Disability in clinically stable patients of schizophrenia

Impact of Cognitive Disturbances and Clinical Symptoms on Disability in Patients with Paranoid Schizophrenia: A Study of a Bulgarian Clinical Sample

The study aimed to assess the impact of clinical symptoms and cognitive impairment on disability in patients with paranoid schizophrenia (PS).

METHODS

108 patients with schizophrenia were included (66 male and 42 female). Their average age was 38.86 ± 10.02 years and the disease duration was 12.80 ± 8.20 years, with mean disease onset of 24 years. Clinical symptoms were assessed with the PANSS, and cognitive performance was measured using a seven-item neurocognitive battery. The disability level of the subjects was assessed using the World Health Organization-Disability Assessment Schedule 2.0 (WHO-DAS 2.0). The relation between the variables studied was assessed using Spearman's rank correlation coefficient (r_s) at a probability level of p < 0.05.

RESULTS

An increase in symptom severity resulted in worsening of the "participation in society" (r = 0.56, p < 0.01), "life activities-household" (r = 0.55, p < 0.01), and "getting along with people" (r = 0.59, p < 0.01) WHO-DAS 2.0 domains. Positive symptoms (13.89 ± 3.48) correlated strongly with "getting along with people" (r = 0.55, p < 0.01), "life activities-household" (r = 0.58, p < 0.01), and "participation in society" (r = 0.62, p < 0.01), and negative symptoms (14.25 ± 4.16) with "participation in society" (r = 0.53, p < 0.01) and "life activities-household" (r = 0.48, p < 0.01). Symptoms of disorganization (15.67 ± 4.16) had the highest impact on "life activities-household" (r = 0.81, p < 0.01), "getting along with people" (r = 0.56, p < 0.05), and "participation in society" (r = 0.65, p < 0.01). Episodic memory (r = -0.28, p < 0.01) was remotely related to comprehension and communication. The information processing speed (r_s = 0.38, p < 0.01), visual memory (r_s = -0.30, p < 0.01), and focused executive functions showed moderate correlations with all domains on the WHO-DAS 2.0 scale (r_s = 0.38, p < 0.01). Attention (r_s = -0.33, p < 0.01) was moderately related to community activities. Semantic (r_s = -0.29, p < 0.01) and literal (r_s = -0.27, p < 0.01) verbal fluency demonstrated weak correlations with "cognition-understanding", "getting along with people", and "participation in society".

CONCLUSION

Symptoms of disorganization and disturbed executive functions contribute most to disability in patients with schizophrenia through impairment of real-world functioning, especially in social interactions and communication. Severe clinical symptoms (negative and disorganization-related ones) as well as deficits in executive function, verbal memory, and verbal fluency cause the biggest problems in the functional domains of interaction with other people and participation in society.

Self-assessment of social cognition in a sample of Lebanese in-patients with schizophrenia

OBJECTIVE

The primary objective was to evaluate social cognitive complaints in a sample of chronic in-patients with schizophrenia and compare it to healthy controls. The secondary objective was to explore factors related to social cognitive complaints in these patients, such as neurocognition, clinical symptoms, depression, and insight.

METHODS

A cross-sectional study conducted between July 2019 and March 2020 at the Psychiatric Hospital of the Cross (HPC)-Lebanon enrolled 120 chronic in-patients diagnosed with schizophrenia and schizoaffective disorders and 60 healthy controls. The Self-Assessment of Social Cognition Impairments (ACSo) scale was used to assess social cognitive complaints.

RESULTS

A significant difference was found between schizophrenia patients and healthy controls in all social cognitive complaints: theory of mind complaint, attributional biases complaint, emotional processes complaint, and social perception and knowledge complaint (p < 0.001 for all). All objective cognitive disorders were significantly associated with social cognitive complaints except for attention and speed of information processing. Higher verbal memory and verbal fluency were significantly associated with lower emotional processes complaint scores. The results of the multivariate analysis showed that a higher cognition (Beta = -0.08, p = 0.001) was significantly associated with a lower social cognitive complaint, contrary a higher depression (Beta = 0.38, p = 0.04) was significantly associated with a higher social cognitive complaint, in particular attributional biases complaints.

