Sex Differences in the Prevalence and Clinical Features of Comorbid Depressive Symptoms in Never-Treated Chinese Patients With First-Episode Schizophrenia.
Wang Dong-Mei,Zhang Guang-Ya,Du Xiang-Dong,Jia Qiu-Fang,Qian Zheng-Kang,Yin Guang-Zhong,Chen Da-Chun,Xiu Mei-Hong,Ning Yu-Ping,Huang Xing-Bing,Wu Feng-Chun,Zhang Xiang-Yang
The Journal of clinical psychiatry
BACKGROUND:Many studies have indicated a sex-specific effect in many aspects of schizophrenia. The presence of depressive symptomatology exists in all phases of schizophrenia. The aim of this study is to investigate the sex differences in the proportion of comorbid depressive symptoms and sex-specific relationships between depressive symptoms and clinical correlates in never-treated Chinese patients with first-episode schizophrenia (NTFE patients), which have not been reported yet. METHODS:Via a cross-sectional design, 240 NTFE inpatients (male/female = 111/129) between ages 16 and 45 years and meeting DSM-IV-TR criteria of schizophrenia were recruited. The Positive and Negative Syndrome Scale (PANSS) was used for the psychopathology, and the 17-item Hamilton Depression Rating Scale (HDRS-17) for the comorbid depressive symptoms. This study was conducted from June 2013 to December 2015. RESULTS:The proportion of patients with depressive symptoms (total score on HDRS-17 ≥ 8) in men was significantly higher than in women (male: 62.2%, female: 48.1%; χ²₁ = 4.28, P = .039). Male patients had significantly greater depressive symptoms as shown on the HDRS-17 than female patients (t1, 238 = 2.75, P = .006). Further, we found that age, the age at onset, smoking rate, and PANSS total and general psychopathology, negative symptoms, and cognitive factor subscores favored significant sex differences in female patients (all P < .05). Interestingly, we found sex differences in the correlation between the HDRS-17 score and clinical phenotype, showing that in male patients, the PANSS general psychopathology subscore (β = 0.75, t = 7.72, P < .001) and total score (β = 0.44, t = 4.81, P < .001) significantly predicted the HDRS-17 total score, while in female patients, the PANSS general psychopathology subscore (β = 0.74, t = 8.45, P < .001), total score (β = 0.47, t = 5.71, P < .001), and cognitive factor subscore (β = 0.24, t = 2.60, P < .001) significantly predicted the HDRS-17 total score. CONCLUSIONS:Our results indicate sex differences in the frequency and severity of comorbid depressive symptoms and in associations between depressive symptoms and clinical correlates in NTFE patients.
Reliability and validity of the Chinese version of the Calgary Depression Scale for Schizophrenia.
Xiao Weidong,Liu Hao,Zhang Hongyan,Liu Qi,Fu Peixin,Chen Jingxu,Wang Xiaoping,Wang Gaohua,Li Lingzhi,Shu Liang
The Australian and New Zealand journal of psychiatry
OBJECTIVE:The aim of the present study was to determine the reliability and validity of the Chinese version of the Calgary Depression Scale for Schizophrenia (CDSS-C) in schizophrenia patients. METHOD:One hundred and one inpatients from four mental health units who met DSM-IV criteria for schizophrenia were enrolled. The Positive and Negative Syndrome Scale (PANSS), Hamilton Depression Rating Scale (HDRS-24), Simpson-Augus Rating Scale (SAS), and Barnes Acathisia Rating Scale (BARS) were administered by the first rater, whereas the CDSS-C was assessed by a second independent rater. RESULTS:The internal consistency (Cronbach's alpha = 0.80) and the inter-rater reliability (kappa coefficient >0.79) were good. The test-retest reliability was high (r = 0.927). The scale had good construct validity, with statistically significant correlations with the HDRS-24, G6 item (depression) of PANSS, and significant weak correlations with the general psychopathology subscale of PANSS. The CDSS-C showed no correlation with the positive and negative subscale of PANSS, the SAS and the BARS. CONCLUSION:The Chinese version of CDSS is a valid and reliable instrument for the assessment of depression in schizophrenia.
Gender differences in attitudes towards antipsychotic medications in patients with schizophrenia.
Zhou Jiansong,Xiang Yu-Tao,Li Qiguang,Zhu Xiaomin,Li Wen,Ungvari Gabor S,Ng Chee H,Ongur Dost,Wang Xiaoping
Non-adherence was more frequent in male than in female psychiatric patients. This multi-center study in China examined the gender difference with regard to attitude towards antipsychotic medications and its associations with socio-demographic variables, insight, and psychopathology. Patients' basic socio-demographic and clinical data were collected. Psychopathology and insight were measured with the Symptom Checklist-90 (SCL-90) and the Insight and Treatment Attitudes Questionnaire (ITAQ), respectively. Their attitudes towards antipsychotic medications were assessed by two standardized questions. Nearly 39.6% (109/275) males and 31.1% (70/225) females reported negative attitudes towards antipsychotic medications. Binary logistic regression revealed that in males single marital status (OR=2.9, 95% CI=1.3-6.4), rural residence (OR=0.4, 95% CI=0.2-0.7), longer duration of schizophrenia (OR=1.0, 95% CI=1.0-1.1), knowledge of medication (OR=1.5, 95% CI=1.3-1.6) and the SCL-90 hostility subscale (OR=0.9, 95% CI=0.9-1.0) were contributors to negative attitudes. In female patients, knowledge about medications (OR=1.4, 95% CI=1.3-1.6), the SCL-90 somatization (OR=0.8, 95% CI=0.8-0.9) and anxiety (OR=1.1, 95% CI=1.0-1.2) subscales were contributors to negative attitudes. The study suggested that different psychosocial and clinical factors accounted for the negative attitude towards antipsychotic treatment in male and female patients.
Sex difference in the association of body mass index and BDNF levels in Chinese patients with chronic schizophrenia.
