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Redlich Bossy M, Müller DR, Niedermoser DW, Burrer A, Spiller TR, Vetter S, Seifritz E, Egger ST. Impact of psychopathology on day-to-day living in patients with schizophrenia: A network analysis. Compr Psychiatry 2024; 133:152501. [PMID: 38820645 DOI: 10.1016/j.comppsych.2024.152501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 04/26/2024] [Accepted: 05/11/2024] [Indexed: 06/02/2024] Open
Abstract
Although the relationship between schizophrenia and disability is well established, the association between the symptoms of the disorder and functional domains remains unclear. The current study explored the nuances of the relationship between symptoms and domains of functioning in a sample of 1127 patients with schizophrenia. We assessed the symptoms of schizophrenia with the Positive and Negative Syndrome Scale (PANSS) and psychosocial functioning with the mini-ICF-APP (mini-International Classification of Functioning Rating for Limitations of Activities and Participation in Psychological Disorders). The mean PANSS score was 94.28 (27.20), and the mean mini-ICF-APP score was 25.25 (8.96), both of which are indicative of severe symptom load and impairment. We were able to show a strong relationship and overlap between symptoms and disability in patients with schizophrenia. We identified several symptoms related to functional impairment. Deficits in judgment and abstract thinking contribute to impairment through poor adherence (to routines and compliance with rules) and difficulties in planning and organizing. We believe that in schizophrenia, symptoms and their interactions constitute a disorder beyond any single manifestation. Furthermore, we suggest that cognitive testing and cognitive treatment should become part of the standard of care for patients with schizophrenia.
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Affiliation(s)
- Mona Redlich Bossy
- Department of Adult Psychiatry and Psychotherapy, University Psychiatric Hospital Zurich, Faculty of Medicine, University of Zurich, Zurich, Switzerland; Department of Psychology, Faculty of Humanities, University of Fribourg, Fribourg, Switzerland
| | - Daniel R Müller
- Department of Psychology, Faculty of Humanities, University of Fribourg, Fribourg, Switzerland; Department of Psychiatry and Psychotherapy, University Hospital of Psychiatry and Psychotherapy, Faculty of Medice, University of Bern, Bern, Switzerland
| | | | - Achim Burrer
- Department of Adult Psychiatry and Psychotherapy, University Psychiatric Hospital Zurich, Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Tobias R Spiller
- Department of Adult Psychiatry and Psychotherapy, University Psychiatric Hospital Zurich, Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Stefan Vetter
- Department of Adult Psychiatry and Psychotherapy, University Psychiatric Hospital Zurich, Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Erich Seifritz
- Department of Adult Psychiatry and Psychotherapy, University Psychiatric Hospital Zurich, Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Stephan T Egger
- Department of Adult Psychiatry and Psychotherapy, University Psychiatric Hospital Zurich, Faculty of Medicine, University of Zurich, Zurich, Switzerland.
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Rosburg T, Deuring G, Ebner G, Hauch V, Pflueger MO, Stieglitz RD, Calabrese P, Schaub B, Cotar T, Jabat M, Jokeit H, Bollag Y, Mager R. Digitally Assisted Standard Diagnostics in Insurance Medicine (DASDIM): psychometric data in psychiatric work disability evaluations. Disabil Rehabil 2023; 45:4457-4470. [PMID: 36523117 DOI: 10.1080/09638288.2022.2151655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 11/20/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE Insurers often commission psychiatric experts to evaluate the eligibility of workers with mental disorders for disability benefits, by estimating their residual work capacity (RWC). We investigated the validity of a standardized, computer-based battery of established diagnostic instruments, for evaluating the personality, cognition, performance, symptom burden, and symptom validity of claimants. METHODS One hundred and fifty-three claimants for benefits were assessed by the assembled test battery, which was applied in addition to a conventional clinical work disability evaluation. RESULTS A principal component analysis of the test and questionnaire battery data revealed six factors (Negative Affectivity, Self-Perceived Work Ability, Behavioral Dysfunction, Working Memory, Cognitive Processing Speed, and Excessive Work Commitment). Claimants with low, medium, and high RWC exclusively varied in the factor Negative Affectivity. Importantly, this factor also showed a strong association to psychiatric ratings of capacity limitations in psychosocial functioning. CONCLUSIONS The findings demonstrate that the used test battery allows a substantiation of RWC estimates and of psychiatric ratings by objective and standardized data. If routinely incorporated in work disability evaluations, the test battery could increase their transparency for all stakeholders (insurers, claimants, medical experts, expert case-coordinators, and legal practitioners) and would open new avenues for research in the field of insurance medicine.Implications for rehabilitationThe residual work capacity (RWC) estimation by medical experts is internationally good practice, but plagued by a relatively low interrater agreement.The current study shows that psychiatric RWC estimates and capacity limitation ratings can be substantiated by data from objective, standardized psychometric instruments.Systematically using such instruments might help to improve the poor interrater agreement for RWC estimates in work disability evaluations.Such data could also be used for adopting vocational trainings and return-to-work programs to the individual needs of workers with mental health problems.
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Affiliation(s)
- Timm Rosburg
- Department of Clinical Research, Evidence-based Insurance Medicine (EbIM) Research & Education, University of Basel Hospital, Basel, Switzerland
- Forensic Department, University of Basel, University Psychiatric Clinics, Basel, Switzerland
| | - Gunnar Deuring
- Forensic Department, University of Basel, University Psychiatric Clinics, Basel, Switzerland
- Center for Affective, Stress and Sleep Disorders, University of Basel, University Psychiatric Clinics, Basel, Switzerland
| | - Gerhard Ebner
- Psychiatric Clinics of the University of Basel, Swiss Insurance Medicine (SIM), Zurich, Switzerland
| | - Valerie Hauch
- Forensic Department, University of Basel, University Psychiatric Clinics, Basel, Switzerland
| | - Marlon O Pflueger
- Forensic Department, University of Basel, University Psychiatric Clinics, Basel, Switzerland
- Faculty of Psychology, University of Basel, Basel, Switzerland
| | | | - Pasquale Calabrese
- Department of Neuropsychology and Behavioral Neurology, Faculty of Psychology, University of Basel, Basel, Switzerland
| | | | | | - Mounira Jabat
- Department of Psychiatry, University of Zurich, Psychiatric University Hospital, Zurich, Switzerland
| | | | - Yvonne Bollag
- University of Basel Hospital, Asim, Basel, Switzerland
| | - Ralph Mager
- Forensic Department, University of Basel, University Psychiatric Clinics, Basel, Switzerland
- Department of Neuropsychology and Behavioral Neurology, Faculty of Psychology, University of Basel, Basel, Switzerland
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Just SA, Bröcker AL, Ryazanskaya G, Nenchev I, Schneider M, Bermpohl F, Heinz A, Montag C. Validation of natural language processing methods capturing semantic incoherence in the speech of patients with non-affective psychosis. Front Psychiatry 2023; 14:1208856. [PMID: 37564246 PMCID: PMC10411549 DOI: 10.3389/fpsyt.2023.1208856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 07/07/2023] [Indexed: 08/12/2023] Open
Abstract
Background Impairments in speech production are a core symptom of non-affective psychosis (NAP). While traditional clinical ratings of patients' speech involve a subjective human factor, modern methods of natural language processing (NLP) promise an automatic and objective way of analyzing patients' speech. This study aimed to validate NLP methods for analyzing speech production in NAP patients. Methods Speech samples from patients with a diagnosis of schizophrenia or schizoaffective disorder were obtained at two measurement points, 6 months apart. Out of N = 71 patients at T1, speech samples were also available for N = 54 patients at T2. Global and local models of semantic coherence as well as different word embeddings (word2vec vs. GloVe) were applied to the transcribed speech samples. They were tested and compared regarding their correlation with clinical ratings and external criteria from cross-sectional and longitudinal measurements. Results Results did not show differences for global vs. local coherence models and found more significant correlations between word2vec models and clinically relevant outcome variables than for GloVe models. Exploratory analysis of longitudinal data did not yield significant correlation with coherence scores. Conclusion These results indicate that natural language processing methods need to be critically validated in more studies and carefully selected before clinical application.
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Affiliation(s)
- Sandra Anna Just
- Department of Psychiatry and Neurosciences, Campus Charité Mitte, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Anna-Lena Bröcker
- Department of Psychiatry and Neurosciences, Campus Charité Mitte, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | | | - Ivan Nenchev
- Department of Psychiatry and Neurosciences, Campus Charité Mitte, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Maria Schneider
- IPB Institut für Integrative Psychotherapieausbildung Berlin, MSB Medical School Berlin, GmbH, Berlin, Germany
| | - Felix Bermpohl
- Department of Psychiatry and Neurosciences, Campus Charité Mitte, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Andreas Heinz
- Department of Psychiatry and Neurosciences, Campus Charité Mitte, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Christiane Montag
- Department of Psychiatry and Neurosciences, Campus Charité Mitte, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
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Schöwe L, Kröger C, Kobelt-Poenicke A. Berentung wegen voller Erwerbsminderung: Erfüllen
psychiatrische Gutachten die Qualitätskriterien für die
sozialmedizinische Begutachtung? DIE REHABILITATION 2022. [DOI: 10.1055/a-1932-3079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Zusammenfassung
Ziel Die Qualität von sozialmedizinischen Gutachten, die im Rahmen
von Anträgen auf Erwerbsminderungsrente wegen psychischer
Störung für die Deutsche Rentenversicherung (DRV) angefertigt
werden, ist bislang kaum untersucht worden. In der vorliegenden Studie sollte
untersucht werden, inwieweit fachärztliche Gutachten zur
Posttraumatischen Belastungsstörung (PTBS) der Leitlinie der DRV zu
sozialmedizinischen Gutachten bei psychischen und Verhaltensstörungen
entsprechen.
Methodik Zur Überprüfung der Gutachtenqualität
wurden 52 sozialmedizinische Gutachten, in denen die Diagnose einer
Posttraumatischen Belastungsstörung (PTBS) vergeben und ein
Leistungsvermögen von unter drei Stunden festgestellt wurde, analysiert.
Die Gutachtenqualität wurde sowohl quantitativ mit der Berechnung von
Qualitätspunkten, als auch qualitativ durch inhaltliche Analysen
erfasst. Zur Überprüfung der
Beurteiler_innenübereinstimmung wurde die prozentuale
Übereinstimmung und Cohens Kappa für zwei Rater_innen anhand
einer Teilstichprobe (n=11) berechnet.
Ergebnisse Die analysierten Gutachten erreichten durchschnittlich 36,1
(SD=7,4) von 92 möglichen Qualitätspunkten (Range
22/56). In den meisten Gutachten waren die Beschreibungen der
Teilhabeeinschränkungen, der Epikrise und der sozialmedizinischen
Schlussbildung unbefriedigend.
Schlussfolgerung Die
unzureichende Darstellung der Funktions- und Teilhabeeinschränkungen in
den Gutachten wird möglicherweise dem tatsächlichen Sachverhalt
nicht gerecht, so dass der Beweis einer Gesundheitsstörung mit den
entsprechenden Leistungseinschränkungen nicht zweifelsfrei erbracht
werden kann. Dementsprechend sind Maßnahmen zur Verbesserung der
Gutachtenqualität wie Schulungen und regelmäßige
Qualitätsüberprüfungen notwendig.
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Affiliation(s)
- Lisa Schöwe
- Klinische Psychologie und Psychotherapie, Universität
Hildesheim Institut für Psychologie, Hildesheim, Germany
| | - Christoph Kröger
- Klinische Psychologie und Psychotherapie, Universität
Hildesheim Institut für Psychologie, Hildesheim, Germany
| | - Axel Kobelt-Poenicke
- Klinische Psychologie und Psychotherapie, Universität
Hildesheim Institut für Psychologie, Hildesheim, Germany
- Referat Rehastrategie, Deutsche Rentenversicherung
Braunschweig-Hannover, Laatzen, Germany
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Hofmann AB, Schmid HM, Jabat M, Brackmann N, Noboa V, Bobes J, Garcia-Portilla MP, Seifritz E, Vetter S, Egger ST. Utility and validity of the Brief Psychiatric Rating Scale (BPRS) as a transdiagnostic scale. Psychiatry Res 2022; 314:114659. [PMID: 35709637 DOI: 10.1016/j.psychres.2022.114659] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 05/15/2022] [Accepted: 05/30/2022] [Indexed: 10/18/2022]
Abstract
The Brief Psychiatric Rating Scale (BPRS) was originally conceived to assess psychopathology in several psychiatric disorders, making it an appropriate candidate to be used as a transdiagnostic instrument. We analyzed the utility and validity of the BPRS in a diagnostically heterogeneous sample of 600 psychiatric inpatients. As a comparator, we chose the mini-ICF-APP, a scale used to measure functioning and impairment across the diagnostic spectrum. Both scales had good internal consistency. The BPRS and the mini-ICF-APP showed a moderate correlation, with good levels of agreement. We were able to identify general symptoms present across the diagnostic spectrum, influencing severity and a cluster of symptoms specific for each diagnosis. Our results show the utility and validity of the BPRS as a transdiagnostic assessment tool that could easily be introduced in routine clinical work.
