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AIM: Although competence and performance in relation to social functioning usually go hand in hand, it is not uncommon to observe a discrepancy between the two in patients with schizophrenia. The present study was aimed at examining the characteristics of patient groups showing such discrepancy. METHODS: A total of 205 outpatients with schizophrenia aged ≤40 years old were enrolled. The symptomatology and social functioning were widely assessed. The patients were divided into four groups by the cut-off scores for competence and performance in relation to social functioning calculated using a comprehensive dataset. RESULTS: The subjects were divided according to their level of competence and performance as follows: high competence and high performance (CP) group, 108 (52.7%) patients; high competence, but low performance (Cp) group, 40 (19.5%) patients; low competence, but high performance (cP) group, 13 (6.3%) patients; low competence and low performance (cp) group, 44 (21.5%) patients. One-way analysis of variance and post-hoc comparisons revealed significantly worse negative symptoms, general psychopathology scores, global functioning, and quality of life in the Cp group than in the CP group, and significantly better social anxiety symptoms, global functioning, and quality of life in the cP group than in the cp group. CONCLUSION: In patients who are capable, but do not perform well, negative symptoms may be involved in the discrepancy. Patients who are able to maintain themselves well despite low social competence appear to have milder social anxiety symptoms as compared to patients who are neither competent nor perform well.
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Ansiedad/fisiopatología , Disfunción Cognitiva/fisiopatología , Relaciones Interpersonales , Esquizofrenia/fisiopatología , Conducta Social , Habilidades Sociales , Adulto , Disfunción Cognitiva/etiología , Femenino , Humanos , Masculino , Esquizofrenia/complicaciones , Adulto JovenRESUMEN
AIM: The importance of early intervention in psychiatry is widely recognized among psychiatrists. However, it is unknown whether precise knowledge of at-risk mental state has been disseminated. With this survey, we aimed to reveal how Japanese psychiatrists diagnose patients with at-risk mental state and prescribe treatment strategies for them. METHODS: Using fictional case vignettes, we conducted a questionnaire survey of psychiatrists (n = 1399) who worked in Tokyo. We mailed study documents to all eligible participants in November 2015 with a requested return date in December. RESULTS: Two hundred and sixty (19.3%) psychiatrists responded to the survey. Their correct diagnosis rates for the patients in the at-risk mental state vignettes were low (14.6% for the vignette describing at-risk mental state with attenuated positive symptom syndrome; 13.1% for the vignette describing at-risk mental state with brief intermittent psychotic syndrome). Many psychiatrists selected pharmacotherapy and antipsychotics to treat patients in the at-risk mental state vignettes. The psychiatrists who correctly diagnosed patients in the at-risk mental state vignettes had significantly fewer years of clinical psychiatric experience than did those who diagnosed them as having a non-at-risk mental state (12.5 years vs 22.7 years for the vignette describing at-risk mental state with attenuated positive symptom syndrome, P < 0.01; 14.3 years vs 22.2 years for the vignette describing at-risk mental state with brief intermittent psychotic syndrome, P < 0.01). CONCLUSION: This study suggests that precise knowledge of at-risk mental state has not been disseminated among Japanese psychiatrists.
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Antipsicóticos/uso terapéutico , Competencia Clínica , Conocimientos, Actitudes y Práctica en Salud , Psiquiatría/estadística & datos numéricos , Trastornos Psicóticos/diagnóstico , Trastornos Psicóticos/tratamiento farmacológico , Adulto , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Síndrome , TokioRESUMEN
BACKGROUND: Stigma toward psychosis can prevent social attendance and help-seeking behavior. Early detection and intervention has been shown to improve patient outcome in schizophrenia. The aim of this study was to reveal the characteristics and formulation process of stigma toward each clinical stage of schizophrenia, taking people's backgrounds into consideration. METHODS: The participants consisted of three groups: general public, patients with mental illness, and psychiatric professionals. We performed a survey examining stigmas toward people with psychotic-like-experiences (PLE), at-risk mental state for psychosis (ARMS), schizophrenia, or depression. Prejudice was measured using a 21-item questionnaire, and discrimination was measured using the Social Distance Scale. RESULTS: The participants consisted of 149 people from the general public, 97 patients, and 119 psychiatric professionals. Generally, a similar pattern was observed among the groups in which prejudice and discrimination against PLE was mildest, followed by that against ARMS and depression, and finally schizophrenia. When the stigma of the general public was compared with that of psychiatric professionals, the prejudice and discrimination against PLE of the general public were both lower than those of the psychiatric professionals. However, the prejudice of the general public was stronger than that of the professionals for ARMS. Furthermore, the discrimination of the general public was stronger than that of the professionals for schizophrenia. CONCLUSIONS: The stigmas of mental illness differed according to the clinical stage, although the pattern of severity was similar among the three groups. A formulation process is suggested in which stigma toward schizophrenia develops from an attitudinal property (prejudice) against ARMS and a behavioral property (discrimination) against schizophrenia.
