrano A, Araya S, Ochoa S, Usall J. Influencia de la menopausia y el sexo en el funcionamiento neuropsicológico de pacientes con esquizofrenia. ACTA ACUST UNITED AC 2007. [DOI: 10.1016/s1134-5934(07)73283-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
40
|
Villalta-Gil V, Vilaplana M, Ochoa S, Haro JM, Dolz M, Usall J, Cervilla J. Neurocognitive performance and negative symptoms: are they equal in explaining disability in schizophrenia outpatients? Schizophr Res 2006; 87:246-53. [PMID: 16859898 DOI: 10.1016/j.schres.2006.06.013] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2006] [Revised: 06/07/2006] [Accepted: 06/08/2006] [Indexed: 01/24/2023]
Abstract
OBJECTIVE The aim of this study is to assess if cognitive variables and symptom dimensions can predict disability in a sample of outpatients with schizophrenia. METHOD A cross-sectional sample of 113 individuals with a diagnosis of schizophrenia (DSM-IV criteria) was selected from a computerized register of five Community Mental Health Centers. Patients were assessed by two trained psychologists, with a neuropsychological battery comprising measures for verbal memory, attention, operative memory and abstraction and flexibility functions. Symptoms were assessed with the Positive and Negative Syndrome Scale (PANSS); a socio-demographic and clinical questionnaire, comprising the Disability Assessment Scale (DAS), was also completed. Test scores were standardized (t scores) to performance of healthy controls. To assess the relationship between clinical and sociodemographic factors and disability and cognitive functioning Pearson's correlation coefficients were computed. In order to establish the predictive capacity of the cognitive, clinical and symptom variables on disability linear regression models were fitted. RESULTS Mean age of patients was 41.6 years and 68% were male. Higher ratings in the negative dimension were associated with more cognitive deficits. Association with the positive dimension was present but less strong. All disability areas, except for disability in occupational functioning, were partially explained by the negative dimension. Disability in family functioning was also partially explained by attention and number of admissions since onset. CONCLUSION Negative symptoms are the major source of disability of our sample and are also associated to cognitive functioning. The present findings suggest that further investigation on the mediators between clinical and social outcomes may help to design specific treatments to reduce disability.
Collapse
Affiliation(s)
- Victoria Villalta-Gil
- Research and Development Unit, Sant Joan de Déu- Serveis de Salut Mental, Fundació Sant Joan de Déu, C/ Dr. Antoni Pujadas 42, 08830, St. Boi de Llobregat, Barcelona, Spain
| | | | | | | | | | | | | |
Collapse
|
41
|
Williams R, Kopala L, Malla A, Smith G, Love L, Balshaw R. Medication decisions and clinical outcomes in the Canadian National Outcomes Measurement Study in Schizophrenia. Acta Psychiatr Scand 2006:12-21. [PMID: 16542321 DOI: 10.1111/j.1600-0447.2006.00757.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate over a 2-year period, patients from academic/non-academic centres, from each region of Canada, to determine whether location or other variables such as medication type, gender or income was associated with outcome as defined by non-hospitalization and persistence on original treatment. METHOD A total of 448 patients were recruited from academic and non-academic centres across all provinces of Canada and followed up for 2 years. RESULTS Patients from British Columbia had significantly lower rates of hospitalization than patients from other provinces. Male patients showed greater symptomatic improvement at 2 years from initial assessment compared to females. Patients on clozapine, risperidone and olanzapine were least likely to be hospitalized. CONCLUSION There were some regional differences noted in both utilization of types of antipsychotic medications and hospitalization rates. In this sample of stable out-patients over 70% who started on monotherapy with clozapine, risperidone, olanzapine and quetiapine remained on the same medication over the 2-year study period.
Collapse
Affiliation(s)
- R Williams
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.
