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PloS One 2016Studies have linked cognitive functioning to everyday social functioning in psychotic disorders, but the nature of the relationships between cognition, social cognition,... (Comparative Study)
Comparative Study
OBJECTIVE
Studies have linked cognitive functioning to everyday social functioning in psychotic disorders, but the nature of the relationships between cognition, social cognition, symptoms, and social functioning remains unestablished. Modelling the contributions of non-social and social cognitive ability in the prediction of social functioning may help in more clearly defining therapeutic targets to improve functioning.
METHOD
In a sample of 745 patients with a non-affective psychotic disorder, the associations between cognition and social cognition at baseline on the one hand, and self-reported social functioning three years later on the other, were analysed. First, case-control comparisons were conducted; associations were subsequently further explored in patients, investigating the potential mediating role of symptoms. Analyses were repeated in a subsample of 233 patients with recent-onset psychosis.
RESULTS
Information processing speed and immediate verbal memory were stronger associated with social functioning in patients than in healthy controls. Most cognition variables significantly predicted social functioning at follow-up, whereas social cognition was not associated with social functioning. Symptoms were robustly associated with follow-up social functioning, with negative symptoms fully mediating most associations between cognition and follow-up social functioning. Illness duration did not moderate the strength of the association between cognitive functioning and follow-up social functioning. No associations were found between (social) cognition and follow-up social functioning in patients with recent-onset psychosis.
CONCLUSIONS
Although cognitive functioning is associated with later social functioning in psychotic disorder, its role in explaining social functioning outcome above negative symptoms appears only modest. In recent-onset psychosis, cognition may have a negligible role in predicting later social functioning. Moreover, social cognition tasks may not predict self-reported social functioning.
Topics: Adolescent; Adult; Case-Control Studies; Cognition Disorders; Cross-Sectional Studies; Female; Follow-Up Studies; Humans; Male; Middle Aged; Neuropsychological Tests; Prognosis; Psychiatric Status Rating Scales; Psychotic Disorders; Social Adjustment; Young Adult
PubMed: 27082629
DOI: 10.1371/journal.pone.0151299 -
Canadian Journal of Psychiatry. Revue... Sep 2017The objective of this article is to identify best practices in the diagnosis and assessment of patients with schizophrenia spectrum and other psychotic disorders. The... (Review)
Review
OBJECTIVE
The objective of this article is to identify best practices in the diagnosis and assessment of patients with schizophrenia spectrum and other psychotic disorders. The diagnosis and assessment may occur in a range of situations from the emergency room to the outpatient clinic and at different stages of the disorder. The focus may be on acute exacerbations of illness, residual symptoms, levels of function, or changes in the response to treatment.
METHODS
A systematic search was conducted for guidelines published in the last 5 years for schizophrenia and schizophrenia spectrum disorders. The guidelines were rated by at least 2 raters, and recommendations adopted on the diagnosis and assessment were primarily drawn from the American Psychiatric Association practice guidelines for the psychiatric evaluation of adults and the National Institute for Health and Care Excellence guideline on psychosis and schizophrenia in adults. A number of de novo recommendations were also developed.
RESULTS
Eleven recommendations were identified that cover a range of assessment situations from diagnosis to the involvement of families in assessments.
CONCLUSIONS
An accurate assessment establishes the baseline for treatment planning based on clinical decision making for both pharmacotherapy and psychosocial treatments.
Topics: Canada; Humans; Neuropsychological Tests; Practice Guidelines as Topic; Psychiatric Status Rating Scales; Psychotic Disorders; Schizophrenia
PubMed: 28730847
DOI: 10.1177/0706743717719899 -
Early Intervention in Psychiatry Jul 2022Disrupted affective processes are core features of psychosis; yet emotion reactivity and emotion regulation impairments have not been fully characterized in individuals...