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Personal de Salud/psicología , Pacientes/psicología , Prejuicio/psicología , Trastornos Psicóticos , Opinión Pública , Esquizofrenia , Discriminación Social/psicología , Estigma Social , Adulto , Depresión , Femenino , Humanos , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios , Adulto JovenRESUMEN
AIM: Although volume reductions in the grey matter have been previously observed in individuals with an at-risk mental state (ARMS) for psychosis, the features of white matter integrity and their correlation with psychiatric symptoms remain unclear. METHODS: Forty-six ARMS subjects were examined using magnetic resonance imaging (MRI) to acquire diffusion tensor imaging (DTI); the subjects were also evaluated using the Scale of Prodromal Symptoms at baseline and at 52 weeks. Sixteen healthy controls also underwent MRI scanning. The DTI results were longitudinally analyzed using a tract-specific analysis to measure the fractional anisotropy (FA) values of the entire corpus callosum (CC), as well as its genu, trunk, and splenium. RESULTS: During the 52-week study period, seven patients developed psychosis (ARMS-P) and 39 did not (ARMS-NP). In the entire CC and the genu, trunk, and splenium of the CC, the FA values of the ARMS subjects were each significantly smaller than the respective values of the healthy controls at baseline. In the genu and trunk, the baseline FA values in the ARMS-NP group were, paradoxically, smaller than those of the ARMS-P group at baseline. Regarding the association between the FA values and psychiatric symptoms, a reduction in the FA value in the genu was significantly correlated with a deterioration of negative symptoms among the ARMS subjects. CONCLUSION: Abnormal white matter integrity in the CC may predict the long-term outcome of patients with prodromal psychosis, since negative symptoms are associated with poor functioning.
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Síntomas Prodrómicos , Trastornos Psicóticos/patología , Sustancia Blanca/patología , Adulto , Anisotropía , Cuerpo Calloso/patología , Imagen de Difusión Tensora , Femenino , Humanos , Estudios Longitudinales , Masculino , Neuroimagen , Adulto JovenRESUMEN
BACKGROUND: Deficits of motivation have been considered to be a core feature of schizophrenia, and recent studies have begun to reveal the biological and psychological characteristics and mechanisms underlying the deficits in motivation in schizophrenia patients. The aims of the present study were to investigate the characteristics of motivation in schizophrenia patients using the General Causality Orientations Scale (GCOS), and the impacts of motivational orientations on the functional outcomes in schizophrenia patients. METHODS: A total of 53 outpatients with schizophrenia and 38 healthy controls were recruited for this study. The GCOS was used to assess individual tendencies in respect of three different motivational orientations: the autonomy, controlled, and impersonal orientations, corresponding to intrinsic motivation, extrinsic motivation, and amotivation, respectively. The cognitive functioning, psychiatric symptoms, social functioning, and quality of life of the subjects were also assessed. RESULTS: The score for autonomy orientation was significantly lower in the patient group than that in the control group, while no significant differences were found between the two groups in respect of the scores for the other two orientations. The autonomy orientation was associated with various clinical variables, and regression analysis identified as one of the variables with the highest predictive accuracy for social functioning. CONCLUSIONS: Intrinsic motivation measured by the GCOS in schizophrenia patients was significantly lower than that in healthy controls. The deficits of intrinsic motivation were broadly associated with the clinical features and were a determinant of social functioning. Development of treatments for enhancing intrinsic motivation would be essential for functional recovery in schizophrenia patients.