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Affiliation(s)
- Andreas B Hofmann
- University of Zurich, Faculty of Medicine, Psychiatric University Hospital of Zurich, Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich, Switzerland
| | - Hanna M Schmid
- University of Zurich, Faculty of Medicine, Psychiatric University Hospital of Zurich, Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich, Switzerland
| | - Mounira Jabat
- University of Zurich, Faculty of Medicine, Psychiatric University Hospital of Zurich, Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich, Switzerland
| | - Nathalie Brackmann
- University of Zurich, Faculty of Medicine, Psychiatric University Hospital of Zurich, Department of Forensic Psychiatry, Zurich, Switzerland
| | - Vanessa Noboa
- University of Zurich, Faculty of Medicine, Psychiatric University Hospital of Zurich, Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich, Switzerland; University San Francisco de Quito, Faculty of Medicine, Quito, Ecuador
| | - Julio Bobes
- University of Oviedo, Faculty of Medicine, Department of Psychiatry, ISPA, INEUROPA, CIBERSAM, Oviedo, Spain
| | - Maria Paz Garcia-Portilla
- University of Oviedo, Faculty of Medicine, Department of Psychiatry, ISPA, INEUROPA, CIBERSAM, Oviedo, Spain
| | - Erich Seifritz
- University of Zurich, Faculty of Medicine, Psychiatric University Hospital of Zurich, Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich, Switzerland
| | - Stefan Vetter
- University of Zurich, Faculty of Medicine, Psychiatric University Hospital of Zurich, Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich, Switzerland
| | - Stephan T Egger
- University of Zurich, Faculty of Medicine, Psychiatric University Hospital of Zurich, Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich, Switzerland; University of Oviedo, Faculty of Medicine, Department of Psychiatry, ISPA, INEUROPA, CIBERSAM, Oviedo, Spain.
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Papst L, Köllner V. Using machine learning to investigate earning capacity in patients undergoing psychosomatic rehabilitation-A retrospective health data analysis. Front Psychiatry 2022; 13:1039914. [PMID: 36339869 PMCID: PMC9630905 DOI: 10.3389/fpsyt.2022.1039914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 10/06/2022] [Indexed: 11/21/2022] Open
Abstract
Psychiatric disorders increasingly contribute to disability and early retirement. This study was conducted to investigate whether machine learning can contribute to a better understanding and assessment of such a reduced earning capacity. It analyzed whether impaired earning capacity is reflected in missing treatment effects, and which interventions drive treatment effects during psychosomatic rehabilitation. Analyses were based on routine clinical data encompassing demographics, diagnoses, psychological questionnaires before, and after treatment, interventions, and an interdisciplinary assessment of earning capacity for N = 1,054 patients undergoing psychosomatic rehabilitation in 2019. Classification of patients by changes in self-reported mental health and interventions predictive of changes were analyzed by gradient boosted model. Clustering results revealed three major groups, one of which was comprised almost exclusively of patients with full earning capacity, one of patients with reduced or lost earning capacity and a third group with mixed assessments. Classification results (Kappa = 0.22) indicated that patients experienced modestly divergent changes over the course of rehabilitation. Relative variable influence in the best model was highest for changes in psychological wellbeing (HEALTH-49). Regression analysis identified intervention A620 (physical exercise therapy with psychological goal setting) as most influential variable predicting changes in psychological wellbeing with a model fit of R 2 = 0.05 (SD = 0.007). Results suggest that disability due to psychiatric disorders does associate with distinct demographic and clinical characteristics but may be less clear-cut in a subgroup of patients. Trajectories of treatment response show moderately divergent paths between patient groups. Moreover, results support both physical exercise therapy as efficient intervention in reducing disability-associated impairments and the complementarity of a multimodal treatment plan.
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Affiliation(s)
- Lilia Papst
- Psychosomatic Rehabilitation Research Group, Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité University Medicine Berlin, Berlin, Germany
| | - Volker Köllner
- Psychosomatic Rehabilitation Research Group, Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité University Medicine Berlin, Berlin, Germany.,Department of Psychosomatics and Behavioural Psychotherapy, Rehabilitation Centre Seehof, Teltow, Germany
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Exploring the factor structure of the mini-ICF-APP in an inpatient clinical sample, according to the psychiatric diagnosis. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2021; 14:186-195. [PMID: 34861928 DOI: 10.1016/j.rpsmen.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 05/16/2020] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Psychosocial functioning is a key factor determining prognosis, severity, impairment and quality of life in people who have a mental disorder. The mini-ICF-APP was developed to provide a standardised classification of functioning and disability. However, despite its gaining popularity little is known about its structure and performance. This paper examines the structure of the mini-ICF-APP using factor analysis techniques. MATERIALS AND METHODS In a clinical sample of 3178 patients, with psychiatric diagnoses from several ICD-10 categories, we analysed internal consistency, item inter-correlations and the factorial structure of the data, with reference to ICD-10 diagnostic categories; Neurocognitive Disorders; Alcohol Use Disorders; Substance Use Disorders; Schizophrenia and Psychotic Disorders; Bipolar Disorder; Major Depressive Disorder; Anxiety Disorders; Personality Disorders; and Neurodevelopmental Disorders. RESULTS We found good internal consistency and item inter-correlations (Cronbach alpha=0.92) for the mini-ICF-APP. We were able to identify pivotal domains (flexibility, assertiveness and intimate relationships), which demonstrate sub-threshold influences on other domains. The factor analysis yielded a one-factor model as ideal for the whole sample and for all diagnostic categories. For some diagnostic categories the data suggested a two or three-factor model, however, with poorer fit indices. CONCLUSIONS The factor structure of the mini-ICF-APP appears to modify according to the main diagnosis. However, a one-factor model demonstrates better fit regardless of diagnostic category. Consequently, we consider the mini-ICF-APP to be a trans-diagnostic measurement instrument for the assessment and grading of psychosocial functioning. The use of the mini-ICF-APP sum score seems to best reflect the degree of impairment in an individual, even taking into account that affected domains may lead to sub-threshold effects on other domains.
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Egger ST, Knorr M, Bobes J, Bernstein A, Seifritz E, Vetter S. Real-Time Assessment of Stress and Stress Response Using Digital Phenotyping: A Study Protocol. Front Digit Health 2021; 2:544418. [PMID: 34713030 PMCID: PMC8521792 DOI: 10.3389/fdgth.2020.544418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 08/26/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Stress is a complex phenomenon that may have a negative influence on health and well-being; consequently, it plays a pivotal role in mental health. Although the incidence of mental disorders has been continuously rising, development of prevention and treatment methods has been rather slow. Through the ubiquitous presence of smartphones and wearable devices, people can monitor stress parameters in everyday life. However, the reliability and validity of such monitoring are still unsatisfactory. Methods: The aim of this trial is to find a relationship between psychological stress and saliva cortisol levels on the one hand and physiological parameters measured by smartphones in combination with a commercially available wearable device on the other. Participants include cohorts of individuals with and without a psychiatric disorder. The study is conducted in two settings: one naturalistic and one a controlled laboratory environment, combining ecological momentary assessment (EMA) and digital phenotyping (DP). EMA is used for the assessment of challenging and stressful situations coincidentally happening during a whole observation week. DP is used during a controlled stress situation with the Trier Social Stress Test (TSST) as a standardized psychobiological paradigm. Initially, participants undergo a complete psychological screening and profiling using a standardized psychometric test battery. EMA uses a smartphone application, and the participants keep a diary about their daily routine, activities, well-being, sleep, and difficult and stressful situations they may encounter. DP is conducted through wearable devices able to continuously monitor physiological parameters (i.e., heart rate, heart rate variability, skin conductivity, temperature, movement and acceleration). Additionally, saliva cortisol samples are repeatedly taken. The TSST is conducted with continuous measurement of the same parameters measured during the EMA. Discussion: We aim to identify valid and reliable digital biomarkers for stress and stress reactions. Furthermore, we expect to find a way of early detection of psychological stress in order to evolve new opportunities for interventions reducing stress. That may allow us to find new ways of treating and preventing mental disorders. Trial Registration: The competing ethics committee of the Canton of Zurich, Switzerland, approved the study protocol V05.1 May 28, 2019 [BASEC: 2019-00814]; the trial was registered at ClinicalTrials.gov [NCT04100213] on September 19, 2019.
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Affiliation(s)
- Stephan T Egger
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, Psychiatric University Hospital of Zurich, University of Zurich, Zurich, Switzerland.,Department of Psychiatry, Faculty of Medicine, University of Oviedo, CIBERSAM, Oviedo, Spain
| | - Marius Knorr
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, Psychiatric University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Julio Bobes
- Department of Psychiatry, Faculty of Medicine, University of Oviedo, CIBERSAM, Oviedo, Spain
| | - Abraham Bernstein
- Department of Informatics, University of Zurich, Zurich, Switzerland
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, Psychiatric University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Stefan Vetter
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, Psychiatric University Hospital of Zurich, University of Zurich, Zurich, Switzerland
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Abstract
BACKGROUND This study addresses the question of whether psychosocial functioning measured by the Personal and Social Performance (PSP) Scale is related to various psychopathological measures in a cohort of patients with schizophrenia. METHODS The 'Neuroleptic Strategy Study' (NeSSy) performed at 14 German hospitals between 2010 and 2013 compared two treatment strategies instead of individual drugs. Secondary end-points were the two PSP scales as well as measures of quality of life (SF-36) and the Positive and Negative Syndrome Scale (PANSS). RESULTS 149 patients were randomised. There was no difference between the two treatment strategies (first-generation versus second-generation antipsychotics) with regard to the PSP. There were differences in doctors' assessments regarding psychosocial functioning compared with patients' own assessments. Furthermore, there were relationships between the PSP and quality of life, level of skills (ICF), and severity of disease (PANSS), level of sexual activities and poor well-being under antipsychotic medication but not with cognitive changes. CONCLUSIONS The findings on psychosocial functioning of patients with schizophrenia related to severity and skill level could be confirmed. Further findings were the correlation between psychosocial functioning and quality of life, well-being under treatment, and sexuality what emphasizes the substantial importance of a reduced psychosocial functioning.
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Redlich Bossy M, Mueller D, Seifritz E, Vetter S, Egger ST. Feasibility and Efficacy of a Psychological Therapy for Patients With a Schizophrenic Psychosis in an Inpatient Setting: Study Protocol of a Randomized Switch Controlled Trial. Front Public Health 2020; 8:391. [PMID: 32903368 PMCID: PMC7434967 DOI: 10.3389/fpubh.2020.00391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 07/03/2020] [Indexed: 11/23/2022] Open
Abstract
Background: Schizophrenic psychoses are severe mental disorders. Despite advances in treatment, outcomes are still unsatisfactory. Pharmacological treatments are still limited, in particular regarding improvements in psychosocial functioning and neuro-cognitive impairment. In recent years new psychological therapies have been developed, demonstrating promising results. However, most of these interventions have been designed for and studied in outpatients; their efficacy and feasibility for patients requiring hospitalization is still unknown. Therefore, we have designed a clinical trial to compare a neuro-cognitive (Integrated Neuro-cognitive Treatment INT); a cognitive-behavioral (Integrated Psychological Therapy IPT); and a control (Cogpack CGP) intervention for patients with a schizophrenic psychosis hospitalized for treatment. Methods: In a three-parallel-arm, single-blind, randomized, controlled study, we compare INT, IPT, and CGP. Participants will take part in two weekly sessions of one intervention for at least 16 sessions. If due to randomization, participants are allocated to a treatment arm not suitable for them, they are allowed to switch intervention after four sessions. Based on a sample size calculation, recruitment will continue until 30 participants have completed the intervention for each treatment arm. Outcome Measurement: Primary outcomes are: change in symptom as measured by the Positive and Negative Syndrome Scale (PANSS), change in psychosocial functioning as assessed by the mini ICF-APP and neuro-cognitive performance, assessed by the Matrics Cognitive Consensus Battery (MCCB). Other outcomes of interest are the Brief Symptom Inventory (BSI) and the Health of the Nation Outcome Scales (HoNOS); together with prescribed medication, treatment retention and completion rates. Outcomes will be measured at baseline, 2 weeks into treatment (prior to a potential switch of intervention arm), post-treatment and at 6 and 12-month post-treatment follow-ups. Expected Outcomes: We expect an overall improvement; however, with differences in specific domains for each treatment arm, with those completing INT showing better outcomes than IPT and CGP, respectively. We anticipate that lower functioning participants will drift to CGP and higher functioning participants to INT. Conclusion: Due to the complexity of treatment for patients with a schizophrenic psychosis, we consider it crucial to compare different treatment options for those more severely affected, therefore, requiring inpatient treatment. Trial registration:www.clinicaltrials.gov (ID: NCT03316664; 17.10.2017).
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Affiliation(s)
- Mona Redlich Bossy
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, Psychiatric University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Daniel Mueller
- Department of Psychiatry, Faculty of Medicine, University of Bern, Bern, Switzerland
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, Psychiatric University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Stefan Vetter
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, Psychiatric University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Stephan T Egger
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, Psychiatric University Hospital of Zurich, University of Zurich, Zurich, Switzerland
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Leopold K, Bauer M, Bechdolf A, Correll CU, Holtmann M, Juckel G, Lambert M, Meyer TD, Pfeiffer S, Kittel-Schneider S, Reif A, Stamm TJ, Rottmann-Wolf M, Mathiebe J, Kellmann EL, Ritter P, Krüger-Özgürdal S, Karow A, Sondergeld LM, Roessner V, Sauer C, Pfennig A. Efficacy of cognitive-behavioral group therapy in patients at risk for serious mental illness presenting with subthreshold bipolar symptoms: Results from a prespecified interim analysis of a multicenter, randomized, controlled study. Bipolar Disord 2020; 22:517-529. [PMID: 32112496 DOI: 10.1111/bdi.12894] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Most patients with bipolar disorders (BD) exhibit prodromal symptoms before a first (hypo)manic episode. Patients with clinically significant symptoms fulfilling at-risk criteria for serious mental illness (SMI) require effective and safe treatment. Cognitive-behavioral psychotherapy (CBT) has shown promising results in early stages of BD and in patients at high risk for psychosis. We aimed to investigate whether group CBT can improve symptoms and functional deficits in young patients at risk for SMI presenting with subthreshold bipolar symptoms. METHOD In a multicenter, randomized, controlled trial, patients at clinical risk for SMI presenting with subthreshold bipolar symptoms aged 15-30 years were randomized to 14 weeks of at-risk for BD-specific group CBT or unstructured group meetings. Primary efficacy endpoints were differences in affective symptomatology and psychosocial functioning at 14 weeks. At-risk status was defined as a combination of subthreshold bipolar symptomatology, reduction of psychosocial functioning and a family history for (schizo)affective disorders. A prespecified interim analysis was conducted at 75% of the targeted sample. RESULTS Of 128 screened participants, 75 were randomized to group CBT (n = 38, completers = 65.8%) vs unstructured group meetings (n = 37, completers = 78.4%). Affective symptomatology and psychosocial functioning improved significantly at week 14 (P < .001) and during 6 months (P < .001) in both groups, without significant between-group differences. Findings are limited by the interim character of the analysis, the use of not fully validated early detection interviews, a newly adapted intervention manual, and the substantial drop-outs. CONCLUSIONS Results suggest that young patients at-risk for SMI presenting with subthreshold bipolar symptoms benefit from early group sessions. The degree of specificity and psychotherapeutic interaction needed requires clarification.
