Could the severity of symptoms of schizophrenia affect ability of self-appraisal of cognitive deficits in patients with schizophrenia? Lack of insight as a mediator between the two domains.

The relationship between subjective appraisal of cognitive deficits and symptom severity in schizophrenia is unclear. Insight reportedly affects both factors. Our aim is to further asses the relationship between subjective perception of cognitive deficits, symptom severity and lack of insight as a mediator variable. 109 subjects with schizophrenia were evaluated. Positive and Negative Syndrome Scale (PANSS) was modelled as independent variable, Subjective Scale to Investigate Cognition in Schizophrenia (SSTICS) as dependent and "Lack of Insight" (LoI) PANSS Item as mediator one. Mediation was assessed using bootstrap estimation approach. LoI acts as a suppressor variable (i.e., it enhances the relation between the independent and dependent variable) between Negative Symptoms and SSTICS, while showing a mediation effect between Depressive symptoms and SSTICS. LoI has a central role in mediating the relationship between negative and depressed symptoms on the one hand and self-appraisals of cognitive deficits (SACD) assessed with SSTICS on the other. Its suppressor role between negative symptoms and STICSS favour a direct effect of negative symptoms on SACD. On the other hand, its mediator role between depression and SSTICS is consistent with several reports of the 'insight paradox' of an enhanced severity of depression in patients with higher awareness of their disability.

On the Implementation of Computerized Adaptive Observations for Psychological Assessment.

The use of observational tools in psychological assessment has decreased in recent years, mainly due to its personnel and time costs, and researchers have not explored methodological innovations like adaptive algorithms in observational assessment. In the present study, we introduce the behavior-driven observation procedure to develop, test, and implement observational adaptive instruments. In Study 1, we use a preexisting observational checklist to evaluate nonverbal behaviors related to psychotic symptoms and to specify the adaptive algorithm's model. We fit the model to observational data collected from 114 participants. The results support the model's goodness of fit. In Study 2, we use the estimated model parameters to calibrate the adaptive procedure and test the algorithm for accuracy and efficiency in adaptively reconstructing 58 nonadaptively collected response patterns. The results show the algorithm's good accuracy and efficiency, with a 40% average reduction in the number of administered items. In Study 3, we used real raters to test the adaptive checklist built with behavior-driven observation. The results indicate adequate intrarater agreement and good consistency of the observed response patterns. In conclusion, the results support the possibility of using behavior-driven observation to create accurate and affordable (in terms of resources) observational assessment tools.

Subjective Scale to Investigate Cognition in Schizophrenia (SSTICS): a validation study in Italian population.

BACKGROUND: Although cognitive deficit in persons with schizophrenia is well documented, the assessment of the patient's perception of its own cognitive functioning is a relevant issue not adequately studied. Several evaluation tools have been elaborated, however none has been validated in Italian. The aim of the study is the validation of the Subjective Scale to Investigate Cognition in Schizophrenia (SSTICS), a rating scale designed to measure subjective cognitive deficits complaints in persons with schizophrenia. < span class="text116">Method. 146 persons meeting the DSM-5 diagnostic criteria for schizophrenia have been recruited. The SSTICS was translated in Italian in accordance with international standard methods. Subjects were also evaluated using the Positive and Negative Syndrome Scale (PANSS) and the Subjective Well-being under Neuroleptic scale (SWN). Cronbach's alpha coefficient was used to assess internal consistency. Constructs were examined using exploratory factor analysis (principal component with varimax rotation). The factorial model was then tested via confirmatory factor analysis. RESULTS: The factorial analysis revealed a 4-factor structure, which is more parsimonious than those obtained in previous studies. Correlations between STICSS and the other rating scales were significant for several domains. CONCLUSIONS: The Italian version of the SSTICS showed good psychometric properties and is suitable to measure the patients' subjective perception of cognitive impairment. Subjective evaluation can integrate objective measures of cognitive performances, supporting a multidimensional model of functional impairment in schizophrenia.

Resilience as a Mediator Between Interpersonal Risk Factors and Hopelessness in Depression.

