Elucidating the relationship between internalized stigma, cognitive insight, illness severity, and functioning in patients with schizophrenia using a path analysis approach.

BACKGROUND: There is a paucity of studies examining the interrelationship between internalized stigma, cognitive insight, illness severity, and functioning. AIMS: This study examined the dynamics of the relationship between these factors using a path modelling approach. METHODS: Two hundred and seven patients with schizophrenia spectrum disorders were recruited in this cross-sectional study. Patients were assessed on internalized stigma, cognitive insight (including its two domains, self-reflectiveness and self-certainty), illness severity and functioning. Path analysis was used to test the hypothesized model for the interrelationship between the variables. RESULTS: A direct positive association was observed between self-certainty and internalized stigma. This was also observed via the paths running through illness severity and functioning. Self-reflectiveness was only associated with self-certainty in the model. The residual variance of internalized stigma in the path model was relatively high. CONCLUSION: Our findings highlight that self-certainty is associated with internalized stigma along with illness severity and functioning in individuals with schizophrenia. Therefore, interventions on reduction of internalized stigma may benefit from a multipronged approach targeting self-certainty, illness severity and functioning. The relatively high residual variance of internalized stigma in the model highlights the need for further research to provide better understanding on the mechanisms underlying internalized stigma.

Reassessing the high proportion of involuntary psychiatric hospital admissions in South Korea.

The 2007 WHO-AIMS report on the mental health system of South Korea documented progress towards a national mental health plan, protection of human rights, and growth of community based services. Yet concern was expressed that the high proportion of involuntary to total psychiatric hospitalizations (92%) may indicate an excessively coercive system. Involuntary hospitalization in Korea rose from 117 to 132 (per 100,000) between 2000 and 2006. In 2000, the median rate in the European Union (EU) was 74 per 100,000 (Range: 6-218). While Korea's involuntary hospitalization rate is within the EU range, its proportion of involuntary hospitalizations is three times that of the highest EU country (30%, Sweden). Underdevelopment of voluntary psychiatric services and culturally mandated family referrals resulting in involuntary hospitalization are apparent reasons for the high proportion of involuntary hospitalizations. Population-based rates per 100,000 more accurately describe involuntary hospitalization than the proportion (ratio) measure used in the WHO-AIMS reports.

Internalized stigma as an independent predictor of employment status in patients with schizophrenia.

OBJECTIVE: This study aimed to clarify the relationship between employment status and internalized stigma in patients with schizophrenia in Hong Kong. METHODS: One hundred and seventy-nine patients with schizophrenia were included in this study. The employed group included patients with full- or part-time open employment and full-time students. The unemployed group included those attending rehabilitation services and those unemployed. Internalized stigma was assessed using the Internalized Stigma of Mental Illness scale, consisting of alienation, stereotype endorsement, discrimination experience, social withdrawal, and stigma resistance domains. The relationship between these domains and employment status was assessed using logistic regression. FINDINGS: Fifty-seven percent of participants were employed. Employment status was positively associated with stigma resistance and negatively associated with stereotype endorsement, but not with total internalized stigma. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Findings suggest that future interventions can focus on increasing stigma resistance and reducing stereotype endorsement to improve vocational outcomes in patients with schizophrenia. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Relationship between subjective quality of life and perceptions of recovery orientation of treatment service in patients with schizophrenia and major depressive disorder.

OBJECTIVE: This study aimed to investigate the relationship between subjective quality of life (QOL) and the specific domains of perceptions of recovery orientation of treatment services in patients with schizophrenia and major depressive disorder (MDD). METHODS: One hundred and seventy-nine patients with schizophrenia spectrum disorders and fifty-seven patients with MDD were recruited. Patients were assessed on subjective QOL, self-reported depressive symptoms, illness severity, functioning, and perception of recovery orientation of the service environment (RSA). A multiple linear regression model was used to assess the relationship between QOL and RSA score, controlling for all other factors. Spearman correlation analysis was used to examine the relationship between RSA domains and total QOL in each diagnostic group separately. RESULTS: The regression model explained 47.4 % of the variance observed in total QOL. Depressive symptoms, functioning and RSA were significantly associated with total QOL in the model. Domains one (life goals) and five (individually tailored services) of the RSA were associated with QOL in both groups. Domains two (patient involvement) and three (diversity of treatment options) were associated with total QOL only in patients with schizophrenia. CONCLUSION: Our findings highlight that perceptions of recovery orientation of service, depressive symptoms and functioning significantly affected the subjective QOL of patients with serious mental illness. The differential relationship observed between QOL and domains of RSA in patients with MDD and schizophrenia suggests that targeted interventions meeting the needs of different patient groups may be crucial to improve QOL of patients.