| | | | | | | | | | | |
Collapse
|
42
|
Lauber C, Lay B, Rössler W. Homeless people at disadvantage in mental health services. Eur Arch Psychiatry Clin Neurosci 2006; 256:138-45. [PMID: 16639520 DOI: 10.1007/s00406-005-0616-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2005] [Accepted: 07/27/2005] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The aims of this study are threefold: to depict characteristics of homeless at discharge from a psychiatric hospital; to describe the utilisation of inpatient care and treatment measures during hospitalisation; and to analyse to what extent psychiatric disorders and clinical variables contribute to the risk for homelessness at discharge. METHODS Based on case register data we analysed all 28,204 people consecutively referred in 1996-2001 to psychiatric hospitals of a well-defined catchment area in Switzerland. RESULTS 1% (N=269) of all admissions were homeless at discharge (mean age: 32.0 years; women: 27.9 %). Compared to other psychiatric inpatients, we found among the homeless more males, more people with younger age and lower education. Regarding treatment measures during the inpatient stay, homeless received less often psychopharmacotherapy, ergotherapy and physiotherapy, but more vocational training, occupational therapy and support by social workers. There was no difference between homeless and others regarding compulsory medication or seclusion. Homeless had a shorter length of inpatient stay. Risk factors for being homeless at discharge were: being homeless at admission, not living in a relationship, having a multiple substance abuse or a dual diagnosis, low clinical improvement during inpatient treatment and discharge against medical advice. DISCUSSION To prevent homelessness at discharge, it is important to consider all independent contributors, i. e. the living situation before admission, health care inequalities during inpatient treatment (care received, low clinical improvement, discharge planning) and psychopathology.
Collapse
Affiliation(s)
- Christoph Lauber
- Psychiatric University Hospital, Research Unit for Clinical and Social Psychiatry, Zurich, Switzerland.
| | | | | |
Collapse
|
43
|
Procopio M, Davies RJE, Marriott P. The hormonal environment in utero as a potential aetiological agent for schizophrenia. Eur Arch Psychiatry Clin Neurosci 2006; 256:77-81. [PMID: 16133738 DOI: 10.1007/s00406-005-0604-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2004] [Accepted: 05/24/2005] [Indexed: 11/24/2022]
Abstract
There is consistent evidence in the literature that the foetal neurodevelopmental period is crucial for the genesis of schizophrenia later in adult life. There are also strong indications that the schizophrenic illness has sexually dimorphic features. A hypothesis consistent with both findings is that sexual hormones may act as aetiological agents for schizophrenia during the foetal period influencing the neurodevelopment in a differential way in males and females. The aim of this study is to verify this hypothesis exploiting the correlation between fingers' length in adults and hormonal concentrations in utero, which has been demonstrated in previous studies. More specifically, the literature shows that the lengths of the second and fourth finger in adults are proportional to the foetal concentrations of respectively oestrogens and androgens. When the sample of patients suffering from schizophrenia analysed in this study was compared with healthy subjects, it was observed that the average length of the second digit in the female schizophrenic sample resulted significantly shorter than in the female controls. There was no significant difference when the male schizophrenic sample was compared with male controls. The result of the study is, therefore, compatible with the hypothesis that oestrogenic hormones protect female foetuses from damage during the neurodevelopment in utero and ultimately give more benign characteristics to the schizophrenic illness in women.
Collapse
Affiliation(s)
- Marco Procopio
- Priory Hospital Hove UK & Medical School, University of Brighton, Brighton, UK.
| | | | | |
Collapse
|
44
|
|
45
|
Ochoa S, Haro JM, Usall J, Autonell J, Vicens E, Asensio F. Needs and its relation to symptom dimensions in a sample of outpatients with schizophrenia. Schizophr Res 2005; 75:129-34. [PMID: 15820331 DOI: 10.1016/j.schres.2004.06.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2004] [Revised: 06/02/2004] [Accepted: 06/02/2004] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To analyse the association between symptom dimensions in schizophrenia and number and type of met and unmet needs. METHOD A sample of 231 outpatients randomly selected from a register that included all patients treated in 5 mental health care centres (MHCC) was evaluated. Assessment instruments included the Camberwell Assessment of Needs (CAN) questionnaire and the PANSS. RESULTS Number of needs are related to overall severity of psychopathology. Patients with more symptoms have more total needs (p < 0.001) and unmet needs (p < 0.001). A multiple lineal regression model showed that the disorganized and excited dimensions of the PANSS are the most important components for explaining the variance of number of needs. Type of needs is related to subtypes of schizophrenia, specially with disorganized and excited symptoms. CONCLUSION Psychosocial needs are related to schizophrenia subtypes. Patients with more needs are those with more disorganized and excitatory symptoms.
Collapse
Affiliation(s)
- S Ochoa
- Research and Development Unit, Sant Joan de Déu-SSM, C/ Dr. Pujades, 42, 08830 Sant Boi de Llobregat, Barcelona, Spain.
| | | | | | | | | | | |
Collapse
|