1
|
Tang SX, Hänsel K, Oliver LD, Dickie EW, Hawco C, John M, Voineskos A, Gold JM, Buchanan RW, Malhotra AK. Functional phenotypes in schizophrenia spectrum disorders: defining the constructs and identifying biopsychosocial correlates using data-driven methods. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2024; 10:58. [PMID: 38914577 DOI: 10.1038/s41537-024-00479-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 06/11/2024] [Indexed: 06/26/2024]
Abstract
Functional impairments contribute to poor quality of life in schizophrenia spectrum disorders (SSD). We sought to (Objective I) define the main functional phenotypes in SSD, then (Objective II) identify key biopsychosocial correlates, emphasizing interpretable data-driven methods. Objective I was tested on independent samples: Dataset I (N = 282) and Dataset II (N = 317), with SSD participants who underwent assessment of multiple functioning areas. Participants were clustered based on functioning. Objective II was evaluated in Dataset I by identifying key features for classifying functional phenotype clusters from among 65 sociodemographic, psychological, clinical, cognitive, and brain volume measures. Findings were replicated across latent discriminant analyses (LDA) and one-vs.-rest binomial regularized regressions to identify key predictors. We identified three clusters of participants in each dataset, demonstrating replicable functional phenotypes: Cluster 1-poor functioning across domains; Cluster 2-impaired Role Functioning, but partially preserved Independent and Social Functioning; Cluster 3-good functioning across domains. Key correlates were Avolition, anhedonia, left hippocampal volume, and measures of emotional intelligence and subjective social experience. Avolition appeared more closely tied to role functioning, and anhedonia to independent and social functioning. Thus, we found three replicable functional phenotypes with evidence that recovery may not be uniform across domains. Avolition and anhedonia were both critical but played different roles for different functional domains. It may be important to identify critical functional areas for individual patients and target interventions accordingly.
Collapse
Affiliation(s)
- Sunny X Tang
- Division of Psychiatry Research, Feinstein Institutes for Medical Research, Northwell Health, New Hyde Park, NY, USA.
- Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, New Hyde Park, NY, USA.
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Uniondale, NY, USA.
| | - Katrin Hänsel
- Division of Psychiatry Research, Feinstein Institutes for Medical Research, Northwell Health, New Hyde Park, NY, USA
| | - Lindsay D Oliver
- Campbell Family Mental Health Research Institute, The Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Erin W Dickie
- Campbell Family Mental Health Research Institute, The Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Colin Hawco
- Campbell Family Mental Health Research Institute, The Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Majnu John
- Division of Psychiatry Research, Feinstein Institutes for Medical Research, Northwell Health, New Hyde Park, NY, USA
| | - Aristotle Voineskos
- Campbell Family Mental Health Research Institute, The Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - James M Gold
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Robert W Buchanan
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Anil K Malhotra
- Division of Psychiatry Research, Feinstein Institutes for Medical Research, Northwell Health, New Hyde Park, NY, USA
- Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, New Hyde Park, NY, USA
| |
Collapse
|
2
|
Szekely R, Mason O, Frohlich D, Barley E. 'It's not everybody's snapshot. It's just an insight into that world': A qualitative study of multiple perspectives towards understanding the mental health experience and addressing stigma in healthcare students through virtual reality. Digit Health 2024; 10:20552076231223801. [PMID: 38188857 PMCID: PMC10768613 DOI: 10.1177/20552076231223801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 12/14/2023] [Indexed: 01/09/2024] Open
Abstract
Objective The resurgence of virtual reality (VR) technologies has led to their increased use in contemporary healthcare education. One promising application is simulating the experiences of individuals with mental health conditions (MHCs) to reduce stigma among future healthcare professionals. This study set out to explore what those impacted by, or involved in, the education of healthcare students think about using VR in this way. Methods One individual interview and five focus groups were conducted with healthcare students (n = 7), healthcare educators (n = 6), and lived experience experts (n = 5). Before sharing their perspectives, participants familiarised themselves with VR equipment and immersive materials simulating MHCs. The constant comparative method and thematic analysis were used to analyse the data. Results Participants recognised the acceptability and utility of VR for addressing mental health stigma in healthcare students, emphasising the immersive nature of this technology. However, some participants raised concerns about the limited insight VR could provide into the experiences of patients with the same MHCs and its potential emotional impact on users. Participants recommended the incorporation of interactive, realistic environments with a person-centred focus into future VR-based stigma reduction interventions while stressing the importance of providing healthcare students with opportunities for reflection and support. Conclusions Healthcare students, healthcare educators, and lived experience experts highlighted both advantages and barriers associated with using VR to understand the experience of patients with MHCs. Furthermore, the recommendations put forward can inform the design, content, and delivery of VR-based stigma reduction interventions in healthcare education.
Collapse
Affiliation(s)
- Raul Szekely
- School of Psychology, University of Surrey, Guildford, UK
| | - Oliver Mason
- School of Psychology, University of Surrey, Guildford, UK
| | - David Frohlich
- Digital World Research Centre, University of Surrey, Guildford, UK
| | | |
Collapse
|
3
|
Wang Q, Tang W, Zhang J, Wang Y, Wang Q, Ma Y, Mao JK, Ye C, Yu X. Visuospatial ability and attention as risk factors for suicidal ideation in middle-aged and elderly schizophrenia patients: a cross-sectional study. BMC Psychiatry 2023; 23:765. [PMID: 37853396 PMCID: PMC10585849 DOI: 10.1186/s12888-023-05272-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 10/11/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Schizophrenia patients have a high risk of suicide, and their cognition function is impaired with increasing age. The association between neurocognitive and suicidality in schizophrenia patients are heterogeneous. We aimed to explore the relationship between neurocognitive function and suicidal ideation in schizophrenia patients across age groups. METHODS A total of 587 patients with schizophrenia were enrolled in this study. The schizophrenia patients were divided into young group (aged 18-44) and middle-aged and elderly group (aged 45-70). The schizophrenia patients were divided into suicidal ideation group and non-suicidal ideation group according to the evaluation results of the Beck Scale for Suicide Ideation. Insomnia symptoms were measured by the Insomnia Severity Index (ISI). Psychotic symptoms were measured by the Positive and Negative Syndrome Scale (PANSS), and cognitive function was measured by the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). RESULTS There was a negative correlation between the age and attention scores of RBANS (P = 0.018). The young schizophrenia patients had higher risk of suicidality than middle-aged and elderly schizophrenia patients (P = 0.001). In the logistic regression analysis, the scores of ISI and positive symptoms scores of PANSS were associated with suicidal ideation among young schizophrenia patients (All P < 0.05). Age, BMI, the scores of ISI, general symptoms scores of PANSS, visuospatial scores of RBANS and attention scores of RBANS were associated with suicidal ideation in middle-aged and elderly schizophrenia patients (All P < 0.05). CONCLUSIONS High visuospatial scores of RBANS and attention scores of RBANS were risk factors for suicidal ideation in middle-aged and elderly schizophrenia patients.
Collapse
Affiliation(s)
- Qiongzhang Wang
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Wei Tang
- The Affiliated Kangning Hospital of Wenzhou Medical University Zhejiang Provincial Clinical Research Center for Mental Disorder, Wenzhou, China.
| | - Junjie Zhang
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Yiwei Wang
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Qing Wang
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Yimin Ma
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Jian Kai Mao
- Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Chengyu Ye
- Wenzhou Central Hospital, The Dingli Clinical Institute of Wenzhou Medical University, Wenzhou, China.
| | - Xin Yu
- School of Mental Health, Wenzhou Medical University, Wenzhou, China.
- Peking University Institute of Mental Health (Sixth Hospital, Beijing, China.
- National Clinical Research Center for Mental Disorders and Key Laboratory of Mental Health, Ministry of Health, Peking University, Beijing, China.
- Beijing Municipal Key Laboratory for Translational Research on Diagnosis and Treatment of Dementia, Beijing, China.
| |
Collapse
|
4
|
Meesters PD. New horizons in schizophrenia in older people. Age Ageing 2023; 52:afad161. [PMID: 37725971 DOI: 10.1093/ageing/afad161] [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: 04/29/2023] [Indexed: 09/21/2023] Open
Abstract
People aged 65 years and older will soon constitute more than a quarter of the total population with schizophrenia, challenging the existing systems of care. For a long time, research into schizophrenia in later life was very limited. However, recent years have seen an encouraging surge in novel and high-quality studies related to this stage of life. Older people with schizophrenia consist of those who had an early onset and aged with the disorder, and of a smaller but sizeable group with a late onset or a very late onset. With ageing, physical needs gain importance relative to psychiatric needs. Medical comorbidity contributes to a markedly higher mortality compared to the general population. In many persons, symptoms and functioning fluctuate with time, leading to deterioration in some but improvement in others. Of note, a substantial number of older people may experience subjective well-being in spite of ongoing symptoms and social impairments. The majority of individuals with schizophrenia reside in the community, but when institutionalization is required many are placed in residential or nursing homes where staff is often ill-equipped to address their complex needs. There is a clear need for implementation of new models of care in which mental health and general health systems cooperate. This review provides a state-of-the-art overview of current knowledge in late life schizophrenia and related disorders, with a focus on themes with clinical relevance.
Collapse
Affiliation(s)
- Paul D Meesters
- Department of Research and Education, Friesland Mental Health Services, Leeuwarden, The Netherlands
| |
Collapse
|
5
|
Oluwoye O, Stokes B. The unique pathways to coordinate specialty care for Black families navigating early psychosis: A preliminary report. Schizophr Res 2023; 253:54-59. [PMID: 34823929 PMCID: PMC9124225 DOI: 10.1016/j.schres.2021.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 10/13/2021] [Accepted: 11/05/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Aversive pathways to coordinated specialty care (CSC) for first episode psychosis have been linked to the extended duration of untreated psychosis, limited engagement, and treatment outcomes. Yet there has been very limited research that has solely explored the unique pathways to care among Black families in the U.S. This study utilized qualitative methods to explore the pathways to CSC among Black individuals experiencing their first episode of psychosis and their family members. METHODS Individuals who were or are enrolled in CSC programs and/or their family members were recruited to participate in semi-structured qualitative interviews. Qualitative interviews were used to characterize events and experiences prior to the initiation of CSC. All interviews were transcribed verbatim and analyzed using a qualitative descriptive approach. RESULTS A total of 14 participants were recruited to complete semi-structured interviews. Findings revealed that during prodromal phase participants noticed changes in social functioning, identified prior childhood experiences that were viewed as traumatic, and sought very little help from formal sources. After the onset of psychosis, the majority of participants highlighted the importance of family members in the initiation of care, yet also expressed difficulties navigating services and engaging with clinical staff, contributing to further delays to the initiation of CSC. CONCLUSIONS Finding from this study sheds light on understanding known disparities in utilization of services and potentially identifies areas that can be leveraged to improve the experiences for Black families seeking CSC.
