1
|
Granholm E, Holden JL, Mikhael T, Link PC, Swendsen J, Depp C, Moore RC, Harvey PD. What Do People With Schizophrenia Do All Day? Ecological Momentary Assessment of Real-World Functioning in Schizophrenia. Schizophr Bull 2020; 46:242-251. [PMID: 31504955 PMCID: PMC7442321 DOI: 10.1093/schbul/sbz070] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Schizophrenia is a major cause of disability worldwide. As new treatments for functioning are tested, the need grows to demonstrate real-world functioning gains. Ecological momentary assessment (EMA) may provide a more ecologically valid measure of functioning. In this study, smartphone-based EMA was used to signal participants with schizophrenia (N = 100) and controls (N = 71) 7 times a day for 7 days to respond to brief questionnaires about social interactions and functioning behaviors. Excellent adherence was found, with both groups completing an average of 85% of surveys and only 3% of participants with schizophrenia excluded for poor adherence. Four-week test-retest reliability was high (r = .83 for total productive behaviors). Relative to controls, participants with schizophrenia reported significantly less total productive activity (d = 1.2), fewer social interactions (d = 0.3), more nonproductive behaviors (d = 1.0; watching TV, resting), and more time at home (d = 0.8). Within the schizophrenia group, participants living independently showed better functioning on EMA relative to participants in supported housing (d = 0.8) and participants engaged in vocational activities showed better functioning than individuals not engaged in vocational activities (d = 0.55). Modest correlations were found between EMA and an in-lab self-report measure of functioning activities performed in the community, but not between EMA and measures of functional capacity or potential. This study demonstrated the feasibility, sensitivity reliability, and validity of EMA methods to assess functioning in schizophrenia. EMA provides a much-needed measure of what individuals with schizophrenia are actually doing in real-world contexts. These results also suggest that there may be important disjunctions between indices of abilities and actual real-world functioning.
Collapse
Affiliation(s)
- Eric Granholm
- University of California, San Diego
- VA San Diego Healthcare System, San Diego, CA
| | | | | | | | - Joel Swendsen
- University of Bordeaux, CNRS, EPHE PSL Research University
| | - Colin Depp
- University of California, San Diego
- VA San Diego Healthcare System, San Diego, CA
| | | | - Philip D Harvey
- University of Miami Miller School of Medicine
- Bruce W. Carter VA Medical Center, Miami, FL
| |
Collapse
|
2
|
Lu SJ, Liou TH, Yen CF, Chang FH, Chen YL, Escorpizo R, Strauser DR, Pan AW. Determinants of Employment Outcome for the People with Schizophrenia Using the WHODAS 2.0. JOURNAL OF OCCUPATIONAL REHABILITATION 2019; 29:375-383. [PMID: 29951935 DOI: 10.1007/s10926-018-9794-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Purpose Since the vocational outcomes of people with schizophrenia should be viewed in a holistic way, the second edition of the World Health Organization Disability Assessment Schedule (WHODAS 2.0) might provide an evaluation regarding employment potential. To determine whether the WHODAS 2.0 scores can be used to predict employment status, we examined the probabilistic cut-off values of the scores and analyzed the relationship between work status and demographic characteristics. Methods We selected 31,793 people aged between 18 and 65 with schizophrenia or schizoaffective disorder from the disability evaluation database in Taiwan and separated them into two groups based on employment status (employed and unemployed). We used logistic regression to explore the association between employment and demographic characteristics. Moreover, we conducted a receiver operating characteristic (ROC) analysis to determine the cut-off point to assist in determining employment potential based on the WHODAS 2.0 score. Results Among the 31,793 participants, 3367 were employed and 18,801 were unemployed. The unemployed participants accounted for a higher percentage of disability in each domain of the WHODAS. The ROC analysis revealed that the optimal cut-off point of the WHODAS score to distinguish the people who were employed and unemployed was 25.78 (area under curve = 0.80). Conclusions The present study indicated that work status can be determined by the total score across the six domains of the WHODAS score. Furthermore, the probability of employment may be determined initially by the cut-off point of the WHODAS score in order to economize evaluation time and prepare prevocational training for those with scores above 25.78.