AIMS
Disrupted affective processes are core features of psychosis; yet emotion reactivity and emotion regulation impairments have not been fully characterized in individuals at clinical high-risk for developing psychosis (CHR) or adolescents diagnosed with a psychotic disorder (AOP). Characterizing these impairments may provide a fuller understanding of factors contributing to psychosis risk and psychosis onset. Using cross-sectional and longitudinal data, we evaluated (1) group-level effects of emotion reactivity and regulation, (2) stability of group-level effects over time and age, (3) relationships between emotion reactivity and regulation, and (4) associations between these measures and psychosocial functioning and clinical symptomatology.
METHODS
Eighty-seven participants (CHR = 32, TD = 42, AOP = 13; 12-25 years, 1-5 visits) completed the Emotion Reactivity Scale, Difficulties in Emotion Regulation Scale, and Emotion Regulation Questionnaire. We assessed psychotic symptoms with the Structured Interview for Prodromal Syndromes and measured real-world functioning with the Global Functioning: Social and Role Scales. We used analysis of variance to assess Aim 1 and linear mixed models to address Aims 2-4.
RESULTS
CHR and AOP endorsed experiencing heightened levels of emotion reactivity and greater difficulty utilizing emotion regulation strategies compared to TD. These impairments were stable across time and adolescent development. Greater levels of emotion reactivity were associated with greater emotion regulation impairments. Greater impairments in emotion regulation were associated with lower social functioning and greater negative symptom severity.
CONCLUSION
Therapeutic interventions designed to reduce emotion reactivity and improve one's ability to utilize emotion regulation strategies may be effective in reducing clinical symptomatology and improving real-world functioning in CHR and AOP.
Topics: Adolescent; Cross-Sectional Studies; Emotional Regulation; Emotions; Humans; Prodromal Symptoms; Psychotic Disorders
PubMed: 34528404
DOI: 10.1111/eip.13212 -
Social Psychiatry and Psychiatric... Oct 2015Urban upbringing and childhood trauma are both associated with psychotic disorders. However, the association between childhood urbanicity and childhood trauma in...
BACKGROUND
Urban upbringing and childhood trauma are both associated with psychotic disorders. However, the association between childhood urbanicity and childhood trauma in psychosis is poorly understood. The urban environment could occasion a background of social adversity against which any effect of childhood trauma increases. Also, any impact of the urban environment on likelihood of exposure to childhood trauma could be stronger in children who later develop psychotic disorder. The aim of this study was twofold: (1) to investigate whether childhood urbanicity moderates the effect of childhood trauma, in a model predicting psychotic disorder; (2) to investigate whether there is an association between the urban environment and childhood trauma and whether this is moderated by genetic liability for psychotic disorder.
METHODS
Patients with a diagnosis of non-affective psychotic disorder (n = 1119) and 589 healthy controls from the Netherlands and Belgium were studied. Childhood trauma was assessed with the Dutch version of the Childhood Trauma Questionnaire Short Form. Urban exposure was defined at four levels, considering the population density, using data from Statistics Netherlands and the equivalent database in Belgium.
RESULTS
There was a significant interaction between childhood urbanicity on the one hand and childhood trauma on the other, indicating that trauma was significantly associated with psychotic disorder, with increasing odds ratios for higher levels of childhood urbanicity. In addition, there was weak evidence that childhood urbanicity was associated with childhood trauma in the patient group: higher levels of childhood urbanicity were associated with higher trauma scores.
CONCLUSION
The urban environment may moderate the risk-increasing effect of childhood trauma for psychotic disorder and childhood urbanicity may be a risk factor for childhood trauma in individuals who later develop psychotic disorder.
Topics: Adult; Adult Survivors of Child Adverse Events; Belgium; Case-Control Studies; Databases, Factual; Female; Humans; Male; Netherlands; Population Density; Psychotic Disorders; Risk Factors; Surveys and Questionnaires; Urban Population
PubMed: 25895686
DOI: 10.1007/s00127-015-1049-7 -
Comprehensive Psychiatry May 2022Psychotic disorder not otherwise specified (PNOS) is considered part of the psychosis spectrum, together with schizophrenia spectrum disorders (SSD) and psychotic...