Collapse
Affiliation(s)
- Oladunni Oluwoye
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA; Washington State Center for Excellence in Early Psychosis, WA, USA.
| | - Bryony Stokes
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| |
Collapse
|
6
|
Horan WP, Depp CA, Hurst S, Linthicum J, Vargas G, Klein H, Keefe RSE, Harvey PD. Qualitative Analysis of the Content Validity of the Virtual Reality Functional Capacity Assessment Tool (VRFCAT) in Schizophrenia: A Multi-Stakeholder Perspective. SCHIZOPHRENIA BULLETIN OPEN 2023; 4:sgad012. [PMID: 38026054 PMCID: PMC10664622 DOI: 10.1093/schizbullopen/sgad012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
The US Food and Drug Agency (FDA) requires clinical trials targeting cognitive impairment associated with schizophrenia (CIAS) to demonstrate the functional relevance of cognitive improvements by employing a functional co-primary measure. Although quantitative evidence supports the suitability of the Virtual Reality Functional Capacity Assessment Tool (VRFCAT) for this purpose, FDA guidelines for qualification of clinical outcome assessments require evidence of content validity, defined as qualitative evidence that key stakeholders view the measure as relevant and important. To collect this important qualitative data, semi-structured interviews were conducted with outpatients with schizophrenia (n = 24), caregivers (n = 12), and professional peer support specialists (n = 12) to elicit their views about the definition and importance of functional independence, the importance of the functional domains assessed by the VRFCAT (meal planning, using transportation, handling money, shopping), and the relevance of the VRFCAT tasks to these domains. Qualitative thematic analyses revealed consistent themes across groups in defining functional independence, including performing instrumental self-care, financial, and social tasks; making decisions autonomously; and not depending on others to carry out daily activities. There were, however, notable differences in their views regarding the importance of and barriers to functional independence. All groups viewed the VRFCAT as assessing skill domains that are central to independent functioning and, with some minor differences, the VRFCAT tasks were viewed as relevant and meaningful examples of the domains. These qualitative results provide converging evidence that key stakeholders view the VRFCAT as a content-valid measure.
Collapse
Affiliation(s)
- William P Horan
- WCG Clinical Endpoint Solutions, Cary, NC
- Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, CA
| | - Colin A Depp
- Herbert Wertheim School of Public Health & Human Longevity Science, University of California, San Diego, CA
| | - Samantha Hurst
- Herbert Wertheim School of Public Health & Human Longevity Science, University of California, San Diego, CA
| | | | - Gabriela Vargas
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Research Service Bruce W. Carter VA Medical Center, Miami, FL
| | - Hans Klein
- WCG Clinical Endpoint Solutions, Cary, NC
| | | | - Philip D Harvey
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Research Service Bruce W. Carter VA Medical Center, Miami, FL
| |
Collapse
|
7
|
Meesters PD. Social Networks of Older Schizophrenia Patients: Fit for Later Life? Am J Geriatr Psychiatry 2022; 30:1168-1170. [PMID: 35732559 DOI: 10.1016/j.jagp.2022.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 05/23/2022] [Indexed: 01/25/2023]
Affiliation(s)
- Paul D Meesters
- Department of Research and Education (PDM), Friesland Mental Health Services, Leeuwarden, the Netherlands.
| |
Collapse
|
8
|
Searle A, Allen L, Lowther M, Cotter J, Barnett JH. Measuring functional outcomes in schizophrenia in an increasingly digital world. Schizophr Res Cogn 2022; 29:100248. [PMID: 35444930 PMCID: PMC9014442 DOI: 10.1016/j.scog.2022.100248] [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: 12/17/2021] [Revised: 03/15/2022] [Accepted: 03/15/2022] [Indexed: 12/01/2022] Open
Abstract
With an unmet clinical need for effective interventions for cognitive and negative symptoms in patients with schizophrenia, measures of functional status (often a co-primary endpoint) remain key clinical trial outcomes. This review aims to give an overview of the different types of functional assessments commonly used in clinical trials and research involving patients with schizophrenia and highlight pertinent challenges surrounding the use of these as reliable, sensitive, and specific assessments in intervention trials. We provide examples of commonly used functional measures and highlight emerging real-time digital assessment tools. Informant- and clinician-rated functional outcome measures and functional capacity assessments are valid, commonly used measures of functional status that try to overcome the need for often overly ambitious and insensitive ‘real world’ milestones. The wide range of scientific and practical challenges associated with these different tools leave room for the development of improved functional outcome measures for use in clinical trials. In particular, many existing measures fail to capture small, but meaningful, functional changes that may occur over the course of typically short intervention trials. Adding passive digital data collection and short active real-time digital assessments whilst patients go about their day offers the opportunity to build a more fine-grained picture of functional improvements that, if thoughtfully developed and carefully applied, could provide the sensitivity needed to accurately evaluate functional status in intervention studies, aiding the development of desperately needed treatments. Functional outcome measures are important for evaluating the efficacy of treatments. A variety of these are available, each with their own strengths and limitations. However, consensus on the optimal functional outcome measure(s) is lacking. Digital measures may enhance the assessment of associated functional constructs.
Collapse
Affiliation(s)
- Anja Searle
- Cambridge Cognition, Tunbridge Court, Bottisham, Cambridge CB25 9TU, UK
| | - Luke Allen
- Cambridge Cognition, Tunbridge Court, Bottisham, Cambridge CB25 9TU, UK
| | - Millie Lowther
- Cambridge Cognition, Tunbridge Court, Bottisham, Cambridge CB25 9TU, UK.,Anxiety Lab, Neuroscience and Mental Health Group, University College London Institute of Cognitive Neuroscience, Alexandra House, 17-19 Queen Square, Bloomsbury, London WC1N 3AZ, UK
| | - Jack Cotter
- Cambridge Cognition, Tunbridge Court, Bottisham, Cambridge CB25 9TU, UK.,Medical and Scientific Affairs, Nutrition, Reckitt, Slough, UK
| | - Jennifer H Barnett
- Cambridge Cognition, Tunbridge Court, Bottisham, Cambridge CB25 9TU, UK.,University of Cambridge Department of Psychiatry, Cambridge CB2 0SZ, UK
| |
Collapse
|
9
|
Lavaud P, McMahon K, Sánchez Rico M, Hanon C, Alvarado JM, de Raykeer RP, Limosin F, Hoertel N. Long-term care utilization within older adults with schizophrenia: Associated factors in a multicenter study. Psychiatry Res 2022; 308:114339. [PMID: 34963089 DOI: 10.1016/j.psychres.2021.114339] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 12/08/2021] [Accepted: 12/09/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Data are scarce regarding the clinical factors associated with utilization of long-term care facilities among older adults with schizophrenia. In this multicenter study, we sought to examine potential clinical differences between older adults with schizophrenia who are living in a long-term care facility and their community-dwelling counterparts. METHOD We used data from the French Cohort of individuals with Schizophrenia Aged 55-years or more (CSA) study, a large multicenter sample of older adults with schizophrenia (N = 353). RESULTS The prevalence of long-term care utilization was 35.1% of older patients with schizophrenia. Living in a long term care facility was significantly and independently associated with higher level of depression (Adjusted odds ratio (AOR) [95%CI]=1.97 [1.06-3.64]), lower cognitive (AOR [95%CI]=0.94 [0.88-0.99]) and global functioning (AOR [95%CI]=0.97 [0.95-0.99]), greater lifetime number of hospitalizations in a psychiatric department (AOR [95%CI]=2.30 [1.18-4.50]), not having consulted a general practitioner in the past year (AOR [95%CI]=0.28 [0.0.14-0.56]), urbanicity (AOR [95%CI]=2.81 [1.37-5.80]), and older age (AOR [95%CI]=1.08 [1.03-1.13]). DISCUSSION Older patients with schizophrenia who live in long-term care facilities appear to belong to a distinct group, marked by a more severe course of illness with higher level of depression and more severe cognitive deficits than older patients with schizophrenia living in other settings. Our study highlights the need of early assessment and management of depression and cognitive deficits in this population and the importance of monitoring closely this vulnerable population.
Collapse
Affiliation(s)
- Pierre Lavaud
- AP-HP Center, University of Paris, Department of Psychiatry, Regional Resource Center of old age psychiatry, Issy-les-Moulineaux 92130, France.
| | - Kibby McMahon
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 2213 Elba Street, Durham, NC, 27710, United States
| | - Marina Sánchez Rico
- AP-HP Center, University of Paris, Department of Psychiatry, Regional Resource Center of old age psychiatry, Issy-les-Moulineaux 92130, France
| | - Cécile Hanon
- AP-HP Center, University of Paris, Department of Psychiatry, Regional Resource Center of old age psychiatry, Issy-les-Moulineaux 92130, France
| | - Jesús M Alvarado
- Department of Psychobiology & Behavioral Sciences Methods, Faculty of Psychology, Universidad Complutense de Madrid, Campus de Somosaguas S/N, 28223 Pozuelo de Alarcon, Spain
| | - Rachel Pascal de Raykeer
- AP-HP Center, University of Paris, Department of Psychiatry, Regional Resource Center of old age psychiatry, Issy-les-Moulineaux 92130, France; Paris University, Paris, France
| | - Frédéric Limosin
- AP-HP Center, University of Paris, Department of Psychiatry, Regional Resource Center of old age psychiatry, Issy-les-Moulineaux 92130, France; INSERM 1266, Psychiatry and Neurosciences Center, Paris, France; Paris University, Paris, France
| | - Nicolas Hoertel
- AP-HP Center, University of Paris, Department of Psychiatry, Regional Resource Center of old age psychiatry, Issy-les-Moulineaux 92130, France; INSERM 1266, Psychiatry and Neurosciences Center, Paris, France; Paris University, Paris, France
| | | |
Collapse
|
10
|
Ongeri L, Kariuki SM, Nyawira M, Schubart C, Tijdink JK, Newton CRJC, Penninx BWJH. Suicidal attempts and ideations in Kenyan adults with psychotic disorders: An observational study of frequency and associated risk factors. Front Psychiatry 2022; 13:1085201. [PMID: 36741571 PMCID: PMC9892760 DOI: 10.3389/fpsyt.2022.1085201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 12/28/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Psychotic disorders increase the risk for premature mortality with up to 40% of this mortality attributable to suicide. Although suicidal ideation (SI) and suicidal behavior (SB) are high in persons with psychotic disorders in sub-Saharan Africa, there is limited data on the risk of suicide and associated factors among persons with psychotic disorders. METHODS We assessed SI and SB in persons with psychotic disorders, drawn from a large case-control study examining the genetics of psychotic disorders in a Kenyan population. Participants with psychotic disorders were identified using a clinical review of records, and the diagnosis was confirmed with the Mini-International Neuropsychiatric Interview (MINI). We conducted bivariate and multivariate logistic (for binary suicide outcomes) or linear regression (for suicide risk score) analysis for each of the suicide variables, with demographic and clinical variables as determinants. RESULTS Out of 619 participants, any current SI or lifetime suicidal attempts was reported by 203 (32.8%) with psychotic disorders, of which 181 (29.2%) had a lifetime suicidal attempt, 60 (9.7%) had SI in the past month, and 38 (20.9%) had both. Family history of suicidality was significantly associated with an increased risk of suicidality across all the following four outcomes: SI [OR = 2.56 (95% CI: 1.34-4.88)], suicidal attempts [OR = 2.01 (95% CI: 1.31-3.06)], SI and SB [OR = 2.00 (95% CI: 1.31-3.04)], and suicide risk score [beta coefficient = 7.04 (2.72; 11.36), p = 0.001]. Compared to persons aged <25 years, there were reduced odds for SI for persons aged ≥ 25 years [OR = 0.30 (95% CI: 0.14-0.62)] and ≥ 45 years [OR = 0.32 (95% CI: 0.12-0.89)]. The number of negative life events experienced increased the risk of SI and SB [OR = 2.91 (95% CI: 1.43-5.94)] for 4 or more life events. Higher negative symptoms were associated with more suicidal attempts [OR = 2.02 (95%CI: 1.15-3.54)]. Unemployment was also associated with an increased risk for suicidal attempts [OR = 1.58 (95%CI: 1.08-2.33)] and SI and SB [OR = 1.68 (95% CI: 1.15-2.46)]. CONCLUSION Suicidal ideation and SB are common in persons with psychotic disorders in this African setting and are associated with sociodemographic factors, such as young age and unemployment, and clinical factors, such as family history of suicidality. Interventions targeted at the community (e.g., economic empowerment) or at increasing access to care and treatment for persons with psychotic disorders may reduce the risk of suicide in this vulnerable population group.