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Affiliation(s)
- Karolina Leopold
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany.,Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Klinikum Am Urban, Berlin, Germany
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Andreas Bechdolf
- Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Klinikum Am Urban, Berlin, Germany.,Department of Psychiatry and Psychotherapy, University Hospital Cologne, University Cologne, Köln, Germany
| | - Christoph U Correll
- Psychiatry and Molecular Medicine Hofstra Northwell School of Medicine, Hempstead, NY, USA.,Center for Psychiatric Neuroscience Feinstein Institute for Medical Research, Manhasset, NY, USA.,Department of Psychiatry, Recognition and Prevention (RAP) Program, The Zucker Hillside Hospital, Long Island, USA.,Department of Child and Adolescent Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Martin Holtmann
- Department of Child and Adolescent Psychiatry and Psychotherapy, LWL-University Hospital Hamm, Ruhr-University, Bochum, Germany
| | - Georg Juckel
- Department of Psychiatry and Psychotherapy, LWL- University Hospital Bochum, Ruhr-University, Bochum, Germany
| | - Martin Lambert
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas D Meyer
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas HSC at Houston, Houston, TX, USA
| | - Steffi Pfeiffer
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Sarah Kittel-Schneider
- Department of Psychiatry and Psychotherapy, University Hospital Würzburg, Würzburg, Germany.,Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital, Frankfurt, Germany
| | - Andreas Reif
- Department of Psychiatry and Psychotherapy, University Hospital Würzburg, Würzburg, Germany.,Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital, Frankfurt, Germany
| | - Thomas J Stamm
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany.,Department of Psychiatry, Psychotherapy and Psychosomatic, Medical School Brandenburg, Neuruppin, Germany
| | - Maren Rottmann-Wolf
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Josephine Mathiebe
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Eva L Kellmann
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Philipp Ritter
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Seza Krüger-Özgürdal
- Department of Psychiatry and Psychotherapy, LWL- University Hospital Bochum, Ruhr-University, Bochum, Germany
| | - Anne Karow
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lene-Marie Sondergeld
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany.,Department of Psychiatry, Psychotherapy and Psychosomatic, Medical School Brandenburg, Neuruppin, Germany
| | - Veit Roessner
- Department of Child and Adolescent Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Cathrin Sauer
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Andrea Pfennig
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
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12
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Egger ST, Weniger G, Bobes J, Seifritz E, Vetter S. Exploring the factor structure of the mini-ICF-APP in an inpatient clinical sample, according to the psychiatric diagnosis. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2020; 14:S1888-9891(20)30066-5. [PMID: 32712046 DOI: 10.1016/j.rpsm.2020.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 04/14/2020] [Accepted: 05/16/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Psychosocial functioning is a key factor determining prognosis, severity, impairment and quality of life in people who have a mental disorder. The mini-ICF-APP was developed to provide a standardised classification of functioning and disability. However, despite its gaining popularity little is known about its structure and performance. This paper examines the structure of the mini-ICF-APP using factor analysis techniques. MATERIALS AND METHODS In a clinical sample of 3178 patients, with psychiatric diagnoses from several ICD-10 categories, we analysed internal consistency, item inter-correlations and the factorial structure of the data, with reference to ICD-10 diagnostic categories; Neurocognitive Disorders; Alcohol Use Disorders; Substance Use Disorders; Schizophrenia and Psychotic Disorders; Bipolar Disorder; Major Depressive Disorder; Anxiety Disorders; Personality Disorders; and Neurodevelopmental Disorders. RESULTS We found good internal consistency and item inter-correlations (Cronbach alpha=0.92) for the mini-ICF-APP. We were able to identify pivotal domains (flexibility, assertiveness and intimate relationships), which demonstrate sub-threshold influences on other domains. The factor analysis yielded a one-factor model as ideal for the whole sample and for all diagnostic categories. For some diagnostic categories the data suggested a two or three-factor model, however, with poorer fit indices. CONCLUSIONS The factor structure of the mini-ICF-APP appears to modify according to the main diagnosis. However, a one-factor model demonstrates better fit regardless of diagnostic category. Consequently, we consider the mini-ICF-APP to be a trans-diagnostic measurement instrument for the assessment and grading of psychosocial functioning. The use of the mini-ICF-APP sum score seems to best reflect the degree of impairment in an individual, even taking into account that affected domains may lead to sub-threshold effects on other domains.
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Affiliation(s)
- Stephan T Egger
- Centre for Integrative Psychiatry, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital of Zurich, University of Zurich, Zurich, Switzerland; Department of Psychiatry, Faculty of Medicine, University of Oviedo, CIBERSAM, Oviedo. Spain.
| | - Godehard Weniger
- Centre for Integrative Psychiatry, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Julio Bobes
- Department of Psychiatry, Faculty of Medicine, University of Oviedo, CIBERSAM, Oviedo. Spain
| | - Erich Seifritz
- Centre for Integrative Psychiatry, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Stefan Vetter
- Centre for Integrative Psychiatry, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital of Zurich, University of Zurich, Zurich, Switzerland
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13
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Listunova L, Bartolovic M, Kienzle J, Jaehn A, Grützner TM, Wolf RC, Weisbrod M, Roesch-Ely D. Predictors of cognitive remediation therapy improvement in (partially) remitted unipolar depression. J Affect Disord 2020; 264:40-49. [PMID: 31846901 DOI: 10.1016/j.jad.2019.12.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 11/26/2019] [Accepted: 12/04/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND There is urgent need for development and evaluation of targeted interventions for cognitive deficits in (partially) remitted major depression. Until now the analyses of the moderators of treatment efficacy were only examined in mixed samples of patients with schizophrenia, affective spectrum and schizoaffective disorders. Thus, the aim of our study was to evaluate the predictors of cognitive remediation therapy (CRT) improvement in a sample of (partially) remitted major depressive disorder patients. METHODS Reliable Change Index with corrections for practice effects was calculated for each participant as an indicator for training improvement. Thirty eight patients, who were randomized within our previously conducted CRT clinical trial, were divided into "Improvers" and "Nonimprovers" in the attention domain, to compare them on sociodemographic, psychopathological, neurocognitive, psychosocial and training factors. RESULTS We detected 13 training participants who improved reliably in the attention domain. Illness duration was the only factor which significantly differentiated between Improvers and Nonimprovers. No significant differences between Improvers and Nonimprovers in terms of other clinical variables, sociodemographic and neuropsychological factors were found. LIMITATIONS Exploratory research results should be taken with caution. Focus on the attention domain could have led to a limited point of view. CONCLUSION Our findings represent a first analysis of the predictors of cognitive remediation training improvement in (partially) remitted unipolar depression. Much more work should be done to refine cognitive treatment approaches. An initiation of cognitive training in early stages of the disease could be beneficial for the affected patients.
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Affiliation(s)
- Lena Listunova
- Centre for Psychosocial Medicine, Department of General Psychiatry, Division Neurocognition, Heidelberg University, Voßstraße 4, 69115 Heidelberg, Germany.
| | - Marina Bartolovic
- Centre for Psychosocial Medicine, Department of General Psychiatry, Division Neurocognition, Heidelberg University, Voßstraße 4, 69115 Heidelberg, Germany
| | - Johanna Kienzle
- Centre for Psychosocial Medicine, Department of General Psychiatry, Division Neurocognition, Heidelberg University, Voßstraße 4, 69115 Heidelberg, Germany
| | - Anna Jaehn
- Centre for Psychosocial Medicine, Department of General Psychiatry, Division Neurocognition, Heidelberg University, Voßstraße 4, 69115 Heidelberg, Germany
| | - Thea Marianne Grützner
- Centre for Psychosocial Medicine, Department of General Psychiatry, Division Neurocognition, Heidelberg University, Voßstraße 4, 69115 Heidelberg, Germany
| | - Robert Christian Wolf
- Centre for Psychosocial Medicine, Department of General Psychiatry, Cognitive Neuropsychiatry Section, Heidelberg University, Voßstraße 4, 69115 Heidelberg, Germany
| | - Matthias Weisbrod
- Centre for Psychosocial Medicine, Department of General Psychiatry, Division Neurocognition, Heidelberg University, Voßstraße 4, 69115 Heidelberg, Germany; Department of Adult Psychiatry, SRH-Klinik, Karlsbad-Langensteinbach, Germany
| | - Daniela Roesch-Ely
- Centre for Psychosocial Medicine, Department of General Psychiatry, Division Neurocognition, Heidelberg University, Voßstraße 4, 69115 Heidelberg, Germany
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14
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Bossert M, Westermann C, Schilling TM, Weisbrod M, Roesch-Ely D, Aschenbrenner S. Computer-Assisted Cognitive Remediation in Schizophrenia: Efficacy of an Individualized vs. Generic Exercise Plan. Front Psychiatry 2020; 11:555052. [PMID: 33192669 PMCID: PMC7524883 DOI: 10.3389/fpsyt.2020.555052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 08/20/2020] [Indexed: 11/17/2022] Open
Abstract
Computer-assisted cognitive remediation (CACR) is an economical, adjustable, and effective treatment for individuals with schizophrenia. The current randomized controlled study examined whether an individualized or generic exercise plan in CACR is superior in patients with multiple cognitive deficits compared to treatment-as-usual (TAU). Fifty-nine inpatients diagnosed with schizophrenia were randomly assigned to 1) TAU, 2) TAU plus an individualized exercise plan in CACR, or 3) TAU plus a generic exercise plan in CACR. Neuropsychological performance, psychopathology, and functional outcome were assessed at baseline and post-treatment. The results show a medium to large training effect for all neuropsychological performance measures. Contrary to our expectations the neuropsychological improvement over time did not differ between groups. Self-reported depression, global level of functioning, and activity and participation functioning showed a significant improvement from baseline to post-treatment. However no further group, time, or interaction effects for other psychopathology and functional outcome could be demonstrated. Possible implications for clinical use of CACR and future studies are discussed.
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Affiliation(s)
- Magdalena Bossert
- Department of Clinical Psychology and Neuropsychology, SRH Klinikum Karlsbad-Langensteinbach, Karlsbad, Germany
| | - Celina Westermann
- Department of Clinical Psychology and Neuropsychology, SRH Klinikum Karlsbad-Langensteinbach, Karlsbad, Germany
| | - Thomas M Schilling
- Department of Clinical Psychology and Neuropsychology, SRH Klinikum Karlsbad-Langensteinbach, Karlsbad, Germany
| | - Matthias Weisbrod
- Department of Psychiatry und Psychotherapy, SRH Klinikum Karlsbad-Langensteinbach, Karlsbad, Germany.,Department of General Psychiatry, Center of Psychosocial Medicine, Heidelberg University, Heidelberg, Germany
| | - Daniela Roesch-Ely
- Centre for Psychosocial Medicine, Department of General Adult Psychiatry, Division Neurocognition, University of Heidelberg, Heidelberg, Germany
| | - Steffen Aschenbrenner
- Department of Clinical Psychology and Neuropsychology, SRH Klinikum Karlsbad-Langensteinbach, Karlsbad, Germany
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15
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Egger ST, Weniger G, Müller M, Bobes J, Seifritz E, Vetter S. Assessing the severity of functional impairment of psychiatric disorders: equipercentile linking the mini-ICF-APP and CGI. Health Qual Life Outcomes 2019; 17:174. [PMID: 31744498 PMCID: PMC6862821 DOI: 10.1186/s12955-019-1235-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 10/18/2019] [Indexed: 12/02/2022] Open
Abstract
Background The assessment of functioning and impairment due to psychiatric illness has been acknowledged to be crucial for research and practice. This led to the development of the mini-ICF-APP, which provides a reliable and time-efficient measure of functioning and impairment. Although its use is increasing, it remains unclear how it reflects severity and how change might be interpreted from a clinical perspective. Methods In a clinical sample of 3067 individuals hospitalized for mental health treatment, we used an equipercentile approach to link the mini-ICF-APP with the Clinical Global Impression scale (CGI) at admission and discharge. We linked the mini-ICF-APP sum score to the CGI-S scale and the mini-ICF-APP proportional change between admission and discharge to the CGI-I scale. Results The mini-ICF-APP and CGI scales showed a Spearman correlation of 0.50 (p < .000). CGI-S: “borderline-ill” corresponded to a mini-ICF-APP score 1–2; “mildly-ill” to 3–7; “moderately-ill” to 8–15; “markedly-ill” to 16–24; “severely-ill” to 25–37; and “extremely-ill” to a score ≥ 38. The Spearman correlation between the percentage change of mini-ICF-APP sum score and the CGI-I was 0.32 (p > .000); “no-change” in the CGI-I corresponded to an increase or decrease of 2%; “minimally-improved” to a mini-ICF-APP reduction of 3–30%; “much-improved” to a reduction of 31–63%; “very-much-improved” to a reduction of ≥64% “minimally-worse” to an increase of 3–34% “much-worse” to an increase of 35–67%; and finally “very-much-worse” with an increase of ≥68%. Conclusions Our findings improve understanding of the clinical meaning of the mini-ICF-APP sum score and percentage change in patients hospitalized for treatment.