Collapse
Affiliation(s)
- Shu-Jen Lu
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
- Vocational Rehabilitation Resource Center for Individuals with Disabilities, Taoyuan, Taiwan
- Department of Psychiatry, Taipei Tzu Chi Hospital, New Taipei City, Taiwan
| | - Tsan-Hon Liou
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chia-Feng Yen
- Department of Public Health, Tzu Chi University, Hualien, Taiwan
| | - Feng-Hang Chang
- Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Yen-Ling Chen
- Institute of Biophotonics, National Yang-Ming University, Taipei, Taiwan
| | - Reuben Escorpizo
- Department of Rehabilitation and Movement Science, College of Nursing and Health Sciences, University of Vermont, Burlington, VT, USA
- Swiss Paraplegic Research, Nottwil, Switzerland
| | - David R Strauser
- Department of Kinesiology and Community Health at the University of Illinois at Urbana-Champaign, University of Illinois, Champaign, IL, USA
| | - Ay-Woan Pan
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.
| |
Collapse
|
3
|
Chan AHL, Wong SYS, Chien WT. A prospective cohort study of community functioning among psychiatric outpatients. Psychiatry Res 2018; 259:125-134. [PMID: 29040948 DOI: 10.1016/j.psychres.2017.10.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Revised: 08/05/2017] [Accepted: 10/07/2017] [Indexed: 11/15/2022]
Abstract
The present study analyzed the community functioning among Chinese people with common mental disorders and their relationships with different factors under the framework of Model of Human Occupation. The research team followed up a stratified random sample of 238 patients in three public psychiatric specialist outpatient clinics in Hong Kong in one year. The patients completed assessments at baseline and 12-month follow-up in four areas of community functioning (i.e., self-care, independent living skills, social skills, and work skills), self-esteem, self-efficacy, physical functioning, behavioral regulation, mental states, family expressed emotion, and perceived social stigma. The data showed that after 12 months, the patients had positive changes in self-care, work skills, and behavioral regulation. Those patients who had higher levels of self-esteem at baseline and reduced their negative reactions to stigma were more likely to improve social skills, while those patients who perceived less discrimination at baseline and enhanced their self-esteem would have a higher likelihood of making improvement in work skills. The findings implied that the rehabilitation services for people with common mental disorders might target on the enhancement of self-esteem and reduction of discrimination experience to facilitate their improvement in social skills and work skills.
Collapse
Affiliation(s)
- Alan H L Chan
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong.
| | - Samuel Y S Wong
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - Wai-Tong Chien
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong
| |
Collapse
|
4
|
Assessing the Relationship between Performance on the University of California Performance Skills Assessment (UPSA) and Outcomes in Schizophrenia: A Systematic Review and Evidence Synthesis. SCHIZOPHRENIA RESEARCH AND TREATMENT 2018; 2018:9075174. [PMID: 30687553 PMCID: PMC6327277 DOI: 10.1155/2018/9075174] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 11/12/2018] [Accepted: 12/05/2018] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To perform a systematic review of the published literature to evaluate how functional capacity, as measured by the University of California at San Diego (UCSD) Performance-based Skills Assessment (UPSA), relates to other functional measures and real-world outcomes among individuals with schizophrenia. METHODS The MEDLINE® and Embase® databases were searched to identify joint evaluations with UPSA and key functional outcomes (functional scale measures; generic or disease-specific, health-related quality of life [HRQoL]; or real-world outcomes [residential status; employment status]) in patients with schizophrenia. Pearson correlations were estimated between UPSA scores, HRQoL, other functional scale measures, and real-world outcomes, for outcomes described in at least six studies. RESULTS The synthesis included 76 studies that provided 73 unique data sets. Quantitative assessment between the Specific Level of Function (SLOF) (n=18) scores and UPSA scores demonstrated a moderate borderline-significant correlation (0.45, p=0.06). Quantitative analysis of the relationship between the Global Assessment of Functioning (GAF) (n=11) and the Multidimensional Scale of Independent Functioning (MSIF) (n=6) scales revealed moderate and small nonsignificant Pearson correlations of -0.34 (p=0.31) and 0.12 (p=0.83), respectively. There was a small borderline-significant correlation between UPSA score and residential status (n=36; 0.31; p=0.08), while no correlation was found between UPSA score and employment status (n=19; 0.04; p=0.88). CONCLUSION The SLOF was the most often used functional measure and had the strongest observed correlation with the UPSA. Although knowledge gaps remain, evidence from this review indicates that there is a quantitative relationship between functional capacity and real-world outcomes in individuals with schizophrenia.
Collapse
|
5
|
Yılmaz E, Okanlı A. Test of Mindfulness-Based Psychosocial Skills Training to İmprove Insight and Functional Recovery in Schizophrenia. West J Nurs Res 2017; 40:1357-1373. [DOI: 10.1177/0193945917697222] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This study was conducted with two groups (training and control) using a pretest/posttest design to determine the effect of mindfulness-based psychosocial skills training for improving insight and functional recovery levels in patients with schizophrenia. The study sample included 45 patients with schizophrenia (21 were in the training group/mindfulness-based psychosocial skills training and 24 were in the control group/standard drug medication). The data were collected using a Personal Information Form, Functional Remission of General Schizophrenia (FROGS) scale, and Beck Cognitive Insight Scale (BCIS). The training group was divided into two groups of 10 to 12 persons on average. Training was given as a group training for a total of 16 sessions, two sessions a week for 8 weeks. The training group scored significantly higher in functional recovery and insight levels than the control group after training ( p < .05). The study determined training has an effect on increasing the levels of insight and functional recovery in schizophrenia.