Yang Fang,Wang Keming,Du Xiangdong,Deng Huiqiong,Wu Hanjing Emily,Yin Guangzhong,Ning Yuping,Huang Xingbing,Teixeira Antonio L,de Quevedo João,Soares Jair C,Li Xiaosi,Lang XiaoE,Zhang Xiang Yang
RATIONALE AND OBJECTIVE:Schizophrenia displays sex differences in many aspects. Decreased brain-derived neurotrophic factor (BDNF) levels have been reported to be associated with high body weight or obesity as well as other psychopathological aspects in schizophrenia patients. This study aimed to explore sex differences in the relationship between serum BDNF levels and obesity in patients with chronic schizophrenia. METHODS:We recruited 132 Chinese patients with chronic schizophrenia (98 males and 34 females) and compared sex differences in the body mass index (BMI), obesity, serum BDNF levels, and their associations. Psychopathology symptoms were assessed using the Positive and Negative Syndrome Scale (PANSS). A regression model with various demographic and clinical variables was applied to predict the serum levels of BDNF. RESULTS:Female patients had a higher rate of obesity and higher BMI, but lower BDNF levels than male schizophrenia patients. A significantly negative correlation was observed between BMI and BDNF levels only in female patients but not in male patients. The multiple regression model with demographic and clinical variables significantly predicted BDNF levels only in female patients, with a medium size effect. And only in female patients, BMI made a significant contribution to this prediction. CONCLUSION:Our results indicate significant sex differences in the obesity, BMI, BDNF levels, and their association in chronic patients with schizophrenia, showing a significant inverse correlation between BMI and BDNF levels only in female patients. Thus, sex needs to be considered when assessing the relationship between BDNF and metabolic syndromes in schizophrenia.
Gender differences in the relationship of childhood trauma and the course of illness in schizophrenia.
Kocsis-Bogár Krisztina,Mészáros Veronika,Perczel-Forintos Dóra
INTRODUCTION:Different types of childhood trauma have been repeatedly shown to contribute to psychotic symptoms. Gender differences in schizophrenia are well known. Some studies argue that trauma history means a significantly higher risk of psychosis for women than men. However, there is evidence of early adverse life events to be associated with higher stress-sensitivity in men. Little is known about the connection of specific type of trauma and specific psychotic symptoms as well as the course of illness with explicit regard to gender differences. METHODS:102 men and women with schizophrenia spectrum disorder were tested using Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Scale for Assessing Positive Symptoms, Early Trauma Inventory-SR. RESULTS:Although, women had a later age at onset without regarding trauma history (d = 0.74), this difference became non-significant when introducing trauma variables. Patients reporting physical abuse had a significantly earlier age at onset, regardless of their sex (V = 0.13, F = 3.11, p = 0.03. Physical abuse predicted an earlier age at onset only in women (R = 0.23). History of general trauma predicted more frequent hospitalizations only in men (R = 0.55). CONCLUSIONS:Although women generally tend to have a more favorable course of illness including a later age at onset men, women with CPA seem to lose this "advantage". It is necessary to investigate the contribution of gender interacting with adverse life events in contribution to the phenomenology and etiology of schizophrenia.
Examining gender difference in adult-onset psychosis in Hong Kong.
Hui Christy L-M,Leung Chung-Ming,Chang Wing-Chung,Chan Sherry K-W,Lee Edwin H-M,Chen Eric Y-H
Early intervention in psychiatry
AIM:Gender-specific treatment strategies for psychosis have been suggested in recent years. Data on gender difference were largely consistent regarding premorbid functioning, age of onset and negative symptoms; however, results regarding neurocognitive function and duration of untreated psychosis were mixed and inconclusive. In this study, we aimed at a thorough examination on the gender differences in 360 Chinese patients with first-episode psychosis in Hong Kong. METHODS:From June 2009 to August 2011, participants were consecutively recruited from a population-based territory-wide study of early psychosis targeting first-episode psychosis in Hong Kong. Comprehensive data on basic demographics, premorbid functioning and schizoid and schizotypal traits, clinical, functioning, medication side effects and a battery of neurocognitive measures were collected upon entry into the service. RESULTS:In 360 patients with first-episode psychosis aged between 26 and 55 years, 43.6% (n = 157) were male and 56.4% (n = 203) were female. Males had poorer premorbid functioning and adjustment, earlier age of onset, more negative symptoms and poorer functioning in terms of work productivity, independent living and immediate social network relationships at presentation of first-episode psychosis. Interestingly, our data indicate that males tend to be more educated, and also characterized by higher IQ, better neurocognitive performance on visual domain compared with females. Duration of untreated psychosis was not different between the two genders. CONCLUSION:Data from this homogeneous cohort of Chinese populations enabled tailored and culturally sensitive recommendation on gender-specific treatment strategies, hence improving patients' care and facilitate better diagnostic and interventional decisions for patients with psychosis.
Gender difference in association of cognition with BDNF in chronic schizophrenia.
Zhang Xiang Yang,Chen Da-Chun,Tan Yun-Long,Tan Shu-Ping,Wang Zhi-Ren,Yang Fu-De,Xiu Mei-Hong,Hui Li,Lv Meng-Han,Zunta-Soares Giovana B,Soares Jair C
While numerous studies have reported that brain-derived neurotrophic factor (BDNF) may be involved in the pathophysiology of schizophrenia, very few studies have explored its association with cognitive impairment or gender differences in schizophrenia which we explored. We compared gender differences in 248 chronic schizophrenic patients (male/female=185/63) to 188 healthy controls (male/female=98/90) on the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and serum BDNF. Schizophrenic symptoms were assessed using the Positive and Negative Syndrome Scale (PANSS). Our results showed that schizophrenic patients performed worse than normals on most of the cognitive tasks, and male patients had significantly lower immediate memory and delayed memory scores than female patients. BDNF levels were significantly lower in patients than controls, and male patients had significantly lower BDNF levels than female patients. For the patients, BDNF was positively associated with immediate memory and the RBANS total score. Furthermore, these associations were only observed in female not male patients. Among healthy controls, no gender difference was observed in cognitive domains and BDNF levels, or in the association between BDNF and cognition. Our results suggest gender differences in cognitive impairments, BDNF levels and their association in chronic patients with schizophrenia. However, the findings should be regarded as preliminary due to the cross-sectional design and our chronic patients, which need replication in a first-episode and drug naïve patients using a longitudinal study.
Structure and correlates of self-reported empathy in schizophrenia.
