Prevalence of Obsessive-Compulsive Disorder in Patients With Schizophrenia and Outcome on Positive and Negative Symptoms, Cognition, and Quality of Life

Validation of the Arabic version of the cyberchondria severity scale 12 items (CSS-12-Ar) among a sample of Lebanese adults

BACKGROUND

To the best of our knowledge, the Cyberchondria Severity Scale-12 (CSS-12) has not been translated into Arabic; therefore, our objective was to assess the psychometric properties of the Arabic version of the CSS (CSS-12-Ar) among a sample of Lebanese adults.

METHODS

Participants were enrolled in January 2021. A confirmatory factor analysis (CFA) was carried out using the MPlus software v.7.2, reporting several goodness-of-fit indicators: Relative Chi-square (χ2/df), Root Mean Square Error of Approximation (RMSEA), Comparative Fit Index (CFI) and Tucker Lewis Index (TLI). To evaluate measurement invariance across gender, we conducted higher-order multiple group confirmatory analysis using lavaan software.

RESULTS

449 participants enrolled in this study (mean age: 24.34 ± 8.22 years, 70.6% females). Since the correlations between the four-factor model were very high (r > 0.8), we ran the higher-order CFA in which all first-order latent variables were loading a general factor. The analyzed model was well-fitted to the data χ2(50) = 173.34; p < 0.001; CFI = 0.926; RMSEA = 0.074 [0.062, 0.086]. The Cronbach's alpha values were good for the total score (0.92), as well as for excessiveness (0.80), distress (0.77), reassurance (0.81) and compulsion (0.76). The results provided evidence of full scalar invariance across gender. The comparison of latent mean scores revealed no significant differences across gender, in either the cyberchondria total score or its facets. The CSS-12 score was positively associated with anxiety (r = 0.10; p = 0.003) (convergent validity), OCD (r = 0.11; p = 0.016) and stress (r = 0.35; p < 0.001) (concurrent validity).

CONCLUSION

The CSS-12-Ar was deemed a suitable scale to measure the severity of cyberchondria among Lebanese university students. We hope that researchers and clinicians can benefit now from this scale.

How Obsessive-Compulsive Symptoms Correlate with other Symptoms and Quality of Life in Schizophrenia? A Cross-Sectional Study

Background

Early psychiatrists inferred that obsessive-compulsive symptoms (OCS) represent a defense against psychosis and prevent the progression of schizophrenia. However, recent clinical research has yielded inconsistent results across studies regarding the link between OCS and the symptom domains of schizophrenia and the influence OCS have on a patient's functioning and quality of life (QOL).This study aimed to determine whether OCS has any association with the symptom severity, functioning, and QOL of schizophrenia patients.

Methods

This cross-sectional study done in a tertiary care hospital consecutively recruited 85 outpatients of schizophrenia in clinical remission over one year. Positive and Negative Syndrome Scale (PANSS), Yale-Brown Obsessive Compulsive Scale (Y-BOCS), WHO Quality of Life Brief Version (WHO QOL-BREF), and Global Assessment of Functioning (GAF) scales were applied.

Results

Eighteen patients (21.2%) had OCS (Y-BOCS score of ≥8). Patients with OCS had higher PANSS scores (mean±SD of total score 77.16± 16.4, P < 0.001), suggestive of more severe psychosis, poor functioning overall (mean GAF score 37.35 ± 15.62, P < 0.001), and poor QOL in the psychological domain (P < 0.001). In addition, significant associations were present between the Y-BOCS score and the PANSS (r = 0.65), GAF (r = -0.61), and WHO QOL BREF scores in the physical (r = -0.39), and psychological domains (r = -0.41) (P < 0.001 on all of the above).

Conclusions

Patients with OCS have more severe symptoms and a lower QOL. A significant association exists between the intensity of OCS and schizophrenia symptoms, global functioning, and QOL.

Relationship between obsessive compulsive symptomatology and severity of psychotic symptoms in schizophrenia: Meta-analysis and meta-regression analysis

BACKGROUND

Schizophrenia patients often show obsessive-compulsive symptoms (OCS) and obsessive-compulsive disorder (OCD) and their presence has been associated with poorer prognosis. However, the impact of OCS/OCD on psychotic severity remains unclear. The aim of this study is twofold: 1) to investigate the effect of OCS/OCD on the severity of positive, negative, and global psychotic symptoms of schizophrenia patients and 2) to analyze the effect of patient and study-related covariates on moderating this relationship.

METHODS

A systematic review and meta-analysis (SRMA) of studies comparing the severity of psychotic symptoms among schizophrenia patients with and without OCS/OCD was performed. Standardized mean difference (SMD) was calculated for positive, negative, and global psychotic symptoms. The difference of SMD (Diff SMD) was calculated to analyze the effect of covariates on study outcomes using meta-regression.

RESULTS

Sixty-seven studies involving 7740 patients were included. Patients with schizophrenia and OCS/OCD showed a slightly higher severity of positive (SMD = 0.17, p value = 0.0089) and global psychotic symptoms (SMD = 0.24, p value = 0.0104) than patients without OCS/OCD but no differences in negative symptoms were found between groups (SMD = 0.11, p value = 0.0367). Only one covariate "proportion of patients without antipsychotics (AP)" was found to modify the effect on psychotic severity (Diff SMD = -0.008, p value = 0.002).