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Affiliation(s)
- Stephan T Egger
- Centre for Integrative Psychiatry, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital of Zurich, University of Zurich, Lenggstrasse 31, 8032, Zurich, Switzerland. .,Department of Psychiatry, Faculty of Medicine, University of Oviedo, CIBERSAM, Oviedo, Spain.
| | - Godehard Weniger
- Centre for Integrative Psychiatry, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital of Zurich, University of Zurich, Lenggstrasse 31, 8032, Zurich, Switzerland
| | - Mario Müller
- Centre for Integrative Psychiatry, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital of Zurich, University of Zurich, Lenggstrasse 31, 8032, Zurich, Switzerland
| | - Julio Bobes
- Department of Psychiatry, Faculty of Medicine, University of Oviedo, CIBERSAM, Oviedo, Spain
| | - Erich Seifritz
- Centre for Integrative Psychiatry, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital of Zurich, University of Zurich, Lenggstrasse 31, 8032, Zurich, Switzerland
| | - Stefan Vetter
- Centre for Integrative Psychiatry, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital of Zurich, University of Zurich, Lenggstrasse 31, 8032, Zurich, Switzerland
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16
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International classification of diseases/disorders diagnosis and International Classification of Functioning, Disability and Health activity/participation limitation among psychiatric patients: a cross-sectional and exploratory study. Int J Rehabil Res 2019; 43:48-54. [PMID: 31688222 DOI: 10.1097/mrr.0000000000000383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
To explore the relationships between international classification of diseases/disorders (ICD)-10 diagnoses and International Classification of Functioning, Disability and Health (ICF) disability dimensions - activity and participation restriction among mental health service users. Three hundred sixty patients from different health services diagnosed with diverse mental disorders (ICD-10) participated in the study. Functioning restrictions were evaluated by use of the Mini-ICF-APP. Selected sociodemographic and clinical variables were also analysed. The Mini-ICF-APP scores correlated positively with the clinical impression of disease severity and negatively with general functioning. As independent factors determining the Mini-ICF-APP score, regression analysis suggests diagnosis and severity of disorder but also contextual factors such as general functioning and active occupation. Percentage and percentile distributions of activity and participation restrictions in diagnostic sections and categories revealed noticeable variability regardless of diagnosis-related differences. The diagnosis determines them neither in an ambiguous nor an absolute manner. There is a need to further explore the covariability between clinical diagnosis and ICF activity and participation restriction, particularly in regard the rationalization of social welfare benefits.
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17
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Łaszewska A, Schwab M, Leutner E, Oberrauter M, Spiel G, Simon J. Measuring broader wellbeing in mental health services: validity of the German language OxCAP-MH capability instrument. Qual Life Res 2019; 28:2311-2323. [PMID: 31030365 PMCID: PMC6620251 DOI: 10.1007/s11136-019-02187-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2019] [Indexed: 12/30/2022]
Abstract
PURPOSE The OxCAP-MH capabilities questionnaire was developed and validated in the UK for outcome measurement in mental health clinical studies. Its broader wellbeing construct or validity in routine mental health services so far has not been assessed. The objectives were to investigate the extent the OxCAP-MH measures broader wellbeing compared to the EQ-5D-5L and to test psychometric properties of the German language OxCAP-MH in routine mental health services in Austria. METHODS Study sample consisted of patients in socio-psychiatric services (n = 159) assessed at baseline and 6-month follow-up. Underlying factors associated with quality-of-life/wellbeing concepts measured by the OxCAP-MH and EQ-5D-5L were identified in exploratory factor analysis (EFA). Responsiveness was assessed using anchor questionnaires and standardised response mean (SRM). For discriminant validity, subgroups of respondents were compared using t test and one-way ANOVA. Test-retest analysis was assessed for a period of maximum 30 days from the baseline assessment with intra-class correlation coefficient (ICC). RESULTS EFA identified a two-factor structure. All EQ-5D-5L items and seven OxCAP-MH items loaded on one factor and nine remaining OxCAP-MH items loaded on a separate factor. Responsiveness was found for patients who improved in anchor questionnaire scores with large or moderate SRM statistics. OxCAP-MH discriminated between various groups in univariable and multivariable analyses. Reliability of the German language OxCAP-MH was confirmed by ICC of 0.80. CONCLUSIONS Besides providing evidence that the OxCAP-MH measures broader wellbeing constructs beyond traditional health-related quality of life, the study also confirms the validity of the instrument for implementation in routine evaluation of mental health services.
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Affiliation(s)
- Agata Łaszewska
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15/1, 1090, Vienna, Austria
| | - Markus Schwab
- pro mente Forschung, Villacher Straße 161, 9020, Klagenfurt am Wörthersee, Austria
| | - Eva Leutner
- pro mente kärnten GmbH, Villacher Straße 161, 9020, Klagenfurt am Wörthersee, Austria
| | - Marold Oberrauter
- pro mente kärnten GmbH, Villacher Straße 161, 9020, Klagenfurt am Wörthersee, Austria
| | - Georg Spiel
- pro mente Forschung, Villacher Straße 161, 9020, Klagenfurt am Wörthersee, Austria
- pro mente kärnten GmbH, Villacher Straße 161, 9020, Klagenfurt am Wörthersee, Austria
| | - Judit Simon
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15/1, 1090, Vienna, Austria.
- Department of Psychiatry, Warneford Hospital, University of Oxford, Warneford Ln, Oxford, OX3 7JX, UK.
- HERC, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, OX3 7LF, UK.
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18
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Caponnetto P, Auditore R, Maglia M, Pipitone S, Inguscio L. Psychological wellness, yoga and quality of life in patients affected by schizophrenia spectrum disorders: A pilot study. Ment Illn 2019; 11:8003. [PMID: 31281606 PMCID: PMC6589643 DOI: 10.4081/mi.2019.8003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 03/20/2019] [Indexed: 12/04/2022] Open
Abstract
Schizophrenia is a serious psychiatric disorder characterized by positive symptoms, negative symptoms and neurocognitive deficits. The aim of this study was to estimate relationships between wellness, yoga and quality of life in patients affected by schizophrenia spectrum disorders. Participants were 30 patients with a diagnosis of schizophrenia in care at the Rehabilitative Psychiatry and Research Villa Chiara Clinic in Mascalucia (Catania, Italy), after that randomly assigned to two groups. The first group followed the experimental treatment with sets of yoga exercises conducted by a yoga trainer and a psychiatrist or a clinical psychologist expert in yoga, while a second control group was treated with usual care. The results revealed a significant difference, before and after treatment, between the experimental group and the control group in quality of life.
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Affiliation(s)
- Pasquale Caponnetto
- CTA-Villa Chiara Psychiatric Rehabilitation Clinic and Research, Mascalucia, Italy.,Department of Clinical and Experimental Biomedicine, University of Catania, Italy.,Institute for Social Marketing, University of Stirling, UK
| | - Roberta Auditore
- CTA-Villa Chiara Psychiatric Rehabilitation Clinic and Research, Mascalucia, Italy
| | - Marilena Maglia
- CTA-Villa Chiara Psychiatric Rehabilitation Clinic and Research, Mascalucia, Italy.,Department of Clinical and Experimental Biomedicine, University of Catania, Italy
| | - Stefano Pipitone
- Vidya Vahini Trust, Uttarkashi, Himalayas, India.,Yoga Vidya, Siracusa, Italy
| | - Lucio Inguscio
- Department of Psychology, La Sapienza University, Rome, Italy
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19
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Seitz T, Stastka K, Schiffinger M, Rui Turk B, Löffler-Stastka H. Interprofessional care improves health-related well-being and reduces medical costs for chronic pain patients. Bull Menninger Clin 2019; 83:105-127. [PMID: 30840490 DOI: 10.1521/bumc_2019_83_01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
This study evaluated whether patients with somatic symptom disorder, expressing chronic pain that could not be attributed to a medical condition, would benefit from an 8-week inpatient residence at a psychiatric ward. In the 1-year follow-up after termination the authors examined the extent to which the integrated treatment decreased patient costs. A total of 106 patients participated in the follow-up and reported a significant improvement in their general health (Cohen's d = 1.5-2.21), a decrease in impairment due to pain (d = 2.24), and a decrease in symptom severity (d = 1.29). They took fewer medications and sick days, reported fewer hospital stays and medical examinations, and consulted and changed physicians and outpatient clinics less often (d = 0.55-1.1). The average cost per patient was cut in half, down to € 80,000/$96,000 per year. From a clinical standpoint, group analysis that focused on aggression was the most effective intervention.
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Affiliation(s)
- Tamara Seitz
- Medical University of Vienna, Department of Psychoanalysis and Psychotherapy, and Teaching Center/Postgraduate Unit/Health Care Management and Psychotherapy Research, Vienna, Austria
- SMZ Süd Hospital of Vienna, Department of Infectious Diseases and Tropical Medicine, Vienna, Austria
| | - Kurt Stastka
- SMZ Süd Hospital of Vienna, Department of Psychiatry, Vienna, Austria
| | | | - Bela Rui Turk
- Kennedy Krieger Institute, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Henriette Löffler-Stastka
- Medical University of Vienna, Department of Psychoanalysis and Psychotherapy, and Teaching Center/Postgraduate Unit/Health Care Management and Psychotherapy Research, Vienna, Austria
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20
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Rössler W, Ujeyl M, Kawohl W, Nordt C, Lasalvia A, Haker H, Hengartner MP. Predictors of Employment for People With Mental Illness: Results of a Multicenter Randomized Trial on the Effectiveness of Placement Budgets for Supported Employment. Front Psychiatry 2019; 10:518. [PMID: 31379630 PMCID: PMC6659611 DOI: 10.3389/fpsyt.2019.00518] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 07/01/2019] [Indexed: 12/31/2022] Open
Abstract
Background: Individual placement and support (IPS) has proven to be effective for vocational outcomes in people with mental illness. The original concept of IPS requires temporally unlimited provision of support. Using limited placement budgets and investigating factors that predict their effectiveness may inform decisions about resource allocation. Methods: A range of patient characteristics were tested as predictors of employment outcomes in participants who attended six outpatient psychiatric clinics in Switzerland between June 2010 and May 2011. Overall, 116 patients with the full spectrum of psychiatric conditions were randomly assigned and started an IPS intervention, which was provided by three different placement budgets. Support lasted 2 years for those who found a job, and outcomes were repeatedly assessed over 3 years. The intervention ended for those who failed to find competitive employment by the time their placement budget had run out. Results: Of the 15 variables tested, only Global Assessment of Functioning (GAF) and Clinical Global Impression (CGI) scores were predictors for obtaining work (for ≥1 day) and for maintaining it over a longer period (>3 months). Higher GAF and lower CGI scores increased the odds of obtaining employment and keeping it for at least 3 months. Functional role impairment, quality of life, self-esteem, or education level did not predict employment. Conclusion: Our data suggest that, if time-restricted budgets are offered to a wide range of patients, such as those included in this study, better functioning and lower symptom severity at baseline are predictive of better employment outcomes (finding and maintaining work) on the first (competitive) labor market in Switzerland. It remains to be investigated whether this holds true under different environmental factors. Clinical Trial Registration: ISRCTN, trial number: ISRCTN89670872.
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Affiliation(s)
- Wulf Rössler
- Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Berlin, Germany
| | - Mariam Ujeyl
- Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Berlin, Germany
| | | | - Carlos Nordt
- Department of Psychiatry, Psychotherapy, and Psychosomatics, University of Zurich, Zurich, Switzerland
| | - Antonio Lasalvia
- Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - Helene Haker
- Translational Neuromodeling Unit, ETH Zürich, Zurich, Switzerland
| | - Michael P Hengartner
- Department of Applied Psychology, Zurich University of Applied Sciences, Zurich, Switzerland
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Abstract
The aim of this study was to identify factors which are associated with the length of stay in a Swiss mental hospital. Demographical and clinical data of all patients who were admitted to the adult inpatient psychiatric service of the Federal State of Aargau in 2016 were examined regarding their association with the length of stay. The study sample included N = 1479 patients. Mean length of stay was 33 days and the median equalled 26 days. Higher age and a primary diagnosis of psychotic or affective disorder were associated with increased length of stay. In contrast, foreign nationality and compulsory admission were associated with reduced length of stay. While some of our findings were in line with recent findings from Italy and the United Kingdom, others could not be replicated.
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[Assement of incapacity to work and the Mini-ICF-APP]. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT ÖSTERREICHISCHER NERVENÄRZTE UND PSYCHIATER 2017; 31:182-186. [PMID: 28856567 DOI: 10.1007/s40211-017-0246-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 08/10/2017] [Indexed: 01/01/2023]
Abstract
OBJECTIVE According to recent recommendations the Mini-ICF Rating for Limitations of Activities and Participation in Psychological Disorders (Mini-ICF-APP) should be used in the assessment of incapacity to work. However evidence from empirical research in the field is missing. METHODS The application of the Mini-ICF-APP in the psychiatric assessment of 121 cases was analysed. RESULTS A significant correlation between capacity to work and the duration of sick-leave with the Mini-ICF-APP sum-score was confirmed. The probability that criteria for disability insurance compensations was fulfilled according to the assessor increased with the Mini-ICF-APP-sum-score. CONCLUSION Our study provides first empirical evidence regarding the application of the Mini-ICF-APP in the psychiatric assessment of incapacity to work.