Horan William P,Reise Steven P,Kern Robert S,Lee Junghee,Penn David L,Green Michael F
Journal of psychiatric research
Research on empathy in schizophrenia has relied on dated self-report scales that do not conform to contemporary social neuroscience models of empathy. The current study evaluated the structure and correlates of the recently-developed Questionnaire of Cognitive and Affective Empathy (QCAE) in schizophrenia. This measure, whose structure and validity was established in healthy individuals, includes separate scales to assess the two main components of empathy: Cognitive Empathy (assessed by two subscales) and Affective Empathy (assessed by three subscales). Stable outpatients with schizophrenia (n = 145) and healthy individuals (n = 45) completed the QCAE, alternative measures of empathy, and assessments of clinical symptoms, neurocognition, and functional outcome. Exploratory and confirmatory factor analyses provided consistent support for a two-factor solution in the schizophrenia group, justifying the use of separate cognitive and affective empathy scales in this population. However, one of the three Affective Empathy subscales was not psychometrically sound and was excluded from further analyses. Patients reported significantly lower Cognitive Empathy but higher Affective Empathy than controls. Among patients, the QCAE scales showed significant correlations with an alternative self-report empathy scale, but not with performance on an empathic accuracy task. The QCAE Cognitive Empathy subscales also showed significant, though modest, correlations with negative symptoms and functional outcome. These findings indicate that structure of self-reported empathy is similar in people with schizophrenia and healthy subjects, and can be meaningfully compared between groups. They also contribute to emerging evidence that some aspects of empathy may be intact or hyper-responsive in schizophrenia.
Executive functioning deficits and childhood trauma in juvenile violent offenders in China.
Zou Zhili,Meng Huaqing,Ma Zhongrui,Deng Wei,Du Lian,Wang Hui,Chen Pinhong,Hu Hua
A large body of evidence indicates that violent offenders have executive functioning deficits. However, previous studies have not considered childhood trauma, which is likely to influence the executive functioning of violent offenders. The aim of the present study was to compare the difference of executive functioning among juvenile violent offenders, with non-violent offenders and normal controls, and then to analyse whether executive functioning was affected independently of childhood trauma. In addition to using a battery of tests assessing executive functioning including the Intra/Extradimensional Shift Test(IED), the Stockings of Cambridge Test (SOC), and the Spatial Working Memory Test (SWM) from the Cambridge Automated Neuropsychological Testing Battery (CANTAB), the short form of the Chinese Revision of the Wechsler Adult Intelligence Scale (WAIS-RC) and Childhood Trauma Questionnaire-28 item Short Form (CTQ) were also used among 107 violent offenders, 107 non-violent offenders and 107 normal controls. Our results showed that both offender groups obtained significantly lower estimated Intelligence Quotient (IQ) scores and experienced more childhood trauma than did normal controls. Violent offenders showed impaired executive functioning on tasks of attention set-shifting, working memory and planning. Finally, spatial working memory (SWM) deficits, particularly SWM strategy scores, may be associated with childhood trauma.
Gender Differences in Child Abuse, Emotional Processing Difficulties, Alexithymia, Psychological Symptoms and Behavioural Problems among Chinese Adolescents.
Chung Man Cheung,Chen Zhuo Sheng
The Psychiatric quarterly
Child abuse among adolescents in China has been documented and can lead to a whole range of psychological and behavioural problems. This study examined whether male and female adolescents would differ in level of child abuse, emotional processing difficulties, alexithymia, psychological symptoms and behavioural problems, and whether the pattern of association between these variables would vary depending on gender. Eight hundred adolescents were recruited from China and completed the Childhood Trauma Questionnaire, Emotional Processing Scale, Toronto Alexithymia Scale, General Health Questionnaire, and Prediction Test of Problem Children. Male adolescents reported significantly higher levels of emotional and physical neglect, and external oriented thinking style than female adolescents. Females reported significantly more anxiety symptoms and problems with learning than males. For males, child abuse was associated with emotional processing difficulties which were associated with alexithymia. In turn, alexithymia was associated with both psychological and behavioural problems. For females, the same association was established for predicting behavioural problems but not psychological symptoms. Male and female adolescents differed in level of child abuse, alexithymia, psychological symptoms and behavioural problems. These psychological constructs were connected in a specific pattern to trigger psychological and behavioural problems for male adolescents whereas for females, different patterns were involved.
Influencing factors of alexithymia in Chinese medical students: a cross-sectional study.
Zhu Yaxin,Luo Ting,Liu Jie,Qu Bo
BMC medical education
BACKGROUND:A much higher prevalence of alexithymia has been reported in medical students compared with the general population, and alexithymia is a risk factor that increases vulnerability to mental disorders. Our aim was to evaluate the level of alexithymia in Chinese medical students and to explore its influencing factors. METHODS:A cross-sectional study of 1,950 medical students at Shenyang Medical College was conducted in May 2014 to evaluate alexithymia in medical students using the Chinese version of the 20-item Toronto Alexithymia Scale (TAS-20). The reliability of the questionnaire was assessed by Cronbach's α coefficient and mean inter-item correlations. Confirmatory factor analysis (CFA) was used to evaluate construct validity. The relationships between alexithymia and influencing factors were examined using Student's t-test, analysis of variance, and multiple linear regression analysis. Statistical analysis was performed using SPSS 21.0. RESULTS:Of the 1,950 medical students, 1,886 (96.7%) completed questionnaires. Overall, Cronbach's α coefficient of the TAS-20 questionnaire was 0.868. The results of CFA showed that the original three-factor structure produced an acceptable fit to the data. By univariate analysis, gender, grade (academic year of study), smoking behavior, alcohol use, physical activity, history of living with parents during childhood, and childhood trauma were influencing factors of TAS-20 scores (p < 0.05). Multiple linear regression analysis showed that gender, physical activity, grade, living with parents, and childhood trauma also had statistically significant association with total TAS-20 score (p < 0.05). CONCLUSIONS:Gender, physical activity, grade, history of living with parents during childhood, and childhood trauma were all factors determining the level of alexithymia. To prevent alexithymia, it will be advisable to promote adequate physical activity and pay greater attention to male medical students and those who are in the final year of training.
Trauma and dissociation in China.
Xiao Zeping,Yan Heqin,Wang Zhen,Zou Zheng,Xu Yong,Chen Jue,Zhang Haiyin,Ross Colin A,Keyes Benjamin B
The American journal of psychiatry
OBJECTIVE:In order to determine whether pathological dissociation occurs in China, the authors conducted a survey among psychiatric inpatients, outpatients, and the general population in Shanghai, China. There is virtually no popular or professional knowledge of dissociative identity disorder in China, and therefore professional and popular contamination cannot exist. METHOD:Chinese versions of the Dissociative Experiences Scale and the Dissociative Disorders Interview Schedule were administered to 423 inpatients, 304 outpatients, and 618 factory workers in Shanghai by Chinese psychiatrists working at the Shanghai Mental Health Center. RESULTS:Dissociative disorders were diagnosed in 24 respondents by structured interview, and 15 respondents fell into the dissociative taxon on the Dissociative Experiences Scale. The outpatients reported the highest rates of childhood physical and/or sexual abuse and of pathological dissociation. CONCLUSIONS:Pathological dissociation can be detected readily among psychiatric outpatients in China but is much less common in the general population. Pathological dissociation is more frequent in more traumatized subsamples of the Chinese population. The findings are not consistent with the sociocognitive, contamination, or iatrogenic models of dissociative identity disorder.
