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Rajput R, Prasad S D, Pai CG. Assessing the Impact of Medication and Stenting on the Quality of Life of Patients With Chronic Pancreatitis: A Prospective Study. Cureus 2023; 15:e50106. [PMID: 38186534 PMCID: PMC10771073 DOI: 10.7759/cureus.50106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2023] [Indexed: 01/09/2024] Open
Abstract
This research aimed to assess the effect of pharmacotherapy alone versus the combination of pharmacotherapy and endoscopic stenting on the quality of life (QoL) outcomes of chronic pancreatitis patients. Chronic pancreatitis, an inflammatory disease, often presents with persistent pain, affecting patients' quality of life. Thirty patients treated either with pharmacotherapy alone or with the addition of endoscopic stenting were analyzed. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) was used to gather data on the patients' QoL. Results showed that both treatment groups experienced improvements in global health, role functioning, fatigue, and abdominal pain scores over follow-ups. Specifically, the stenting group saw notable enhancements in global health and role functioning. The study's conclusions provide valuable insights into the potential benefits of both treatments, with stenting offering significant improvements in certain QoL parameters. However, the sample size and source limit generalizability, suggesting the need for more extensive research across diverse settings.
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Affiliation(s)
| | - Durga Prasad S
- Pharmacology, American University of Antigua College of Medicine, St. John's, ATG
| | - C Ganesh Pai
- Gastroenterology, Kasturba Medical College, Manipal, IND
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2
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Pilz MJ, Rothmund M, Lidington E, Piccinin C, Arraras JI, Groenvold M, Holzner B, van Leeuwen M, Petersen MA, Schmidt H, Young T, Giesinger JM. Content comparison of the EORTC CAT Core, SF-36, FACT-G, and PROMIS role and social functioning measures based on the International Classification of Functioning, Disability and Health. Psychooncology 2023; 32:1372-1384. [PMID: 37491796 DOI: 10.1002/pon.6188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/20/2023] [Accepted: 06/22/2023] [Indexed: 07/27/2023]
Abstract
OBJECTIVES In line with the World Health Organizations' health definition, patient-reported outcome (PRO) measures frequently cover aspects of social health. Our study aimed to evaluate the role functioning (RF) and social functioning (SF) contents assessed by PRO measures commonly used in cancer patients. METHODS We analysed the item content of the SF and RF domains of the EORTC CAT Core, the EORTC QLQ-C30, the SF-36, and the FACT-G as well as the PROMIS item bank covering the Ability to Participate in Social Roles and Activities. Following an established methodology we linked item content to the International Classification of Functioning, Disability and Health (ICF) framework. RESULTS The content of 85 items was assigned to three ICF components ('Activities and Participation', 'Body Functions', and 'Environmental Factors'). The EORTC CAT Core RF items were mostly related to the first-level ICF categories 'Domestic life' and 'Community, social and civic life', while its SF item bank focused on 'Interpersonal interactions and relationships'. These three categories were also covered by the PROMIS social participation item bank. The FACT-G Social/Family scale focused on environmental factors ('Support and Relationships' and 'Attitudes') while the SF-36 Role-physical/emotional scales had a stronger focus on 'General tasks and demands' and 'Major life areas'. CONCLUSIONS Our results highlight conceptual overlap and differences among PRO measures for the assessment of social health in cancer. This information may help to select the most appropriate measure for a specific setting or study purpose and to better understand the possibilities of linking scores across different PRO measures.
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Affiliation(s)
- Micha J Pilz
- University Hospital of Psychiatry II, Innsbruck Medical University, Innsbruck, Austria
| | - Maria Rothmund
- University Hospital of Psychiatry II, Innsbruck Medical University, Innsbruck, Austria
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
| | - Emma Lidington
- Cancer Behavioural Science Unit, King's College London, Guy's Hospital, London, UK
| | | | - Juan I Arraras
- Medical Oncology Department, Hospital Universitario de Navarra, Pamplona, Spain
| | - Mogens Groenvold
- Palliative Care Research Unit, Bispebjerg/Frederiksberg Hospital, Copenhagen, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Bernhard Holzner
- University Hospital of Psychiatry I, Innsbruck Medical University, Innsbruck, Austria
| | - Marieke van Leeuwen
- Division of Psychosocial Research & Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Morten Aa Petersen
- Palliative Care Research Unit, Bispebjerg/Frederiksberg Hospital, Copenhagen, Denmark
| | - Heike Schmidt
- University Clinic and Outpatient Clinic for Radiotherapy and Institute of Health and Nursing Science, Medical Faculty of Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Teresa Young
- Lynda Jackson Macmillan Centre, Mount Vernon Cancer Centre, Northwood, UK
| | - Johannes M Giesinger
- University Hospital of Psychiatry II, Innsbruck Medical University, Innsbruck, Austria
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3
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Addington J, Liu L, Braun A, Brummitt K, Cadenhead KS, Cornblatt BA, Holden JL, Granholm E. Cognitive-Behavioral Social Skills Training: Outcome of a Randomized Controlled Trial for Youth at Risk of Psychosis. Schizophr Bull Open 2023; 4:sgad020. [PMID: 37601286 PMCID: PMC10439516 DOI: 10.1093/schizbullopen/sgad020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
Aim Difficulties in social functioning have been observed in youth at clinical high-risk (CHR) of psychosis even in those who do not go on to develop a psychotic illness. Few treatment studies have attempted to improve social functioning in this population. The aim of this study was to conduct a randomized trial comparing the effects of Cognitive-Behavioral Social Skills Training (CBSST) with a supportive therapy (ST). Methods Both CBSST and ST were weekly group therapies, delivered over 18 weeks. This was a 2-arm trial with single-blinded ratings and intention-to-treat analyses. Assessments occurred at baseline, end-of-treatment, and 12 months after the baseline assessment. The primary outcome was social and role functioning and defeatist performance attitudes were the secondary outcome. Attenuated positive and negative symptoms, anxiety, depression, self-efficacy, and beliefs about self and others were examined as exploratory outcomes. Results There were no significant differences between the 2 groups at baseline or either of the 2 follow-ups. However, at follow-ups, in each group there were significant improvements in clinical symptoms. These could not be attributed to group treatment since there was no control or wait-list group. Conclusions Since poor social functioning is one of the most observed difficulties in CHR individuals, and a decline in social functioning may be a significant predictor of later transition to psychosis, future work will be needed to find effective treatments for this decline in functioning for CHR youth.