CONCLUSION

This study showed that patients with schizophrenia have complaints about their social cognition. It could also demonstrate that subjective social cognitive complaints are correlated with depressive symptoms and objective cognitive deficits among these patients.

Subjective cognitive complaints and relations to objective cognitive performance among Lebanese patients with schizophrenia

BACKGROUND

Patients with schizophrenia have a particularly low level of insight into their illness compared to people with other mental health disorders. The objectives of the study were to evaluate: 1) subjective cognitive complaints in individuals with schizophrenia in comparison with health controls, 2) the relation between subjective cognitive complaint (SCC) and objective cognitive performance in the patients group, and 3) factors related to cognitive complaint, such as depression, insight, autonomy, and psychological symptoms.

METHODS

Cross-sectional study was conducted between July 2019 and March 2020 enrolled 120 patients with schizophrenia disorders, selected from the Psychiatric Hospital of the Cross (HPC) - Lebanon and 60 healthy controls. The Self-Assessment Scale of Cognitive Complaints in Schizophrenia (SASCCS) was used to measure people living with schizophrenia perception of their cognitive impairment, while the Brief Assessment of Cognition in Schizophrenia (BACS) was used to evaluate their cognitive functioning.

RESULTS

A significant difference was found between schizophrenia patients and healthy controls in all neurocognition and SASCCS tests. The hierarchical regression analysis showed that the BACS total score (Beta = -.06, p = .04), the PANSS general psychopathology (Beta = .29, p = .003), higher depression (Beta = .75, p = .003) were significantly associated with higher SCC. However, higher autonomy (Beta = - 6.35, p = .001) was significantly associated with lower SCC. A Structural equation model showed that the two most contributing variables were general psychopathology (Standardized Beta (SB): .33, p < 0.001) and autonomy (SB: -.29, p < 0.001).

CONCLUSION

A significant proportion of patients with schizophrenia could estimate their cognitive impairment. It also showed a positive correlation between depression and activity of daily living with SCC, suggesting that this aspect should be investigated alongside the clinical symptoms when a patient with schizophrenia presents with SCC.

Cross-cultural adaptation and validation of the Arabic version of the BACS scale (the brief assessment of cognition in schizophrenia) among chronic schizophrenic inpatients

BACKGROUND

Assessment of cognitive disorders in schizophrenia is becoming a part of clinical and research practice by using batteries that differ widely in their content. The Brief Assessment of Cognition in Schizophrenia (BACS) was developed to cover the main cognitive deficits of schizophrenia. The objective of this study was to assess concurrent validity of the Arabic version of the BACS with a standard neurocognitive battery of tests in Lebanese patients with schizophrenia and healthy controls.

METHODS

A sample of 120 stable inpatients diagnosed with schizophrenia and 60 healthy controls received the Arabic version of the BACS in a first session, and a standard battery in a second session.

RESULTS

Mean duration of completion for the BACS was 31.2 ± 5.4 min in patients with schizophrenia. All tests demonstrated significant differences between controls and patients (p < .01). Principal components analysis demonstrated that a one-factor solution best fits our dataset (64.8% of the variance). High Cronbach alpha was found (.85). The BACS composite scores were significantly correlated with the standard battery composite scores in patients (r = .73, p < .001) and healthy controls (r = .78, p < .001). Also, correlation analysis between the BACS sub-scores and the standard battery sub-scores showed significant results (p < .05).

CONCLUSION

Results showed that the Arabic version of the BACS demonstrated high ability to discriminate patients with schizophrenia from healthy controls and it is a useful tool for assessing cognition in patients with schizophrenia and could be used in clinical practice in Lebanon.