Burden of caregivers of people suffering from schizophrenia versus symptom severity, social functioning and treatment satisfaction of patients treated by a CMHT. / Obciazenie opiekunów osób chorujacych na schizofrenie a nasilenie objawów, funkcjonowanie spoleczne i satysfakcja z leczenia pacjentów leczonych w ZLS.

OBJECTIVES: This study aims to assess the caregivers' burden in schizophrenia amongst patients treated by Community Mental Health Teams (CMHTs) and its relation to patients' demographic, clinical and social characteristics, with emphasis on their satisfaction with care, and to evaluate the correlation of selected characteristics of caregivers with the level of their burden. METHODS: A total of 65 patient-caregiver dyads remaining in home treatment were included. Caregivers were assessed with demographic questionnaires, and the Caregiver Burden Inventory (CBI). The patients were assessed with the Positive and Negative Syndrome Scale (PANSS), the Verona Service Satisfaction Scale (VSSS-54), the Disability Assessment Schedule (WHODAS 2.0), the Social Network Index (SNI) and with the UCLA Loneliness Scale. Data were analysed using multiple linear regression. RESULTS: Increased caregiver burden was associated with: greater symptom severity in patients, lower satisfaction with staff professionalism, and a high level of emotional expressiveness in relationships. The regression model explaining 57% of the variance in the caregivers' emotional burden consisted of four factors: the patient's positive syndrome intensity, patient's remaining in an emotional relationship, gender i.e. higher burden amongst female caregivers of male patients, and smaller social network. CONCLUSIONS: The caregivers' burden severity is related to patients' sociodemographic, clinical and social characteristics and their satisfaction with treatment. The emotional burden of caregivers is impacted by: greater symptom severity, especially the positive syndrome, lower patient satisfaction with staff professionalism, and a high expression of emotions in family relationships. The patient's and caregiver's gender and education level, the patient's degree of disability, them being in a relationship and social support network size are also significant.

The relationships of need for closure dimensions with psychotic-like experiences and jumping to conclusions. A study of a large cross-population sample. / Zwiazki miedzy wymiarami potrzeby domkniecia poznawczego a doswiadczeniami podobnymi do objawów psychotycznych oraz przeskokiem do konkluzji Badanie na duzej próbie populacyjnej.

OBJECTIVES: The theoretical affinity between need for closure (NFC) construct and psychotic symptomatology, especially delusionality, has been tested in various studies and brought diverse results. This study tested this relationship on a large sample from the general population using an online survey. METHODS: "Preference for Predictability","Discomfort with Ambiguity" and "Decisiveness" from an abridged NFC scale (NFCS) were used to check for associations with the symptoms of delusion-like ideations and hallucination-like experiences measured with an abridged version of Prodromal Questionnaire (PQ-16). Analyses included both linear and cluster models. Additionally, we examined the associations between jumping to conclusions (JTC) task, full abridged NFCS and psychotic-like symptoms (PLEs) in asmaller sample of individuals who had the highest scores in the online PLEs assessment. RESULTS: Our study confirmed that NFC is not a homogenous construct. It showed weak associations with psychotic-like symptoms and virtually no associations with JTC results. "Decisiveness" exhibited negative associations with the severity of PLEs. CONCLUSIONS: The NFCS should not be used as auniform measure and the clinical utility of high NFCS results as an indicatorof vulnerability to psychopathology seems questionable. However, being indecisive might be a general sign of struggling with some sort of mental problems.

The neural substrates of diminished humor comprehension in schizophrenia and its relationship with psychopathology.

Patients with schizophrenia commonly revealed difficulties in understanding humor. Previous research suggested links between impaired humor comprehension, psychopathology symptoms and cognitive deficits. In this study, we investigated the associations between neural substrates of humor processing and psychopathology and cognition in schizophrenia. We assessed 25 schizophrenia outpatients in an functional magnetic resonance imaging (fMRI) procedure and 40 in an electroencephalography (EEG) procedure. A punchline­based humor comprehension task was used in which outpatients rated stories by their comprehensibility and funniness. The symptom severity and cognition were correlated with activation within the humor processing network using fMRI and effective connectivity using an EEG­based directed transfer function (DTF) method. More severe positive and disorganization symptoms were associated with impaired humor comprehension and with altered temporo­parietal effective connectivity during humor processing. More severe excitement and emotional reactivity symptoms were associated with increased activation in the bilateral frontal and temporo­parietal regions. Moreover, schizophrenia outpatients with better cognitive functioning were more accurate in humor comprehension that was associated with increased fronto­temporo­parietal activation and effective connectivity. We found the intensity of humor processing (fMRI) in schizophrenia is related to the level of cognitive abilities and the severity of schizophrenia psychopathology that is also reflected in altered effective connectivity (EEG­DTF) in the humor processing network.