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Motivación , Calidad de Vida/psicología , Esquizofrenia/diagnóstico , Psicología del Esquizofrénico , Ajuste Social , Adulto , Estudios de Casos y Controles , Cognición , Femenino , Humanos , Masculino , Análisis de RegresiónRESUMEN
BACKGROUND: In cases of untreated schizophrenia, the patients' entourage often does not recognize the psychotic symptoms of the patient and the possibility that the patient may attempt suicide. The aim of this study was to investigate the discrepancies between the subjective experiences and observed behaviors in near-fatal suicide attempters with untreated schizophrenia. METHODS: A semi-structured interview was carried out with seven near-fatal suicide attempters with untreated schizophrenia to examine the subjective experiences at the time of the suicide attempt. The families of the patients were also interviewed to determine their recognition of the patients' psychotic symptoms and the suicidal ideation. The interview data were analyzed qualitatively. RESULTS: Six subjects were undergoing exacerbation of the psychotic symptoms at the time of exhibiting the suicide-related ideation. One subject had been in a prolonged depressive state before attempting suicide. Although all the patients experienced severe distress due to psychotic symptoms and depressive mood, they all exhibited only low level or no help-seeking behavior, and six of seven families had not recognized the change in the patient's mental condition. CONCLUSIONS: Appropriate information about schizophrenia should be provided to the general public so that any help-seeking by the patients with this disease is not overlooked. In addition, accessible early intervention services for psychosis should be established.
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Early detection of, and intervention for, schizophrenia improve the social and functional outcome of the schizophrenia patient. A shorter duration of untreated psychosis (DUP) is an indication of a good prognosis for schizophrenia, but the DUP in Japan is comparatively long. There are some reports which have suggested shortening the DUP, for example, the Buckingham project and TIPS. They show early intervention services reduce the rate of onset of schizophrenia, and improve functions of schizophrenia patients. Intervention for patients with At Risk Mental State (ARMS) may stop or delay the onset of schizophrenia. Furthermore, intensive cares for patients in the critical period can also induce better clinical and functional outcomes. A shorter DUP and an intensive and comprehensive approach within the critical period are eagerly awaited in Japan.
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Diagnóstico Precoz , Intervención Educativa Precoz , Trastornos Psicóticos/diagnóstico , Esquizofrenia/diagnóstico , Antipsicóticos/uso terapéutico , Intervención Educativa Precoz/métodos , Humanos , Japón , Trastornos Psicóticos/tratamiento farmacológico , Esquizofrenia/tratamiento farmacológico , Prevención SecundariaRESUMEN
Recently, shortening of the duration of untreated psychosis (DUP) and intensive treatment within the critical period are taken as determinants of a favorable prognosis, and various service systems and treatment approaches for early intervention in schizophrenia have been proposed in the world. At the Toho University Omori Medical Center, Early Psychosis Unit "Il Bosco" was established as an intervention service from the viewpoint of preventing full-blown psychosis at the prodromal stage, where cognitive training for a direct therapeutic approach to brain function and psychosocial treatment for patients at puberty and adolescence are administered. In this article, we introduce the practice at "Il Bosco" and consider future prospects.
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Intervención Educativa Precoz , Promoción de la Salud , Trastornos Psicóticos/terapia , Esquizofrenia/terapia , Intervención Educativa Precoz/métodos , Promoción de la Salud/métodos , Humanos , Japón , Pronóstico , Trastornos Psicóticos/diagnóstico , Derivación y Consulta , Esquizofrenia/diagnósticoRESUMEN
BACKGROUND: This study evaluated the effectiveness of a comprehensive mental health literacy (MHL) educational programme known as "Sanita" for improving junior high school students' knowledge of mental illness, attitudes towards people with mental health problems, and help-seeking behaviour. METHODS: A randomised controlled trial with a parallel-group design was conducted. A total of 125 students (51 in the intervention group and 74 in the control group) received three 50-min classes and completed self-report questionnaires (Mental Illness and Disorder Understanding Scale, MIDUS; Reported and Intended Behaviour Scale, RIBS-J; and an original questionnaire investigating help-seeking behaviour) before and after the programme and three months later. RESULTS: Regarding MIDUS, the post-test and 3-month follow-up test results showed a significant main effect of time-by-group interactions in a linear mixed model. Regarding RIBS-J, the post-test results showed a significant main effect of time-by-group interactions; however, the 3-month follow-up test showed no significant effect. No significant effects of time-by-group interactions were seen in the post-test and 3-month follow-up test results for help-seeking behaviour in a logistic regression-mixed model. CONCLUSIONS: The Sanita MHL educational programme was longitudinally effective at improving junior high school students' knowledge of mental illness, although improvements in attitudes and help-seeking behaviour were insufficient.