Collapse
Affiliation(s)
- Emine Yılmaz
- Bingöl University, Faculty of Health Sciences, Department of Nursing, Turkey
| | | |
Collapse
|
6
|
Baseline Predictors for Success Following Strategy-Based Cognitive Remediation Group Training in Schizophrenia. J Nerv Ment Dis 2016; 204:585-9. [PMID: 27011310 DOI: 10.1097/nmd.0000000000000509] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Our aim was to examine predictive variables associated with the improvement in cognitive, clinical, and functional outcomes after outpatient participation in REPYFLEC strategy-based Cognitive Remediation (CR) group training. In addition, we investigated which factors might be associated with some long-lasting effects at 6 months' follow-up. Predictors of improvement after CR were studied in a sample of 29 outpatients with schizophrenia. Partial correlations were computed between targeted variables and outcomes of response to explore significant associations. Subsequently, we built linear regression models for each outcome variable and predictors of improvement. The improvement in negative symptoms at posttreatment was linked to faster performance in the Trail Making Test B. Disorganization and cognitive symptoms were related to changes in executive function at follow-up. Lower levels of positive symptoms were related to durable improvements in life skills. Levels of symptoms and cognition were associated with improvements following CR, but the pattern of resulting associations was nonspecific.
Collapse
|
7
|
Best MW, Bowie CR. Neurophysiological evidence for a processing bias towards schizophrenia-associated communication abnormalities. Schizophr Res 2015; 169:334-339. [PMID: 26476618 DOI: 10.1016/j.schres.2015.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 10/01/2015] [Accepted: 10/05/2015] [Indexed: 01/23/2023]
Abstract
BACKGROUND The current study aimed to examine the effects of diagnostic and symptomatic information on auditory linguistic event-related potentials (ERPs) in the listener, in response to speech containing schizophrenia-associated communication abnormalities. METHODS 73 participants listened to conversation segments while continuous EEG was recorded. Participants were told that the responder in the conversation was either a university student, had symptoms from a stroke, had symptoms from schizophrenia, or had recovered from schizophrenia. The final word of the response was randomly presented as a typical ending, word approximation, neologism, or filler ending. RESULTS A significant N400 was observed over centro-parietal electrode sites in response to word approximations and neologisms in the university student condition only. There were no differences between conditions in the N100 ERP, and EEG measures were not related to either subjective or objective measures of stigmatizing attitudes. CONCLUSIONS The N400 effect may represent disengagement, at a semantic level, from what an individual is saying based on symptomatic or diagnostic information about schizophrenia.
Collapse
Affiliation(s)
| | - Christopher R Bowie
- Department of Psychology, Queen's University, Canada; Department of Psychiatry, Queen's University, Canada; Centre for Neuroscience Studies, Queen's University, Canada.
| |
Collapse
|
8
|
Yıldırım A, Hacıhasanoğlu Aşılar R, Camcıoğlu TH, Erdiman S, Karaağaç E. Effect of Psychosocial Skills Training on Disease Symptoms, Insight, Internalized Stigmatization, and Social Functioning in Patients with Schizophrenia. Rehabil Nurs 2015; 40:341-8. [DOI: 10.1002/rnj.195] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2014] [Indexed: 11/12/2022]
|
9
|
Londono Y, McMillan DE. Psychosocial adaptation: an evolutionary concept analysis exploring a common multidisciplinary language. J Adv Nurs 2015; 71:2504-19. [PMID: 26148125 DOI: 10.1111/jan.12723] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2015] [Indexed: 12/01/2022]
Abstract
AIMS To provide the first known concept analysis of psychosocial adaptation, exploring its evolution from the concept adaptation. We also determine how psychosocial adaptation is conceptualized across nursing, health, sociobehavioural and education disciplines. BACKGROUND Psychosocial adaptation is an important conceptual term that is poorly defined in nursing and other health, sociobehavioural and education disciplines. A thorough understanding of the concept's application in nursing and across disciplines can help to clarify its meaning, facilitate a more effective common language between disciplines and inform future psychosocial adaptation research. DESIGN Rodger's evolutionary view guided this concept analysis. DATA SOURCES Peer-reviewed English and Spanish manuscripts published between 2011-2013 were retrieved from the following databases: CINAHL, Psych INFO, PubMed, Scopus and LILACS. REVIEW METHODS Eighty-nine articles related to psychosocial adaptation were included in the analysis. Findings identify key attributes, antecedents and consequences associated with the use of the concept. Findings were compared vis-a-vis reported characteristics of adaptation. RESULTS The attributes characterizing psychosocial adaptation are: change, process, continuity, interaction and influence. In psychosocial adaptation, new life conditions serve as antecedents, while consequences are good or bad outcomes. Important features of the evolution of this concept include its broad appropriation across the reviewed disciplines. The attributes of psychosocial adaptation, have some similarities to those of general adaptation. Both concepts include an aspect of change, but unlike adaptation, psychosocial adaptation has branched away from biological descriptors, such as homeostasis and tends to focus on relational characteristics, such as interaction and influences.