On the relation of white matter brain abnormalities and the asociality symptoms in schizophrenia outpatients - a DTI study.

Recent MRI studies have shown that abnormal functional connections in schizophrenia coexist with subtle changes in the structure of axons in the brain. However, there is a discrepancy in the literature concerning the relationship between white matter abnormalities and the occurrence of negative psychopathological symptoms. In the present study, we investigate the relationship between the altered white matter structure and specific psychopathology symptoms, i.e., subscales of Positive and Negative Syndrome Scale (PANSS) and Brief Negative Symptoms Scale (BNSS) in a sample of schizophrenia outpatients. For investigation on white matter abnormalities in schizophrenia, the diffusion tensor imaging analysis of between-group differences in main diffusion parameters by tract-based spatial statistics was conducted on schizophrenia outpatients and healthy controls. Hence, the correlation of PANSS and BNSS psychopathology subscales in the clinical group with fractional anisotropy was analyzed in the 17 selected cortical regions of interest. Presented between-group results revealed widespread loss of white matter integrity located across the brain in schizophrenia outpatients. Results on the white matter relationship with psychopathology revealed the negative correlation between fractional anisotropy in the left orbital prefrontal cortex, right Heschl's gyrus, bilateral precuneus and posterior cingulate cortex and the severity of asociality, as assessed with the BNSS. In conclusion, the presented study confirms the previous evidence on the widespread white matter abnormalities in schizophrenia outpatients and indicates the existence of the subtle but specific association between fractional anisotropy in the fronto-temporo-parietal regions with the asociality.Recent MRI studies have shown that abnormal functional connections in schizophrenia coexist with subtle changes in the structure of axons in the brain. However, there is a discrepancy in the literature concerning the relationship between white matter abnormalities and the occurrence of negative psychopathological symptoms. In the present study, we investigate the relationship between the altered white matter structure and specific psychopathology symptoms, i.e., subscales of Positive and Negative Syndrome Scale (PANSS) and Brief Negative Symptoms Scale (BNSS) in a sample of schizophrenia outpatients. For investigation on white matter abnormalities in schizophrenia, the diffusion tensor imaging analysis of between-group differences in main diffusion parameters by tract-based spatial statistics was conducted on schizophrenia outpatients and healthy controls. Hence, the correlation of PANSS and BNSS psychopathology subscales in the clinical group with fractional anisotropy was analyzed in the 17 selected cortical regions of interest. Presented between-group results revealed widespread loss of white matter integrity located across the brain in schizophrenia outpatients. Results on the white matter relationship with psychopathology revealed the negative correlation between fractional anisotropy in the left orbital prefrontal cortex, right Heschl's gyrus, bilateral precuneus and posterior cingulate cortex and the severity of asociality, as assessed with the BNSS. In conclusion, the presented study confirms the previous evidence on the widespread white matter abnormalities in schizophrenia outpatients and indicates the existence of the subtle but specific association between fractional anisotropy in the fronto-temporo-parietal regions with the asociality.

Premorbid social relationships and the course of schizophrenia in a 20-year follow-up study. / Relacje spoleczne przed wybuchem choroby a przebieg schizofrenii przez okres 20 lat.

OBJECTIVES: An important dimension indicating a growing risk of psychosis outbreak and its subsequent unfavorable course is deteriorating social functioning, especially the lack of sufficient social relationships. The aim of the study was to evaluate the association of the quality of social contacts and the scope of support system before the onset of the illness with treatment outcomes in clinical and social dimension in various time intervals of the 20-year illness course. METHODS: During the first hospitalization, an 80-person group living in Krakow and suffering from schizophrenia was selected, diagnosed according to DSM-IV-TR criteria and examined six times: at admission and discharge during first hospitalization, after 3, 7, 12 and 20 years. The analysis involved 55 persons (69% of the group included to the study) who went through all the examinations over a period of 20 years. Two-factor analysis of variance was used with one grouping factor (social contacts) and one repeated measures factor (follow-ups) for the results of GAF, BPRS, DSM-III Axis V and a series of simple linear regressions for the associations between these outcome indicators and the Surtees' Index of Social Support. RESULTS: Satisfactory, positive contacts before the outbreak of the illness translated, especially after 20 years, into better general and social functioning and fewer symptoms, especially negative ones. Awider social support before the outbreak was associated with better general and social functioning of patients and lesser severity of general, positiveand negative symptoms; however, in this last case the effect disappeared after 20 years. CONCLUSIONS: The quality and scope of social contacts before the outbreak of the illness, especially satisfactory relationship in non-familial milieu, are an important prognostic factor of amany-year beneficial clinical and social course of psychoses from the schizophrenia group.