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Affiliation(s)
- Jean Addington
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Lu Liu
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Amy Braun
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Kali Brummitt
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Kristin S Cadenhead
- Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
| | | | - Jason L Holden
- Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
| | - Eric Granholm
- Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
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4
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West ML, Parrish EM, Green J, Howland C, Friedman-Yakoobian M. Individualized vocational and educational support and training for youth at clinical high risk for psychosis. Early Interv Psychiatry 2022; 16:492-499. [PMID: 34309187 DOI: 10.1111/eip.13186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 06/04/2021] [Accepted: 07/01/2021] [Indexed: 11/30/2022]
Abstract
AIM Early intervention for psychosis has been of high interest in the past two decades. Research demonstrates that clinical high risk for psychosis (CHR-p) populations experience impairments in role functioning. Although several vocational and cognitive interventions exist for people living with psychosis, there are no known evidence-based treatments for role functioning difficulties during the CHR-p stage. There is clear evidence for a need for interventions that directly target role functioning. METHODS This paper describes the theoretical development and implementation of a novel intervention targeting role functioning impairments: Individualized Vocational and Educational Support and Training (InVEST). The CEDAR Clinic, a specialized CHR-p coordinated specialty care (CSC) team, has worked to develop InVEST to target core aspects of role functioning, namely executive functioning, stress sensitivity, and task initiation. The intervention is cost-efficient, as bachelor level clinicians provide the service under supervision of licensed clinicians. This summary describes InVEST, provides a disguised case example, and presents initial exploratory data (N = 135) focused on the intervention's feasibility in this CSC program. RESULTS Although these preliminary data are limited, available information suggests that InVEST may provide a core treatment modality within CHR-p treatment programs. CONCLUSIONS More research formally investigating InVEST with a larger sample would provide further evidence of the intervention's efficacy.
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Affiliation(s)
- Michelle L West
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Department of Mental Health, Massachusetts Mental Health Center, Boston, Massachusetts, USA.,Brookline Center for Community Mental Health, Brookline, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Anschutz Medical Campus, University of Colorado, Aurora, Colorado, USA
| | - Emma M Parrish
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Department of Mental Health, Massachusetts Mental Health Center, Boston, Massachusetts, USA.,Brookline Center for Community Mental Health, Brookline, Massachusetts, USA.,San Diego State University, University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA
| | - James Green
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Department of Mental Health, Massachusetts Mental Health Center, Boston, Massachusetts, USA.,Brookline Center for Community Mental Health, Brookline, Massachusetts, USA
| | - Caroline Howland
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Department of Mental Health, Massachusetts Mental Health Center, Boston, Massachusetts, USA.,Brookline Center for Community Mental Health, Brookline, Massachusetts, USA
| | - Michelle Friedman-Yakoobian
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Department of Mental Health, Massachusetts Mental Health Center, Boston, Massachusetts, USA.,Brookline Center for Community Mental Health, Brookline, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
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Antonucci LA, Penzel N, Sanfelici R, Pigoni A, Kambeitz-Ilankovic L, Dwyer D, Ruef A, Sen Dong M, Öztürk ÖF, Chisholm K, Haidl T, Rosen M, Ferro A, Pergola G, Andriola I, Blasi G, Ruhrmann S, Schultze-Lutter F, Falkai P, Kambeitz J, Lencer R, Dannlowski U, Upthegrove R, Salokangas RKR, Pantelis C, Meisenzahl E, Wood SJ, Brambilla P, Borgwardt S, Bertolino A, Koutsouleris N. Using combined environmental-clinical classification models to predict role functioning outcome in clinical high-risk states for psychosis and recent-onset depression. Br J Psychiatry 2022; 220:1-17. [PMID: 35152923 DOI: 10.1192/bjp.2022.16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Clinical high-risk states for psychosis (CHR) are associated with functional impairments and depressive disorders. A previous PRONIA study predicted social functioning in CHR and recent-onset depression (ROD) based on structural magnetic resonance imaging (sMRI) and clinical data. However, the combination of these domains did not lead to accurate role functioning prediction, calling for the investigation of additional risk dimensions. Role functioning may be more strongly associated with environmental adverse events than social functioning. AIMS We aimed to predict role functioning in CHR, ROD and transdiagnostically, by adding environmental adverse events-related variables to clinical and sMRI data domains within the PRONIA sample. METHOD Baseline clinical, environmental and sMRI data collected in 92 CHR and 95 ROD samples were trained to predict lower versus higher follow-up role functioning, using support vector classification and mixed k-fold/leave-site-out cross-validation. We built separate predictions for each domain, created multimodal predictions and validated them in independent cohorts (74 CHR, 66 ROD). RESULTS Models combining clinical and environmental data predicted role outcome in discovery and replication samples of CHR (balanced accuracies: 65.4% and 67.7%, respectively), ROD (balanced accuracies: 58.9% and 62.5%, respectively), and transdiagnostically (balanced accuracies: 62.4% and 68.2%, respectively). The most reliable environmental features for role outcome prediction were adult environmental adjustment, childhood trauma in CHR and childhood environmental adjustment in ROD. CONCLUSIONS Findings support the hypothesis that environmental variables inform role outcome prediction, highlight the existence of both transdiagnostic and syndrome-specific predictive environmental adverse events, and emphasise the importance of implementing real-world models by measuring multiple risk dimensions.