Collapse
Affiliation(s)
- Linnet Ongeri
- Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Symon M Kariuki
- Department of Public Health, Pwani University, Kilifi, Kenya.,Neuroscience Unit, Kenya Medical Research Institute-Wellcome Trust Research Program, Kilifi, Kenya.,Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Miriam Nyawira
- Neuroscience Unit, Kenya Medical Research Institute-Wellcome Trust Research Program, Kilifi, Kenya
| | | | - Joeri K Tijdink
- Department of Ethics, Law and Humanities, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Department of Philosophy, Faculty of Humanities, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Charles R J C Newton
- Department of Public Health, Pwani University, Kilifi, Kenya.,Neuroscience Unit, Kenya Medical Research Institute-Wellcome Trust Research Program, Kilifi, Kenya.,Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Brenda W J H Penninx
- Department of Psychiatry, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| |
Collapse
|
11
|
O’Keeffe D, Sheridan A, Kelly A, Doyle R, Madigan K, Lawlor E, Clarke M. A qualitative study exploring personal recovery meaning and the potential influence of clinical recovery status on this meaning 20 years after a first-episode psychosis. Soc Psychiatry Psychiatr Epidemiol 2022; 57:473-483. [PMID: 34143247 PMCID: PMC8934321 DOI: 10.1007/s00127-021-02121-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 06/02/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Long-term data on recovery conceptualisation in psychotic illness are needed to support mental health services to organise themselves according to recovery-oriented frameworks. To our knowledge, no previous research has investigated how first-episode psychosis (FEP) service users (sampled across psychotic illness type) perceive recovery beyond 5 years after diagnosis. We aimed to explore personal recovery meaning with individuals 20 years after their FEP and examine the potential influence of clinical recovery status on how they defined recovery (i.e. personal recovery). METHODS Twenty participants were purposefully sampled from an epidemiologically representative FEP incidence cohort. At 20-year follow-up, semi-structured interviews were conducted with 10 cohort members who met full 'functional recovery criteria' (Clinically Recovered Group) and 10 who did not (Not Clinically Recovered Group). A thematic analysis was performed to develop shared themes and group-specific sub-themes to capture agreement and divergence between groups. RESULTS Five shared themes were produced: pursuing balance in conflict, generating meaning in life, experiencing a dynamic personal relationship with time, redressing inequality while managing added challenges/vulnerability, and directing life from resilience to flourishing. The five group-specific sub-themes developed illuminate differences in the meaning ascribed to personal recovery by each group. CONCLUSION Findings emphasise the role of time in how personal recovery is conceptualised by service users and identify ways clinical recovery may influence personal recovery meaning in FEP at mid-later life. Mental health services failing to consider temporal changes in meaning-making and discounting clinical recovery risk ignoring key factors affecting personal recovery.
Collapse
Affiliation(s)
- Donal O’Keeffe
- DETECT Early Intervention in Psychosis Service, Dublin, Ireland ,School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Ann Sheridan
- School of Nursing, Midwifery, and Health Systems, University College Dublin, Dublin, Ireland
| | - Aine Kelly
- Saint John of God Hospitaller Services, Dublin, Ireland
| | - Roisin Doyle
- DETECT Early Intervention in Psychosis Service, Dublin, Ireland
| | - Kevin Madigan
- Saint John of God Community Services, Dublin, Ireland ,School of Postgraduate Studies, Faculty of Medicine and Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Mary Clarke
- DETECT Early Intervention in Psychosis Service, Dublin, Ireland ,School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
| |
Collapse
|
12
|
Harmanci P, Budak FK. The Effect of Psychoeducation Based on Motivational Interview Techniques on Medication Adherence, Hope, and Psychological Well-Being in Schizophrenia Patients. Clin Nurs Res 2021; 31:202-216. [PMID: 34596461 DOI: 10.1177/10547738211046438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study was conducted to determine the effect of psychoeducation based on motivational interview techniques on medication adherence, hope, and psychological well-being in schizophrenia patients. There are many studies using Motivational Interviewing for individuals with schizophrenia. However, there are no studies on whether the concept of "adherence to treatment," which is clearly shown to be corrected with 6 to 8 weeks of motivational interviewing, will positively affect concepts such as "hope and well-being," which require longer interventions, in a shorter time. In this context, there are not enough studies in which motivational interviewing techniques are integrated into psychoeducational interventions that can be organized with more individuals. The study was conducted with a pretest-posttest control group design. The sample size of the study was determined as 150 schizophrenia patients including 75 in the experimental group and 75 in the control group based on power analysis. The researcher provided the patients in the experimental group with a six-session psychoeducation program based on motivational interview techniques. A "Descriptive Characteristics Form," the "Herth Hope Index," the "Morisky Medication Adherence Scale," and the "Psychological Well-Being Scale" were used to collect the data. In the study, psychoeducation based on motivational interview techniques created a statistically significant difference in the medication adherence, hope and psychological well-being levels of the patients in the experimental and control groups (p < .05). Psychoeducation based on motivational interview techniques provided for schizophrenia patients was found to be effective in enhancing their medication adherence, hope, and psychological well-being levels.
Collapse
|
13
|
Olfson M, Stroup TS, Huang C, Wall MM, Crystal S, Gerhard T. Suicide Risk in Medicare Patients With Schizophrenia Across the Life Span. JAMA Psychiatry 2021; 78:876-885. [PMID: 34037667 PMCID: PMC8156163 DOI: 10.1001/jamapsychiatry.2021.0841] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 03/15/2021] [Indexed: 11/14/2022]
Abstract
Importance Although adults with schizophrenia have an increased risk of suicide, sample size limitations of previous research have hindered characterizations of suicide risk across the life span. Objective To describe suicide mortality rates and correlates among adults with schizophrenia across the life span and standardized mortality ratios (SMRs) for suicide compared with the general US population. Design, Setting, and Participants Five national retrospective longitudinal cohorts of patients with schizophrenia in the Medicare program from January 1, 2007, to December 31, 2016, were identified by age: 18 to 34, 35 to 44, 45 to 54, 55 to 64, and 65 years or older. Death record information was obtained from the National Death Index. The total cohort included 668 836 Medicare patients with schizophrenia, 2 997 308 years of follow-up, and 2218 suicide deaths. Data were analyzed from September 30, 2020, to March 10, 2021. Main Outcomes and Measures For each age group, suicide mortality rates per 100 000 person-years and adjusted hazard ratios (aHRs) with 95% CIs of suicide were determined. Suicide SMRs were estimated for the total cohort and by sex and age cohorts standardized to the general US population by age, sex, and race/ethnicity. Results The study population of adults 18 years and older included 668 836 Medicare recipients with schizophrenia (52.5% men, 47.5% women). The total suicide rate per 100 000 person-years was 74.00, which is 4.5 times higher than that for the general US population (SMR, 4.54; 95% CI, 4.35-4.73) and included a rate of 88.96 for men and 56.33 for women, which are 3.4 (SMR, 3.39; 95% CI, 3.22-3.57) and 8.2 (SMR, 8.16; 95% CI, 7.60-8.75) times higher, respectively, than the rates for the general US population. Suicide rates were significantly higher for men (aHR, 1.44; 95% CI, 1.29-1.61) and those with depressive (aHR, 1.32; 95% CI, 1.17-1.50), anxiety (aHR, 1.15; 95% CI, 1.02-1.30), drug use (aHR, 1.55; 95% CI, 1.36-1.76), and sleep disorders (aHR, 1.22; 95% CI, 1.07-1.39), suicidal ideation (aHR, 1.41; 95% CI, 1.22-1.63), and suicide attempts or self-injury (aHR, 2.48; 95% CI, 2.06-2.98). The adjusted hazards of suicide were lower for Hispanic patients (aHR, 0.66; 95% CI, 0.54-0.80) or Black patients (aHR, 0.29; 95% CI, 0.24-0.35) than White patients. The suicide rate declined with age, from 141.95 (SMR, 10.19; 95% CI, 9.29-11.18) for patients aged 18 to 34 years to 24.01 (SMR, 1.53; 95% CI, 1.32-1.77) for patients 65 years or older. The corresponding declines per 100 000 person-years were from 153.80 (18-34 years of age) to 34.17 (65 years or older) for men and from 115.70 (18-34 years of age) to 18.66 (65 years or older) for women. In the group aged 18 to 34 years, the adjusted hazards of suicide risk were significantly increased for patients with suicide attempt or self-injury (aHR, 2.57; 95% CI, 18.20-2.04) and with comorbid drug use disorders (aHR, 1.48; 95% CI, 1.17-1.88), but not with comorbid depressive disorders (aHR, 0.99; 95% CI, 0.38-1.26) during the year before the start of follow-up. Conclusions and Relevance In this cohort study of adult Medicare patients with schizophrenia, suicide risk was elevated, with the highest absolute and relative risk among young adults. These patterns support suicide prevention efforts with a focus on young adults with schizophrenia, especially those with suicidal symptoms and substance use.