Sheltered employment in schizophrenia is related to disorganization symptoms, processing speed and metaphor comprehension. / Zatrudnienie chronione w schizofrenii jest zwiazane z objawami dezorganizacji, szybkoscia przetwarzania i rozumieniem metafor.

OBJECTIVES: The significance of cognitive functioning deficits in schizophrenia is already well acknowledged. The relationships among lower and higher order cognitive skills and symptoms, as well as their relevance to holding a paid job are relatively less researched, though. The purpose of this study was to conduct an analysis concerning these issues. METHODS: This study included 62 individuals with schizophrenia, 33 of them employed in paid sheltered jobs and 29 attending occupational therapy. They were assessed with tests of cognitive functions including communication skills. Psychopathological symptoms were assessed with the PANSS. RESULTS: The assessed cognitive skills turned out to be interrelated as well as showed associations with positive, negative and disorganization symptoms. Furthermore, regression analysis showed that sheltered employment status is predicted by shorter reaction time, better comprehension of metaphors and lower severity of disorganization symptoms. CONCLUSIONS: Multiple associations among basic and higher cognitive skills provide support for the concept of a generalized cognitive dysfunction in schizophrenia. Beside psychopathology symptoms, both basic and higher cognitive skills are also independently predictive of professional functioning in schizophrenia. This suggests potential areas of cognitive rehabilitation that could affect employability.

Differences in subjective quality of life of people with a schizophrenia diagnosis between participants in Occupational Therapy Workshops and those working in a Sheltered Employment Establishment. / Róznice w subiektywnej jakosci zycia osób z diagnoza schizofrenii pomiedzy uczestnikami Warsztatów Terapii Zajeciowej a osobami pracujacymi w Zakladzie Pracy Chronionej.

OBJECTIVES: The research objective was to compare the course of illness among patients with schizophrenia undergoing rehabilitation in Occupational Therapy Workshops (OTW) or employed in the Vocational Development Center "Pensjonat u Pana Cogito" (VDC), with particular focus on quality of life (QoL), and to analyse the relations between QoL and general, social, and cognitive functioning, psychopathological condition and insight in the two groups. METHODS: The sample comprised 52 subjects (VDC = 25 and OT = 27). The following tools were used: the LQoLP (for quality of life assessment) by Oliver, the PANSS, GAF, and SOFAS scales, the MoCA, RAVLT and RHLB cognitive tests, and the insight questionnaire "My thoughts and feelings". RESULTS: Differences were found between the groups, to the VDC group's advantage, in such areas of subjective QoL as: family relationships (p . 0.05), somatic health (p . 0.05) and selfesteem (p . 0.05). In the VDC group, QoL correlated negatively with symptoms of distress and positively with overall insight into symptoms, while in the OTW group it correlated negatively with cognitive function and positively with insight as a reaction to information from others. CONCLUSIONS: For people with schizophrenia obtaining and retaining employment in a VDC translates into better outcomes in important areas of quality of life such as family relationships, overall health, and self-esteem. Poorer QoL was associated with the severity of symptoms, in particular depressive symptoms. People employed in the VDC benefited to a greater extent from autonomous control of symptoms, while among the OTW group an important role was played by others.

Do better communication skills promote sheltered employment in schizophrenia?

Alongside various psychopathological symptoms and neurocognitive dysfunctions, communication skill impairments may be considered core feature of schizophrenia. Although many studies examined the relation between employment status and neurocognition in schizophrenia, we still know very little about the role of communication skills in vocational status among people with schizophrenia. The purpose of this study is to identify the most characteristic communication, neurocognitive and social cognition differences which separate the employed schizophrenia outpatients from those who do not work. The study included three groups: 33 schizophrenia outpatients employed in social firms, 29 unemployed schizophrenia outpatients participating in occupational therapy and sex & age matched 31 healthy controls. We assessed communication skills, global cognitive functioning, executive functions, memory, social cognition as well as severity of psychopathology. Our results indicate that the most characteristic differences between employed and unemployed schizophrenia outpatients are associated with selective language and communication skills, i.e. paralinguistic aspects of communication, understanding of discrete meaning of linguistic context and figurative meaning of language. We find no significant differences between both clinical groups with regard to neurocognition and social cognition. Moreover, unemployed group had more severe psychopathology than the employed group, so we re-analyzed results controlling for symptom severity. The only differences that endured were related to general communication skills and explanation of pictured metaphors, but only when controlling solely for positive or negative syndrome. In conclusion, the present study indicates that employment in schizophrenia is associated with better symptomatic remission and communication skills, but not with better neurocognition and social cognition.