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Veeh J, Kopf J, Kittel-Schneider S, Deckert J, Reif A. Cognitive remediation for bipolar patients with objective cognitive impairment: a naturalistic study. Int J Bipolar Disord 2017; 5:8. [PMID: 28168631 PMCID: PMC5389951 DOI: 10.1186/s40345-017-0079-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 01/20/2017] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Many bipolar patients (BP) are affected by cognitive impairments and reduced psychosocial function even after complete remission. In the present naturalistic study, we developed a tailored cognitive remediation program (CR) to evaluate the effect on objective and subjective neuropsychological performance, psychosocial functioning and quality of life. METHODS The CR program used a cognitive training software combined with group sessions to educate cognitive skills. 102 BP were screened by a neuropsychological test battery. Of those, 39 BP showed distinct cognitive impairments and 26 patients of them participated in the CR program for 12 weeks and then were retested. A matched control group consisting of 10 BP was measured at baseline and follow-up after three months (treatment as usual). RESULTS Within the training group, a significant improvement of cognitive performance after CR was observed in working memory (p = .043), problem solving (p = .031) and divided attention (trend, p = .065). The control group did not improve in any test measure. In addition, we detected a significant reduction of sub-depressive symptoms (p = .011) after the CR program. However, there was no change in psychosocial functioning and quality of life. Subjective cognitive complaints were not associated with objective test performance. LIMITATIONS As we included exclusively BP with objectively assessed neurocognitive deficits, recruitment was difficult and subsequently we had a small sample size and were not able to implement a randomized group design. CONCLUSIONS Our results suggest that BP with objective cognitive impairments could benefit from CR potentially with regard to executive functioning. Furthermore, there is preliminary evidence that CR could have a positive effect on subthreshold residual symptoms. However, to fully identify the possible implications of CR in bipolar disorder, larger randomized-controlled trials are needed in this new field of research.
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Affiliation(s)
- J Veeh
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe-University, Heinrich-Hoffmann-Straße 10, 60528, Frankfurt, Germany.
| | - J Kopf
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe-University, Heinrich-Hoffmann-Straße 10, 60528, Frankfurt, Germany
| | - S Kittel-Schneider
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe-University, Heinrich-Hoffmann-Straße 10, 60528, Frankfurt, Germany
| | - J Deckert
- Department of Psychiatry, Psychosomatics and Psychotherapy, University of Wuerzburg, Fuechsleinstrasse 15, 97080, Würzburg, Germany
| | - A Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe-University, Heinrich-Hoffmann-Straße 10, 60528, Frankfurt, Germany
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Schreiner A, Bergmans P, Cherubin P, Hargarter L. The effect of long-acting paliperidone palmitate once-monthly on negative and depressive symptoms in patients with schizophrenia switched from previous unsuccessful treatment with oral aripiprazole. Ther Adv Psychopharmacol 2017; 7:59-65. [PMID: 28255435 PMCID: PMC5315228 DOI: 10.1177/2045125316673012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The negative symptoms of schizophrenia are generally harder to recognize, more difficult to treat than positive symptoms, and have a significant impact on patient functioning and overall outcomes. Treatment with aripiprazole may be associated with benefits on negative symptoms and functioning given its partial agonism to the dopamine D2 receptor. The aim of this subanalysis was to explore the impact of flexibly dosed, long-acting paliperidone palmitate once monthly (PP1M) on negative and depressive symptoms, disorganized thoughts, anxiety, extrapyramidal symptoms, and patient functioning in nonacute adult patients with schizophrenia previously unsuccessfully treated with oral aripiprazole monotherapy. METHODS Post-hoc subanalysis of 46 nonacute but symptomatic patients enrolled in a prospective, interventional, single-arm, multicenter, open-label 6-month study. RESULTS At endpoint, improvements of ⩾ 20% and ⩾ 50% in the Positive and Negative Syndrome Scale (PANSS) total score were observed in 52.2% and 21.7% of patients, respectively. Significant and clinically relevant improvements were observed at endpoint in mean (standard deviation [SD]) PANSS negative subscale score (-3.0 (5.0); p < 0.0001) and in the PANSS Marder factor scores for negative symptoms (-2.9 (5.4); p = 0.0006), disorganized thoughts (-2.8 (4.3); p < 0.0001) and anxiety/depression (-1.8 (3.9); p = 0.0031). Patient functioning assessed by mean (SD) Personal and Social Performance scale score (3.9 (13.2); p = 0.0409), Mini International Classification of Functioning rating for Activity and Participation Disorders in Psychological Illnesses total scores (-2.9 (7.1); p = 0.0079), and Extrapyramidal Symptom Rating Scale scores (-0.6 (3.4); p = 0.0456) improved significantly at endpoint. PP1M was well tolerated with no new safety signals. CONCLUSIONS Six-month treatment with flexibly dosed PP1M was associated with significant and clinically relevant improvements in negative and depressive symptoms, disorganized thoughts, functioning, and extrapyramidal symptoms in nonacute but symptomatic patients with schizophrenia previously unsuccessfully treated with oral aripiprazole.
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Affiliation(s)
- Andreas Schreiner
- Medical and Scientific Affairs, Janssen Cilag EMEA, Johnson & Johnson Platz 1, Neuss, 41470, Germany
| | - Paul Bergmans
- Biometrics, Janssen Cilag Benelux, Tilburg, The Netherlands
| | - Pierre Cherubin
- EMEA Medical Affairs, Janssen Cilag, Issy-les-Moulineaux, France
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Switching from oral atypical antipsychotic monotherapy to paliperidone palmitate once-monthly in non-acute patients with schizophrenia: A prospective, open-label, interventional study. Psychopharmacology (Berl) 2017; 234:3-13. [PMID: 27815602 PMCID: PMC5203852 DOI: 10.1007/s00213-016-4445-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Accepted: 09/03/2016] [Indexed: 02/06/2023]
Abstract
RATIONALE Long-acting injectable antipsychotic therapies may offer benefits over oral antipsychotics in patients with schizophrenia. OBJECTIVE This study aimed to explore the safety, tolerability, and treatment response of paliperidone palmitate once-monthly in non-acute but symptomatic adult patients switched from previously unsuccessful monotherapy with frequently used oral atypical antipsychotics. METHODS This was a post hoc analysis of a prospective, interventional, single-arm, international, multicenter, open-label, 6-month study. RESULTS The patients (N = 472) were switched to paliperidone palmitate once-monthly (PP1M) from daily oral treatment with either aripiprazole (n = 46), olanzapine (n = 87), paliperidone extended-release (n = 104), quetiapine (n = 44), or risperidone (n = 191). In all groups, mean Positive and Negative Syndrome Scale total (p < 0.0001) and Clinical Global Impression-Severity scores improved significantly (p = 0.0004 to p < 0.0001). An improvement of ≥50 % in the Positive and Negative Syndrome Scale total score was observed in 21.7 % (aripiprazole), 29.9 % (olanzapine), 29.8 % (paliperidone extended-release), 27.3 % (quetiapine), and 37.2 % (risperidone) of patients. The patients showed significant improvements in the Personal and Social Performance score (aripiprazole p = 0.0409, all others p ≤ 0.0015); Mini International Classification of Functionality, Disability and Health Rating for Activity and Participation Disorders in Psychological Illnesses total scores (all p < 0.01); and Treatment Satisfaction Questionnaire for Medication Global Satisfaction score (olanzapine and risperidone p < 0.0001, quetiapine p = 0.0465, paliperidone extended-release p = 0.0571, aripiprazole p = NS). Paliperidone palmitate once-monthly was well tolerated, presenting no new safety signals. CONCLUSIONS These data illustrate that stable, non-acute but symptomatic patients on oral antipsychotic monotherapy may show clinically meaningful improvement of symptoms, functioning, and treatment satisfaction after direct transition to PP1M. The findings are limited by the naturalistic study design; thus, further studies are required to confirm the current findings.
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26
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Bachmann M, de Boer W, Schandelmaier S, Leibold A, Marelli R, Jeger J, Hoffmann-Richter U, Mager R, Schaad H, Zumbrunn T, Vogel N, Bänziger O, Busse JW, Fischer K, Kunz R. Use of a structured functional evaluation process for independent medical evaluations of claimants presenting with disabling mental illness: rationale and design for a multi-center reliability study. BMC Psychiatry 2016; 16:271. [PMID: 27474008 PMCID: PMC4966817 DOI: 10.1186/s12888-016-0967-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 07/12/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Work capacity evaluations by independent medical experts are widely used to inform insurers whether injured or ill workers are capable of engaging in competitive employment. In many countries, evaluation processes lack a clearly structured approach, standardized instruments, and an explicit focus on claimants' functional abilities. Evaluation of subjective complaints, such as mental illness, present additional challenges in the determination of work capacity. We have therefore developed a process for functional evaluation of claimants with mental disorders which complements usual psychiatric evaluation. Here we report the design of a study to measure the reliability of our approach in determining work capacity among patients with mental illness applying for disability benefits. METHODS/DESIGN We will conduct a multi-center reliability study, in which 20 psychiatrists trained in our functional evaluation process will assess 30 claimants presenting with mental illness for eligibility to receive disability benefits [Reliability of Functional Evaluation in Psychiatry, RELY-study]. The functional evaluation process entails a five-step structured interview and a reporting instrument (Instrument of Functional Assessment in Psychiatry [IFAP]) to document the severity of work-related functional limitations. We will videotape all evaluations which will be viewed by three psychiatrists who will independently rate claimants' functional limitations. Our primary outcome measure is the evaluation of claimant's work capacity as a percentage (0 to 100 %), and our secondary outcomes are the 12 mental functions and 13 functional capacities assessed by the IFAP-instrument. Inter-rater reliability of four psychiatric experts will be explored using multilevel models to estimate the intraclass correlation coefficient (ICC). Additional analyses include subgroups according to mental disorder, the typicality of claimants, and claimant perceived fairness of the assessment process. DISCUSSION We hypothesize that a structured functional approach will show moderate reliability (ICC ≥ 0.6) of psychiatric evaluation of work capacity. Enrollment of actual claimants with mental disorders referred for evaluation by disability/accident insurers will increase the external validity of our findings. Finding moderate levels of reliability, we will continue with a randomized trial to test the reliability of a structured functional approach versus evaluation-as-usual.
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Affiliation(s)
- Monica Bachmann
- Division Evidence-based Insurance Medicine, University Hospital Basel, Spitalstrasse 8 + 12, CH-4031 Basel, Switzerland ,Department Clinical Research, University of Basel, Spitalstrasse 8 + 12, CH-4031 Basel, Switzerland
| | - Wout de Boer
- Division Evidence-based Insurance Medicine, University Hospital Basel, Spitalstrasse 8 + 12, CH-4031 Basel, Switzerland ,Department Clinical Research, University of Basel, Spitalstrasse 8 + 12, CH-4031 Basel, Switzerland
| | - Stefan Schandelmaier
- Division Evidence-based Insurance Medicine, University Hospital Basel, Spitalstrasse 8 + 12, CH-4031 Basel, Switzerland ,Department Clinical Research, University of Basel, Spitalstrasse 8 + 12, CH-4031 Basel, Switzerland ,Basel Institute for Clinical Epidemiology & Biostatistics, University Hospital Basel, Basel, Switzerland
| | - Andrea Leibold
- School of Applied Psychology, Institute Humans in Complex Systems, Olten, Switzerland
| | - Renato Marelli
- Swiss Society of Insurance Psychiatry, SGVP, Basel, Switzerland
| | - Joerg Jeger
- Institute of Medical Disability Evaluations of Central Switzerland, Lucerne, Switzerland
| | - Ulrike Hoffmann-Richter
- Department of Insurance Psychiatry, Swiss Accident Insurance Fund, Lucerne, Switzerland ,Private practice for Psychiatry and Psychotherapy, Lucerne, Switzerland
| | - Ralph Mager
- Psychiatric University Clinic of Basel, Basel, Switzerland
| | - Heinz Schaad
- Institute for Medical Disability Evaluation Interlaken, Lucerne, Switzerland
| | - Thomas Zumbrunn
- Department Clinical Research, University of Basel, Spitalstrasse 8 + 12, CH-4031 Basel, Switzerland ,Clinical Trial Unit, University Hospital Basel, Basel, Switzerland
| | - Nicole Vogel
- Division Evidence-based Insurance Medicine, University Hospital Basel, Spitalstrasse 8 + 12, CH-4031 Basel, Switzerland ,Department Clinical Research, University of Basel, Spitalstrasse 8 + 12, CH-4031 Basel, Switzerland
| | - Oskar Bänziger
- Zurich Office of the Swiss National Disability Insurance, Zurich, Switzerland ,Private practice, Wetzikon, Switzerland
| | - Jason W. Busse
- Department of Clinical Epidemiology and Biostatics, McMaster University, Hamilton, ON Canada ,The Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, ON Canada ,Department of Anesthesia, McMaster University, Hamilton, ON Canada
| | - Katrin Fischer
- School of Applied Psychology, Institute Humans in Complex Systems, Olten, Switzerland
| | - Regina Kunz
- Division Evidence-based Insurance Medicine, University Hospital Basel, Spitalstrasse 8 + 12, CH-4031, Basel, Switzerland. .,Department Clinical Research, University of Basel, Spitalstrasse 8 + 12, CH-4031, Basel, Switzerland.
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Müller M, Vandeleur C, Weniger G, Prinz S, Vetter S, Egger ST. The performance of the Health of the Nation Outcome Scales as measures of clinical severity. Psychiatry Res 2016; 239:20-7. [PMID: 27137958 DOI: 10.1016/j.psychres.2016.02.060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 02/12/2016] [Accepted: 02/27/2016] [Indexed: 11/26/2022]
Abstract
The aim of this study was to examine the performance of the Health of the Nation Outcome Scales (HoNOS) against other measures of functioning and mental health in a full three-year cohort of admissions to a psychiatric hospital. A sample of N=1719 patients (35.3% females, aged 17-78 years) was assessed using observer-rated measures and self-reports of psychopathology at admission. Self-reports were available from 51.7% of the sample (34.4% females, aged 17-76 years). Functioning and psychopathology were compared across five ICD-10 diagnostic groups: substance use disorders, schizophrenia and psychotic disorders, affective disorders, anxiety/somatoform disorders and personality disorders. Associations between the measures were examined, stratifying by diagnostic subgroup. The HoNOS were strongly linked to other measures primarily in psychotic disorders (except for the behavioral subscale), while those with substance use disorders showed rather poor links. Those with anxiety/somatoform disorders showed null or only small associations. This study raises questions about the overall validity of the HoNOS. It seems to entail different levels of validity when applied to different diagnostic groups. In clinical practice the HoNOS should not be used as a stand-alone instrument to assess outcome but rather as part of a more comprehensive battery including diagnosis-specific measures.