Collapse
Affiliation(s)
- Mark Olfson
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York
- Mailman School of Public Health, Columbia University, New York, New York
| | - T. Scott Stroup
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York
| | - Cecilia Huang
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey
| | - Melanie M. Wall
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York
- Mailman School of Public Health, Columbia University, New York, New York
| | - Stephen Crystal
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey
| | - Tobias Gerhard
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey
- Ernest Mario School of Pharmacy, Rutgers University, Piscataway, New Jersey
| |
Collapse
|
14
|
"Moving forward despite adversity": The lives of Korean older adults with schizophrenia. Arch Psychiatr Nurs 2021; 35:243-249. [PMID: 33966787 DOI: 10.1016/j.apnu.2021.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 02/13/2021] [Accepted: 02/20/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Older adults with schizophrenia experience aging-related challenges and chronic psychiatric difficulties. However, their uniqueness is understudied. Aim This study explored three life stories to illuminate schizophrenia's trajectory. METHOD A narrative inquiry method was used to elicit rich narratives in chronic patients' lives. Two men and one woman suffering from chronic schizophrenia for more than 20 years were engaged in conversation three times. RESULTS The analysis revealed one main theme expressing their fundamental perspective on their lives: "moving forward despite adversity." Three subthemes emerged: living with the mental disorder, giving and receiving support, and adaptation to old age. They reflected on their interpersonal relationships, failures, and successes in the context of the challenges of schizophrenia. They indicated adapting to schizophrenia, exchanging social support with loved ones, and meeting aging-related challenges with confidence. They were hopeful about brighter personal futures than their pasts. DISCUSSION Family and community supports were very important; self-acceptance positively influenced their successful community living. IMPLICATIONS FOR PRACTICE For effective long-term treatment of older adults with schizophrenia, mental health policies should focus on meeting the social needs of patients and families and reorient programs away from the medical model limited to symptom reduction.
Collapse
|
15
|
Abstract
PURPOSE OF REVIEW The aim of this review was to summarize the recent literature on the clinical symptoms, functioning, outcomes and treatments for older adults with chronic schizophrenia. RECENT FINDINGS The number and proportion of older adults with schizophrenia is rapidly increasing. Schizophrenia is a heterogeneous disorder and older adults with schizophrenia display significant variability in symptom severity, quality of life and overall outcomes. Many achieve stable disease remission, some display persistent nonremission and others experience fluctuating symptoms. Depression is commonly reported, and although rates of suicide are higher when compared with age-matched peers, the excess mortality seen in this population is mainly attributed to natural causes of death. Cognitive decline and reduced illness awareness have important implications for functional status and quality of life. Antipsychotics remain essential in the treatment regimen, although elderly patients with chronic disease may be good candidates for gradual dose reduction. Interdisciplinary treatment approaches as well as nonpharmacologic psychosocial interventions play a critical adjunctive role in the treatment of older adults with schizophrenia. SUMMARY Research focusing on schizophrenia in late life is sparse. Too often, older patients are eliminated from research studies or averaged in with all age groups. Thus, there continues to be gaps in our understanding of modifiable predictors of remission and recovery, and the most efficacious and safest treatment approaches for this age group.
Collapse
|
16
|
Advances in the Conceptualization and Study of Schizophrenia in Later Life: 2020 Update. Clin Geriatr Med 2020; 36:221-236. [DOI: 10.1016/j.cger.2019.11.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
|
17
|
Frey S. The economic burden of schizophrenia in Germany: A population-based retrospective cohort study using genetic matching. Eur Psychiatry 2020; 29:479-89. [DOI: 10.1016/j.eurpsy.2014.04.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Revised: 04/07/2014] [Accepted: 04/10/2014] [Indexed: 11/16/2022] Open
Abstract
AbstractObjectivePrior studies to determine the economic consequences of schizophrenia have largely been undertaken in clinical settings with a small number of cases and have been unable to analyze effects across different age cohorts. The aim of this study is to investigate the burden of schizophrenia in Germany.MethodsCosts, service utilization, and premature mortality attributable to schizophrenia were estimated for the year 2008 using a retrospective matched cohort design. Therefore, 26,977 control subjects as well as 9411 individuals with a confirmed diagnosis of schizophrenia were drawn from a sickness fund claims database. To reduce conditional bias, the non-parametric genetic matching method was employed.ResultsThe final study population comprised 8224 matched pairs. The annual cost attributable to schizophrenia was €11,304 per patient from the payers’ perspective and €20,609 from the societal perspective with substantial variations among age groups: direct medical expenses were highest among patients aged > 65 years, whereas younger individuals (< 25 years) incurred the greatest non-medical costs. The annual burden of schizophrenia from the perspective of German society ranges between €9.63 billion and €13.52 billion.ConclusionThere are considerable differences in the distribution of costs and service utilization for schizophrenia. Because schizophrenia is characterized by an early age of onset and a long duration, research efforts should be targeted at particular populations to obtain the most beneficial outcomes, both clinically and economically.
Collapse
|
18
|
Suicide ideation, suicide attempts, their sociodemographic and clinical associates among the elderly Chinese patients with schizophrenia spectrum disorders. J Affect Disord 2019; 256:611-617. [PMID: 31299442 DOI: 10.1016/j.jad.2019.06.069] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 05/23/2019] [Accepted: 06/30/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND It is still unknown whether many well-identified risk factors of suicide could be applied to the elderly Chinese patients with schizophrenia. METHODS 1-month suicidal ideation and lifetime suicide attempts together with their sociodemographic and clinical associates were analyzed by retrospective data on 263 elderly patients with schizophrenia spectrum disorders at the Kangning Hospital, Shenzhen, China. T-tests and Chi-square tests were used to examine the differences between patients with and without suicidality. Backward stepwise logistic regression was performed to identify the associated factors. RESULTS Among the selected patients, 17.87% had 1-month suicide ideation and 7.60% had lifetime suicide attempts. It was further observed that the elderly patients with schizophrenia who had 1-month suicide ideation were more likely to report lifetime suicide attempts, suffer from severe hopelessness and negative symptoms, and have no pension. However, the backward stepwise logistic regression analyses revealed that lifetime suicide attempts and negative symptoms were most significantly associated with 1-month suicide ideation. In contrast, lifetime suicide attempters were more likely to be men, receive a pension, display symptoms of hopelessness, have longer duration of illness and poor family relationships. The regression analyses also indicated that only hopelessness, relatively long duration of schizophrenia, and poor family relationships were the most significantly associated with lifetime suicide attempts. LIMITATIONS The retrospective design do not allow for causal inferences. CONCLUSIONS Early interventions designed to decrease hopelessness, control negative symptoms, and improve family relationships may result in reduced risks of suicide among elderly Chinese patients with schizophrenia.
Collapse
|
19
|
Promoting Personal and Social Recovery in Older Persons with Schizophrenia: The Case of The New Club, a Novel Dutch Facility Offering Social Contact and Activities. Community Ment Health J 2019; 55:994-1003. [PMID: 30877502 DOI: 10.1007/s10597-019-00389-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 03/01/2019] [Indexed: 10/27/2022]
Abstract
Many older community-living persons with schizophrenia report unmet psychological and social needs. The Amsterdam-based New Club is a novel facility that intends to foster self-reliance and social participation in this group. To explore participants' and staff perceptions, a naturalistic qualitative study combined participant observation with interviews. The results illustrate how the New Club contributes to the personal and social recovery of its participants. At the personal level, attending the facility, activation and feeling accepted were valued positively. At the social level, engaging with others, experiencing a sense of community, and learning from one another's social skills were positive contributors. Next, various environmental factors proved important. The New Club demonstrates the feasibility of creating a facility that offers an accepting and non-demanding social environment to older community-living individuals with severe mental illnesses. It may offer a suitable alternative for the more demanding psychotherapeutic interventions offered to younger populations.
Collapse
|
20
|
Cheng SC, Schepp KG, Liu CC, McGrath BG, Walsh E, Chen E. From manageable to losing control: a grounded theory study of psychosis risk syndrome. Early Interv Psychiatry 2019; 13:574-581. [PMID: 29271066 DOI: 10.1111/eip.12525] [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: 08/20/2017] [Revised: 10/09/2017] [Accepted: 11/08/2017] [Indexed: 11/29/2022]
Abstract
AIM The purpose of this study is to develop a theoretical explanation of the prodromal schizophrenia process, or so-called psychosis risk syndrome, by describing patients' own experiences with symptoms, thoughts and feelings. METHODS A total of 40 interviews were conducted in Taiwan. A Grounded Theory method was selected because of its demonstrated effectiveness in generating theory around dynamic and complex processes on which little is known, all of which is the case with psychosis risk syndrome. Constant comparison analysis, memo writing, member checking, and theoretical sampling were adopted. RESULTS A core theoretical framework was developed in which the process of the psychosis risk syndrome is described as proceeding from manageable to uncontrollable. Four stages emerged from the analysis: (1) something is wrong, (2) boiling up, (3) breaking point, and (4) losing control. CONCLUSIONS The framework resulting from this Grounded Theory research is innovative in presenting patterns and clinical staging that marks the progression from premorbid stage to full-blown psychosis. In addition to specifying the detailed process through in-depth interviews, this research makes two fundamental contributions by: (1) adding evidence to current science and (2) taking patients' experience into consideration to improve the validity of screening tools and design appropriate intervention programs for people with early warning signs of developing schizophrenia.