INTRODUCTION
Psychotic disorder not otherwise specified (PNOS) is considered part of the psychosis spectrum, together with schizophrenia spectrum disorders (SSD) and psychotic bipolar spectrum disorders (PBD). The atypical clinical presentations of PNOS conditions may lead to uncertainty regarding treatment choices and expected outcomes. PNOS is understudied, and little is known about patients' premorbid characteristics including premorbid adjustment, prevalence of early cannabis use and childhood trauma. Knowledge about early illness phases can increase our understanding of this diagnostic group.
METHODS
We included 1099 participants from the Norwegian TOP-study; 688 with narrow SSD diagnoses (schizophrenia, schizoaffective disorder, schizophreniform disorder), 274 with PBD (psychotic bipolar 1 and bipolar NOS) and 137 with PNOS diagnosed with the SCID-I for DSM-IV. Participants were assessed with the Premorbid Adjustment Scale (PAS) divided into the areas of premorbid academic and social functioning. We obtained information on age at first exposure to cannabis and use of cannabis before the age of 16. The participants also provided information regarding early traumatic experiences using the Childhood Trauma Questionnaire (CTQ).
RESULTS
Participants with PNOS and SSD had poorer premorbid academic functioning than those with PBD (F = 7.81, p < 0.001, η = 0.015). Premorbid social adjustment was significantly worse in the SSD group compared to the PBD group (F = 3.10, p = 0.045, η = 0.006), with PNOS in the middle position. Significantly more of the participants with PNOS (17.5%) and SSD (11.5%) used cannabis before the age of 16 compared with PBD (5.3%, Wald χ = 6.86, p = 0.03). There were no significant differences between the three groups regarding mean CTQ scores or in the proportion of participants who had experienced at least one type of childhood adversity.
CONCLUSIONS
Participants with PNOS appear as more similar to participants with SSD than to those with PBD regarding early premorbid adjustment and early cannabis use. The results indicate that many conditions classified as PNOS have functional impairments and problematic substance use from an early age. The prevalence of childhood adversities are high in all three groups.
Topics: Bipolar Disorder; Cannabis; Diagnostic and Statistical Manual of Mental Disorders; Humans; Psychotic Disorders; Schizophrenia; Social Adjustment
PubMed: 35385814
DOI: 10.1016/j.comppsych.2022.152310 -
Journal of Psychiatric Research Jun 2024Increased risk for somatic comorbidity in individuals with schizophrenia has been well established. In addition, psychiatric patients with somatic illnesses are more...
BACKGROUND
Increased risk for somatic comorbidity in individuals with schizophrenia has been well established. In addition, psychiatric patients with somatic illnesses are more likely to have more psychiatric readmissions. Increased burden of treatment related to chronic somatic comorbidities may be associated with lower adherence to psychiatric medication.
METHODS
Cross-sectional study of 275 patients with schizophrenia spectrum disorder. A general practitioner performed a complete physical health checkup for all participants, including a complete medical examination and laboratory tests. Patients' adherence, attitudes, insight, and side-effects were evaluated using the Attitudes toward Neuroleptic Treatment Scale. Overall symptomatology was measured using the Brief Psychiatric Rating Scale. Regression analysis was used to investigate interactions and associations among health beliefs, disease burden, and treatment adherence. Separate regression models were utilized to account for the complexity of health behavior and treatment adherence pathways.
RESULTS
Patients' somatic comorbidity and health behavior were not associated with adherence or attitudes toward antipsychotic treatment. High dose of antipsychotics and obesity were related to the need for medical interventions, while a healthy diet reduced the risk. Higher BPRS score and older age were associated with having somatic symptoms. Somatic comorbidities had no negative effects on treatment adherence or attitudes.