Translation and validation of the Chinese ICD-11 International Trauma Questionnaire (ITQ) for the Assessment of Posttraumatic Stress Disorder (PTSD) and Complex PTSD (CPTSD).
Ho Grace W K,Karatzias Thanos,Cloitre Marylene,Chan Athena C Y,Bressington Daniel,Chien Wai Tong,Hyland Philip,Shevlin Mark
European journal of psychotraumatology
: Two stress-related disorders have been proposed for inclusion in the revised ICD-11: Posttraumatic Stress Disorder (PTSD) and Complex PTSD (CPTSD). The International Trauma Questionnaire (ITQ) is a bespoke measure of PTSD and CPTSD and has been widely used in English-speaking countries. : The primary aim of this study was to develop a Chinese version of the ITQ and assess its content, construct, and concurrent validity. : Six mental health practitioners and experts rated the Chinese translated and back-translated items to assess content validity. A sample of 423 Chinese young adults completed the ITQ, the WHO Adverse Childhood Experiences International Questionnaire, and the Hospital Anxiety and Depression Scale. Among them, 31 participants also completed the English and Chinese versions of the ITQ administered in random order at retest. Four alternative confirmatory factor analysis models were tested using data from participants who reported at least one adverse childhood experience (ACE; N = 314). : The Chinese ITQ received excellent ratings on relevance and appropriateness. Test-retest reliability and semantic equivalence across English and Chinese versions were acceptable. The correlated first-order six-factor model and a second-order two-factor (PTSD and DSO) both provided an acceptable model fit. The six ITQ symptoms clusters were all significantly correlated with anxiety, depression, and the number of ACEs. : The Chinese ITQ generates scores with acceptable psychometric properties and provides evidence for including PTSD and CPTSD as separate diagnoses in ICD-11.
Comparison of first-episode and chronic patients diagnosed with schizophrenia: symptoms and childhood trauma.
Wang Zheng,Xue Zhimin,Pu Weidan,Yang Bo,Li Li,Yi Wenyin,Wang Peng,Liu Chang,Wu Guowei,Liu Zhening,Rosenheck Robert A
Early intervention in psychiatry
AIM:There has been considerable interest in identifying and addressing the specific needs of early-episode patients diagnosed with schizophrenia in the hope that by addressing such needs early, chronic disabilities can be avoided. METHODS:One hundred twenty-eight early-episode and 571 chronic patients were compared on socio-demographic characteristics, clinical symptoms and history of childhood trauma. Symptoms were measured with the Positive and Negative Syndrome Scale (PANSS), and trauma with the short version of the Childhood Trauma Questionnaire. RESULTS:First-episode patients scored 9.3% higher than chronic patients on the PANSS positive symptom scale and 16.3% lower on the negative symptom scale. More first episode patients reported childhood sexual abuse (P = 0.033); however, fewer reported childhood emotional neglect (P = 0.01). Childhood trauma was associated with positive symptoms, specifically with hallucinations in first-episode patients (r = 0.174; P = 0.049). Moreover, fewer parents of first episode patients were living alone (P = 0.008). On multiple logistic regression, the first-episode patients were younger (odds ratio = 0.92), had higher PANSS positive symptom scores (odds ratio 1.04) and lower negative symptom scores (odds ratio 0.948 recalculate). CONCLUSIONS:More positive symptoms, fewer negative symptoms, less isolated parents and greater risk of childhood sexual abuse might warrant attention in first episode schizophrenia and perhaps should be a focus for the development of targeted interventions.
Stigma and discrimination experienced by people with schizophrenia living in the community in Guangzhou, China.
Li Jie,Guo Yang-Bo,Huang Yuan-Guang,Liu Jing-Wen,Chen Wen,Zhang Xiang-Yang,Evans-Lacko Sara,Thornicroft Graham
The aims of this study were to investigate experienced stigma and discrimination and their associated factors in people with schizophrenia who live in the community in Guangzhou, China. A total of 384 people with schizophrenia were randomly recruited from four districts of Guangzhou and completed the scales and questionnaires: Internalized Stigma of Mental Illness scale (ISMI), Self-Esteem Scale (SES), Discrimination and Stigma Scale (DISC-12), Brief Psychiatric Rating Scale (BPRS), PANSS negative scale (PANSS-N), Global Assessment of Functioning (GAF) and Schizophrenia Quality of Life Scale (SQLS). Insight and medication compliance were evaluated by psychiatrists. Data were analyzed by using descriptive statistics, Pearson correlation and multivariable linear regression. We found a significant positive correlation between BPRS score and PANSS-N score, GAF score was significantly negative correlated with SQLS score, Insight score was significantly negative correlated with medication compliance score, ISMI score was significantly positive correlated with SES score and experienced discrimination score. Multivariable linear regression found SQLS, SES and experienced discrimination were the main independent variables of ISMI and experienced discrimination was the most important factor of ISMI. Our findings suggest that people with schizophrenia often experienced stigma and discrimination in this Chinese population, and more anti-stigma interventions should be provided.
A cross-sectional study on perception of stigma by Chinese schizophrenia patients.
Ren Zhibin,Wang Heqiu,Feng Bin,Gu Chenyu,Ma Yongchun,Chen Hong,Li Bingling,Liu Lanying
Neuropsychiatric disease and treatment
OBJECTIVE:In this cross-sectional study, we sought to assess the extent of internalized stigma among inpatients and outpatients with schizophrenia in the People's Republic of China and to investigate whether education level correlated with the experience of stigma. METHODS:Schizophrenia patients were evaluated using the Brief Psychiatric Rating Scale (BPRS), the Positive and Negative Syndrome Scale (PANSS), the Clinical Global Impressions-Severity of Illness (CGI-S) scale and the Stigma Scale for Mental Illness (SSMI-C). Patients were categorized into high education and low education groups, according to their educational levels. RESULTS:One hundred thirty-three subjects were included in the study. Their mean course of illness was 4.32±6.14 years (range: 1 month to 15 years). Their mean BPRS score was 19.87±5.46, their mean PANSS score was 44.11±13.1, and their mean CGI-S score was 2.22±0.81. In addition, their mean SSMI-C score was 6.49±0.9. The mean SSMI-C score of patients who have received high school education or above was 7.15±0.98, which was markedly higher than that of patients who have received middle school education or below, which was 5.75±0.79 (P<0.05). Before the study most patients (92.5%, 123/133) took atypical drugs. CONCLUSION:Education level impacts on the perception of stigma by schizophrenia patients, and more psychoeducation should be undertaken to improve patients' knowledge about schizophrenia.