Collapse
Affiliation(s)
- Yenly Londono
- Department of Applied Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Diana E McMillan
- College of Nursing, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| |
Collapse
|
10
|
Elliott CS, Fiszdon JM. Comparison of self-report and performance-based measures of everyday functioning in individuals with schizophrenia: implications for measure selection. Cogn Neuropsychiatry 2014; 19:485-94. [PMID: 24901357 DOI: 10.1080/13546805.2014.922062] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Both self-report and performance-based measures are often used in assessment of everyday functioning for individuals with schizophrenia. However, there is little evidence of overlap between them, and there are no established standards for which measures might be most appropriate. In order to better understand differences among these types of measures, we examined relationships between a self-report and two performance-based measures of everyday functioning. We also examined their patterns of interrelationships to neurocognition and psychiatric symptoms. METHODS Participants were 71 outpatients with schizophrenia spectrum disorder. Measures of everyday functioning (Independent Living Skill Survey-Self Report (ILSS-SR); University of California San Diego Performance-based Skills Assessment; and Medication Management Ability Assessment), cognition and psychiatric symptoms were administered. Correlation analyses were conducted to examine the relationships among the functioning measures, and their relationships to cognition and symptoms. Regression analyses further examined the unique contributions of neurocognitive and symptom variables to functional measures. RESULTS Consistent with the literature, the two performance-based measures were related to each other, but not to the self-report measure. Whereas the performance-based measures were related to neurocognition but not to the psychiatric symptoms, the opposite pattern was observed for the self-report measure. CONCLUSIONS The pattern of interrelationships among these self-report and performance-based measures suggests that they tap different aspects of everyday functioning. This has important implications for measure selection, particularly for evaluating intervention outcomes. When targeting symptoms, a self-report measure like the ILSS-SR may be more appropriate, whereas a performance-based measure may be more sensitive to functional changes subsequent to treatments targeting cognition.
Collapse
Affiliation(s)
- Colette Seter Elliott
- a VA Connecticut Healthcare System , Psychology Service (116B), 950 Campbell Avenue, West Haven , CT 06516 , USA
| | | |
Collapse
|
11
|
Best MW, Bowie CR. Neurophysiological responses to schizophrenia-associated communication abnormalities. Schizophr Res 2013; 148:157-62. [PMID: 23800615 DOI: 10.1016/j.schres.2013.06.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2013] [Revised: 05/30/2013] [Accepted: 06/03/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND Individuals with schizophrenia experience difficulty with interpersonal interactions, in part resulting from communication abnormalities that are common in the disorder, and to the expectancy effects from knowledge of the person's diagnosis. The auditory N400 event-related potential provides an objective measure of recognition of incongruent speech and thus is a potential tool to understand how listeners respond to disordered speech as a function of awareness of diagnosis. METHODS In this study, participants listened to segments of conversation between two people in which the sentence final word was a normal ending, a word approximation, or a neologism while EEG was recorded. Participants were randomized to two groups: told that the speaker had a diagnosis of schizophrenia or not told about a diagnosis. RESULTS Participants who were not told that the speaker had schizophrenia displayed a significant N400 during both word approximations and neologisms. However, no significant N400 was observed for participants who were told that the speaker had schizophrenia. CONCLUSIONS Differential neurological responses to the same abnormal speech depending on whether the diagnosis of the speaker was known, indicate an early processing expectancy effect for abnormal communication to come from someone with schizophrenia. Such responses to abnormal speech in schizophrenia indicate an expectation of abnormality from individuals with schizophrenia, which has implications for understanding social exclusion of individuals with the disorder.
Collapse
|
12
|
Current world literature. Curr Opin Psychiatry 2013; 26:231-6. [PMID: 23364282 DOI: 10.1097/yco.0b013e32835dd9de] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|