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Affiliation(s)
- Linda A Antonucci
- Department of Education Science, Psychology and Communication Science, University of Bari Aldo Moro, Italy; and Department of Psychiatry and Psychotherapy, Ludwig Maximilians University Munich, Germany
| | - Nora Penzel
- Department of Psychiatry and Psychotherapy, Ludwig Maximilians University Munich, Germany; and Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Rachele Sanfelici
- Department of Psychiatry and Psychotherapy, Ludwig Maximilians University Munich, Germany; and Institute for Psychiatry, Max Planck School of Cognition, Germany
| | - Alessandro Pigoni
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Italy; and Social and Affective Neuroscience Group, MoMiLab, IMT School for Advanced Studies Lucca, Italy
| | - Lana Kambeitz-Ilankovic
- Department of Education Science, Psychology and Communication Science, University of Bari Aldo Moro, Italy; and Department of Psychiatry and Psychotherapy, Ludwig Maximilians University Munich, Germany
| | - Dominic Dwyer
- Department of Psychiatry and Psychotherapy, Ludwig Maximilians University Munich, Germany
| | - Anne Ruef
- Department of Psychiatry and Psychotherapy, Ludwig Maximilians University Munich, Germany
| | - Mark Sen Dong
- Department of Psychiatry and Psychotherapy, Ludwig Maximilians University Munich, Germany
| | - Ömer Faruk Öztürk
- Department of Psychiatry and Psychotherapy, Ludwig Maximilians University Munich, Germany; and Institute for Psychiatry, International Max Planck Research School for Translational Psychiatry, Germany
| | - Katharine Chisholm
- Institute for Mental Health, University of Birmingham, UK; and Department of Psychology, Aston University, UK
| | - Theresa Haidl
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Marlene Rosen
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Adele Ferro
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Italy
| | - Giulio Pergola
- Department of Basic Medical Science, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Italy
| | - Ileana Andriola
- Department of Basic Medical Science, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Italy
| | - Giuseppe Blasi
- Department of Basic Medical Science, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Italy
| | - Stephan Ruhrmann
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, Heinrich-Heine University Düsseldorf, Germany; Department of Psychology and Mental Health, Faculty of Psychology, Airlangga University, Indonesia; and University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Switzerland
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, Ludwig Maximilians University Munich, Germany
| | - Joseph Kambeitz
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Rebekka Lencer
- Institute for Translational Psychiatry, University of Münster, UK; and Department of Psychiatry and Psychotherapy, University of Lübeck, Germany
| | - Udo Dannlowski
- Institute for Translational Psychiatry, University of Münster, UK
| | - Rachel Upthegrove
- Institute for Mental Health, University of Birmingham, UK; and Early Intervention Service, Birmingham Women's and Children's NHS Foundation Trust, UK
| | | | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne, Australia
| | - Eva Meisenzahl
- Department of Psychiatry and Psychotherapy, Heinrich-Heine University Düsseldorf, Germany
| | - Stephen J Wood
- Department of Psychiatry and Psychotherapy, Ludwig Maximilians University Munich, Germany; Orygen, Australia; Centre for Youth Mental Health, University of Melbourne, Australia; and School of Psychology, University of Birmingham, UK
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Italy; and Department of Pathophysiology and Transplantation, University of Milan, Italy
| | - Stefan Borgwardt
- Institute for Translational Psychiatry, University of Münster, UK; and Department of Psychiatry (Psychiatric University Hospital, University Psychiatric Clinics Basel), University of Basel, Switzerland
| | - Alessandro Bertolino
- Department of Basic Medical Science, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Italy
| | - Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, Ludwig Maximilians University Munich, Germany
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6
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Addington J, Liu L, Santesteban-Echarri O, Brummitt K, Braun A, Cadenhead KS, Cornblatt BA, Holden JL, Granholm E. Cognitive behavioural social skills training: Methods of a randomized controlled trial for youth at risk of psychosis. Early Interv Psychiatry 2021; 15:1626-1636. [PMID: 33398922 DOI: 10.1111/eip.13102] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 11/16/2020] [Accepted: 12/13/2020] [Indexed: 11/30/2022]
Abstract
AIM Poor functioning has become a hallmark of many youth at clinical high-risk (CHR) of psychosis. Even for those who do not make the transition to psychosis remain troubled by functional deficits and a decline in functioning increases the odds of transitioning to psychosis. There are very few treatment studies that have attempted to improve social and role functioning. The aim of this paper is to describe the methods of a treatment study to address social and role functioning in CHR. METHODS This was a randomized controlled trial of cognitive-behavioural social skills training (CBSST) versus a supportive therapy. CBSST combines elements of cognitive behaviour therapy (CBT) and social skills training (SST), two evidence-based treatments for schizophrenia. By adding CBT to SST to target functioning outcomes, SST can be used to train new social skills, and thoughts that interfere with skilled performance in the real world can be addressed using CBT. We developed an adapted version of CBSST, more appropriate for the age range and illness severity of typical CHR individuals, to attempt to show improvements in social and role functioning for these young people. RESULTS Two hundred and three participants were recruited for this study. Results include initial baseline data. CONCLUSION This article describes the baseline methodology of a CHR youth who have difficulties in social and/or role functioning. It is one of the first clinical trials to address this significant problem.