Predictors of quality of life among Chinese people with schizophrenia.
Wang Xiao Qin,Petrini Marcia A,Morisky Donald E
Nursing & health sciences
This study was designed to investigate the association of quality of life, perceived stigma, and medication adherence among Chinese patients with schizophrenia, and to ascertain the predictors of quality of life. A cross-sectional correlation study was conducted with 146 participants. All participants completed self-report scales: the Schizophrenia Quality of Life Scale, Link's Stigma Scale, and the Morisky Medication Adherence Scale. Pearson parametric correlations and stepwise multiple regressions were performed. The total quality of life score and psychosocial subscale was significantly positively correlated with perceived stigma, coping orientation of withdrawal, and feelings of stigma, and negatively correlated with age and medication adherence. The means of all subscale scores except perceived devaluation-discrimination and different/guilty feelings were significantly higher than the midpoint of 2.5. The best predictors of quality of life and psychosocial domains were stigma-related feelings: feeling misunderstood, feeling different/shame, and age. Our findings suggest that an individual's negative emotional response may strengthen internalized stigma and decrease quality of life. As the best predictor, age indicated that adaptation to mental illness may relieve perceived stigma and achieve favorable quality of life.
Prediction of self-stigma in early psychosis: 3-Year follow-up of the randomized-controlled trial on extended early intervention.
Ho Ryan Wui Hang,Chang Wing Chung,Kwong Vivian Wing Yan,Lau Emily Sin Kei,Chan Gloria Hoi Kei,Jim Olivia Tsz Ting,Hui Christy Lai Ming,Chan Sherry Kit Wa,Lee Edwin Ho Ming,Chen Eric Yu Hai
BACKGROUND:Self-stigma represents a major barrier to recovery in people with psychotic disorders but is understudied in early illness stage. Longitudinal investigation of prediction for self-stigma is scarce and none is conducted in early psychosis. We aimed to prospectively examine baseline predictors of self-stigma in early psychosis patients in the context of a 3-year follow-up of a randomized-controlled trial (RCT) comparing 1-year extension of early intervention (EI) with step-down psychiatric care for first-episode psychosis (FEP). METHOD:One hundred sixty Chinese patients were recruited from a specialized EI program for FEP in Hong Kong after they had completed this 2-year EI service, and underwent a 12-month RCT. Participants were followed up and reassessed 3years after inclusion to the trial. Comprehensive evaluation encompassing clinical, functional, subjective quality of life and treatment-related variables were conducted. Data analysis was based on 136 participants who completed self-stigma assessment at 3-year follow-up. RESULTS:Fifty patients (36.8%) had moderate to high levels of self-stigma at 3-year follow-up. Multivariate regression analysis revealed that female gender, prior psychiatric hospitalization, longer duration of untreated psychosis and greater positive symptom severity at study intake independently predicted self-stigma at the end of 3-year study period. CONCLUSION:Our results of more than one-third of early psychosis patients experienced significant self-stigma underscore the clinical needs for early identification and intervention of self-stigmatization in the initial years of psychotic illness. Further research is warranted to clarify prediction profile and longitudinal course of self-stigma in the early illness phase.
Experienced stigma and self-stigma in Chinese patients with schizophrenia.
Lv Ying,Wolf Achim,Wang Xiaoping
General hospital psychiatry
OBJECTIVE:To investigate experienced stigma and self-stigma in patients with schizophrenia in mainland China. METHODS:Ninety-five patients with schizophrenia, enrolled between January 2011 and March 2011, completed Chinese versions of two self-report questionnaires: the Internalized Stigma of Mental Illness (ISMI) scale and the Modified Consumer Experiences of Stigma Questionnaire (MCESQ). They also completed two other self-report questionnaires: the Social Support Rating Scale (SSRS) and the World Health Organization Quality of Life (WHOQOL-BREF) questionnaire. Patients were also assessed by a senior psychiatrist using the Scale for Assessment of Positive Symptoms (SAPS) and the Scale for Assessment of Negative Symptoms (SANS). All analyses were performed using SPSS 17.0 and included descriptive statistics, correlation analysis and multiple linear regression. RESULTS:On the ISMI, the percentage of participants who rated themselves above the mid-point of 2.5 (meaning high level of self-stigma) on subscales and overall score was 44.2% (n=42) for alienation, 14.7% (n=14) for stereotype endorsement, 25.3% (n=24) for perceived discrimination, 32.6% (n=31) for social withdrawal and 20.0% (n=19) on the overall score. On the MCESQ, the percentage of participants who rated themselves above the mid-point of 3.0 on subscales and overall score was 24.2% (n=23) for stigma, 1.1% (n=1) for discrimination and 1.1% (n=1) on the overall score. Some socioeconomic variables, but not positive or negative symptoms, were related to the severity of psychiatric stigma. CONCLUSIONS:Results document the seriousness of experienced stigma and self-stigma in persons with schizophrenia. Strategies are needed to improve how governments and persons with schizophrenia cope with stigma.
Executive function impairments in depression and bipolar disorder: association with functional impairment and quality of life.
Cotrena Charles,Branco Laura Damiani,Shansis Flávio Milman,Fonseca Rochele Paz
Journal of affective disorders
BACKGROUND:The neuropsychological correlates of major depressive (MDD) and bipolar disorder (BD), and their association with quality of life (QOL) and functioning, have not been sufficiently studied in the literature. The present study aimed to compare executive functions, attention, processing speed, QOL and disability between patients with BD type I, BD type II, MDD and healthy controls. METHOD:205 participants (n=37 BDI, 81% female; n=35 BDII, 80% female; n=45 MDD, 69% female; n=89C, 46% female) aged between 18 and 67 years were administered an extensive neurocognitive battery consisting of widely used standardized measures such as the Trail Making Test, the Stroop Color-Word Test and a modified version of the Wisconsin Card Sorting Task. Z-scores were compared between groups by ANCOVA. The prevalence of impairments on each measure (Z-score<1.5) was compared between groups using chi-square tests. The associations between cognition, quality of life and functioning were evaluated through correlational analysis. RESULTS:Patients with MDD showed poor selective and sustained attention, and exhibited impairments in timed tasks, suggesting low efficiency of executive processing. Patients with BDI displayed more widespread cognitive impairment than the remaining groups, and performed worse than subjects with MDD on measures of sustained attention and inhibitory control. Decision-making ability and attentional control were able to distinguish between patients with BDI and BDII. QOL and disability were most impaired in patients with BDI, and more closely associated with cognitive impairment than in the remaining groups. LIMITATIONS:No control of pharmacological variables, clinical or demographic characteristics. CONCLUSIONS:Our results provide important information regarding the nature and severity of the cognitive alterations associated with different mood disorders, and may contribute to the diagnosis, rehabilitation and treatment of these conditions.