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Affiliation(s)
- Mario Müller
- Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich University Hospital of Psychiatry, Zurich, Switzerland.
| | | | - Godehard Weniger
- Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich University Hospital of Psychiatry, Zurich, Switzerland
| | - Susanne Prinz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich University Hospital of Psychiatry, Zurich, Switzerland
| | - Stefan Vetter
- Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich University Hospital of Psychiatry, Zurich, Switzerland
| | - Stephan T Egger
- Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich University Hospital of Psychiatry, Zurich, Switzerland
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Hargarter L, Bergmans P, Cherubin P, Keim S, Conca A, Serrano-Blanco A, Bitter I, Bilanakis N, Schreiner A. Once-monthly paliperidone palmitate in recently diagnosed and chronic non-acute patients with schizophrenia. Expert Opin Pharmacother 2016; 17:1043-53. [PMID: 27042990 PMCID: PMC4898156 DOI: 10.1080/14656566.2016.1174692] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Objective: To explore the treatment response, tolerability and safety of once-monthly paliperidone palmitate (PP1M) in non-acute patients switched from oral antipsychotics, stratified by time since diagnosis as recently diagnosed (≤3 years) or chronic patients (>3 years). Research design and methods: Post hoc analysis of a prospective, interventional, single-arm, multicentre, open-label, 6-month study performed in 233 recently diagnosed and 360 chronic patients. Main outcome measures: The proportion achieving treatment response (defined as ≥20% improvement in Positive and Negative Syndrome Scale [PANSS] total score from baseline to endpoint) and maintained efficacy (defined as non-inferiority in the change in PANSS total score at endpoint [Schuirmann’s test]). Results: 71.4% of recently diagnosed and 59.2% of chronic patients showed a ≥20% decrease in PANSS total score (p = 0.0028 between groups). Changes in PANSS Marder factors, PANSS subscales, and the proportion of patients with a Personal and Social Performance scale (PSP) total score of 71–100 were significantly greater in recently diagnosed compared with chronic patients. PP1M was well tolerated, presenting no unexpected safety findings. Conclusion: These data show that recently diagnosed patients treated with PP1M had a significantly higher treatment response and improved functioning, as assessed by the PSP total score, than chronic patients.
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Affiliation(s)
- L Hargarter
- a Medical & Scientific Affairs , Janssen Cilag EMEA , Neuss , Germany
| | - P Bergmans
- b Biometrics & Reporting , Janssen Cilag Benelux , Tilburg , The Netherlands
| | - P Cherubin
- c Medical Affairs , Janssen Cilag EMEA , Issy-les-Moulineaux , France
| | - S Keim
- d Global Clinical Operations EMEA MAO, Janssen Cilag , Barcarena , Portugal
| | - A Conca
- e Department of Psychiatry , General Hospital , Bolzano , Italy
| | - A Serrano-Blanco
- f Acute Inpatient Unit , Parc Sanitari Sant Joan de Déu , Barcelona , Spain and redIAPP, Spain
| | - I Bitter
- g Department of Psychiatry and Psychotherapy , Semmelweis University , Budapest , Hungary
| | - N Bilanakis
- h Department of Psychiatric , General Hospital of Arta , Arta , Greece
| | - A Schreiner
- a Medical & Scientific Affairs , Janssen Cilag EMEA , Neuss , Germany
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Frei A, Balzer C, Gysi F, Leros J, Plohmann A, Steiger G. Kriterien zur Bestimmung des Schweregrades einer neuropsychologischen Störung sowie Zuordnungen zur Funktions- und Arbeitsfähigkeit. ZEITSCHRIFT FÜR NEUROPSYCHOLOGIE 2016. [DOI: 10.1024/1016-264x/a000177] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Zusammenfassung. Im Folgenden wird ein Beurteilungssystem zur Einschätzung des Schweregrades von neuropsychologischen Störungen vorgestellt. Insbesondere umfasst es spezifische Kriterien zur Ermittlung des Schweregrades einer Störung, die wiederum in Beziehung zur Funktions- und Arbeitsfähigkeit eines Patienten oder Versicherten gesetzt werden. Das Beurteilungssystem beruht auf den in der Suva-Tabelle 8 zur Einschätzung der psychischen Folgen einer Hirnverletzung definierten Kriterien. Infolgedessen ist es auch grundsätzlich damit vereinbar, stellt aber aufgrund des Miteinbezugs von neuropsychologischen Testergebnissen in Form von Standardwerten als Beurteilungskriterium sowie verbunden mit den Erläuterungen zu deren Interpretation und Anwendung eine wesentliche Weiterentwicklung dar. Im Gegensatz zur Suva-Tabelle 8 ist das Beurteilungssystem unabhängig vom kausalen Versicherungskontext des UVG. Es kann somit unter anderem auch in Rahmen des IVG und KVG/VVG angewandt werden. In diesem Sinne ist es sowohl unabhängig von der Ätiologie des jeweiligen Beschwerdebildes wie auch unabhängig von der artifiziellen dichotomen Unterscheidung zwischen „organischen“ und „nichtorganischen“ psychischen Störungen. Mit der Erstellung und Publikation dieser neuen Kriterien-Tabelle soll ein Beitrag zur weiteren Verbesserung der Interrater-Reliabilität im Rahmen der Beurteilung des Schweregrades von neuropsychologischen Störungen sowie der Einschätzung der Funktionsfähigkeit geleistet werden. Nicht zuletzt ist das Beurteilungssystem auch kompatibel mit den im DSM-5 festgelegten Kriterien zur Einschätzung des Schweregrades einer neurokognitiven Störung.
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Affiliation(s)
- Adrian Frei
- Arbeitsgruppe im Auftrag des Vorstandes der Schweizerischen Vereinigung der Neuropsychologinnen und Neuropsychologen (SVNP), Basel
- Clienia Schlössli, Privatklinik für Psychiatrie und Psychotherapie, Oetwil am See
| | - Christian Balzer
- Arbeitsgruppe im Auftrag des Vorstandes der Schweizerischen Vereinigung der Neuropsychologinnen und Neuropsychologen (SVNP), Basel
- Reha Rheinfelden, Rheinfelden
| | - Françoise Gysi
- Arbeitsgruppe im Auftrag des Vorstandes der Schweizerischen Vereinigung der Neuropsychologinnen und Neuropsychologen (SVNP), Basel
- Reha Clinic, Bad Zurzach
| | - Julie Leros
- Arbeitsgruppe im Auftrag des Vorstandes der Schweizerischen Vereinigung der Neuropsychologinnen und Neuropsychologen (SVNP), Basel
- Consultation de Neuropsychologie, La Tour-de-Peilz
| | - Andrea Plohmann
- Arbeitsgruppe im Auftrag des Vorstandes der Schweizerischen Vereinigung der Neuropsychologinnen und Neuropsychologen (SVNP), Basel
- Praxis für Neuropsychologie und Psychotherapie, Basel
| | - Gregor Steiger
- Arbeitsgruppe im Auftrag des Vorstandes der Schweizerischen Vereinigung der Neuropsychologinnen und Neuropsychologen (SVNP), Basel
- asim Begutachtung, Universitätsspital Basel
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Pinna F, Fiorillo A, Tusconi M, Guiso B, Carpiniello B. Assessment of functioning in patients with schizophrenia and schizoaffective disorder with the Mini-ICF-APP: a validation study in Italy. Int J Ment Health Syst 2015; 9:37. [PMID: 26526168 PMCID: PMC4628277 DOI: 10.1186/s13033-015-0030-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 09/21/2015] [Indexed: 11/19/2022] Open
Abstract
Background The aim of the study was to evaluate validity of the Italian Mini-ICF-APP (Mini-ICF Rating for Limitations of Activities and Participation in Psychological Disorders) in schizophrenia and related disorders. Methods 74 outpatients affected by schizophrenia or schizoaffective disorders attending a University-based community mental health centre were recruited to the study. All participants underwent comprehensive evaluation using standardized instruments to assess clinical, neurocognitive and functional status. Concurrent validity of Mini-ICF-APP was evaluated and compared to severity scores obtained using the Clinical Global Impression-Schizophrenia scale (CGI-SCH), Positive and Negative Syndrome scale (PANSS), Mini Mental State Examination test (MMSE), Brief Assessment of Cognition in Schizophrenia scale (BACS) and Personal and Social Performance scale (PSP). Construct validity was evaluated by comparing scores obtained at Mini-ICF-APP by remitted versus non-remitted patients, and by recovered versus unrecovered patients. Discriminant validity was evaluated comparing scores on Mini-ICF-APP and Subjective Well-being (SWN) scale. Results: the total score and 12 out of the 13 Mini-ICF-APP items correlated significantly with total score at PSP; Mini-ICF-App total score was moreover significantly correlated with total scores at CGI-SCH, PANSS, MMSE, as well as with several BACS items. Total scores obtained at Mini-ICF-APP were significantly higher among remitted and recovered patients. No relevant correlations were found between scores of Mini-ICF-APP and SWN scales. Results The total score and 12 out of the 13 Mini-ICF-APP items correlated significantly with total score at PSP; Mini-ICF-App total score was moreover significantly correlated with total scores at CGI-SCH, PANSS, MMSE, as well as with several BACS items. Total scores obtained at Mini-ICF-APP were significantly higher among remitted and recovered patients. No relevant correlations were found between scores of Mini-ICF-APP and SWN scales. Conclusion the Italian version of Mini-ICF-APP is a valid instrument for use in evaluating functioning in chronic patients with schizophrenia and related disorders.
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Affiliation(s)
- Federica Pinna
- Department of Public Health, Clinical and Molecular Medicine-Unit of Psychiatry, University of Cagliari, Via Liguria 13, 0917 Cagliari, Italy
| | - Andrea Fiorillo
- Department of Psychiatry, University of Naples SUN, Naples, Italy
| | - Massimo Tusconi
- Department of Public Health, Clinical and Molecular Medicine-Unit of Psychiatry, University of Cagliari, Via Liguria 13, 0917 Cagliari, Italy
| | - Beatrice Guiso
- Department of Public Health, Clinical and Molecular Medicine-Unit of Psychiatry, University of Cagliari, Via Liguria 13, 0917 Cagliari, Italy
| | - Bernardo Carpiniello
- Department of Public Health, Clinical and Molecular Medicine-Unit of Psychiatry, University of Cagliari, Via Liguria 13, 0917 Cagliari, Italy
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Schreiner A, Bergmans P, Cherubin P, Keim S, Llorca PM, Cosar B, Petralia A, Corrivetti G, Hargarter L. Paliperidone palmitate in non-acute patients with schizophrenia previously unsuccessfully treated with risperidone long-acting therapy or frequently used conventional depot antipsychotics. J Psychopharmacol 2015; 29:910-22. [PMID: 25999398 PMCID: PMC4512527 DOI: 10.1177/0269881115586284] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
PALMFlexS, a prospective multicentre, open-label, 6-month, phase IIIb interventional study, explored tolerability, safety and treatment response in adults (n = 231) with non-acute but symptomatic schizophrenia switching to flexibly dosed paliperidone palmitate (PP) after unsuccessful treatment with risperidone long-acting injectable therapy (RLAT) or conventional depot antipsychotics (APs). Treatment response was measured by change in Positive and Negative Syndrome Scale (PANSS) total score from baseline (BL) to last-observation-carried-forward (LOCF) endpoint (EP). Safety and tolerability assessments included Extrapyramidal Symptom Rating Scale (ESRS) total score and treatment-emergent adverse events. Significant reductions in mean PANSS total score were observed for all groups (-7.5 to -10.6; p ⩽ 0.01 [BL to LOCF EP]). After switching to PP, more than 50% of all patients achieved ⩾20% and one-third of RLAT-treated patients even achieved ⩾50% improvement in PANSS total score. Across groups, there were significant improvements (p < 0.05) in symptom severity as measured by Clinical Global Impression-Severity (CGI-S; trend for improvement with RLAT; p = 0.0568), subjective well-being, medication satisfaction, and patient functioning with PP. PP was generally well tolerated. Clinically relevant benefits were observed in non-acute patients with schizophrenia switched from RLAT or conventional depot APs to PP.