The stability of negative syndrome, persistent negative syndrome and deficit syndrome in a twenty-year follow-up study of schizophrenia patients.

AIMS: To assess the prevalence and stability of negative symptoms in schizophrenia according to the BPRS-withdrawal/retardation, persistent negative symptoms and deficit syndrome over twenty years. METHOD: Fifty people diagnosed with schizophrenia were evaluated during their first psychiatric hospitalisation and after three, seven, twelve and twenty years. the presence of negative symptoms was assumed when at least one of the BPRS-withdrawal/retardation symptoms (blunted affect, emotional withdrawal, motor retardation), equalled three or more points at the discharge from the index hospitalisation. The groups with persistent negative symptoms and deficit syndrome were identified based on two measurements taken at the index discharge and one year later. The Proxy for the Deficit Syndrome (PDS) was employed to identify deficit syndrome. RESULTS: The prevalence of BPRS-withdrawal/retardation, persistent negative symptoms and deficit syndrome after one year was 20%, 4% and 6% respectively. Four of the ten people with BPRS-withdrawal/retardation symptoms maintained them at all follow-ups. No symptoms, however, were found in any of the members of the persistent negative symptoms and deficit syndrome group after twelve and twenty years. CONCLUSIONS: The prevalence of primary, persistent negative symptoms after the first episode of psychosis was minimal. A long-term observation does not confirm their stability.

Quality of life in a 20-year follow-up study of people suffering from schizophrenia.

AIMS: 1. To assess the changes in quality of life indicators in schizophrenia sufferers at three measurement points: 7, 12 and 20 years after the first hospitalization. 2. To assess changes in the level of functioning and psychopathological state. 3. To assess the relationships between quality of life, the level of functioning and the severity of symptoms. METHOD: A sample group of fifty-two people diagnosed with schizophrenia was investigated using the Lehman's QOLQ, the GAF scale and BPRS. RESULTS: A deterioration was noted in the subjective and objective areas of family life and health, subjectively assessed social relationships and objectively assessed finances. The better functioning sub-group returned better scores for the following objective quality of life indicators: free time, family life, health, social relationships and financial situation. The sub-group in remission obtained better results for general, subjective quality of life and for subjectively assessed health, as well as better scores for objectively assessed free time, social relationships, financial situation and health. An improvement in general, subjective quality of life was seen in the sub-group whose symptoms had grown more severe. CONCLUSIONS: The decline in subjective and objective quality of life in the areas of health and family life, in the subjective evaluation of social relationships and in the objective assessment of financial situation was associated with a deterioration in functioning and an absence of symptom remission. The improvement in general, subjective quality of life in the sub-group with severe symptoms may be evidence of the formation of adaptive mechanisms.

Duration of untreated psychosis (DUP) and the course of schizophrenia in a 20-year follow-up study.

Our aims were to analyze the relationship between the duration of psychosis (DUP) and short- and long-term outcomes of treatment, and to determine the cut-off point between short and long DUP at which differences in treatment outcomes are most significant. We assessed 80 participants with schizophrenia at the point of their first hospitalization. Fifty participated in all four follow-ups over 20 years. DUP was divided into short (up to 6 months) and long (over 6 months). ANOVA and Chi-square tests were employed to identify significant differences in both clinical and social indicators of functioning. ROC curves were used to estimate the best DUP division point. Significant differences favoring the short-DUP group were found for: GAF, total severity of symptoms and severity of positive symptoms, social functioning measured according to DSM-III criteria, employment, and social contacts. The optimal cut-off point for DUP was the 23rd week. We concluded that: (1) the relationship between longer DUP and worse overall treatment outcomes was sustained throughout the 20 years, (2) a positive correlation between DUP and the severity of psychopathological symptoms was observed over the first 12 years of illness, (3) the results indicate the efficacy of early therapeutic interventions in psychosis.

[The effect of two predictors' interaction on short- and long-term treatment outcomes of schizophrenia]. / Wplyw interakcji dwóch predyktorów na wczesne i odlegle wyniki leczenia schizofrenii.