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The purpose of the present study was to investigate regional cerebral blood flow (rCBF) changes in a patient with very-late-onset schizophrenia-like psychosis (VLOS) with catatonia. A 64-year-old woman developed catatonia after experiencing persecutory delusions. The patient's rCBF was examined using single photon emission computed tomography (SPECT) with easy Z-score imaging system. Before treatment, hypoperfusion was observed in the striatum and the thalamus, whereas hyperperfusion was observed in the left lateral frontal cortex and the left temporal cortex. After treatment, the disproportions in rCBF disappeared, and hyperperfusion was observed in the motor cortex. Sequential SPECT findings suggest that rCBF abnormalities may be correlated with the symptomatology of catatonia in patients with VLOS.
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Encéfalo/fisiopatología , Catatonia/fisiopatología , Circulación Cerebrovascular/fisiología , Trastornos Psicóticos/fisiopatología , Esquizofrenia/fisiopatología , Antipsicóticos/farmacología , Antipsicóticos/uso terapéutico , Aripiprazol , Encéfalo/irrigación sanguínea , Encéfalo/diagnóstico por imagen , Mapeo Encefálico , Catatonia/diagnóstico por imagen , Catatonia/tratamiento farmacológico , Circulación Cerebrovascular/efectos de los fármacos , Femenino , Haloperidol/farmacología , Haloperidol/uso terapéutico , Humanos , Persona de Mediana Edad , Piperazinas/farmacología , Piperazinas/uso terapéutico , Trastornos Psicóticos/diagnóstico por imagen , Trastornos Psicóticos/tratamiento farmacológico , Quinolonas/farmacología , Quinolonas/uso terapéutico , Esquizofrenia/diagnóstico por imagen , Esquizofrenia/tratamiento farmacológico , Tomografía Computarizada de Emisión de Fotón Único , Resultado del TratamientoRESUMEN
In patients with schizophrenia, motivation has been assumed to act as an intervening factor between cognitive function and social functioning. Motivation is thought to comprise three domains defined by their orientations: intrinsic motivation, extrinsic motivation, and amotivation. Although these orientations can confound each other, the effects of motivation domains on social functioning remain obscure. We investigated these relationships after confirming the factor structure of social functioning using the Social Functioning Scale (SFS). A total of 97 stable outpatients with schizophrenia were recruited. In addition to the SFS, the General Causality Orientations Scale (GCOS) was used to measure the motivation domains. First, we examined the factor structure of the SFS using exploratory and confirmatory factor analyses. Next, we conducted structural equation modeling to examine the effects of motivation domains on social functioning. The SFS showed a two-factor structure: interpersonal and intrapersonal functioning. The structural equation model revealed that (1) amotivation was negatively related to both intrapersonal and interpersonal functioning, (2) intrinsic motivation was positively related only to intrapersonal functioning, and (3) extrinsic motivation was positively related only to interpersonal functioning. Each motivation domain was associated with different factors of social functioning. Future interventions aimed at improving social functioning should consider these motivation domains based on their orientations. Cognitive remediation accompanied by considerations for and approaches to each of the domains may maximize recovery in patients with schizophrenia.