Medication-free research in early episode schizophrenia: evidence of long-term harm?

This study investigates the question of whether short periods of medication-free research in early episode schizophrenia result in demonstrable long-term harm to human subjects. A meta-analysis of published quasi-experimental and random assignment studies that had a majority of first- or second-episode schizophrenia spectrum subjects, at least 1 initially unmedicated group, and a minimum of 1-year results was conducted. Only 6 studies, with 623 subjects, met inclusion criteria. The initially unmedicated groups showed a small, statistically nonsignificant long-term advantage (r = -0.09). Incorporating only random assignment studies into a composite effect size produced a similar near-zero result (r = 0.01). Good-quality evidence is inadequate to support a conclusion of long-term harm resulting from short-term postponement of medication in early episode schizophrenia research. A categorical prohibition against such research should be reconsidered.

At issue: predicting drug-free treatment response in acute psychosis from the Soteria project.

Although an estimated 25 to 40 percent of acute psychoses remit without antipsychotic drug treatment, only limited efforts have been made to identify individuals in early episodes who might be able to recover without medications. This retrospective exploratory study uses baseline information from the Soteria project (young, unmarried, first and second episode DSM-II schizophrenia, n = 179) to develop a preliminary model for this purpose. Forty-three percent of experimentally treated subjects received no antipsychotic medications during the 2-year followup period and were designated "drug-free responders." At followup, this group had better outcomes (+ 0.82 of a standard deviation [SD]) on a composite outcome scale (representing rehospitalization, psychopathology, independent living, social and occupational functioning). A predictive model using three variables (age, the Goldstein Adolescent Social Competence Scale score, and number of diagnostic symptoms) correctly identified this subgroup 79 percent of the time (boot-strapped 95% confidence interval [CI], 65-90%). Predicted drug-free responders exhibited moderately better outcomes (effect size: 0.38 to 0.61 of an SD) when treated at Soteria. These data advance the hypothesis that an identifiable subgroup of individuals with early episode psychosis might fare better when receiving specialized psychosocial intervention and minimal or no use of antipsychotic medications.

Treatment of acute psychosis without neuroleptics: two-year outcomes from the Soteria project.

The Soteria project (1971-1983) compared residential treatment in the community and minimal use of antipsychotic medication with "usual" hospital treatment for patients with early episode schizophrenia spectrum psychosis. Newly diagnosed DSM-II schizophrenia subjects were assigned consecutively (1971 to 1976, N = 79) or randomly (1976 to 1979, N = 100) to the hospital or Soteria and followed for 2 years. Admission diagnoses were subsequently converted to DSM-IV schizophrenia and schizophreniform disorder. Multivariate analyses evaluated hypotheses of equal or better outcomes in Soteria on eight individual outcome measures and a composite outcome scale in three ways: for endpoint subjects (N = 160), for completing subjects (N = 129), and for completing subjects corrected for differential attrition (N = 129). Endpoint subjects exhibited small to medium effect size trends favoring experimental treatment. Completing subjects had significantly better composite outcomes of a medium effect size at Soteria (+.47 SD, p =.03). Completing subjects with schizophrenia exhibited a large effect size benefit with Soteria treatment (+.81 SD, p =.02), particularly in domains of psychopathology, work, and social functioning. Soteria treatment resulted in better 2-year outcomes for patients with newly diagnosed schizophrenia spectrum psychoses, particularly for completing subjects and for those with schizophrenia. In addition, only 58% of Soteria subjects received antipsychotic medications during the follow-up period, and only 19% were continuously maintained on antipsychotic medications.

Ethnicity and treatment outcome variation in schizophrenia: a longitudinal study of community-based psychosocial rehabilitation interventions.

The purpose of this study was to investigate cross-ethnic variations in prospective treatment outcomes over a period of 12 months from community-based psychosocial rehabilitation interventions for people with schizophrenia. Data were pooled from two similar studies of psychosocial rehabilitation for clients with schizophrenia conducted in the same urban settings. The final sample consisted of 226 people diagnosed with a schizophrenia spectrum disorder, consisting of 108 (48%) white subjects, 81 (36%) African American subjects, and 37 (16%) Latino subjects. Main analyses were performed using hierarchical linear modeling. Analyses indicated that both study groups demonstrated statistically significant rehabilitative improvement over a period of 12 months. Although African American subjects had a significantly slower rate of improvement (compared with white subjects) in social functioning, analyses in several other outcome domains generally revealed that all three ethnic groups showed similar change trajectories over time, with no additional ethnic-related differences reaching statistical significance. With the exception of slower social improvement for African Americans, the findings from this study suggest that community-based psychosocial rehabilitation interventions did not result in significantly poorer outcomes for the ethnic minority groups examined. Several important implications are discussed.