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Affiliation(s)
- Jean Addington
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Lu Liu
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Olga Santesteban-Echarri
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Kali Brummitt
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Amy Braun
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Kristin S Cadenhead
- Department of Psychiatry, University of California, San Diego, San Diego, California, USA
| | - Barbara A Cornblatt
- Department of Psychiatry, Zucker Hillside Hospital, Long Island, New York, USA
| | - Jason L Holden
- Department of Psychiatry, University of California, San Diego, San Diego, California, USA
| | - Eric Granholm
- Department of Psychiatry, University of California, San Diego, San Diego, California, USA.,Veterans Affairs San Diego Healthcare System, San Diego, California, USA
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Abstract
This study examined the association of spatial working memory and attenuated psychotic-like experiences and related symptoms with social and role functioning. Findings from this study suggest that symptom dimensions and working memory impairment were associated with diminished functioning across a variety of domains. Specifically, negative symptoms and working memory impairment were inversely associated with both social and role functioning, whereas positive and disorganized symptoms showed inverse associations with social functioning only. Symptom dimensions did not moderate cognitive and functional variables, although working memory and attenuated clinical symptoms had an additive effect on functioning. Post-hoc analyses examining symptom dimensions simultaneously showed negative symptoms to be the variable most strongly predictive of overall functioning. These findings suggest that even in a non-clinical sample, sub-threshold psychosis symptoms and cognition may influence people’s social and role functioning.
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Affiliation(s)
- Charlotte A Chun
- Department of Psychology, Temple University, Philadelphia, Pennsylvania, USA
| | - Shanna Cooper
- Department of Mental Health, VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego, California, USA
| | - Lauren M Ellman
- Department of Psychology, Temple University, Philadelphia, Pennsylvania, USA
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8
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Devoe DJ, Braun A, Seredynski T, Addington J. Negative Symptoms and Functioning in Youth at Risk of Psychosis: A Systematic Review and Meta-analysis. Harv Rev Psychiatry 2020; 28:341-55. [PMID: 33156155 DOI: 10.1097/HRP.0000000000000273] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
LEARNING OBJECTIVE After participating in this activity, learners should be better able to:• Evaluate the relationship between negative symptoms and functioning in youth at clinical high risk for psychosis. AIM Youth at CHR for psychosis often demonstrate significant negative symptoms and poor functioning, though the magnitude and direction of the relationship between the two remains unknown. The objective of this systematic review is to summarize the relationship between negative symptoms and functioning in CHR samples. METHOD Electronic databases CINAHL, EBM, Embase, MEDLINE, and PsycINFO were searched from inception. Studies were selected if they included any study that reported a relationship between negative symptoms and functioning in youth at clinical high risk (CHR). The correlation coefficient r was converted to Cohen's d, and all random-effects meta-analyses were performed using the transformed values. RESULTS Forty-one studies met the inclusion criteria, including a total of 4574 individuals at CHR for psychosis. Negative symptom total scores were significantly associated with poorer global functioning (d, -1.40; 95% CI, -1.82 to -0.98; I = 79.4%; p < .001 [9 studies, n = 782]), social functioning (d, -1.10; 95% CI, -1.27 to -0.93; I = 10.40%; p < .001 [12 studies, n = 811]), and role functioning (d, -0.96; 95% CI, -1.17 to -0.76; I = 41.1%; p < .001 [9 studies, n = 881]). In addition, negative symptoms were consistently associated with poor premorbid functioning. When examining negative symptom domains, avolition, anhedonia, and blunted affect were each significantly and independently associated with poorer social functioning and role functioning. In terms of prediction models, negative symptoms contributed to the prediction of lower functioning across multiple studies. CONCLUSION This meta-analysis demonstrates a strong relationship between negative symptoms and functioning in youth at clinical high risk for psychosis.