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Affiliation(s)
- A Schreiner
- EMEA Medical Affairs, Janssen Cilag GmbH, Neuss, Germany
| | - P Bergmans
- Biometrics & Reporting, Janssen Cilag Benelux, Tilburg, the Netherlands
| | - P Cherubin
- EMEA Medical Affairs, Janssen Cilag, Issy-les-Moulineaux, France
| | - S Keim
- Global Clinical Operations EMEA Medical Affairs, Janssen Cilag, Barcarena, Portugal
| | - P-M Llorca
- CHRU Clermont-Ferrand, Hôpital Gabriel Montpied, Clermont-Ferrand, France
| | - B Cosar
- Gazi University Medical Faculty, Ankara, Turkey
| | - A Petralia
- UOPI of Psychiatry, AOU Policlinico Vittorio Emanuele, Catania, Italy
| | - G Corrivetti
- UOSM Distretto D, Pontecagnano-Faiano (Sa), Italy
| | - L Hargarter
- EMEA Medical Affairs, Janssen Cilag GmbH, Neuss, Germany
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Hargarter L, Cherubin P, Bergmans P, Keim S, Rancans E, Bez Y, Parellada E, Carpiniello B, Vidailhet P, Schreiner A. Intramuscular long-acting paliperidone palmitate in acute patients with schizophrenia unsuccessfully treated with oral antipsychotics. Prog Neuropsychopharmacol Biol Psychiatry 2015; 58:1-7. [PMID: 25448776 DOI: 10.1016/j.pnpbp.2014.11.006] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 10/28/2014] [Accepted: 11/10/2014] [Indexed: 11/26/2022]
Abstract
In this prospective multicentre, open-label, 6-month study (Paliperidone Palmitate Flexible Dosing in Schizophrenia [PALMFlexS]), tolerability, safety and treatment response with paliperidone palmitate (PP) were explored in patients with acute symptoms of schizophrenia following switching from previously unsuccessful treatment with oral antipsychotics. This pragmatic study was conducted in a large, more representative sample of the general schizophrenia population compared to randomized controlled pivotal trials, to specifically mimic real-world clinical situations. After initiation on Day 1 and Day 8, patients received PP once monthly at flexible doses (50-150mgeq.) intramuscularly. The primary efficacy outcome was defined as the percentage of patients achieving ≥30% improvement in PANSS total score from baseline (BL) to last-observation-carried-forward (LOCF) endpoint (EP). Safety and tolerability assessments included Extrapyramidal Symptom Rating Scale (ESRS) total score and treatment-emergent adverse events (TEAEs). Overall, 212 patients received PP at least once after switching from oral antipsychotics, primarily due to lack of efficacy (45.8%). Significant improvements from BL in mean (SD) PANSS total score were observed from Day 8 onwards (BL to LOCF EP: -31.0 [29.0]; p<0.0001). At endpoint, two-thirds (66.7%) and 43.5% of patients achieved a ≥30% and ≥50% improvement in mean PANSS total score, respectively. PP was associated with significant improvements across secondary measures of symptom severity, subjective well-being, medication satisfaction, illness-related disorders of activity and participation, and patient functioning (p<0.0001; BL to LOCF EP). PP was generally well tolerated, with significant reductions in ESRS total score (p<0.0001) and mainly mild-to-moderate TEAEs. TEAEs reported in ≥5% of patients were injection-site pain (13.7%), insomnia (10.8%), psychotic disorder (10.4%), headache and anxiety (both 6.1%). The PALMFlexS study findings provide valuable pragmatic clinical data on PP treatment in patients with acute schizophrenia previously unsuccessfully treated with oral antipsychotics.
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Affiliation(s)
- Ludger Hargarter
- Medical & Scientific Affairs, Janssen Cilag EMEA, Neuss, Germany.
| | - Pierre Cherubin
- Medical Affairs, Janssen Cilag EMEA, Issy-les-Moulineaux, France
| | - Paul Bergmans
- Biometrics and Reporting, Janssen Cilag Benelux, Tilburg, The Netherlands
| | - Sofia Keim
- Global Clinical Operations EMEA MAO, Janssen Cilag, Barcarena, Portugal
| | - Elmars Rancans
- Department of Psychiatry and Narcology, Riga Stradins University, Riga, Latvia
| | - Yasin Bez
- Dicle University Medical Faculty, Diyarbakir, Turkey
| | - Eduard Parellada
- Barcelona Clinic Schizophrenia Unit (BCSU), Hospital Clínic de Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | | | - Pierre Vidailhet
- Centre Hospitalier Régional Universitaire de Strasbourg, Strasbourg, France
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A prospective flexible-dose study of paliperidone palmitate in nonacute but symptomatic patients with schizophrenia previously unsuccessfully treated with oral antipsychotic agents. Clin Ther 2014; 36:1372-88.e1. [PMID: 25444566 DOI: 10.1016/j.clinthera.2014.08.014] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 07/18/2014] [Accepted: 08/09/2014] [Indexed: 11/23/2022]
Abstract
PURPOSE The goal of this study was to explore the tolerability, safety, and treatment response of flexible doses of once-monthly paliperidone palmitate (PP) in the subset of nonacute but symptomatic adult patients with schizophrenia previously unsuccessfully treated with oral antipsychotic agents in the PALMFlexS (Paliperidone Palmitate Flexible Dosing in Schizophrenia) study. METHODS This was an interventional, single-arm, international, multicenter, unblinded, 6-month study performed in patients with schizophrenia. Patients were categorized according to reasons for switching. In patients switching because of lack of efficacy or for other reasons, primary efficacy outcomes were the proportion achieving treatment response (defined as ≥20% improvement in Positive and Negative Syndrome Scale [PANSS] total score from baseline to last-observation-carried-forward end point) and maintained efficacy (defined as noninferiority in the change in PANSS total score at end point versus baseline [Schuirmann's test]), respectively. FINDINGS A total of 593 patients (intention-to-treat population) were enrolled: 63.1% were male; their mean (SD) age was 38.4 (11.8) years; and 78.6% had paranoid schizophrenia. The main reasons for transition to PP were patient's wish (n = 259 [43.7%]), lack of efficacy (n = 144 [24.3%]), lack of compliance (n = 138 [23.3%]), and lack of tolerability (n = 52 [8.8%]) with the previous oral antipsychotic medication. The recommended PP initiation regimen (150 milligram equivalents [mg eq] day 1 and 100 mg eq day 8) was administered in 93.9% of patients. Mean PANSS total score decreased from 71.5 (14.6) at baseline to 59.7 (18.1) at end point (mean change, -11.7 [15.9]; 95% CI, -13.0 to -10.5; P < 0.0001). Sixty-four percent of patients showed an improvement of ≥20% in PANSS total score, and the percentage of patients rated mildly ill or less in Clinical Global Impression-Severity increased from 31.8% to 63.2%. Mean personal and social performance total score (SD) increased (ie, improved) significantly for all patients from baseline to end point (58.1 [13.4] to 66.1 [15.7]; P < 0.0001). IMPLICATIONS The PALMFlexS study is a pragmatic interventional study compared with randomized controlled trials, conducted in a large, more representative sample of patients with schizophrenia, and designed specifically to mimic real-world clinical situations. The findings support the results from randomized controlled studies. They also demonstrate that a clinically relevant treatment response is possible in patients who are considered to be clinically stable by their physician, supporting the use of flexibly dosed PP in such patients. Clinical trials.gov number: NCT01281527.
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Brütt AL, Schulz H, Andreas S. Psychometric properties of an instrument to measure activities and participation according to the ICF concept in patients with mental disorders. Disabil Rehabil 2014; 37:259-67. [PMID: 24833419 DOI: 10.3109/09638288.2014.918189] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE The International Classification of Functioning, Disability and Health (ICF) conceptualizes the bio-psycho-social model of health and illness, but cannot be used as an assessment instrument in routine care. The objective of this study was to psychometrically test a self-report instrument for measuring activities and social participation (ICF-Mental-A&P) of psychotherapy patients. METHODS For the psychometric evaluation of the ICF-Mental-A&P, participants completed a questionnaire on symptoms, interpersonal problems and quality of life at admission and at discharge of in-patient treatment. A consecutive sample of 2256 patients diagnosed with at least one mental disorder was recruited from eight in-patient units in Germany. RESULTS After item selection, the ICF-Mental-A&P contained 31 items comprising six subscales examined by confirmatory factor analysis. Subscales had acceptable internal consistency (α = 0.78-0.90) and test-retest correlations (r = 0.71-0.86). There were several expected correlations (r ≥ 0.6) between ICF-Mental-A&P scores and measures of symptoms and interpersonal problems. CONCLUSIONS Findings suggest that the ICF-Mental-A&P is a comprehensive, reliable measure of activities and participation according to the ICF concept for patients with mental disorders. It may therefore be an important instrument in clinical practice and could help to determine and evaluate functioning-related and patient-focused treatment outcomes.
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Affiliation(s)
- Anna Levke Brütt
- Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf , Hamburg , Germany and
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Pfennig A, Leopold K, Bechdolf A, Correll CU, Holtmann M, Lambert M, Marx C, Meyer TD, Pfeiffer S, Reif A, Rottmann-Wolf M, Schmitt NM, Stamm T, Juckel G, Bauer M. Early specific cognitive-behavioural psychotherapy in subjects at high risk for bipolar disorders: study protocol for a randomised controlled trial. Trials 2014; 15:161. [PMID: 24886581 PMCID: PMC4020379 DOI: 10.1186/1745-6215-15-161] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 04/08/2014] [Indexed: 11/25/2022] Open
Abstract
Background Bipolar disorders (BD) are among the most severe mental disorders with first clinical signs and symptoms frequently appearing in adolescence and early adulthood. The long latency in clinical diagnosis (and subsequent adequate treatment) adversely affects the course of disease, effectiveness of interventions and health-related quality of life, and increases the economic burden of BD. Despite uncertainties about risk constellations and symptomatology in the early stages of potentially developing BD, many adolescents and young adults seek help, and most of them suffer substantially from symptoms already leading to impairments in psychosocial functioning in school, training, at work and in their social relationships. We aimed to identify subjects at risk of developing BD and investigate the efficacy and safety of early specific cognitive-behavioural psychotherapy (CBT) in this subpopulation. Methods/Design EarlyCBT is a randomised controlled multi-centre clinical trial to evaluate the efficacy and safety of early specific CBT, including stress management and problem solving strategies, with elements of mindfulness-based therapy (MBT) versus unstructured group meetings for 14 weeks each and follow-up until week 78. Participants are recruited at seven university hospitals throughout Germany, which provide in- and outpatient care (including early recognition centres) for psychiatric patients. Subjects at high risk must be 15 to 30 years old and meet the combination of specified affective symptomatology, reduction of psychosocial functioning, and family history for (schizo)affective disorders. Primary efficacy endpoints are differences in psychosocial functioning and defined affective symptomatology at 14 weeks between groups. Secondary endpoints include the above mentioned endpoints at 7, 24, 52 and 78 weeks and the change within groups compared to baseline; perception of, reaction to and coping with stress; and conversion to full BD. Discussion To our knowledge, this is the first study to evaluate early specific CBT in subjects at high risk for BD. Structured diagnostic interviews are used to map the risk status and development of disease. With our study, the level of evidence for the treatment of those young patients will be significantly raised. Trial registration WHO International Clinical Trials Platform (ICTRP), identifier: DRKS00000444, date of registration: 16 June 2010.
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Affiliation(s)
- Andrea Pfennig
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Fetscherstrasse 74, 01307 Dresden, Germany.
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Molodynski A, Linden M, Juckel G, Yeeles K, Anderson C, Vazquez-Montes M, Burns T. The reliability, validity, and applicability of an English language version of the Mini-ICF-APP. Soc Psychiatry Psychiatr Epidemiol 2013; 48:1347-54. [PMID: 23080483 DOI: 10.1007/s00127-012-0604-8] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Accepted: 10/05/2012] [Indexed: 11/28/2022]
Abstract
PURPOSE This study aimed at establishing the validity and reliability of an English language version of the Mini-ICF-APP. METHODS One hundred and five patients under the care of secondary mental health care services were assessed using the Mini-ICF-APP and several well-established measures of functioning and symptom severity. 47 (45 %) patients were interviewed on two occasions to ascertain test-retest reliability and 50 (48 %) were interviewed by two researchers simultaneously to determine the instrument's inter-rater reliability. Occupational and sick leave status were also recorded to assess construct validity. RESULTS The Mini-ICF-APP was found to have substantial internal consistency (Chronbach's α 0.869-0.912) and all 13 items correlated highly with the total score. Analysis also showed that the Mini-ICF-APP had good test-retest (ICC 0.832) and inter-rater (ICC 0.886) reliability. No statistically significant association with length of sick leave was found, but the unemployed scored higher on the Mini ICF-APP than those in employment (mean 18.4, SD 9.1 vs. 9.4, SD 6.4, p < 0.001). The Mini-ICF-APP correlated highly with the other measures of illness severity and functioning considered in the study. CONCLUSIONS The English version of the Mini-ICF-APP is a reliable and valid measure of disorders of capacity as defined by the International Classification of Functioning. Further work is necessary to establish whether the scale could be divided into sub scales which would allow the instrument to more sensitively measure an individual's specific impairments.
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Affiliation(s)
- Andrew Molodynski
- Social Psychiatry Group, Department of Psychiatry, University of Oxford, Oxford, OX3 7JX, UK.
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Validation of the Italian version of Mini-ICF-APP, a short instrument for rating activity and participation restrictions in psychiatric disorders. Epidemiol Psychiatr Sci 2013; 22:81-91. [PMID: 22989494 PMCID: PMC6998349 DOI: 10.1017/s2045796012000480] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Aims. The assessment of limitations in social capacities can be done with the Mini-ICF-APP, a rating scale built in reference to the International Classification of Functioning, Disability and Health (ICF). The aim of this study was to assess the reliability and the convergent validity of the Italian version of this scale. Methods. We recruited 120 consecutive patients diagnosed with schizophrenia, major depression, bipolar I disorder and anxiety disorders. Included measures were the Brief Psychiatric Rating Scale (BPRS), the Clinical Global Impression Scale (CGI-S), the Personal and Social Performance Scale (PSP) and the Social and Occupational Functioning Assessment Scale (SOFAS). Results. The median CGI-S and BPRS scores were 5 and 16.5. Mean Mini-ICF-APP total score was 18.1. Schizophrenics' Mini-ICF-APP score was higher, while that of anxious patients was lower than in the other diagnoses. Intra-class correlations (ICC) revealed a significant inter-rater agreement for total score (ICC 0.987) and for each item of the Mini-ICF-APP. The test-retest agreement was also highly significant (ICC 0.993). The total score of the Mini-ICF-APP obtained good negative correlations with PSP (r s = -0.767) and with SOFAS scores (r s = -0.790). The distribution items of the Mini-ICF-APP showed some skewness, indicating that self-care (item 12) and mobility (item 13) were amply preserved in most patients. The Mini-ICF-APP total score was significantly correlated with both CGI-S (r s = 0.777) and BPRS (r s = 0.729). Conclusions. As a short instrument, the Mini-ICF-APP scale seems to be well suited to everyday psychiatric practice as a means of monitoring changes in psychosocial functioning, in particular in schizophrenic patients.