Collapse
Affiliation(s)
- Sunny Chieh Cheng
- Nursing & Healthcare Leadership, University of Washington, Tacoma, Washington
| | - Karen G Schepp
- Psychosocial & Community Health Department, School of Nursing, University of Washington, Tacoma, Washington
| | - Chen-Chung Liu
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
| | - Barbara G McGrath
- Psychosocial & Community Health Department, School of Nursing, University of Washington, Tacoma, Washington
| | - Elaine Walsh
- Psychosocial & Community Health Department, School of Nursing, University of Washington, Tacoma, Washington
| | - Eleanor Chen
- Department of Pathology, University of Washington, Tacoma, Washington
| |
Collapse
|
21
|
Bergström T, Seikkula J, Holma J, Mäki P, Köngäs-Saviaro P, Alakare B. How do people talk decades later about their crisis that we call psychosis? A qualitative study of the personal meaning-making process. PSYCHOSIS 2019. [DOI: 10.1080/17522439.2019.1603320] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Tomi Bergström
- Department of Psychology, University of Jyväskylä, Jyväskylä, Finland
- Department of Psychiatry, Länsi-Pohja healthcare district, Kemi, Finland
| | - Jaakko Seikkula
- Department of Psychology, University of Jyväskylä, Jyväskylä, Finland
| | - Juha Holma
- Department of Psychology, University of Jyväskylä, Jyväskylä, Finland
| | - Pirjo Mäki
- Department of Psychiatry, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland
| | | | - Birgitta Alakare
- Department of Psychiatry, Länsi-Pohja healthcare district, Kemi, Finland
| |
Collapse
|
22
|
Subramaniam M, Abdin E, Jeyagurunathan A, Chang S, Samari E, Shafie S, Wei KC, Verma S, Chong SA. Exploration of illness perception among patients with mental illness in a multi-ethnic Asian sample. Psychiatry Res 2018; 267:516-527. [PMID: 29980132 DOI: 10.1016/j.psychres.2018.06.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 06/12/2018] [Accepted: 06/12/2018] [Indexed: 01/12/2023]
Abstract
Illness perceptions are beliefs that patients have about their illness. These beliefs play an important role in influencing their behaviour and outcomes. This study examined the factor structure and correlates of the Illness Perception Questionnaire Mental Health (IPQ-MH) among patients with mental illness in a multi-ethnic Asian sample. 400 participants with schizophrenia and other psychotic disorders, mood or anxiety disorder were recruited from a tertiary psychiatric institution and administered the IPQ-MH. Data on sociodemographic variables were also collected. A multi-factor structure was identified for the Identity, Structure and Cause subscale of the IPQ-MH. Age was consistently associated with a positive perception of illness across all three disorders; women had a more positive perception of schizophrenia and other psychotic disorders as compared to men while those of Indian ethnicity had a more negative perception of their mood disorder as compared to those of Chinese ethnicity. Those with lower education had a poorer understanding of their illness among those with mood disorder, and a poorer understanding of their illness and the effectiveness of treatment among those with anxiety disorder. The study identified specific groups which can be targeted through tailored and culturally relevant psychoeducational interventions to enhance their understanding and perception of mental illness.
Collapse
Affiliation(s)
- Mythily Subramaniam
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, 539747 Singapore.
| | - Edimansyah Abdin
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, 539747 Singapore
| | - Anitha Jeyagurunathan
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, 539747 Singapore
| | - Sherilyn Chang
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, 539747 Singapore
| | - Ellaisha Samari
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, 539747 Singapore
| | - Saleha Shafie
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, 539747 Singapore
| | - Ker Chiah Wei
- Department of Community Psychiatry, Institute of Mental Health, Singapore
| | - Swapna Verma
- Department of Early Psychosis Intervention, Institute of Mental Health, Singapore
| | - Siow Ann Chong
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, 539747 Singapore
| |
Collapse
|
23
|
Mushkin P, Band-Winterstein T, Avieli H. "Like Every Normal Person?!" The Paradoxical Effect of Aging With Schizophrenia. QUALITATIVE HEALTH RESEARCH 2018; 28:977-986. [PMID: 29577846 DOI: 10.1177/1049732318764389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Studies on aging with schizophrenia have focused mainly on the adversities of aging with mental illness. The present study, however, examined the subjective experience of well-being among individuals with schizophrenia. Taking a phenomenological reflective life-world approach, in-depth, semistructured interviews with 18 aging individuals with schizophrenia were thematically analyzed. Four main themes emerged: (a) "I love the pills . . . they are very helpful": A balanced course of the illness as a basis for well-being in old age; (b) "I'm going to have my own exhibition at the museum": Self-fulfillment as promoting well-being; (c) "It's just like a family here": Experiencing a sense of belonging; and (d) "I live like everyone else": Aging as an opportunity for normalization. Alongside hardship, the participants perceived old age as a "window of opportunity," enabling the fulfillment of lifelong desires for a social life, acceptance, and a satisfying occupation. Implications regarding interventions with this unique population are discussed.
Collapse
|
24
|
Abstract
A crisis looms as research and clinical programs have not kept pace with dramatic increases in the number of older adults with schizophrenia. This article provides an overview of the advances in the conceptualization and study of schizophrenia in later life. Theoretic and clinical models in psychiatry and gerontology are integrated. Specifically, recovery is examined in the context of aging, how clinical dimensionality affects diagnoses in older adults, how various features of schizophrenia are implicated in models of accelerated and paradoxic aging, and how outcome in later life is a more dynamic and heterogeneous than assumed previously.
Collapse
|
25
|
Harber L, Takeuchi H, Borlido C, Hamidian R, Remington G. Factors associated with drug attitude in patients with schizophrenia spectrum disorders. Schizophr Res 2017; 188:185-186. [PMID: 28131597 DOI: 10.1016/j.schres.2017.01.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 01/16/2017] [Accepted: 01/19/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Lillian Harber
- Schizophrenia Division, Complex Care & Recovery Program, Centre for Addiction and Mental Health, Toronto, Canada
| | - Hiroyoshi Takeuchi
- Schizophrenia Division, Complex Care & Recovery Program, Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada; Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.
| | - Carol Borlido
- Schizophrenia Division, Complex Care & Recovery Program, Centre for Addiction and Mental Health, Toronto, Canada
| | - Reza Hamidian
- Schizophrenia Division, Complex Care & Recovery Program, Centre for Addiction and Mental Health, Toronto, Canada
| | - Gary Remington
- Schizophrenia Division, Complex Care & Recovery Program, Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
| |
Collapse
|
26
|
Joseph J, Kremen WS, Franz CE, Glatt SJ, van de Leemput J, Chandler SD, Tsuang MT, Twamley EW. Predictors of current functioning and functional decline in schizophrenia. Schizophr Res 2017; 188:158-164. [PMID: 28139356 PMCID: PMC5529271 DOI: 10.1016/j.schres.2017.01.038] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 01/20/2017] [Accepted: 01/23/2017] [Indexed: 12/19/2022]
Abstract
Positive, negative, and cognitive symptoms of schizophrenia may affect functional outcomes. However, these factors alone do not account for a large percentage of variance in outcomes. We investigated demographic, cognitive, symptom, and functional capacity predictors of current functional status in 280 outpatients with schizophrenia or schizoaffective disorder. Functional decline over the lifespan was also examined in a subset of participants. Stepwise regressions modeled predictors of current functional status and functional decline as measured by the Assessment of Lifespan Functioning Attainment (ALFA). ALFA functional domains included paid employment, independence in living situation, romantic relationships, close friendships, and recreational engagement. More severe depressive symptoms were consistently associated with worse current community integration (lower levels of close friendships and recreational engagement). Better working memory performance was associated with higher rates of current paid employment. There were no consistent modifiable predictors of decline in functioning, but women reported less functional decline in the domains of employment and close friendships than men. Better cognitive performance was associated with less decline in living independence and romantic relationships, but more decline in paid employment and recreational engagement. Increased assessment and treatment of comorbid depressive symptoms may improve functional outcomes in people with schizophrenia.
Collapse
Affiliation(s)
- Jamie Joseph
- Center for Behavioral Genomics, Department of Psychiatry, School of Medicine, University of California, San Diego, 9500 Gilman Drive, San Diego, CA 92093, USA
| | - William S Kremen
- Center for Behavioral Genomics, Department of Psychiatry, School of Medicine, University of California, San Diego, 9500 Gilman Drive, San Diego, CA 92093, USA; Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161, USA
| | - Carol E Franz
- Center for Behavioral Genomics, Department of Psychiatry, School of Medicine, University of California, San Diego, 9500 Gilman Drive, San Diego, CA 92093, USA
| | - Stephen J Glatt
- Psychiatric Genetic Epidemiology & Neurobiology Laboratory, Department of Psychiatry, SUNY Upstate Medical University, 750 East Adams Street, 3710 Neuroscience Research Building, Syracuse, NY 13210, USA
| | - Joyce van de Leemput
- Center for Behavioral Genomics, Department of Psychiatry, School of Medicine, University of California, San Diego, 9500 Gilman Drive, San Diego, CA 92093, USA
| | - Sharon D Chandler
- Center for Behavioral Genomics, Department of Psychiatry, School of Medicine, University of California, San Diego, 9500 Gilman Drive, San Diego, CA 92093, USA
| | - Ming T Tsuang
- Center for Behavioral Genomics, Department of Psychiatry, School of Medicine, University of California, San Diego, 9500 Gilman Drive, San Diego, CA 92093, USA; Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161, USA; Institute for Genomic Medicine, School of Medicine, University of California, San Diego, 9500 Gilman Drive, San Diego, CA 92093, USA
| | - Elizabeth W Twamley
- Center for Behavioral Genomics, Department of Psychiatry, School of Medicine, University of California, San Diego, 9500 Gilman Drive, San Diego, CA 92093, USA; Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161, USA.
| |
Collapse
|
27
|
Norlin Bagge E, Esbjörnsson E, Sunnerhagen KS. Cognitive screening and behavioural observation of functional ability in patients with multiple episode schizophrenia: an exploratory study. BMJ Open 2017; 7:e014783. [PMID: 28645961 PMCID: PMC5623419 DOI: 10.1136/bmjopen-2016-014783] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To evaluate the usability of a neuropsychological screening instrument and two observation scales of everyday behaviour to describe cognitive and functional capacity of patients with multiepisode schizophrenia and considerable care needs, who frequently refuse to participate in cognitive testing or performance-based functional measurement. SETTING One psychiatric unit specialised in severe mental illness at the Sahlgrenska University Hospital, Gothenburg, Sweden. PARTICIPANTS Patients were included consecutively from date of admission to the unit. INCLUSION CRITERIA age 18-65 years, International Classification of Diseases 10 diagnoses F20.0-F20.9 (schizophrenia) or F25.0-F25.9 (schizoaffective disorder) since at least 5 years. EXCLUSION CRITERIA acute serious psychotic episodes or physical illness, alcohol or drug abuse during the year before the study, diagnosed cerebral disorder at admission to the unit, and insufficient ability to speak Swedish. 64 patients filled the criteria and 19 accepted participation: 14 males, 5 females, median age 56 years. OUTCOME MEASURES Barrow Neurological Institute Screen for Higher Cerebral Functions (BNIS) scores, measured by a psychologist; Frontal Systems Behaviour Scale (FrSBe) Family Version and Functional Independence Measure (FIM) V.4.0 scores, measured by nursing staff. Non-parametric statistics were consistently applied to process the data. RESULTS Failure analysis showed differences regarding gender and subdiagnoses between participants and non-participants. All participants had BNIS scores indicating cognitive dysfunction. FrSBe group medians showed apathy and executive problems, indicating possible frontal lobe disturbance. FIM showed dependency on others for linguistic and social communication, everyday problem solving, and remembering persons and daily routines. Correlations between FrSBe and FIM (p≤0.01) suggested executive dysfunction being crucial to explain difficulties in performing activities of daily functioning. CONCLUSIONS Indications of considerable cognitive and functional difficulties found among the participants suggestedthat the instruments are clinically applicable for tentative assessment of cognitive and functional ability among patients with multiepisode schizophrenia and considerable care needs.