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9
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McLaughlin D, Carrión RE, Auther AM, Olvet DM, Addington J, Bearden CE, Cadenhead KS, Cannon TD, Heinssen RK, Mathalon DH, McGlashan TH, Perkins DO, Seidman LJ, Tsuang MT, Walker EF, Woods SW, Goldberg TE, Harvey PD, Cornblatt BA. Functional Capacity Assessed by the Map Task in Individuals at Clinical High-Risk for Psychosis. Schizophr Bull 2016; 42:1234-42. [PMID: 27105902 PMCID: PMC4988745 DOI: 10.1093/schbul/sbw039] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Recent studies have recognized that signs of functional disability in schizophrenia are evident in early phases of the disorder, and, as a result, can potentially serve as vulnerability markers of future illness. However, functional measures in the psychosis prodrome have focused exclusively on real-world achievements, rather than on the skills required to carry-out a particular real-world function (ie, capacity). Despite growing evidence that diminished capacity is critical to the etiology of the established disorder, virtually no attention has been directed towards assessing functional capacity in the pre-illness stages. In the present study, we introduce the Map task, a measure to assess functional capacity in adolescent and young-adult high-risk populations. METHODS The Map task was administered to 609 subjects at Clinical High-Risk (CHR) for psychosis and 242 Healthy Controls (HCs) participating in the North American Prodrome Longitudinal Study (NAPLS2). Subjects were required to efficiently complete a set of specified errands in a fictional town. RESULTS CHR participants showed large impairments across major indices of the Map task, relative to the HCs. Most importantly, poor performance on the Map task significantly predicted conversion to psychosis, even after adjusting for age, IQ, clinical state, and other potential confounders. CONCLUSIONS To the best of our knowledge, the Map task is one of the first laboratory-based measures to assess functional capacity in high-risk populations. Functional capacity deficits prior to the onset of psychosis may reflect a basic mechanism that underlies risk for psychosis. Early intervention targeting this domain may help to offset risk and independently improve long-term outcome.
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Affiliation(s)
- Danielle McLaughlin
- Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health System, Glen Oaks, NY;
| | | | - Andrea M. Auther
- Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health System, Glen Oaks, NY;,Department of Psychiatry, Hofstra Northwell School of Medicine, Hempstead, NY
| | - Doreen M. Olvet
- Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health System, Glen Oaks, NY
| | - Jean Addington
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Carrie E. Bearden
- Semel Institute for Neuroscience and Human Behavior and Department of Psychology, University of California, Los Angeles, Los Angeles, CA
| | | | - Tyrone D. Cannon
- Department of Psychology, Yale University, School of Medicine, New Haven, CT;,Department of Psychiatry, Yale University, School of Medicine, New Haven, CT
| | - Robert K. Heinssen
- Division of Treatment and Prevention Research, National Institute of Mental Health, Rockville, MD
| | | | - Thomas H. McGlashan
- Department of Psychiatry, Yale University, School of Medicine, New Haven, CT
| | - Diana O. Perkins
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Larry J. Seidman
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts General Hospital, Boston, MA
| | - Ming T. Tsuang
- Department of Psychiatry, University of California, San Diego, La Jolla, CA;,Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts General Hospital, Boston, MA
| | | | - Scott W. Woods
- Department of Psychiatry, Yale University, School of Medicine, New Haven, CT
| | | | - Philip D. Harvey
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL;,Research Service, Bruce W. Carter VA Medical Center, Miami, FL
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Wilson C, Kline E, Thompson E, Demro C, Pitts S, Bussell K, Reeves GM, Schiffman J. Comparison of measures of functioning for use with treatment-seeking adolescents experiencing attenuated symptoms of psychosis. Early Interv Psychiatry 2016; 10:81-7. [PMID: 25263507 DOI: 10.1111/eip.12189] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 08/19/2014] [Indexed: 11/29/2022]
Abstract
AIM A growing body of research documents a relation between psychosis risk and functional impairment. Although a general picture of psychosis risk and impaired functioning is emerging, less is known about how different functional measures relate to specific psychosis-risk symptoms. METHODS The current study examines the relative contribution of psychosis-risk symptoms across multiple measures of functioning in a sample of treatment-seeking adolescents and young adults. RESULTS Results indicate that different domains of psychosis-risk symptoms (negative and positive psychotic symptoms, related affective symptoms) contribute differentially to measures of different types of functioning. CONCLUSION Study of the relation between psychosis-risk symptoms and different measures of functional impairment can potentially contribute towards a more efficient use of measures of functioning and help inform individualized treatment considerations.