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Nordt C, Brantschen E, Kawohl W, Bärtsch B, Haker H, Rüsch N, Rössler W. 'Placement budgets' for supported employment--improving competitive employment for people with mental illness: study protocol of a multicentre randomized controlled trial. BMC Psychiatry 2012; 12:165. [PMID: 23034095 PMCID: PMC3512514 DOI: 10.1186/1471-244x-12-165] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Accepted: 09/27/2012] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Vocational integration of people with mental illness is poor despite their willingness to work. The 'Individual Placement and Support' (IPS) model which emphasises rapid and direct job placement and continuing support to patient and employer has proven to be the most effective vocational intervention programme. Various studies have shown that every second patient with severe mental illness was able to find competitive employment within 18 months. However, the goal of taking up employment within two months was rarely achieved. Thus, we aim to test whether the new concept of limited placement budgets increases the effectiveness of IPS. METHODS/DESIGN Six job coaches in six out-patients psychiatric clinics in the Canton of Zurich support unemployed patients of their clinic who seek competitive employment. Between June 2010 and May 2011 patients (N=100) are randomly assigned to three different placement budgets of 25h, 40h, or 55h working hours of job coaches. Support lasts two years for those who find a job. The intervention ends for those who fail to find competitive employment when the respective placement budgets run out. The primary outcome measure is the time between study inclusion and first competitive employment that lasted three months or longer. Over a period of three years interviews are carried out every six months to measure changes in motivation, stigmatization, social network and social support, quality of life, job satisfaction, financial situation, and health conditions. Cognitive and social-cognitive tests are conducted at baseline to control for confounding variables. DISCUSSION This study will show whether the effectiveness of IPS can be increased by the new concept of limited placement budgets. It will also be examined whether competitive employment leads in the long term to an improvement of mental illness, to a transfer of the psychiatric support system to private and vocational networks, to an increase in financial independence, to a reduction of perceived and internalized stigma, and to an increase in quality of life and job satisfaction of the patient. In addition, factors connected with fast competitive employment and holding that job down in the long term are being examined (motivation, stigmatization, social and financial situation). TRIAL REGISTER ISRCTN89670872.
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Affiliation(s)
- Carlos Nordt
- Psychiatric University Hospital Zurich, Research Unit for Clinical and Social Psychiatry, Lenggstrasse 31, PO Box 1931, 8032, Zürich, Switzerland.
| | - Elisabeth Brantschen
- Psychiatric University Hospital Zurich, Research Unit for Clinical and Social Psychiatry, Lenggstrasse 31, PO Box 1931, 8032, Zürich, Switzerland
| | - Wolfram Kawohl
- Psychiatric University Hospital Zurich, Research Unit for Clinical and Social Psychiatry, Lenggstrasse 31, PO Box 1931, 8032, Zürich, Switzerland
| | - Bettina Bärtsch
- Psychiatric University Hospital Zurich, Research Unit for Clinical and Social Psychiatry, Lenggstrasse 31, PO Box 1931, 8032, Zürich, Switzerland
| | - Helene Haker
- Psychiatric University Hospital Zurich, Research Unit for Clinical and Social Psychiatry, Lenggstrasse 31, PO Box 1931, 8032, Zürich, Switzerland
| | - Nicolas Rüsch
- Psychiatric University Hospital Zurich, Research Unit for Clinical and Social Psychiatry, Lenggstrasse 31, PO Box 1931, 8032, Zürich, Switzerland
| | - Wulf Rössler
- Psychiatric University Hospital Zurich, Research Unit for Clinical and Social Psychiatry, Lenggstrasse 31, PO Box 1931, 8032, Zürich, Switzerland
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[PSP Scale: German version of the Personal and Social Performance Scale: valid instrument for the assessment of psychosocial functioning in the treatment of schizophrenia]. DER NERVENARZT 2012; 82:1178-84. [PMID: 21174069 DOI: 10.1007/s00115-010-3204-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
In the treatment of schizophrenia, the domain of psychosocial functioning is an important aspect of therapeutic success that should be considered in addition to the reduction of psychopathology. Valid and standardised measures are necessary for diagnostics and the assessment of patients" personal, social and professional functioning. The German version of the Personal and Social Performance (PSP) Scale (with its four subdimensions: "socially useful activities, work and study included", "personal and social relationships", "self-care" and "disturbing and aggressive behaviour") was administered to patients with schizophrenia in previous studies. These data demonstrated this scale to be a reliable, valid and efficient tool for measuring psychosocial functioning in schizophrenia. Thus, it is argued that, for everyday clinical practice, the PSP Scale is useful for the assessment of psychosocial functioning in schizophrenia during short, medium and long-term treatment courses.
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Salvador-Carulla L, Garcia-Gutierrez C. The WHO construct of health-related functioning (HrF) and its implications for health policy. BMC Public Health 2011; 11 Suppl 4:S9. [PMID: 21624195 PMCID: PMC3104222 DOI: 10.1186/1471-2458-11-s4-s9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The International Classification of Functioning (ICF) has acquired a central role in the WHO Family of International Classifications and it has been extensively adopted as the reference framework for health-related functioning (HrF). This review aims to provide a description of the ICF/HrF to contextualise ICF/HrF in relation to other approaches to health functioning and to describe its application in policy and legislation with a special focus on Spain. METHODS Narrative review based on the scientific literature and prior expert knowledge. RESULTS ICF is both a coding system and a conceptual framework of HrF, which is framed as a unidimensional, bipolar and asymmetric construct with a negative pole (disability) and a positive pole (good functioning) with higher complexity. Other models of HrF include health promotion, quality of life and activities of daily living (ADL). The curtailed taxonomy of ICF and its unclear distinction from other approaches have had significant implications for research, policy and legislation, as illustrated by the case of the legislation and services for functional dependency in Spain and other examples. CONCLUSIONS The ICF model of functioning is more comprehensive and usable than previous alternatives, but a full taxonomy of the HrF construct is needed to avoid further confusions in this field. This should also comprise harmonization with other classifications of the WHO Family of International Classifications and other models of health functioning.
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The illness and everyday living: close interplay of psychopathological syndromes and psychosocial functioning in chronic schizophrenia. Eur Arch Psychiatry Clin Neurosci 2011; 261:85-93. [PMID: 20652295 DOI: 10.1007/s00406-010-0122-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2009] [Accepted: 06/22/2010] [Indexed: 10/19/2022]
Abstract
The interaction of psychopathological states and psychosocial functioning determine the long-term course of schizophrenia and its treatment. To be able to achieve this interplay better, exact assessment of psychosocial functioning is needed besides measurement of psychopathology. Using the Personal and Social Performance (PSP) Scale, examination of the association between psychosocial functioning and psychopathology was conducted in a sample of 103 patients with chronic schizophrenia. Rating instruments were in addition Global Assessment of Functioning Scale and Social and Occupational Functioning Assessment Scale, as well as Positive and Negative Syndrome Scale (PANSS), Clinical Global Impression Scale, and Mini-ICF-APP-Rating for Mental Disorders (Mini-ICF-APP). Besides good psychometric properties for the PSP scale in this chronic sample, we found, as expected, significant associations between the two relevant outcome domains: results showed significant negative correlations between PSP and PANSS. Findings prove the close interplay between social functioning and psychopathology in the chronic course of schizophrenia.
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[The "reasonable effort of will" in the expert opinion in social medicine]. DER NERVENARZT 2010; 81:1092-6. [PMID: 20383483 DOI: 10.1007/s00115-010-2990-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The assessment of "effort of will" and "reasonableness" in the social medical expert opinion needs the empirical recording of concrete psychopathological and/or physical symptoms and its connection to fitness for work. The discussion of abstract, philosophical problems is not necessary. From the psychiatric point of view, a proposal for handling these complex terms is presented. The expert assessment should be carried out in several steps.
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Petermann F. Klinisches Untersuchungsverfahren. ZEITSCHRIFT FUR KLINISCHE PSYCHOLOGIE UND PSYCHOTHERAPIE 2010. [DOI: 10.1026/1616-3443/a000042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Baron S, Linden M. Disorders of functions and disorders of capacity in relation to sick leave in mental disorders. Int J Soc Psychiatry 2009; 55:57-63. [PMID: 19129326 DOI: 10.1177/0020764008091660] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND With the publication of the International Classification of Functioning, Disability and Health (ICF), the description of functional health as opposed to symptoms of illness has gained in importance. AIMS To study the interrelation between disorders of functions, capacity and participation in mental disorders. METHOD Two hundred and thirteen psychosomatic inpatients were assessed with the Mini-ICF-Rating for Mental Disorders (Mini-ICF-P), the Symptom Checklist (SCL-90-R) and an interview on sick leave. RESULTS The highest scores in the Mini-ICF-P were found for 'flexibility' (M = 1.64, SD = 0.94), 'structuring of tasks' (M = 1.12, SD = 1.05) and 'endurance' (M = 1.12, SD = 1.02), the lowest for 'self maintenance' (M = 0.19, SD = 0.44), 'mobility' (M = 0.43, SD = 0.85) and 'adherence to regulations' (M = 0.74, SD = 0.98). The correlation between Mini-ICF-P and SCL-90-R GSI is r = 0.51 (p < 0.001), between sick leave and GSI is r = -0.05 and between sick leave and Mini-ICF-P r = 0.34 ( p < 0.001). CONCLUSION Disorders of capacity are more closely related to disorders of participation/sick leave than disorders of functions.
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Affiliation(s)
- S Baron
- Research Group Psychosomatic Rehabilitation, Charité University Medicine, Berlin/Teltow
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Juckel G, Schaub D, Fuchs N, Naumann U, Uhl I, Witthaus H, Hargarter L, Bierhoff HW, Brüne M. Validation of the Personal and Social Performance (PSP) Scale in a German sample of acutely ill patients with schizophrenia. Schizophr Res 2008; 104:287-93. [PMID: 18595665 DOI: 10.1016/j.schres.2008.04.037] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2008] [Revised: 04/20/2008] [Accepted: 04/28/2008] [Indexed: 11/19/2022]
Abstract
In trying to more broadly define outcome in the efficient long-term treatment of patients with schizophrenia it is necessary to consider not only a reduction in psychopathological symptoms but also a successful psychosocial reintegration. Thus, a more exact assessment of psychosocial functioning is needed. Since the GAF (Global Assessment of Functioning) scale and the SOFAS (Social and Occupational Functioning Assessment Scale) are less operationalized and confuse psychosocial facts with psychopathological symptoms, the Personal and Social Performance (PSP) scale was developed [Morosini, P.L., Magliano, L., Brambilla, L., Ugolini, S., Pioli, R. (2000). Development, reliability and acceptability of a new version of the DSM-IV Social and Occupational Functioning Assessment Scale (SOFAS) to assess routine social functioning. Acta Psychiatrica Scandinavica, 1001, 323-329.] containing the four main areas "socially useful activities, personal and social relationships, self-care, as well as disturbing and aggressive behaviour". Validation of the PSP scale was conducted in a sample of 62 patients with acute schizophrenia. Rating instruments were PSP, GAF, SOFAS, PANSS, CGI, and Mini-ICF-P (Mini-ICF-Rating for Mental Disorders). The results showed good reliability with alpha=.64-.84, high test-retest reliability as well as good inter-rater reliability for the PSP scale. Furthermore, PSP proved good validity with high correlations to GAF (r=.91), SOFAS (r=.91), and Mini-ICF-P (r=-.69). The hypothesis that more critically ill patients would show lower scores on PSP than lesser ill patients was only confirmed for PANSS negative symptoms. Thus, the findings prove the PSP scale to be a reliable and valid instrument for assessing social functioning of patients with schizophrenia during the course of treatment as well as in the acute state.
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Affiliation(s)
- Georg Juckel
- Department of Psychiatry, Ruhr University Bochum, LWL Hospital, Germany.
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Linden M, Muschalla B. Anxiety disorders and workplace-related anxieties. J Anxiety Disord 2007; 21:467-74. [PMID: 16890399 DOI: 10.1016/j.janxdis.2006.06.006] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2006] [Revised: 06/19/2006] [Accepted: 06/27/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Workplace-related anxieties are often connected with sick leave. There are no established instruments which allow to assess this phenomenologically heterogeneous group of disorders. METHOD One hundred and thirty-two psychosomatic inpatients were interviewed with a standardized diagnostic interview in respect to mental illnesses, especially primary anxiety disorders, and in addition in respect to different work-related anxiety disorders. RESULTS Seventy-one percent of women and 54% of men complained about work-related anxiety. 20.5% of participants are suffering from work-related panic, 58% from work-related phobia, 34.1% from work-related social phobia, 39.4% from work-related generalized anxiety, and 1.5% from work-related PTSD. There is a moderate relation between mental disorders or primary anxiety disorders and work-related anxiety. Fourteen percent of the participants did only suffer from workplace-related anxiety and did not report any other anxiety disorder outside the workplace situation. CONCLUSION There are various types of workplace-related anxieties. They are partly independent clinical phenomena deserving special diagnostic and therapeutic attention.
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Affiliation(s)
- Michael Linden
- Research Group Psychosomatic Rehabilitation, Charité University Medicine Berlin, Germany.
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Abstract
Sick leave certifications allow patients to stay away from work without negative consequences. German regulations state that patients can be granted sick leave when duties can no longer be fulfilled or may endanger health status and when there is a causal relationship between illness and disability. Relevant is not the presence of illness but of a disability which interferes with work requirements. In Germany, an average of 4% of workers are on sick leave at any given time, corresponding to about 2 weeks per year and person. The level of sick leave depends not only on the patient's health status but also on social factors. Mental disorders are a major reason for sick leave. Sick leave can have negative effects by fostering chronicity. In 75% of cases, physicians have been found to grant sick leave incorrectly. It must be kept in mind that not illness per se but only disorders of participation justify sick leave.
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Affiliation(s)
- M Linden
- Forschungsgruppe Psychosomatische Rehabilitation an der Charité und dem Rehabilitationszentrum Seehof, Teltow/Berlin.
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