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Esquizofrenia , Humanos , Motivación , Psicología del Esquizofrénico , Ajuste Social , Interacción SocialRESUMEN
AIM: Although numerous studies have demonstrated promising results for the cognitive rehabilitation in subjects with schizophrenia, the efficacy of cognitive rehabilitation for everyday and social functioning is not yet sufficient. Although consideration of the contents and methods are vital, the timing for implementing cognitive rehabilitation also seems to be crucial. The aim of this study was to examine the feasibility and acceptability of cognitive rehabilitation during the acute phase of schizophrenia. METHODS: Patients were recruited from consecutive acute admissions to the inpatient unit during a 15-month period and were evaluated to determine whether they could be enrolled in an 8-week cognitive rehabilitation program within 14 days of their hospital admission. Cognitive rehabilitation programs with a workbook style were adopted, taking the patients' conditions and burdens into consideration. RESULTS: Eighty-three patients were newly admitted during the entry period, and 49 patients (59.0%) were eligible for inclusion. Of them, 22 patients (44.9%) agreed to participate and started the program. Sixteen patients completed the program and underwent a second assessment. Thus, 32.7% (16/49) of all the eligible patients actually completed the study. The participants were quite satisfied with the program. CONCLUSIONS: This preliminary study yielded encouraging data demonstrating the feasibility and acceptability of cognitive remediation for patients with schizophrenia during the acute phase. The provision of cognitive rehabilitation during the acute phase of the first episode can reasonably be expected to lead to better functional outcomes.
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Terapia Cognitivo-Conductual , Remediación Cognitiva , Esquizofrenia , Cognición , Estudios de Factibilidad , HumanosRESUMEN
As a biomarker for the degree of psychosis development, the lateral asymmetry of white matter (WM) integrity in each area of the cerebrum has been investigated; as a result, a reduced leftward asymmetry of WM integrity has been reported in patients with schizophrenia. Although individuals with an at-risk mental state for psychosis (ARMS) who subsequently develop psychosis are believed to have poorer social functioning, only a few studies have actually examined the associations between WM abnormalities and social functioning. The aim of the present study was to clarify the possibly predictive association between a reduced asymmetry of WM integrity and impairments in social functioning in patients with ARMS. Thirty ARMS subjects underwent MRI scanning and were assessed using the Social Functioning Scale (SFS). We examined the fractional anisotropy (FA) values in the cingulum bundle (CB) and the uncinate fasciculus (UF) using a tract-specific analysis. Lateral asymmetry was assessed using the laterality index (LI). The LI of the FA value was positive (leftward) in the CB and negative (rightward) in the UF. Although the LI was not correlated with the Scale of Prodromal Symptoms (SOPS) score, the LI in the CB was positively correlated with the SFS score. In ARMS patients, the degree of reduced leftward asymmetry in the CB might affect deteriorations in social functioning and may be useful as a biomarker for predicting future outcomes at an early stage of psychosis.
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Trastornos Psicóticos , Sustancia Blanca , Anisotropía , Biomarcadores , Encéfalo , Imagen de Difusión Tensora , Humanos , Trastornos Psicóticos/diagnóstico por imagen , Sustancia Blanca/diagnóstico por imagenRESUMEN
The prevalence of comorbid social anxiety disorder among patients with schizophrenia is currently attracting attention, and symptoms of social anxiety are reportedly associated with various clinical features. However, the contribution of social anxiety to social functioning and quality of life (QOL) over time remains obscure. The aim of this study was to examine the impact of changes in social anxiety symptoms on social functioning and QOL among outpatients with schizophrenia. Of the 207 outpatients who were eligible at baseline, 118 patients agreed with and completed a follow-up investigation at least 1 year (695.8 days on average) after the baseline study. Stepwise multiple regressions examining the change in social functioning using demographic data and changes in clinical variables as explanatory variables demonstrated that the changes in social anxiety and general psychopathology contributed to the change in the Social Functioning Scale, while the changes in clinical severity and negative symptoms contributed to the change in the Global Assessment of Functioning scale. Stepwise multiple regressions for the change in QOL demonstrated that the changes in social anxiety and depression contributed to the change in the World Health Organization QOL scale, Brief version, and the changes in social anxiety and positive symptoms contributed to the Subjective Well-being Under Neuroleptic Drug Treatment, Short Form. The results revealed that the changes in social anxiety symptoms were significantly associated with the change in functional outcome among patients with schizophrenia. Treatments targeting social anxiety seem to be key to achieving a full recovery in patients with schizophrenia.