Collapse
Affiliation(s)
- Eva Norlin Bagge
- Department of Psychiatry, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Clinical Neuroscience and Rehabilitation, Rehabilitation Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Eva Esbjörnsson
- Department of Psychiatry, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | |
Collapse
|
28
|
Araten-Bergman T, Avieli H, Mushkin P, Band-Winterstein T. How aging individuals with schizophrenia experience the self-etiology of their illness: a reflective lifeworld research approach. Aging Ment Health 2016; 20:1147-1156. [PMID: 26193335 DOI: 10.1080/13607863.2015.1063110] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE In recent years, there are an increasing number of individuals with schizophrenia who are aging within the general society. Self-etiology of the illness refers to its causal attributions by this population as part of the life review process. The aim of this paper is to develop knowledge from the perspective of older people with schizophrenia regarding the self-etiology of their illness. Focusing on the self-etiology of this particular population is useful, to enhance the understanding of their lived experience in the context of their lifeworld. METHOD The study was carried out using the reflective lifeworld phenomenological approach. In-depth semi-structured interviews were conducted with 18 aging individuals with schizophrenia followed by analysis for meaning. RESULTS Five major constituents of the phenomenon under study - the experience of self-etiology among aging people with schizophrenia - emerged from the findings: 'It leaves you to your fate' - schizophrenia as a decree of fate; 'I have sinned against God' - schizophrenia as a punishment from God; 'They put something in my coffee' - schizophrenia as a result of witchcraft; 'Her genes are in me' - schizophrenia as genetic; and 'She left me and that's how I got sick' - schizophrenia as a result of personal trauma. CONCLUSIONS The findings show that self-etiology in old age tends to be stable, externally attributed and culturally oriented, and serves as a central component in the life review process. This is relevant for professionals developing intervention methods for aging people with schizophrenia.
Collapse
Affiliation(s)
| | - Hila Avieli
- b Department of Criminology , Ariel University, Ariel , Israel
| | - Peli Mushkin
- c Department of Gerontology , University of Haifa, Haifa , Israel
| | | |
Collapse
|
29
|
Abstract
OBJECTIVE Recognizing that needs differ between men and women with schizophrenia and that they vary over time, this review attempts to categorize the needs that are relevant to younger and to older women. METHOD This is a selective literature review focusing on topic areas the two authors determined to be most germane to women with schizophrenia. Articles were selected on the basis of currency, comprehensiveness, and study design. Particular attention was paid to the voices of the women themselves. RESULTS There is considerable overlap between the needs of younger and older women with schizophrenia, but as a general rule, younger women require preventive strategies to stop the escalation of illness while older women require recovery interventions to regain lost hopes and abilities. CONCLUSIONS There is clinical utility in cataloguing the needs of younger and older women with schizophrenia and conceptualizing interventions according to gender and age rather than viewing needed services along purely diagnostic lines.
Collapse
Affiliation(s)
- Mary V Seeman
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Rina Gupta
- North East London Foundation Trust, Goodmayes Hospital, Ilford, Essex, UK
| |
Collapse
|
30
|
Wang XQ, Petrini MA, Morisky DE. Predictors of quality of life among Chinese people with schizophrenia. Nurs Health Sci 2016; 19:142-148. [PMID: 27109014 DOI: 10.1111/nhs.12286] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 03/15/2016] [Accepted: 03/19/2016] [Indexed: 11/29/2022]
Abstract
This study was designed to investigate the association of quality of life, perceived stigma, and medication adherence among Chinese patients with schizophrenia, and to ascertain the predictors of quality of life. A cross-sectional correlation study was conducted with 146 participants. All participants completed self-report scales: the Schizophrenia Quality of Life Scale, Link's Stigma Scale, and the Morisky Medication Adherence Scale. Pearson parametric correlations and stepwise multiple regressions were performed. The total quality of life score and psychosocial subscale was significantly positively correlated with perceived stigma, coping orientation of withdrawal, and feelings of stigma, and negatively correlated with age and medication adherence. The means of all subscale scores except perceived devaluation-discrimination and different/guilty feelings were significantly higher than the midpoint of 2.5. The best predictors of quality of life and psychosocial domains were stigma-related feelings: feeling misunderstood, feeling different/shame, and age. Our findings suggest that an individual's negative emotional response may strengthen internalized stigma and decrease quality of life. As the best predictor, age indicated that adaptation to mental illness may relieve perceived stigma and achieve favorable quality of life.
Collapse
Affiliation(s)
- Xiao Qin Wang
- HOPE School of Nursing, Wuhan University, Wuhan, China
| | | | - Donald E Morisky
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, California, USA
| |
Collapse
|
31
|
Avieli H, Mushkin P, Araten-Bergman T, Band-Winterstein T. Aging With Schizophrenia: A Lifelong Experience of Multidimensional Losses and Suffering. Arch Psychiatr Nurs 2016; 30:230-6. [PMID: 26992876 DOI: 10.1016/j.apnu.2015.11.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 11/03/2015] [Accepted: 11/07/2015] [Indexed: 10/22/2022]
Abstract
The aim of this study was to explore the subjective experience of suffering in aging individuals with schizophrenia. Qualitative interviews were conducted with 18 participants aged 60-69. Phenomenological content analysis was performed. Nine dimensions of suffering emerged: social rejection; familial rejection; the symptoms of schizophrenia; hospitalisation; the side effects of medication; loss of employment potential; loss of independent accommodation; loss of social life, and loss of hope to be a partner and a parent. The suffering of aging people with schizophrenia is cumulative and ongoing and thus evokes issues such as existential loneliness and feelings of homelessness.
Collapse
Affiliation(s)
- Hila Avieli
- Department of Criminology, Ariel University; Department of Gerontology, University of Haifa
| | | | | | | |
Collapse
|
32
|
Resilience in schizophrenia: A comparative study between a remote island and an urban area in Japan. Schizophr Res 2016; 171:92-6. [PMID: 26805409 DOI: 10.1016/j.schres.2016.01.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Revised: 12/25/2015] [Accepted: 01/14/2016] [Indexed: 11/24/2022]
Abstract
The resilience levels between patients with schizophrenia residing in a rural island and a metropolitan area in Tokyo, Japan, was compared and the factors associated with resilience were explored. The Resilience Scale (RS) and EuroQol were assessed, together with biological markers and multiple demographic variables. No significant difference was found in the RS scores between the two groups (40 subjects each). However, longer duration of illness and higher EuroQol score were significantly associated with a greater RS score, which indicates that potentially successful adaptation and subjective perspectives appear more pertinent than the degree of urbanicity in determining resilience levels.
Collapse
|
33
|
Joseph J, Kremen WS, Glatt SJ, Franz CE, Chandler SD, Liu X, Johnson BK, Tsuang MT, Twamley EW. Assessment of Lifespan Functioning Attainment (ALFA) scale: A quantitative interview for self-reported current and functional decline in schizophrenia. J Psychiatr Res 2015; 65:102-7. [PMID: 25898804 PMCID: PMC4439273 DOI: 10.1016/j.jpsychires.2015.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 03/30/2015] [Accepted: 04/02/2015] [Indexed: 12/11/2022]
Abstract
Schizophrenia has been characterized as a disorder with poor outcomes across various functional domains, especially social and occupational functioning. Although these outcomes have been investigated based on patients' current functioning, few studies have considered the assessment of functional outcomes across the lifespan in schizophrenia. We developed a novel and brief scale of adulthood lifespan functioning, the Assessment of Lifespan Functioning Attainment (ALFA). We assessed current functioning and percentage of pre- and post-psychosis onset engagement for five functional domains including paid employment, living independently, romantic partnerships, close friendships, and recreational engagement with others. Pre-to post-psychosis functional decline was observed for all domains, with paid employment having the greatest decline (d = 2.68) and living independently having the least decline (d = .59). Our exploratory factor analysis suggests that a single factor accounted for the most variance in Pre-Psychosis Functioning in ALFA domains. Two factors explain the majority of variance in Post-Psychosis Functioning and Pre-to-Post Psychosis Decline: a sociability factor (close friendships and recreational engagement with others) and an independence factor (paid employment, living independently, romantic relationships). To our knowledge, this is the first study to report on a self-reported quantitative assessment of adult lifespan functioning in schizophrenia. The ALFA scale may be a useful tool for future research on functional outcomes in schizophrenia.
Collapse
Affiliation(s)
- Jamie Joseph
- Center for Behavior Genomics, Department of Psychiatry, School of Medicine, University of California San Diego, 9500 Gilman Drive #0603, La Jolla, CA 92093-0603
| | - William S. Kremen
- Center for Behavior Genomics, Department of Psychiatry, School of Medicine, University of California San Diego, 9500 Gilman Drive #0603, La Jolla, CA 92093-0603, Center of Excellence for Stress and Mental Health, Veterans Affairs San Diego Healthcare System, 3350 La Jolla Village Drive (116A), San Diego, CA 92161
| | - Stephen J. Glatt
- Psychiatric Genetic Epidemiology & Neurobiology Laboratory (PsychGENe Lab); Department of Psychiatry, SUNY Upstate Medical University, 750 East Adams Street, 3710 Neuroscience Research Building, Institute for Human Performance, Syracuse, NY 13210
| | - Carol E. Franz
- Center for Behavior Genomics, Department of Psychiatry, School of Medicine, University of California San Diego, 9500 Gilman Drive #0603, La Jolla, CA 92093-0603
| | - Sharon D. Chandler
- Center for Behavior Genomics, Department of Psychiatry, School of Medicine, University of California San Diego, 9500 Gilman Drive #0603, La Jolla, CA 92093-0603
| | - Xiaohua Liu
- Center for Behavior Genomics, Department of Psychiatry, School of Medicine, University of California San Diego, 9500 Gilman Drive #0603, La Jolla, CA 92093-0603
| | - Barbara K. Johnson
- Center for Behavior Genomics, Department of Psychiatry, School of Medicine, University of California San Diego, 9500 Gilman Drive #0603, La Jolla, CA 92093-0603
| | - Ming T. Tsuang
- Center for Behavior Genomics, Department of Psychiatry, School of Medicine, University of California San Diego, 9500 Gilman Drive #0603, La Jolla, CA 92093-0603, Center of Excellence for Stress and Mental Health, Veterans Affairs San Diego Healthcare System, 3350 La Jolla Village Drive (116A), San Diego, CA 92161
| | - Elizabeth W. Twamley
- Center for Behavior Genomics, Department of Psychiatry, School of Medicine, University of California San Diego, 9500 Gilman Drive #0603, La Jolla, CA 92093-0603, Center of Excellence for Stress and Mental Health, Veterans Affairs San Diego Healthcare System, 3350 La Jolla Village Drive (116A), San Diego, CA 92161,To whom correspondence should be addressed: Dr. Elizabeth W. Twamley, Ph.D., Associate Professor of Psychiatry, University of California, San Diego, 140 Arbor Drive (0851), San Diego, CA 92103, Phone: (619) 543-6684, Fax: (619) 543-6489
| |
Collapse
|
34
|
Cohen CI, Meesters PD, Zhao J. New perspectives on schizophrenia in later life: implications for treatment, policy, and research. Lancet Psychiatry 2015; 2:340-50. [PMID: 26360087 DOI: 10.1016/s2215-0366(15)00003-6] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 01/06/2015] [Indexed: 11/17/2022]
Abstract
Worldwide, in the past few decades, the demographics of older people (ie, people 55 years and over) with schizophrenia have changed completely with respect to absolute numbers of people affected, the proportion of all people with the disorder, life expectancy, and residential status. The ageing schizophrenia population has created vast health-care needs and their medical comorbidity contributes to higher mortality than in the general population. Proposals to classify schizophrenia into early-onset, late-onset, and very-late-onset subtypes now should be tempered by the recognition that comorbid medical and neurological disorders can contribute to psychotic symptoms in later life. The concept of outcome has become more nuanced with an appreciation that various outcomes can occur, largely independent of each other, that need different treatment approaches. Data show that schizophrenia in later life is not a stable end-state but one of fluctuation in symptoms and level of functioning, and show that pathways to improvement and recovery exist. Several novel non-pharmacological treatment strategies have been devised that can augment the clinical options used to address the specific needs of older adults with schizophrenia.