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Affiliation(s)
- Camille Wilson
- Department of Psychology, University of Maryland, Baltimore County, Baltimore, Maryland, USA
| | - Emily Kline
- Department of Psychology, University of Maryland, Baltimore County, Baltimore, Maryland, USA
| | - Elizabeth Thompson
- Department of Psychology, University of Maryland, Baltimore County, Baltimore, Maryland, USA
| | - Caroline Demro
- Department of Psychology, University of Maryland, Baltimore County, Baltimore, Maryland, USA
| | - Steven Pitts
- Department of Psychology, University of Maryland, Baltimore County, Baltimore, Maryland, USA
| | - Kristin Bussell
- Child and Adolescent Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Gloria M Reeves
- Child and Adolescent Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Jason Schiffman
- Department of Psychology, University of Maryland, Baltimore County, Baltimore, Maryland, USA
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11
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Minor KS, Friedman-Yakoobian M, Leung YJ, Meyer EC, Zimmet SV, Caplan B, Monteleone T, Bryant C, Guyer M, Keshavan MS, Seidman LJ. The impact of premorbid adjustment, neurocognition, and depression on social and role functioning in patients in an early psychosis treatment program. Aust N Z J Psychiatry 2015; 49:444-52. [PMID: 25586755 DOI: 10.1177/0004867414565473] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Functional impairments are debilitating concomitants of psychotic disorders and are present early in the illness course and, commonly, prior to psychosis onset. The factors affecting social and role functioning in early psychosis (EP) following treatment are unclear. We evaluated whether six months of participation in the PREP(R), Boston, EP treatment program, part of a public-academic community mental health center, was related to improvements in social and role functioning and whether premorbid adjustment in adolescence, baseline neurocognition, and depression symptoms predicted functional improvement. METHOD The Global Functioning Social and Role scales, MATRICS neurocognitive battery, and Calgary Depression Scale were assessed at baseline and six months during naturalistic treatment, while premorbid adjustment was measured at baseline. All participants were psychotic disorder patients in PREP(R) (n = 46 with social functioning and 47 with role functioning measures at both time points). RESULTS Large improvements were observed in role functioning (d = 0.84) and medium to large improvements were observed in social functioning (d = 0.70). Models consisting of adolescent premorbid adjustment and change in depression symptoms predicted social and role functioning change, whereas neuropsychological functioning did not. CONCLUSIONS Substantial improvements in social and role functioning were observed among this sample participating in a recovery-based EP program. The impact of clinical factors on social and role functioning was highlighted. Further studies of premorbid adjustment in adolescence and the treatment of depression in EP programs in controlled treatment trials are needed to confirm these findings.
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Affiliation(s)
- Kyle S Minor
- Department of Psychology, Indiana University - Purdue University Indianapolis, Indianapolis, IN, USA
| | - Michelle Friedman-Yakoobian
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA Massachusetts Mental Health Center Division of Public Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Y Jude Leung
- Massachusetts Mental Health Center Division of Public Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Eric C Meyer
- U.S. Department of Veteran Affairs VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, TX, USA Central Texas Veterans Healthcare System, Temple, TX, USA
| | - Suzanna V Zimmet
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA Massachusetts Mental Health Center Division of Public Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Thomas Monteleone
- Massachusetts Mental Health Center Division of Public Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA Department of Mental Health, Massachusetts Mental Health Center, Boston, MA, USA
| | - Caitlin Bryant
- Massachusetts Mental Health Center Division of Public Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Margaret Guyer
- Massachusetts Mental Health Center Division of Public Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA Department of Mental Health, Massachusetts Mental Health Center, Boston, MA, USA
| | - Matcheri S Keshavan
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA Massachusetts Mental Health Center Division of Public Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Larry J Seidman
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA Massachusetts Mental Health Center Division of Public Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA
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12
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O'Dea B, Glozier N, Purcell R, McGorry PD, Scott J, Feilds KL, Hermens DF, Buchanan J, Scott EM, Yung AR, Killacky E, Guastella AJ, Hickie IB. A cross-sectional exploration of the clinical characteristics of disengaged (NEET) young people in primary mental healthcare. BMJ Open 2014; 4:e006378. [PMID: 25537785 PMCID: PMC4275674 DOI: 10.1136/bmjopen-2014-006378] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Youth with mental health problems often have difficulties engaging in education and employment. In Australia, youth mental health services have been widely established with a key aim of improving role functioning; however, there is little knowledge of those who are not engaged in employment, education or training (NEET) and the factors which may influence this. This study aimed to examine NEET status and its correlates in a sample of such youth. DESIGN Cross-sectional data from a longitudinal cohort study. SETTING Between January 2011 and August 2012, young people presenting to one of the four primary mental health centres in Sydney or Melbourne were invited to participate. PARTICIPANTS Young adults (N=696) aged between 15 and 25 years (M=19.0, SD=2.8), 68% female, 58% (n=404) attended headspace in Sydney. MEASURES Individuals 'Not in any type of Education, Employment or Training' in the past month were categorised as NEET. Demographic, psychological and clinical factors alongside disability and functioning were assessed using clinical interview and self-report. RESULTS A total of 19% (n=130/696) were NEET. NEETs were more likely to be male, older, have a history of criminal charges, risky cannabis use, higher level of depression, poorer social functioning, greater disability and economic hardship, and a more advanced stage of mental illness than those engaged in education, training or work. Demographics such as postsecondary education, immigrant background and indigenous background, were not significantly associated with NEET status in this sample. CONCLUSIONS One in five young people seeking help for mental health problems were not in any form of education, employment and training. The commonly observed risk factors did not appear to influence this association, instead, behavioural factors such as criminal offending and cannabis use appeared to require targeted intervention.