CONCLUSION
This study focuses on exploring possible associations between health beliefs and treatment adherence pathways in patients with psychotic disorders. Contrary to our hypotheses, we found no evidence to support our health belief and diseases burden models and their associations.
Topics: Humans; Male; Female; Psychotic Disorders; Adult; Middle Aged; Cross-Sectional Studies; Antipsychotic Agents; Comorbidity; Psychiatric Status Rating Scales; Medication Adherence; Schizophrenia; Treatment Adherence and Compliance
PubMed: 38598974
DOI: 10.1016/j.jpsychires.2024.03.039 -
Schizophrenia Research Jun 2021We used proton magnetic resonance spectroscopy (H MRS) to quantify N-acetylaspartate (NAA) concentrations and apparent spin-spin (T2) relaxation times, which also...
We used proton magnetic resonance spectroscopy (H MRS) to quantify N-acetylaspartate (NAA) concentrations and apparent spin-spin (T2) relaxation times, which also include diffusion attenuations, in first episode and chronic psychosis patients compared to matched healthy controls. 104 patients diagnosed with psychotic disorders and 50 matched controls were scanned at 4 Tesla. H MRS data were collected at four echo times (TE = 30, 90, 150 and 200 ms) using PRESS. NAA concentrations referenced to water and apparent T2 relaxation times of NAA and water were calculated. At TE = 30 ms, NAA concentration without T2 correction was significantly lower in chronic psychosis patients compared to age-matched healthy controls (p = 0.013, N = 61 and 26, respectively) but normal in first episode patients compared to matched controls (N = 43 and 24, respectively). After T2 correction, no significant differences remained between the groups. While diffusion attenuation was not independently accounted for, these findings indicate that T2 relaxation makes a major impact on NAA concentration measures in psychotic disorders. Thus, it may be neuronal microenvironment indexed by NAA and water T2 relaxation times and not neuronal integrity indexed by NAA concentration that underlies the widely reported NAA concentration reductions in psychotic disorders.
Topics: Aspartic Acid; Choline; Creatine; Humans; Magnetic Resonance Spectroscopy; Neurons; Psychotic Disorders
PubMed: 34015554
DOI: 10.1016/j.schres.2021.04.012 -
Psychological Medicine Jul 2023Social capital is thought to represent an environmental factor associated with the risk of psychotic disorder (PD). This study aims to investigate the association...
A 6-year follow-up study in a community-based population: Is neighbourhood-level social capital associated with the risk of emergence and persistence of psychotic experiences and transition to psychotic disorder?
BACKGROUND
Social capital is thought to represent an environmental factor associated with the risk of psychotic disorder (PD). This study aims to investigate the association between neighbourhood-level social capital and clinical transitions within the spectrum of psychosis.
METHODS
In total, 2175 participants, representative of a community-based population, were assessed twice (6 years apart) to determine their position within an extended psychosis spectrum: no symptoms, subclinical psychotic experiences (PE), clinical PE, PD. A variable representing change between baseline (T1) and follow-up (T2) assessment was constructed. Four dimensions of social capital (informal social control, social disorganisation, social cohesion and trust, cognitive social capital) were assessed at baseline in an independent sample, and the measures were aggregated to the neighbourhood level. Associations between the variable representing psychosis spectrum change from T1 to T2 and the social capital variables were investigated.
RESULTS
Lower levels of neighbourhood-level social disorganisation, meaning higher levels of social capital, reduced the risk of clinical PE onset (OR 0.300; = -2.75; = 0.006), persistence of clinical PE (OR 0.314; = -2.36; = 0.018) and also the transition to PD (OR 0.136; = -2.12; = 0.034). The other social capital variables were not associated with changes from T1 to T2.
CONCLUSIONS
Neighbourhood-level social disorganisation may be associated with the risk of psychosis expression. Whilst replication of this finding is required, it may point to level of social disorganisation as a public health target moderating population psychosis risk.