Collapse
Affiliation(s)
- Carl I Cohen
- SUNY Downstate Medical Center, Brooklyn, NY, USA.
| | - Paul D Meesters
- Department of Psychiatry, VU University Medical Center, GGZ inGeest and EMGO+, Institute for Health and Care Research, Amsterdam, Netherlands
| | - Jingna Zhao
- SUNY Downstate Medical Center, Brooklyn, NY, USA
| |
Collapse
|
35
|
Cummings SM, Kropf NP. Predictors of depression among caregivers of older adults with severe mental illness. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2014; 58:253-271. [PMID: 25357014 DOI: 10.1080/01634372.2014.978927] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 10/16/2014] [Indexed: 06/04/2023]
Abstract
Caregivers of older persons with severe mental illness (SMI) contend with the double challenge of providing assistance related to both the psychiatric condition and older age of their family member. Study explored factors influencing negative psychological outcomes experienced by caregivers (n = 96) of older adults with SMI. One-quarter of caregivers scored at or above the clinical point for depression. Low income, care recipient gender, poor health, problems dealing with care recipient's symptoms and the interaction of health and problems dealing with symptoms were associated with higher rates of depression. Implications for service provision and future research are discussed.
Collapse
Affiliation(s)
- Sherry M Cummings
- a College of Social Work , University of Tennessee , Nashville , Tennessee , USA
| | | |
Collapse
|
36
|
Ben-David S, Birnbaum ML, Eilenberg ME, DeVylder JE, Gill KE, Schienle J, Azimov N, Lukens EP, Davidson L, Corcoran CM. The subjective experience of youths at clinically high risk of psychosis: a qualitative study. Psychiatr Serv 2014; 65:1499-501. [PMID: 25179420 PMCID: PMC4358875 DOI: 10.1176/appi.ps.201300527] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Understanding the experience of individuals across stages of schizophrenia is important for development of services to promote recovery. As yet, little is known about the experience of individuals who exhibit prodromal symptoms of schizophrenia. METHODS Audiotaped interviews were conducted with 27 participants of diverse racial-ethnic backgrounds who were at clinically high risk of psychosis (15 males and 12 females; mean age 21). Phenomenological qualitative research techniques of coding, consensus, and comparison were used. RESULTS Emergent themes differed by gender. Themes for males were feeling abnormal or "broken," focus on going "crazy," fantasy and escapism, and alienation and despair, with a desire for relationships. Themes for females were psychotic illness among family members, personal trauma, struggle with intimate relationships, and career and personal development. CONCLUSIONS The finding of relative social engagement and future orientation of females identified as at risk for psychosis is novel and has implications for outreach and treatment.
Collapse
Affiliation(s)
- Shelly Ben-David
- Ms. Ben-David is with the Silver School of Social Work, New York University, New York City. Dr. Birnbaum is with the Department of Psychiatry, Zucker Hillside Hospital, New York City. Ms. Eilenberg and Dr. Corcoran are with the Department of Psychiatry, Columbia University, and the New York State Psychiatric Institute, New York City. Dr. DeVylder is with the School of Social Work, University of Maryland, Baltimore. Ms. Gill is with the Department of Psychology, Catholic University of America, Washington, D.C. Ms. Schienle is with the Department of Psychology, Stanford University, Palo Alto, California. Ms. Azimov is a medical student at the Stony Brook University School of Medicine, Stony Brook, New York. Dr. Lukens is with the School of Social Work, Columbia University, New York City. Dr. Davidson is with the Department of Psychiatry, Yale University, New Haven, Connecticut. Send correspondence to Dr. Corcoran (e-mail: )
| | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Güner P. Illness perception in Turkish schizophrenia patients: a qualitative explorative study. Arch Psychiatr Nurs 2014; 28:405-12. [PMID: 25457692 DOI: 10.1016/j.apnu.2014.08.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 08/21/2014] [Accepted: 08/29/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND Schizophrenia is a serious mental illness that is highly complex and not fully understood. Individuals with serious mental illnesses like schizophrenia experience difficulty trying to access mental health services. Few have the opportunity to receive the most optimal evidence-based treatment and only half of those who do actually adhere to the recommended treatment. Understanding what it is like to have this illness would help in our approaches to treatment. METHODS In-depth interviews were conducted on nine Turkish patients with schizophrenia in order to explore the illness from the perspective of patients in remission. RESULTS Five themes emerged from the patients' descriptions of schizophrenia: schizophrenia is a complicated illness, a mystery, a lost life, a dynamic journey towards recovery, and a developmental process of recovery. CONCLUSION This study has identified areas of concern about reflecting the patients' perspectives on their experiences thoroughly, which should help improve healthcare provision and guide future research.
Collapse
Affiliation(s)
- Perihan Güner
- Mental Health Nursing, Koç University, School of Nursing, Istanbul, Turkey.
| |
Collapse
|
38
|
Izaute M, Jalenques I. Metamemory with ageing in schizophrenia: a first study. Psychiatry Res 2014; 219:703-6. [PMID: 25023367 DOI: 10.1016/j.psychres.2014.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 05/31/2014] [Accepted: 06/04/2014] [Indexed: 10/25/2022]
Abstract
The aim was to study metamemory during encoding in older schizophrenia patients. Thirteen older patients were compared to 13 healthy controls. Despite their memory impairment, older schizophrenia patients were able to assess the material accurately. They were not able, however, to adapt their learning time as efficiently as controls.
Collapse
Affiliation(s)
- Marie Izaute
- Clermont University, Blaise Pascal University, LAPSCO, F-63037 Clermont-Ferrand, France; CNRS, UMR 6024, LAPSCO, 34 avenue Carnot, F-63037 Clermont-Ferrand, France.
| | - Isabelle Jalenques
- CHU Clermont-Ferrand, Service de Psychiatrie de l׳Adulte A et Psychologie médicale, Pôle de Psychiatrie, F-63003 Clermont-Ferrand, France; Clermont Université, Université d׳Auvergne Clermont 1, UFR Médecine, Equipe d׳Accueil 7280, F-63001 Clermont-Ferrand, France
| |
Collapse
|
39
|
Gerretsen P, Plitman E, Rajji TK, Graff-Guerrero A. The effects of aging on insight into illness in schizophrenia: a review. Int J Geriatr Psychiatry 2014; 29:1145-61. [PMID: 25055980 PMCID: PMC4472640 DOI: 10.1002/gps.4154] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 05/03/2014] [Accepted: 05/05/2014] [Indexed: 01/17/2023]
Abstract
OBJECTIVES Impaired insight into illness is a prevalent feature of schizophrenia, which negatively influences treatment adherence and clinical outcomes. Little is known about the effects of aging on insight impairment. We aimed to review the available research literature on the effects of aging on insight into illness in schizophrenia, in relation to positive, negative, and cognitive symptoms. Ultimately, we propose a trajectory of insight in schizophrenia across the lifespan. METHOD A systematic Medline® literature search was conducted, searching for English language studies describing the relationship of insight into illness in schizophrenia with aging. RESULTS We identified 62 studies. Insight impairment is associated with illness severity, premorbid intellectual function (i.e. IQ), executive function, and memory. Insight impairment improves modestly during midlife, worsening again in late life. It tends to fluctuate with each episode of psychosis, likely in relation to worsening positive symptoms that improve with antipsychotic treatment. The relationship between insight impairment and cognitive dysfunction appears to attenuate with age, while the relationship with lower premorbid intellectual function is preserved. The association between impaired insight and negative symptoms is unclear. CONCLUSIONS The available literature suggests that the course of insight impairment follows a U-shaped curve, where insight impairment is severe during the first episode of psychosis, modestly improves over midlife, and declines again in late life. Future studies are required to investigate the trajectory of insight into illness and its core domains across the lifespan from prodromal phase to late life.
Collapse
Affiliation(s)
- Philip Gerretsen
- University of Toronto and the Centre for Addiction and Mental Health; Toronto ON Canada
| | - Eric Plitman
- University of Toronto and the Centre for Addiction and Mental Health; Toronto ON Canada
| | - Tarek K. Rajji
- University of Toronto and the Centre for Addiction and Mental Health; Toronto ON Canada
| | - Ariel Graff-Guerrero
- University of Toronto and the Centre for Addiction and Mental Health; Toronto ON Canada
| |
Collapse
|
40
|
Holt L, Tickle A. Exploring the experience of hearing voices from a first person perspective: a meta-ethnographic synthesis. Psychol Psychother 2014; 87:278-97. [PMID: 24227763 DOI: 10.1111/papt.12017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2011] [Revised: 08/31/2013] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this review was to identify, appraise, and synthesize the current peer-reviewed qualitative literature which explores the phenomenon of hearing voices from a first person perspective. METHODS A comprehensive systematic search of the literature was conducted. Seven studies utilizing various qualitative methodologies met the criteria to be included in the synthesis. An appraisal tool (Walsh & Downe, 2005, J. Adv. Nurs., 50, 204-211) was used to assess their quality. A meta-ethnographic approach was used to synthesize the data extracted from them. RESULTS The interpretation of the findings suggested five key themes: identity of the voice(s), power of the voice(s), impact of hearing voices on relationships, relationship with the voice(s), and the distinction between thoughts and voices. The identity of the voices seemed inextricably linked to the perceived power the voice(s) wielded over the voice hearer. The quality of the studies included in the synthesis varied greatly. CONCLUSIONS The findings of this synthesis highlight the importance of the voice hearer's individual frame of reference for understanding their experience. Clinical implications include the need for mental health professionals to explore an individual's understanding of their experience of hearing voices and address the perceived power of the voice(s). Further research is indicated in this area with a focus of improving the quality of qualitative research studying this phenomenon. PRACTITIONER POINTS There are multiple frames of reference in which to understand an individual's experience of hearing voices. Mental health professionals should attend to the meaning and understanding voice hearers give to the experience.