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Calidad de Vida , Esquizofrenia , Ansiedad/epidemiología , Humanos , Estudios Longitudinales , Pacientes Ambulatorios , Esquizofrenia/complicaciones , Esquizofrenia/epidemiología , Psicología del Esquizofrénico , Interacción SocialRESUMEN
OBJECTIVE: Functional capacity, which indicates one's ability to perform everyday living tasks, contributes to real-world functional performance in patients with schizophrenia. However, functional capacity is sometimes not comparable with functional performance in clinical settings. We hypothesized that specific personality traits are related to this capacity-performance discrepancy of functional outcome. METHODS: The measures in this study were the UCSD Performance-based Skills Assessment Brief (UPSA-B) for functional capacity, the Social Functioning Scale (SFS) for functional performance, and the Temperament and Character Inventory-140 (TCI-140) for personality traits. A total of 94 stable outpatients with schizophrenia were divided into four groups based on combinations of their UPSA-B and SFS cut-off points, as follows: a high capacity and high performance (HH) group, a high capacity but low performance (HL) group, a low capacity but high performance (LH) group, and a low capacity and low performance (LL) group. RESULTS: There were no significant differences in demographics among the four groups. The LH group showed a significantly lower harm avoidance level than the LL group. The HL group showed a significantly lower persistence level than the HH group. CONCLUSION: Lower harm avoidance may enhance functional performance, and lower persistence can limit functional performance, regardless of the primary levels of functional capacity in patients with schizophrenia. Novel and individualized psychosocial treatments considering the individual's personality traits seem to be helpful for maximizing their functional performance in the community.
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Recent studies have revealed that several psychotic symptom changes observed in the 'at risk mental state' (ARMS) are associated with changes in the striatum. We investigated if structural changes in the striatum are associated with recovery of sub-threshold psychotic symptoms in subjects with an ARMS who did not develop psychosis (ARMS-N). Sixteen healthy controls and 42 subjects with an ARMS participated in this study. Striatal volumes (caudate, putamen, and nucleus accumbens) were analyzed using MRI. The sub-threshold psychotic symptoms of the subjects with an ARMS were measured using the SOPS. Imaging and symptoms were reevaluated after 52 weeks. Significant right putamen volume reduction was observed at the follow-up in ARMS-N subjects. Improvement in sub-threshold positive symptoms significantly correlated with an increase in volume in the right accumbens at follow up. No relationship was found for negative symptoms. From these findings, the association between improvement in sub-threshold positive symptoms and an increase in the volume of the right accumbens may suggest that changes in the accumbens, which is a major site for dopamine innervation, are associated with symptom recovery. These findings may point to neurobiological resilience that may be associated with lower transition to psychosis.
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Cuerpo Estriado/diagnóstico por imagen , Imagen por Resonancia Magnética/tendencias , Trastornos Mentales/diagnóstico por imagen , Trastornos Mentales/psicología , Síntomas Prodrómicos , Adolescente , Adulto , Estudios Transversales , Femenino , Estudios de Seguimiento , Humanos , Estudios Longitudinales , Masculino , Factores de Riesgo , Adulto JovenRESUMEN
The presently reported patient was a 37-year-old married primipara with peripartum depression comorbid with bonding disorder. Care anxiety and a lack of affection towards her baby first appeared at around the time of delivery, and the patient developed major depression at one month after the birth of her healthy baby. At first, standard treatment for major depression including the use of antidepressants, electroconvulsive therapy, and supportive psychotherapy were provided. However, bonding problems appeared to impede and obstruct the amelioration of depression. Although treatment methods for bonding disorder have not yet been established, Kangaroo Care was introduced to facilitate skin-to-skin contact. We also educated her in better parenting behavior and provided repeated motivational interviews with her family because a lack of partner and social support and personal temperament (low self-directedness and cooperativeness) were thought to be related to her bonding disorder. This case suggests the effectiveness of Kangaroo Care, which promotes a humanizing maturation of both baby and parent alike, for mothers with postpartum depression and comorbid severe bonding disorder.