Evaluation Of Subjective Cognitive Function Using The Cognitive Complaints In Bipolar Disorder Rating Assessment (COBRA) In Japanese Adults.
Toyoshima Kuniyoshi,Inoue Takeshi,Masuya Jiro,Ichiki Masahiko,Fujimura Yota,Kusumi Ichiro
Neuropsychiatric disease and treatment
Purpose:To examine the relationship between depressive symptoms, subjective cognitive function, and quality of life in Japanese adults using the Cognitive Complaints in Bipolar Disorder Rating Assessment (COBRA). Patients and methods:We evaluated 585 adult community volunteers using the Patient Health Questionnaire-9 (PHQ-9) for evaluation of depressive symptoms and the COBRA for evaluation of subjective cognitive function. We additionally used the 8-item Short-Form Health Survey and the Sheehan Disability Scale to evaluate the quality of life (QoL). Results:Measures of subjective cognitive function were significantly correlated with depressive symptoms and QoL. Structural equation modeling demonstrated that depressive symptoms directly and indirectly decreased QoL via their effects on subjective cognitive dysfunction. Measures of depressive symptoms were more closely related to QoL than were measures of subjective cognitive function. Limitations:Study participants were general adult population community volunteers and included healthy people; thus, these results may not be generalizable to patients with depression or bipolar disorder. In addition, the cross-sectional design of this study prevented the identification of causal relationships among the parameters. Conclusion:Changes in subjective cognitive function may affect QoL via depressive symptoms. Evaluations of subjective cognitive function may help identify factors that reduce QoL.
Associations between cognitive impairment and quality of life in euthymic bipolar patients.
Toyoshima Kuniyoshi,Kako Yuki,Toyomaki Atsuhito,Shimizu Yusuke,Tanaka Teruaki,Nakagawa Shin,Inoue Takeshi,Martinez-Aran Anabel,Vieta Eduard,Kusumi Ichiro
During the euthymic state in bipolar disorder, cognitive functions often remain affected. Specifically, subjective and objective cognitive impairment might distinctly affect patients' quality of life (QoL); however, this question had not been examined previously in Japanese patients. Therefore, the current study investigated the associations between cognitive complaints, QoL, and objective cognitive functions. Forty patients in remission were recruited from the Hokkaido University Hospital, Sapporo, Japan and assessed with the translated version of the cognitive complaints in bipolar disorder rating assessment (COBRA), medical outcomes study 36-item short-form health survey version 2 (SF-36v2), and Sheehan disability scale (SDS). The Japanese adult reading scale, Wisconsin card sorting test, word fluency, continuous performance test, trail making test (TMT), auditory verbal learning, and Stroop test evaluated objective cognitive functions. Significant correlations were observed between the COBRA, SF-36v2, and SDS results, as well as the TMT scores. Overall, euthymic patients were aware of their cognitive dysfunction, which could be understood in relation to the decrease in satisfaction in their daily life. Therefore, even mild cognitive impairments can have ramifications for patients in the euthymic state of bipolar disorder.
Subjective neurocognition and quality of life in patients with bipolar disorder and siblings.
Tatay-Manteiga Amparo,Cauli Omar,Tabarés-Seisdedos Rafael,Michalak Erin E,Kapczinski Flavio,Balanzá-Martínez Vicent
Journal of affective disorders
BACKGROUND:Bipolar disorder (BD) is associated with significant neurocognitive and functional impairment, which may progress across stages. However, the potential progression of subjective cognitive complaints and quality of life (QoL) has not been addressed. Our main objective was to assess subjective cognitive complaints and QoL on euthymic patients with BD and their healthy siblings. METHODS:Four groups were compared: euthymic patients with type I BD in the early (n = 25) and late (n = 23) stages, their healthy siblings (latent stage; n = 23) and healthy controls (n = 21). Cognitive complaints and QoL were assessed using the COBRA and WHO-QoLBREF questionnaires, respectively. RESULTS:Late-stage patients had greater number of subjective cognitive complaints and reported a worse QoL compared to the other groups. Early-stage patients also had more cognitive complaints than controls and siblings, although differences were not significant. Siblings and controls reported similar QoL. LIMITATIONS:the most important limitation of this study is the criterion used to define the early and late stages of BD, as currently there is no consensus and previous studies have used different criteria. CONCLUSIONS:This is the first study to examine subjective cognition and QoL in patients with BD and siblings. Our results raise the possibility that burden of cognitive complaints increase with disorder progression, in tandem with deterioration in subjective QoL. That would support a clinical staging model of BD. This hypothesis remains to be confirmed by a longitudinal analysis.
Validity and reliability of the Brief version of Quality of Life in Bipolar Disorder" (Bref QoL.BD) among Chinese bipolar patients.
Xiao Lin,Gao Yulin,Zhang Lili,Chen Peiyun,Sun Xiaojia,Tang Siyuan
Journal of affective disorders
BACKGROUND:Previous literatures on quality of life (QoL) in bipolar disorder (BD) strongly suggested that a disease-specific QoL measure for patients with BD should be developed to evaluate QoL more specifically and reliably. To our knowledge, "Quality of Life in Bipolar Disorder" (QoL.BD) is the first and only questionnaire produced to specifically measure QoL in people with BD. In China, there is no disease-targeted measure available to specifically measure QoL in Chinese patients with BD. OBJECTIVE:The aim of the study is to revise and validate the brief version of the QoL.BD (Bref QoL.BD ) into Chinese version. METHODS:All the items of the Bref QoL.BD was translated into Chinese language, using the Brislin translation mode. The questionnaire was administered to a total sample of 231 subjects, including 101 BD patients and 130 healthy controls, to test the psychometric properties of Bref QoL.BD (e.g. internal consistency, retest reliability, content validity, item analysis, confirmatory factor analysis, criterion validity, convergent validity, discriminative validity and feasibility). RESULTS:The Chinese version of the Bref QoL.BD had very high internal consistency (Cronbach's alpha=0.815) and retest reliability (intraclass correlation coefficient (ICC )=0.808). Confirmatory factor analysis (CFA) validated the original one-factor structure. The direction and magnitude of correlations with 36-item Short-Form Health Survey (SF-36; rs= 0.313, P<0.001) and 17-Hamilton Depression Rating Scale(HAMD; rs=-0.328, P <0.001) suggesting the criterion validity and convergent validity, respectively. The scores of Bref QoL.BD in subsyndromic BD group (HDRS≥4 and BRMS≥3), asymptomatic BD group (HDRS≤3 and BRMS≤2) and the control group significantly decreased successively, suggesting a discriminative validity of the instrument. LIMITATIONS:Cross-sectional design and a small sample size from only one tertiary care center. And BD patients enrolled were euthymic, excluding the acute BD patients. CONCLUSIONS:The Chinese version of the Bref QoL.BD is a feasible, reliable and valid tool for the assessment of QoL for Chinese BD patients.