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Affiliation(s)
- Bridianne O'Dea
- Brain and Mind Research Institute, The University of Sydney, Sydney, New South Wales, Australia
| | - Nicholas Glozier
- Brain and Mind Research Institute, The University of Sydney, Sydney, New South Wales, Australia
| | - Rosemary Purcell
- Centre for Forensic Behavioural Science, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Patrick D McGorry
- Orygen Research Centre, Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia
| | - Jan Scott
- Institute of Neuroscience, Newcastle University, Newcastle, UK
| | - Kristy-Lee Feilds
- Brain and Mind Research Institute, The University of Sydney, Sydney, New South Wales, Australia
| | - Daniel F Hermens
- Brain and Mind Research Institute, The University of Sydney, Sydney, New South Wales, Australia
| | - John Buchanan
- Brain and Mind Research Institute, The University of Sydney, Sydney, New South Wales, Australia
| | - Elizabeth M Scott
- The University of Sydney Business School, Sydney, New South Wales, Australia
| | - Alison R Yung
- Institute of Brain, Behaviour and Mental Health, University of Manchester, UK
| | - Eoin Killacky
- Orygen Research Centre, Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia
| | - Adam J Guastella
- Brain and Mind Research Institute, The University of Sydney, Sydney, New South Wales, Australia
| | - Ian B Hickie
- Brain and Mind Research Institute, The University of Sydney, Sydney, New South Wales, Australia
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13
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Abstract
As researchers continue to understand non-clinical psychosis (NCP-brief psychotic-like experiences occurring in 5-7% of the general population; van Os et al., 2009), it is becoming evident that functioning deficits and facial emotion recognition (FER) impairment characterize this phenomenon. However, the extent to which these domains are related remains unclear. Social/role functioning and FER were assessed in 65 adolescents/young adults exhibiting low and high-NCP. Results indicate that FER and social/role functioning deficits were present in the High-NCP group, and that the domains were associated in this group alone. Taken together, findings suggest that a core emotive deficit is tied to broader social/role dysfunction in NCP.
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Affiliation(s)
- Andrea L. Pelletier
- Department of Psychology and Neuroscience, University of Colorado Boulder,Center for Neuroscience, University of Colorado Boulder
| | - Derek J. Dean
- Department of Psychology and Neuroscience, University of Colorado Boulder
| | | | - Ashley K. Smith
- Department of Psychology and Neuroscience, University of Colorado Boulder,Institute for Behavioral Genetics, University of Colorado Boulder
| | - Joseph M. Orr
- Department of Psychology and Neuroscience, University of Colorado Boulder,Institute of Cognitive Science, University of Colorado Boulder
| | - Tina Gupta
- Department of Psychology and Neuroscience, University of Colorado Boulder
| | - Zachary B. Millman
- Department of Psychology and Neuroscience, University of Colorado Boulder
| | - Vijay A. Mittal
- Department of Psychology and Neuroscience, University of Colorado Boulder,Center for Neuroscience, University of Colorado Boulder
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14
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Mittal VA, Jalbrzikowski M, Daley M, Roman C, Bearden CE, Cannon TD. Abnormal movements are associated with poor psychosocial functioning in adolescents at high risk for psychosis. Schizophr Res 2011; 130:164-9. [PMID: 21636252 PMCID: PMC3139832 DOI: 10.1016/j.schres.2011.05.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Revised: 05/11/2011] [Accepted: 05/11/2011] [Indexed: 10/18/2022]
Abstract
The period immediately preceding the onset of overt psychosis is characterized by a range of symptoms and behaviors including emerging attenuated psychosis, spontaneous movement abnormalities, and a broad decline in role and social functioning. Recent evidence suggests that basal ganglia dysfunction, which is implicated in the development of psychotic symptomatology, may manifest in the form of both movement abnormalities and deficits in processes integral to psychosocial functioning. However, little is known about the relationship between abnormal movement function and the observed psychosocial deficits. In the present study, 40 clinical high-risk participants meeting criteria for a prodromal syndrome were assessed for movement abnormalities and global role and social functioning at baseline. Role and social functioning were then followed up after a one-year period. At baseline, the severity of spontaneous movement abnormalities was associated with poor role functioning. Further, when controlling for baseline functioning, movement abnormalities predicted changes in social functioning one-year later, with a trend in the same direction for role functioning. Exploratory analyses also indicated that elevated baseline movement abnormalities distinguished those at-risk participants who eventually converted to psychosis and that this was also the case for poorer baseline global role functioning (at the trend level). Taken together, the results suggest that movement abnormalities are closely associated with deficits in psychosocial functioning. Elucidating the link between these phenomena may serve to refine etiological models of frontal-subcortical circuit dysfunction and inform understanding of functioning and outcome of these affected youth.