Topics: Humans; Follow-Up Studies; Social Capital; Psychotic Disorders; Risk Factors; Residence Characteristics
PubMed: 35301975
DOI: 10.1017/S0033291722000642 -
BMC Research Notes Apr 2017This study aimed to explore the neuro-cognitive deficits of alcohol-induced psychotic disorder as compared to the cognitive deficits of uncomplicated alcohol dependence.
AIMS
This study aimed to explore the neuro-cognitive deficits of alcohol-induced psychotic disorder as compared to the cognitive deficits of uncomplicated alcohol dependence.
METHODS
Participants were recruited from the acute psychiatric admission wards of the Department of Psychiatry, University of Stellenbosch and Stikland and Tygerberg Academic Hospitals in the Western-Cape, South Africa. Participants who met DSM IV TR criteria (American Psychiatric Association. Diagnostic and statistical manual of mental disorders. American Psychiatric Association, Washington, DC, 2000) for Alcohol Dependence and for alcohol-induced psychotic disorder, respectively, were included. Participants who met criteria for another current DSM IV TR Axis I disorder were excluded. A structured interview was done prior to neuropsychological assessment to ascertain current mental state and to obtain relevant demographic detail and history. Neuropsychological assessments were performed and supervised by clinical psychologists at either Tygerberg or Stikland Hospital.
RESULTS
The groups were matched demographically with similar period of abstinence prior to assessment. The alcohol-induced psychotic disorder group experienced first psychotic symptoms at age 35. The results reflected statistically significant differences on tasks measuring immediate memory; recall upon delay; exaggeration of memory difficulty and abstract thinking.
CONCLUSION
This study concurs with earlier literature that some cognitive deficits are greater in alcohol-induced psychotic disorder compared to uncomplicated alcohol dependence.
Topics: Adult; Alcoholism; Cognition; Cognitive Dysfunction; Cross-Sectional Studies; Female; Humans; Male; Memory, Short-Term; Mental Recall; Neuropsychological Tests; Psychiatric Status Rating Scales; Psychometrics; Psychotic Disorders; South Africa
PubMed: 28446210
DOI: 10.1186/s13104-017-2485-0 -
PloS One 2020Even though all guidelines recommend generally against antipsychotic polypharmacy, antipsychotic polypharmacy appears to be a very common practice across the globe. This...
OBJECTIVE
Even though all guidelines recommend generally against antipsychotic polypharmacy, antipsychotic polypharmacy appears to be a very common practice across the globe. This study aimed to examine the prescription patterns of antipsychotics in Qatar, in comparison with the international guidelines, and to scrutinize the sociodemographic and clinical features associated with antipsychotic polypharmacy.
METHODS
All the medical records of all the inpatients and outpatients treated by antipsychotics at the Department of Psychiatry-Hamad Medical Corporation (HMC) in Doha, Qatar (between October 2012 and April 2014) were retrospectively analyzed. We retrieved the available sociodemographic data, psychiatric features, and details on the medication history.
RESULTS
Our sample consisted of 537 individuals on antipsychotics (2/3 were male; mean age 33.8±10.2 years), prescribed for a psychotic disorder in 57%, a mood disorder in 9.3%, and various other diagnoses in 33.7%. About 55.9% received one antipsychotic, 29.6% received two antipsychotics, and 14.5% received more than two antipsychotics. Polypharmacy was associated with younger age (p = 0.025), being single (p<0.001), the diagnosis of a psychotic disorder (p<0.001), and previous admissions to psychiatry (p<0.001).
CONCLUSIONS
Antipsychotic polypharmacy appears to be quite common in Qatar, as it is the case in many other countries, in contrast with most international recommendations. Studies are needed to explore the reasons behind this disparity.
Topics: Adult; Antipsychotic Agents; Drug Prescriptions; Female; Humans; Male; Polypharmacy; Psychotic Disorders; Qatar; Retrospective Studies; Young Adult
PubMed: 33166337
DOI: 10.1371/journal.pone.0241986