OBJECTIVES: To monitor the effect of interaction of duration of untreated psychosis (DUP) and expressed emotion (EE) on treatment outcomes in schizophrenia. METHODS: 56 individuals diagnosed with schizophrenia were assessed at 4 time points. The number of relapses, the number and duration of rehospitalizations and the severity of symptoms were assessed at index hospitalization and at 3, 7 and 12-year follow-ups. RESULTS: No correlation was found between DUP and EE measured at index hospitalization. Over the 12-year period the number of rehospitalizations for individuals with short DUP and low EE did not increase, as opposed to those with short DUP and with high EE. In the group with long DUP, the number of rehospitalizations increased irrespectively of EE level. The positive syndrome in the group with short DUP and high EE was less severe than in individuals with long DUP and high EE. Analogous differences appeared in the group with low EE. CONCLUSIONS: 1) No correlation was found between DUP and EE at index hospitalization. 2) Number of rehospitalizations and intensity of positive symptoms proved to be associated over time with the interaction of DUP and EE. 3) Long-time observation and multiple assessments allow to obtain more reliable results.

[The role of expressed emotions indicator as a predictor of the course of schizophrenia]. / Wskaznik ekspresji emocji (EE) jako rodzinny predyktor przebiegu schizofrenii.

OBJECTIVE: The study is a part of a prospective schizophrenia research project run in Krak6w. The general objective of the project is a long-time observation of people with schizophrenia, starting from the first episode through the years of living with the illness, the assessment of treatment results and predictors. The goal of this study was to investigate whether the level of expressed emotions in family at the onset of schizophrenia may have a prognostic value in regard to the further course of the illness. METHOD: Four indicators of treatment results were observed: the number of relapses, the overall time of inpatient hospitalisations, the number of inpatient hospitalisations and the severity of psychopathological symptoms, all in 3, 7 and 12 years since first hospitalisations. Expressed emotions (EE) were assessed with Camberwell Family Interview (CFI), the severity of symptoms was assessed with BPRS-SA, the UCLA version. RESULTS: (1) The increase of the number of relapses in subsequent follow-ups was more pronounced in the group of subjects with higher EE at the time of their first hospitalisations. (2) The number and overall time of hospitalisations did not correspond in any way with the EE level at the time of the first hospitalisation. (3) The dynamics of general and positive symptoms was related to the EE level at the time of the first hospitalisation. The negative syndrome was found to have no significant relationships. CONCLUSIONS: (1) The level of EE at the time of the first hospitalisation can be regarded as a specific predictor of relapses in the study group. (2) Creating research models that enable to differentiate: trait and state as well as dependent on family and on the course of illness aspects of EE, would enable better understanding of this phenomenon, which appears both as predictor and as effect of the course of schizophrenia.

[Correlation between cognitive defects and the course of schizophrenia. Initial study of a rehabilitation programme participants]. / Zwiazek deficytów poznawczych z przebiegiem schizofrenii. Badania wstepne uczestników programu rehabilitacyjnego.

AIM: Cognitive deficits are the "primary" dysfunction in schizophrenia. They make possible a reliable prediction of the broadly understood adjustment of the psychiatric patients. The purpose of this paper is to evaluate the relation between the results of rehabilitation and the cognitive deficits among the patients diagnosed with schizophrenia. METHOD: The assessment of the cognitive deficits presented in this paper was conducted using the WCST, the Trial Making Test and a verbal fluency tests. These tests evaluated mainly executive functioning and working memory. Four indicators of the course of schizophrenia were taken into consideration: the severity of symptoms assessed by PANNS, the range of social interactions, professional functioning (readiness to be employed) and the Quality of Life self-evaluation questionnaire by Olivier. Altogether 64 patients diagnosed with schizophrenia (in accordance with the DSM-IV and ICD-10) who participated in a rehabilitation programme were assessed. RESULTS: The study showed correlation between poorer verbal fluency and severity of negative symptoms, worse professional functioning, limited range of social interactions and lesser satisfaction with work, privacy level and the time spent outside home estimated by the QLQ. The poorer results of the TMT correlate with the severity of negative symptoms and the level of general psychopathology as well as with worse professional functioning. The number of correct answers in the WCST is correlated with the level of professional functioning. Persons with higher education made less perseverative errors. Persons who managed to finish the first category of the test faster are characterised by a broader social interactions network. CONCLUSIONS: It was demonstrated that within the studied group of people with a long-term course of schizophrenia cognitive deficits correlate with the considered indicators of the results of rehabilitation process.