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Affiliation(s)
- Vijay A. Mittal
- Department of Psychology and Neuroscience, University of Colorado at Boulder
,Center for Neuroscience, University of Colorado at Boulder
| | | | - Melita Daley
- , Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles
| | - Cristina Roman
- Department of Psychology, University of California Los Angeles
| | - Carrie E. Bearden
- Department of Psychology, University of California Los Angeles
,, Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles
| | - Tyrone D. Cannon
- Department of Psychology, University of California Los Angeles
,, Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles
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15
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Buist-Bouwman MA, Ormel J, de Graaf R, de Jonge P, van Sonderen E, Alonso J, Bruffaerts R, Vollebergh WAM. Mediators of the association between depression and role functioning. Acta Psychiatr Scand 2008; 118:451-8. [PMID: 18853945 PMCID: PMC3659780 DOI: 10.1111/j.1600-0447.2008.01285.x] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE While the adverse effect of Major Depressive Episode on role functioning is well established, the exact pathways remain unclear. METHOD Data from The European Study of the Epidemiology of Mental Disorders, a cross-sectional survey including 21 425 adults from six European countries, were used to assess 12-month depression (Composite International Diagnostic Interview), activity limitations and role functioning in the past 30 days (Disability Assessment Schedule). An a priori model based on the World Health Organization's International Classification of Functioning, Disability and Health was designed and a structural equation model for categorical and ordinal data was used (MPlus) to estimate the extent to which six limitations mediated the association between depression and role functioning. RESULTS The unadjusted association between depression and role functioning was strong (0.43; SE = 0.04). In the best-fitting model, only concentration and attention problems and embarrassment mediated a significant amount of association (direct effect dropped to 0.17; SE = 0.10, which was no longer significant). CONCLUSIONS Targeting cognition and embarrassment in treatment could help reduce depression-associated role disfunctioning.
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Affiliation(s)
- M. A. Buist-Bouwman
- University Medical Center Groningen, University of Groningen,Graduate Research School of Behavior, Cognition and Neurosciences (BCN), University of Utrecht, the Netherlands,Netherlands Institute of Mental Health and Addiction, University of Utrecht, the Netherlands
| | - J. Ormel
- University Medical Center Groningen, University of Groningen,Graduate Research School of Behavior, Cognition and Neurosciences (BCN), University of Utrecht, the Netherlands
| | - R. de Graaf
- Netherlands Institute of Mental Health and Addiction, University of Utrecht, the Netherlands
| | - P. de Jonge
- University Medical Center Groningen, University of Groningen,Graduate Research School of Behavior, Cognition and Neurosciences (BCN), University of Utrecht, the Netherlands
| | - E. van Sonderen
- University Medical Center Groningen, University of Groningen,Northern Centre for Healthcare Research (NCH), University of Utrecht, the Netherlands
| | - J. Alonso
- Institut Municipal d’investigació Mèdica (IMIM), Spain
| | | | - W. A. M. Vollebergh
- Netherlands Institute of Mental Health and Addiction, University of Utrecht, the Netherlands,Faculty of Social and Behavioral Sciences, University of Utrecht, the Netherlands
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16
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Addington J, Penn D, Woods SW, Addington D, Perkins DO. Social functioning in individuals at clinical high risk for psychosis. Schizophr Res 2008; 99:119-24. [PMID: 18023329 PMCID: PMC2292799 DOI: 10.1016/j.schres.2007.10.001] [Citation(s) in RCA: 186] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2007] [Revised: 09/27/2007] [Accepted: 10/01/2007] [Indexed: 11/24/2022]
Abstract
Poor social functioning is a hallmark of schizophrenia. The purpose of this study was to examine social functioning in individuals at clinical high risk for psychosis. Social functioning was assessed in a sample of 86 clinical high risk (CHR) individuals and compared to that of 50 first-episode of psychosis (FE) subjects, 53 multi-episode schizophrenia subjects (ME) and 55 non-psychiatric controls (NPC). Subjects were assessed on the Social Functioning Scale (SFS), the Role Functioning subscale of the Quality of Life Scale (QLS-role), and the premorbid functioning scale. On the SFS, the CHR group did not differ significantly from the FE and ME groups and all were impaired relative to the NPCs. On QLS-role, the CHR group performed significantly better than the ME patients and significantly worse than NPCs. CHR subjects did not differ from patients in terms of premorbid functioning. This study demonstrates that even at the pre-psychotic phase of the illness, these young people are demonstrating significant deficits in social functioning, supporting that social deficits are present long before the onset of psychotic symptoms.
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Affiliation(s)
- Jean Addington
- Department of Psychiatry, University of Toronto, Toronto, Canada.
| | - David Penn
- Department of Psychology, University of North Carolina at Chapel Hill, Chapel Hill NC
| | | | | | - Diana O. Perkins
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill NC
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17
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Abstract
OBJECTIVE This study aimed to determine the profile of dementia in a sub-Saharan Africa country and assess its effects on role functioning and quality of life. METHODS Using a multistage, stratified, clustered sampling of households in the Yoruba-speaking areas of Nigeria, representing 22% of the national population, 2152 persons aged 65 years and above were studied. Probable dementia was evaluated using a validated cognitive test - the 10-Word Delay Recall Test. Activities of daily living (ADL), instrumental ADL, and quality of life were also assessed. RESULTS The prevalence of probable dementia in this sample was 10.1% (95% confidence interval, 8.6-11.8). Female sex and increasing age were risk factors. Also, lifetime history of alcohol use doubles the risk. Affected persons had relatively preserved functioning and quality of life. CONCLUSION The findings suggest that the diagnosis of dementia may be downwardly biased in this culture due to relatively preserved levels of social and functional roles.
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Affiliation(s)
- Oye Gureje
- Department of Psychiatry, University of Ibadan, Ibadan, Nigeria.
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