Quality of life in bipolar disorder: towards a dynamic understanding.
Morton E,Murray G,Michalak E E,Lam R W,Beaulieu S,Sharma V,Cervantes P,Parikh S V,Yatham L N
BACKGROUND:Although quality of life (QoL) is receiving increasing attention in bipolar disorder (BD) research and practice, little is known about its naturalistic trajectory. The dual aims of this study were to prospectively investigate: (a) the trajectory of QoL under guideline-driven treatment and (b) the dynamic relationship between mood symptoms and QoL. METHODS:In total, 362 patients with BD receiving guideline-driven treatment were prospectively followed at 3-month intervals for up to 5 years. Mental (Mental Component Score - MCS) and physical (Physical Component Score - PCS) QoL were measured using the self-report SF-36. Clinician-rated symptom data were recorded for mania and depression. Multilevel modelling was used to analyse MCS and PCS over time, QoL trajectories predicted by time-lagged symptoms, and symptom trajectories predicted by time-lagged QoL. RESULTS:MCS exhibited a positive trajectory, while PCS worsened over time. Investigation of temporal relationships between QoL and symptoms suggested bidirectional effects: earlier depressive symptoms were negatively associated with mental QoL, and earlier manic symptoms were negatively associated with physical QoL. Importantly, earlier MCS and PCS were both negatively associated with downstream symptoms of mania and depression. CONCLUSIONS:The present investigation illustrates real-world outcomes for QoL under guideline-driven BD treatment: improvements in mental QoL and decrements in physical QoL were observed. The data permitted investigation of dynamic interactions between QoL and symptoms, generating novel evidence for bidirectional effects and encouraging further research into this important interplay. Investigation of relevant time-varying covariates (e.g. medications) was beyond scope. Future research should investigate possible determinants of QoL and the interplay between symptoms and wellbeing/satisfaction-centric measures of QoL.
Prevalence of smoking in patients with bipolar disorder, major depressive disorder and schizophrenia and their relationships with quality of life.
Li Xiao-Hong,An Feng-Rong,Ungvari Gabor S,Ng Chee H,Chiu Helen F K,Wu Ping-Ping,Jin Xin,Xiang Yu-Tao
Few studies have compared the prevalence of smoking between patients with bipolar disorder, major depressive disorder (MDD) and schizophrenia. This study examined the prevalence of smoking and its relationships with demographic and clinical characteristics, and quality of life (QOL) in patients with these psychiatric disorders. A total of 1,102 inpatients were consecutively screened. Psychopathology and QOL were measured with standardized instruments. The prevalence of current smoking in the whole sample was 16.7%; 17.5% in bipolar disorder, 10.6% in MDD and 18.5% in schizophrenia. The rates of smoking in bipolar disorder (p = 0.004, OR = 2.5, 95%CI: 1.3-4.7) and schizophrenia (p = 0.03, OR = 2.0, 95%CI: 1.06-3.8) were significantly higher than in MDD, while no difference was found between bipolar disorder and schizophrenia. Smokers had a higher mental QOL than non-smokers (p = 0.007) in MDD, but no difference was found in the other two groups. Male gender, living alone, higher personal income, older age of onset, health insurance coverage, and first episode was significantly associated with smoking in one or more diagnostic groups. Smoking appears more common in bipolar disorder and schizophrenia than in MDD in China. The figures in all disorders were lower than that reported in most of other countries.
Religiosity, mood symptoms, and quality of life in bipolar disorder.
Stroppa André,Moreira-Almeida Alexander
OBJECTIVES:The aim of the present study was to investigate the relationship between religiosity and mood, quality of life, number of hospitalizations, and number of severe suicide attempts among bipolar disorder patients. METHODS:In a cross-sectional study of bipolar disorder outpatients (N = 168), we assessed symptoms of mania [Young Mania Rating Scale (YMRS)], depression [Montgomery-Åsberg Depression Rating Scale (MADRS)], religiosity (Duke Religious Index), religious coping (Brief RCOPE), and quality of life [World Health Organization Quality of Life-Brief Version (WHOQOL-BREF)]. Sociodemographic data, number of suicide attempts, and number of hospitalizations were obtained through an interview with the individual and analysis of the patient's medical records. Logistical and linear regressions of the association between the religious indicators and clinical variables were conducted, controlling for sociodemographic variables. RESULTS:A total of 148 (88.1%) individuals reported some type of religious affiliation. Intrinsic religiosity [odds ratio (OR) = 0.19, 95% confidence interval (CI): 0.06-0.57, p = 0.003] and positive religious coping strategies (OR = 0.25, CI: 0.09-0.71, p = 0.01) were associated with fewer depressive symptoms. All four domains of quality of life were directly and significantly correlated with intrinsic religiosity. Positive religious coping was correlated with higher levels of the psychological (β = 0.216, p = 0.002) and environmental (β = 0.178, p = 0.028) quality-of-life domains. Negative religious coping was associated with lower scores on the psychological domain of quality of life (β = -0.182, p = 0.025). CONCLUSIONS:Intrinsic religiosity and positive religious coping are strongly associated with fewer depressive symptoms and improved quality of life. Negative religious coping is associated with worse quality of life. Religiosity is a relevant aspect of patients' lives and should be taken into consideration by physicians when assessing and managing bipolar disorder patients. Further longitudinal studies are needed to determine the causality and therapeutic implications of our findings.
The relationship between cognitive function and quality of life in euthymic Chinese patients with bipolar disorder.