CONCLUSIONS

Comorbid OCS/OCD in schizophrenia has, at most, a minor impact on psychotic severity. Variability in this effect was considerable and was poorly explained by the covariates analyzed.

COVID-19 and psychosis, depression, obsession and quality of life in Lebanese patients with schizophrenia: Any changes after 5 months of quarantine?

BACKGROUND

Previous research revealed an absence of any previous studies reporting the impact that pandemics may have on psychotic symptomology, nor on the physical health of people with psychosis in response to the epidemics of the COVID-19. The direction of the impact of the COVID-19 on schizophrenia is unknown, as the risk of infection could vary from patients to patients according to clinical comorbidities, cognitive impairment, acute symptoms, and family support. To the best of our knowledge, no study has provided details on the variation of symptoms in patients with schizophrenia during the quarantine of COVID-19 outbreak. Therefore, the primary objective of the study is to investigate the variation of psychotic symptoms, depression, obsession and quality of life in patients with schizophrenia before and after 5 months of quarantine and evaluate factors associated with these variations during the quarantine period.

METHODS

A cross-sectional study was performed on a sample of 190 chronic patients institutionalized for schizophrenia for more than 1 year at the Psychiatric Hospital of the Cross. The baseline assessment was done in December 2019; the second assessment was done in August 2020 (5 months after the lockdown).

RESULTS

Getting updates about the coronavirus minimally, some and most of the times were significantly associated with a decrease in positive psychotic and psychopathologic symptoms 5 months after quarantine compared to before it. Practicing religiosity some and all the time versus not was significantly associated with a decrease in negative, psychopathology symptoms and total PANSS score after 5 months of quarantine compared to before it. Finally, female gender (B = 1.77) was significantly associated with an increase in the WHO Domain 3 score (better social relations) after 5 months of quarantine compared to before it.

CONCLUSION

Patients with schizophrenia fare better symptomatically after 5 months of quarantine if they receive constant updates about COVID-19 and if they tended to practice religiosity.

Cyberchondria severity and quality of life among Lebanese adults: the mediating role of fear of COVID-19, depression, anxiety, stress and obsessive-compulsive behavior-a structural equation model approach

BACKGROUND

This study highlights the significant association between cyberchondria and quality of life among the Lebanese population in the time of COVID-19. The aim was to assess the association between cyberchondria and quality of life (QOL) of Lebanese community during the COVID-19 pandemic and assess the mediating effect of fear of COVID-19, depression, anxiety, stress and Yale-Brown Obsessive-Compulsive Scale in this association.

METHODS

This cross-sectional study was carried out between December 2020 and January 2021, during the COVID-19 pandemic. A total of 449 persons participated in this study by filling the online questionnaire. Structural equation modeling (SEM) was performed to examine the structural relationship between cyberchondria severity, the mediator (anxiety, stress, depression, obsessive-compulsive disorder (OCD) and fear of COVID-19) and physical/mental QOL.

RESULTS

Having a university level of education and older age were significantly associated with higher physical QOL scores, whereas higher obsession-compulsion disorder, higher stress and higher anxiety were significantly associated with lower physical QOL scores. Higher anxiety was significantly associated with lower mental QOL scores. The results of the SEM showed that stress, fear of COVID-19 and to a lesser limit OCD, mediated the association between cyberchondria severity and physical QOL, whereas anxiety, stress and fear of COVID-19 mediated the association between cyberchondria severity and mental QOL.

CONCLUSION

This research reported interesting results encouraging more exploration of cyberchondria and its association with quality of life during this unique period of the pandemic. However, this virus has altered the lives of individuals all across the world, and the consequences will last for a long time. Along with all of the steps done to stop the development of COVID-19 and improve physical outcomes, mental health requires immediate care. More research is needed to determine the coping techniques people are employing to deal with the pandemic.

General description of cognitive deficits in schizophrenia and assessment tools in Lebanon: A scoping review

Many cognitive functions are affected in schizophrenia patients, particularly memory, attention, motor skills, executive function, and social cognition. Cognitive assessment is one of the best indicators of the functional and social prognosis of schizophrenic patients. In Lebanon, no study has yet examined the assessment of cognitive functions in patients with neurological or psychiatric diseases. This review aims to provide an overview of the cognitive profiles of schizophrenia and describe the different cognitive tests used in Lebanon. The MEDLINE/PubMed database was used to conduct a literature review covering all studies related to cognition in psychosis patients from 1990 until March 2021. This screening resulted in 97 articles focused on cognition in psychiatric patients or cognitive tests in schizophrenia and required an in-depth analysis. The majority of measures developed to evaluate cognition in patients with schizophrenia were from Western countries, most of which are long and complex and may require several hours to administer. The number of neuropsychological tests available in Arab countries is unknown, although it is likely to be limited compared to what is available in Western countries. In Lebanon, some neuropsychological batteries have been locally used to assess cognition without being translated and validated to be adapted to the Lebanese sociocultural context. Clinicians in Lebanon underestimate the extent of cognitive impairment in schizophrenia patients as they have limited options, using untranslated tests or using translations that have not been validated. Future studies should target the development and adaptation of instruments that predict and measure cognition and functional ability.

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Many cognitive functions are generally impaired in patients with schizophrenia

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The number of neuropsychological tests available in Arab countries is unknown

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In Lebanon, some neuropsychological batteries have been used to assess cognition without being translated and validated

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Few studies conducted in Lebanon have used neurocognitive tests among schizophrenia.