Collapse
Affiliation(s)
- Lucy Holt
- University of Nottingham and Derbyshire Healthcare Foundation Trust, Nottingham, UK
| | | |
Collapse
|
41
|
Meesters PD. Late-life schizophrenia: remission, recovery, resilience. Am J Geriatr Psychiatry 2014; 22:423-6. [PMID: 24725626 DOI: 10.1016/j.jagp.2014.01.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 01/17/2014] [Indexed: 11/16/2022]
Affiliation(s)
- Paul D Meesters
- GGZ in Geest, Ouderenpsychiatrie, Polikliniek ouderen, Amsterdam.
| |
Collapse
|
42
|
Gearing RE, DeVylder JE, Chen F, Pogge DL, Buccolo M. Changing perceptions of illness in the early course of psychosis: psychological pathways to self-determination and self-management of treatment. Psychiatry 2014; 77:344-59. [PMID: 25386775 DOI: 10.1521/psyc.2014.77.4.344] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Treatment early in the course of psychosis can improve prognostic outcomes, facilitate adaptive functioning, and reduce familial and societal burden. However, little is known about the pathway of first episode psychosis (FEP) from the perspective of highly adherent adolescents and young adults. This study sought to understand the pathways in youth self-determination and self-management of treatment by investigating youth and parents' changing perceptions of illness in the early course of psychosis. Twenty-eight (n = 28) interviews were conducted using a semistructured interview guide on 12 adolescents following their FEP hospitalization and 16 parents. Standardized self-report forms and hospital inpatient records were used to collect and confirm demographic and clinical data. On average, three years had passed from initial hospitalization (age 16.2 years, SD = 1.2) to time of interview (age 19.3 years, SD = 2.3), thus allowing for a range of experiences across the early period of illness. Highly adherent adolescents experienced identifiable temporal phases of early psychosis, comprised of emergent and specific themes. Parents described a parallel pathway toward supporting their child's self-determination and self-management of treatments, with some distinct experiential differences. Five dominant themes that emerged across time were symptom recognition, awareness of change, negative appraisals, positive appraisals, and treatment self-management. Examining how these themes evolve over the early course of psychosis can help guide interventions that are compatible with the parent and adolescent's perceptions of illness at that point in time, and can therefore work in concert with the family's existing efforts to understand and manage their emerging condition and progress toward recovery.
Collapse
|
43
|
Meesters PD, Comijs HC, de Haan L, Smit JH, Eikelenboom P, Beekman ATF, Stek ML. Subjective quality of life and its determinants in a catchment area based population of elderly schizophrenia patients. Schizophr Res 2013; 147:275-80. [PMID: 23693066 DOI: 10.1016/j.schres.2013.04.030] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Revised: 03/27/2013] [Accepted: 04/22/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Subjective quality of life (SQOL) is an established outcome measure in schizophrenia. In spite of the substantial proportion of elderly in the total schizophrenia population, evaluation of their SQOL and its determinants has been scarce and findings from epidemiological samples are lacking. METHODS We assessed SQOL in elderly Dutch patients with schizophrenia or schizoaffective disorder (n=107; mean age 68 years), treated within a psychiatric catchment area. Demographic, clinical and social variables were evaluated for their impact on SQOL. RESULTS The mean SQOL score was 4.83, moderately surpassing the midpoint of the SQOL scale. Nearly half of all patients (47.7%) reported an overall favorable SQOL. Of the total variance in SQOL, clinical variables explained 50%, and social variables explained 16%, while demographic factors did not contribute. In multivariable analysis, less self-reported depressive symptoms, worse global neurocognition, and higher observer-based level of social functioning significantly predicted a higher SQOL, explaining 53% of the total variance. CONCLUSION The relatively high level of SQOL in this epidemiological sample of elderly patients is in line with what has been reported for both older and younger schizophrenia populations. Depressive symptoms are a robust predictor of SQOL in late life schizophrenia, clearly outweighing psychotic symptoms. This finding has major clinical relevance, as depression is amenable to therapeutic intervention.
Collapse
Affiliation(s)
- Paul D Meesters
- GGZ inGeest, VU University Medical Center, Amsterdam, The Netherlands.
| | | | | | | | | | | | | |
Collapse
|
44
|
Leutwyler H, Hubbard EM, Jeste DV, Vinogradov S. "We're not just sitting on the periphery": a staff perspective of physical activity in older adults with schizophrenia. THE GERONTOLOGIST 2013; 53:474-83. [PMID: 22936534 PMCID: PMC3635853 DOI: 10.1093/geront/gns092] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Accepted: 05/24/2012] [Indexed: 11/14/2022] Open
Abstract
UNLABELLED Targeted physical activity interventions to improve the poor physical function of older adults with schizophrenia are necessary but currently not available. Given disordered thought processes and institutionalization, it is likely that older adults with schizophrenia have unique barriers and facilitators to physical activity. It is necessary to consider the perspective of the mental health staff about barriers and facilitators to physical activity to design a feasible intervention. PURPOSE OF THIS STUDY To describe the perceptions of mental health staff about barriers and facilitators to engage in physical activities that promote physical function among older adults with schizophrenia. DESIGN AND METHOD We conducted qualitative interviews with 23 mental health staff that care for older adults with schizophrenia. The data were collected and analyzed with grounded theory methodology. RESULTS The participants were interested in promoting physical activity with older adults with schizophrenia. Facilitators and barriers to physical activity identified were mental health, role models and rewards, institutional factors, and safety. IMPLICATIONS In order to design successful physical activity interventions for this population, the intervention may need to be a routine part of the mental health treatment program and patients may need incentives to participate. Staff should be educated that physical activity may provide the dual benefit of physical and mental health treatment.
Collapse
Affiliation(s)
- Heather Leutwyler
- Department of Physiological Nursing, University of California, 2 Koret Way, N631A, Box 0610, San Francisco, CA 94143-0610, USA.
| | | | | | | |
Collapse
|
45
|
Sano W, Nakamura T, Yoshiuchi K, Kitajima T, Tsuchiya A, Esaki Y, Yamamoto Y, Iwata N. Enhanced persistency of resting and active periods of locomotor activity in schizophrenia. PLoS One 2012; 7:e43539. [PMID: 22952701 PMCID: PMC3429496 DOI: 10.1371/journal.pone.0043539] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Accepted: 07/23/2012] [Indexed: 02/07/2023] Open
Abstract
Patients with schizophrenia frequently exhibit behavioral abnormalities associated with its pathological symptoms. Therefore, a quantitative evaluation of behavioral dynamics could contribute to objective diagnoses of schizophrenia. However, such an approach has not been fully established because of the absence of quantitative biobehavioral measures. Recently, we studied the dynamical properties of locomotor activity, specifically how resting and active periods are interwoven in daily life. We discovered universal statistical laws ("behavioral organization") and their alterations in patients with major depressive disorder. In this study, we evaluated behavioral organization of schizophrenic patients (n = 19) and healthy subjects (n = 11) using locomotor activity data, acquired by actigraphy, to investigate whether the laws could provide objective and quantitative measures for a possible diagnosis and assessment of symptoms. Specifically, we evaluated the cumulative distributions of resting and active periods, defined as the periods with physical activity counts successively below and above a predefined threshold, respectively. Here we report alterations in the laws governing resting and active periods; resting periods obeyed a power-law cumulative distribution with significantly lower parameter values (power-law scaling exponents), whereas active periods followed a stretched exponential distribution with significantly lower parameter values (stretching exponents), in patients. Our findings indicate enhanced persistency of both lower and higher locomotor activity periods in patients with schizophrenia, probably reflecting schizophrenic pathophysiology.
Collapse
Affiliation(s)
- Wataru Sano
- Department of Psychiatry, Fujita Health University School of Medicine, Aichi, Japan.
| | | | | | | | | | | | | | | |
Collapse
|
46
|
Abstract
Psychosis is common in late-life and exacts enormous costs to society, affected individuals, and their caregivers. A multitude of etiologies for late-life psychosis exist, the two most prototypical being schizophrenia and psychosis of Alzheimer disease (AD). As such, this article focuses on the nonaffective, neuropsychiatric causes of chronic psychosis in the elderly, specifically schizophrenia, delusional disorder, and the psychosis of AD and other dementias.
Collapse
|
47
|
Jeste DV, Wolkowitz OM, Palmer BW. Divergent trajectories of physical, cognitive, and psychosocial aging in schizophrenia. Schizophr Bull 2011; 37:451-5. [PMID: 21505111 PMCID: PMC3080682 DOI: 10.1093/schbul/sbr026] [Citation(s) in RCA: 120] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Aging is not a uniform process. In the general population, there is a paradox of aging: age-associated decline in physical and some cognitive functions stands in contrast to an enhancement of subjective quality of life and psychosocial functioning. This paradox is even more striking in people with schizophrenia. Compared with the overall population, individuals with schizophrenia have accelerated physical aging (with increased and premature medical comorbidity and mortality) but a normal rate of cognitive aging, although with mild cognitive impairment starting from premorbid period and persisting throughout life. Remarkably, psychosocial function improves with age, with diminished psychotic symptoms, reduced psychiatric relapses requiring hospitalization and better self-management. Many older adults with schizophrenia successfully adapt to the illness, with increased use of positive coping techniques, enhanced self-esteem and increased social support. Although complete remission is uncommon, most individuals with schizophrenia experience significant improvement in their quality of well-being. Cohort effect and survivor bias may provide a partial explanation for this phenomenon. However, the improvement also may reflect some brain changes that are beneficial for the course of schizophrenia along with neuroplasticity of aging. The proposed hypothesis has several implications. As significant medical morbidity in schizophrenia takes years to develop, studies of changes in sensitive biomarkers of aging during the course of illness may point to new treatments aimed at normalizing the rate of biological aging in schizophrenia. At the same time, effective psychotherapeutic interventions can affect brain structure and function and produce lasting positive behavioral changes in aging adults with schizophrenia.
Collapse
Affiliation(s)
- Dilip V. Jeste
- Department of Psychiatry and Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, CA,To whom correspondence should be addressed; Estelle and Edgar Levi Chair in Aging, Sam and Rose Stein Institute for Research on Aging, Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive #0664, La Jolla, CA 92093, US; tel: (858)-534-4020, fax: (858)-543-5475, e-mail:
| | - Owen M. Wolkowitz
- Department of Psychiatry, University of California, San Francisco, CA
| | - Barton W. Palmer
- Department of Psychiatry and Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, CA
| |
Collapse
|