Several studies investigated the role of resilience as a mediating factor for psychopathological phenotypes. The aim of the current study is to explore the putative role of resilience as a mediator between different vulnerability factors and depressive symptoms. One hundred and fifty patients with a major depressive disorder diagnosis have been evaluated on the basis of humiliation (Humiliation Inventory), adverse past family experiences (Risky Family Questionnaire), hopelessness (Beck Hopelessness Scale), and resilience (Resilience Scale for Adult) scores. A multiple regression analysis and a bootstrapping method were carried out to assess the hypothesis that resilience could mediate the relationships between these risk factors as predictors and hopelessness as a dependent variable. Our results show that resilience has a mediating role in the relationship between several risk factors that are specifically involved in interpersonal functioning and hopelessness. The main limitations of the study are the cross-sectional nature of the study, the use of self-report instruments, the lack of personality assessment, and the consideration of the resilience as a unique construct. The understanding of the mechanisms through which resilience mediates the effects of different interpersonal risk factors is crucial in the study of depression. In fact, future prevention-oriented studies can also be carried out considering the mediating role of resilience between interpersonal risk factors and depressive symptoms.

Different roles of resilience in depressive patients with history of suicide attempt and no history of suicide attempt.

OBJECTIVE:: Suicidal ideation is modulated by several risk and protective factors. The aim of this study was to evaluate differences between patients with a history of suicide attempt and those with no such history, with special attention to depression, interpersonal sensitivity, humiliation, and resilience. METHODS:: One hundred consecutively admitted patients with an index depressive episode were recruited. The Brief Symptom Inventory, Humiliation Inventory, and Resilience Scale for Adult were administered. RESULTS:: Scores for humiliation, interpersonal sensitivity, and depression were higher in subjects with history of suicide attempt, while higher scores for resilience were observed in the group with no such history. Different patterns of relationships among the variables of interest were found in the two groups. Resilience dimensions such as social resources and familial cohesion were strongly and negatively correlated with humiliation, interpersonal sensitivity, and depression in subjects with a past suicide attempt. CONCLUSIONS:: Resilience factors can modulate and reduce the impact of suicide risk. Assessing risk and protective factors could enhance the ability to intervene appropriately.

The metabolic syndrome in an Italian psychiatric sample: a retrospective chart review of inpatients treated with antipsychotics.

INTRODUCTION: The metabolic syndrome (MS) is an area of interest for mental health research because individuals with mental illnesses have an increased risk of medical morbidity and mortality compared with the general population. This cross-sectional study is aimed to estimate the prevalence of metabolic syndrome in an Italian psychiatric sample, treated with different types of antipsychotics. METHODS: The data were derived from medical records of patient with affective and non-affective psychosis, admitted to the Hospital of L'Aquila psychiatric ward, from January 2012 to July 2014. The sample refers to consecutive admissions of subjects of both sexes, aged over 18 years, receiving one or more antipsychotic treatment. The diagnosis of MS was established when the clinical subject at least three of the five diagnostic criteria of the Adult Treatment Panel (NCEP-ATP III) were met. RESULTS: 389 subjects were evaluated. We report a MS prevalence of 27.5%. This figure is very close to the metabolic syndrome prevalence in the Italian general population quoted around 26%. The BMI values also are very similar in these two populations, despite a higher obesity rate in the clinical sample. The MS prevalence rates in subject with schizophrenia, bipolar disorders and depressive disorders were respectively 30.6%, 36.4% and 36.8%. No significant differences in MS, diabetes or dyslipidemia rates were found among the three diagnostic groups. We did not find differences in metabolic syndrome prevalence either in relation to psychotropic polypharmacy or in relation to typical or atypical antipsychotics. However the psychiatric females in the clinical sample tend to have higher obesity rate, with a sort of all or none distribution (i.e. more obesity, more normal weight, but less overweight) compared to the general population. CONCLUSIONS: These findings could be explained by the interaction of some sort of liability due to drug treatment, illness related lifestyles, gender and other interacting factors (e.g. genetic) with metabolic issues.

Different roles of resilience in depressive patients with history of suicide attempt and no history of suicide attempt

Objective: Suicidal ideation is modulated by several risk and protective factors. The aim of this study was to evaluate differences between patients with a history of suicide attempt and those with no such history, with special attention to depression, interpersonal sensitivity, humiliation, and resilience. Methods: One hundred consecutively admitted patients with an index depressive episode were recruited. The Brief Symptom Inventory, Humiliation Inventory, and Resilience Scale for Adult were administered. Results: Scores for humiliation, interpersonal sensitivity, and depression were higher in subjects with history of suicide attempt, while higher scores for resilience were observed in the group with no such history. Different patterns of relationships among the variables of interest were found in the two groups. Resilience dimensions such as social resources and familial cohesion were strongly and negatively correlated with humiliation, interpersonal sensitivity, and depression in subjects with a past suicide attempt. Conclusions: Resilience factors can modulate and reduce the impact of suicide risk. Assessing risk and protective factors could enhance the ability to intervene appropriately.