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AIM: Preventive intervention and treatment using internet-based cognitive behaviour therapy (iCBT) can be easily administered to school students, as they are quite familiar with internet tools. This study aims to investigate the effectiveness and contribution of iCBT to mental healthcare in a school setting. METHODS: Eighty Japanese high school boys who were participating in a sports specialist course were enrolled in this study. The participants were randomly assigned to either the iCBT intervention group or the control group. Both programmes were administered for 4 weeks. To evaluate the effects, physical and mental health problems and self-efficacy were assessed. RESULTS: The mean number of times that the iCBT website was accessed during the intervention period was 16.9, and the mean access frequency (percentage of the number of times the website was accessed during the intervention period) was 40.1% in the iCBT group. A statistically significant interaction between group and time in favour of the iCBT group was observed based on the Kessler-6 (K6) scale for depression and anxiety. CONCLUSIONS: The results suggest that a school mental healthcare programme using iCBT is suitable for students and useful for coping with stress and reducing depressed mood and anxiety in young people, especially athletes, who are regarded as needing special mental health support.
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Ansiedad/terapia , Atletas/psicología , Terapia Cognitivo-Conductual , Depresión/terapia , Internet , Servicios de Salud Mental , Servicios de Salud Escolar , Adolescente , Adulto , Humanos , Japón , Masculino , Autoeficacia , Resultado del TratamientoRESUMEN
Previous studies have revealed that changes in sub-threshold psychotic symptoms observed in individuals with an 'at risk mental state' (ARMS) are associated with biological changes in the corpus callosum (CC). To elucidate the biological background for resilience against transition to psychosis, we investigated the relationship between CC structural changes and recovery of sub-threshold psychotic symptom in subjects with ARMS who did not develop psychosis (ARMS-N). Sixteen healthy controls and 42 ARMS (37 ARMS-N) subjects participated this study. The volumes of five sub-regions of the CC were analyzed using MRI. The sub-threshold psychotic symptoms of the ARMS were measured using the Scale of Prodromal Symptoms (SOPS). Imaging and symptoms were re-administered in the ARMS group 52 weeks later. Significant baseline volume differences in the mid-posterior CC, central CC and mid-anterior CC were found between the controls and the ARMS-N subjects. These findings suggest that biological abnormalities are present in a so-called "false-positive" group of individuals. For the ARMS-N subjects, improvement in negative symptoms significantly correlated with an increase in the volume of the central CC at follow-up. This finding may suggest that a neurobiological 'resilience' is associated with symptom recovery.
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Cuerpo Calloso/diagnóstico por imagen , Cuerpo Calloso/fisiología , Trastornos Mentales/diagnóstico por imagen , Síntomas Prodrómicos , Recuperación de la Función/fisiología , Adolescente , Adulto , Estudios Transversales , Femenino , Estudios de Seguimiento , Humanos , Estudios Longitudinales , Imagen por Resonancia Magnética/métodos , Masculino , Trastornos Mentales/psicología , Trastornos Psicóticos/diagnóstico por imagen , Trastornos Psicóticos/psicología , Factores de Riesgo , Adulto JovenRESUMEN
Social anxiety is commonly reported as a comorbid condition among people with schizophrenia. The aims of this study were to elucidate the associations between demographic/clinical features and social anxiety. A total of 207 outpatients with schizophrenia underwent assessments for social anxiety, psychiatric symptoms, social cognition, cognitive function, social functioning, and quality of life (QOL). To confirm the prediction model for social anxiety, we conducted multiple linear regressions using the Liebowitz Social Anxiety Scale (LSAS) score as an outcome variable and demographic/clinical variables as predictors. Of the 207 patients, 30 (14.5%) met the criteria for social anxiety disorder and 109 (52.7%) had a mean LSAS score higher than 30, suggesting that their social anxiety symptoms had reached a clinical level. Social anxiety was significantly correlated with psychiatric symptoms, social functioning, and QOL, whereas significant correlations with social cognition and cognitive function were not observed. A multiple regression analysis identified social functioning, gender, age of onset, and duration of untreated psychosis (DUP) as predictors that were most closely associated with the LSAS score. We confirmed that social anxiety symptoms were highly prevalent among outpatients with schizophrenia and were closely associated with social functioning and DUP, rather than social cognitive impairments.