Xiao Lin,Gao Yulin,Zhang Lili,Chen Peiyun,Sun Xiaojia
This study aimed to identify the relationship between cognitive function and quality of life (QOL) in Chinese patients with bipolar disorder (BD) in the remission stage, by adopting disease-specific instruments. The remission stage was assessed using the Hamilton Depression Rating Scale (HAMD) and the Bech-Rafaelsen Mania Rating Scale (BRMS). One hundred euthymic bipolar patients and 115 healthy controls completed the "cognitive complaints in bipolar disorder rating assessment"(COBRA), Montreal Cognitive Assessment scale (MoCA), and "Brief version of Quality of Life in Bipolar Disorder" (Bref QOL.BD), which were used to assess the subjective cognitive function, objective cognitive function, and QOL, respectively. Compared to the healthy controls, the patient group had significantly lower total scores on both MoCA and Brief QOL.BD, and higher total score of COBRA. After controlling the influence of mood symptoms (HAMD and BRMS), both objective (MoCA) and subjective (COBRA) cognitive function could predict QOL significantly when entered either separately or simultaneously into hierarchical multiple regression models. When entered simultaneously, cognitive function explained 21% of the variance in QOL. The findings indicated that both objective and subjective cognitive function could influence QOL in euthymic bipolar patients, so continuous cognitive-improving interventions could help euthymic bipolar patients improve their QOL.
Correlation between depression/anxiety symptom severity and quality of life in patients with major depressive disorder or bipolar disorder.
Gao Keming,Su Meilei,Sweet Jennifer,Calabrese Joseph R
Journal of affective disorders
OBJECTIVE:To study the correlation between depression/anxiety severity and the quality of life (QOL) in patients with major depressive disorder (MDD) or bipolar disorder (BP). METHODS:Two hundred forty-three outpatients diagnosed with MDD or BP were used to study the relationship between depression/anxiety severity and QOL. Depression and anxiety symptom-severity were measured with the QIDS-16-SR (the 16 Item Quick Inventory of Depressive Symptomatology - Self Report), and Zung-SAS (Zung Self-Rating Anxiety Scale). The QOL was measured with the Q-LES-Q short-form (the Quality of Life, Enjoyment and Satisfaction Questionnaire). Correlation was assessed with regression analysis. RESULTS:The percentage of maximum possible scores (MPS) of Q-LES-Q was 72.1%, 70.5%, and 67.6% for euthymic MDD, BPI, and BPII, respectively. Increases in QIDS-16-SR total scores significantly correlated to decreases in Q-LES-Q total scores, with an R = 0.61, R = 0.52, and R = 0.45 for MDD, BPI, and BPII, respectively. Increases in Zung-SAS scores also significantly correlated to decreases in Q-LES-Q total scores with an R = 0.20, R = 0.21, and R = 0.12 for MDD, BPI, and BPII. However, after controlling for depression severity, significant differences between Q-LES-Q and Zung-SAS scores disappeared in MDD and BP. After controlling for anxiety and other clinical variables, the negative correlation between QIDS-16-SR and Q-LES-Q scores remained significant in MDD and BP. CONCLUSIONS:In this outpatient sample, the MPS of Q-LES-Q in euthymic MDD and BP patients was at the lower end of non-psychiatric or medical community norm spectrum. Depression severity was the only independent variable negatively correlated to the QOL in both disorders.
Higher cardio-respiratory fitness is associated with increased mental and physical quality of life in people with bipolar disorder: A controlled pilot study.
Vancampfort Davy,Hagemann Noemi,Wyckaert Sabine,Rosenbaum Simon,Stubbs Brendon,Firth Joseph,Schuch Felipe B,Probst Michel,Sienaert Pascal
The aim of this study was to investigate whether cardiorespiratory fitness among outpatients with bipolar disorder is associated with health related quality of life (HRQL) and explore differences versus healthy controls. Outpatients with bipolar disorder and healthy controls matched for age, sex and body mass index completed the 36-item Short Form Health Survey, the Positive-and-Negative-Affect-Schedule (PANAS), a maximal cardiorespiratory fitness test, and wore a Sensewear Armband to measure physical activity and sedentary behavior for eight days. Unpaired t-tests, Pearson correlations and backward regression analyses were performed. Outpatients with bipolar disorder (n = 20; 14♀; 47.9 ± 7.9 years) had a significantly lower physical and mental HRQL than healthy controls (n = 20; 14♀; 47.8 ± 7.6 years), a lower maximum oxygen uptake (VOmax) and were more sedentary. While no significant correlates were found for HRQL in controls, higher VOmax values and lower PANAS negative affect scores predicted better physical and mental HRQL in people with bipolar disorder. The final regression model explained 68% and 58% of the variability in physical and mental HRQL respectively. Cardiorespiratory fitness is associated with mental and physical HRQL among people with bipolar disorder. The current study offers novel targets for scientific investigation and clinical interventions to increase HRQL in people with bipolar disorder.
Elevated mirror neuron system activity in bipolar mania: Evidence from a transcranial magnetic stimulation study.
Basavaraju Rakshathi,Mehta Urvakhsh M,Pascual-Leone Alvaro,Thirthalli Jagadisha
OBJECTIVES:The role of the "mirror neuron system" (MNS) in the pathophysiology of mood disorders is not well studied. Given its posited role in the often-impaired socio-emotional processes like intention detection, empathy, and imitation, we compared putative MNS-activity in patients with bipolar mania and healthy comparison subjects. We also examined the association between putative MNS-activity and hyper-imitative behaviors in patients. METHODS:We studied 39 medication-free individuals diagnosed with mania and 45 healthy comparison subjects. TMS-evoked motor cortical reactivity was measured via single- and paired-pulse stimuli (assessing SICI-short and LICI-long interval intracortical inhibition) while subjects viewed a static image and goal-directed actions. Manic symptom severity and imitative behaviors were quantified using the Young's Mania Rating Scale and a modification of the Echolalia Questionnaire. RESULTS:Two-way repeated measures analysis of variance demonstrated a significant group ×time interaction effect indicating greater facilitation of cortical reactivity during action-observation (putative MNS-activity) in the patient group as compared to the healthy group. While LICI-mediated MNS-activity had a significant association with manic symptom severity (r = 0.35, P = 0.038), SICI-mediated MNS-activity was significantly associated with incidental echolalia scores in a subgroup of 17 patients with incidental echolalia (r = 0.75, P < 0.001). CONCLUSIONS:Our findings demonstrate that putative MNS-activity is heightened in mania, possibly because of disinhibition, and associated with behavioral consequences (incidental echolalia).
Neurophysiological and Psychological Predictors of Social Functioning in Patients with Schizophrenia and Bipolar Disorder.
Kim Yourim,Kwon Aeran,Min Dongil,Kim Sungkean,Jin Min Jin,Lee Seung-Hwan
OBJECTIVE:The aim of this study is to examine social functioning in patients with schizophrenia and bipolar disorder and explore the psychological and neurophysiological predictors of social functioning. METHODS:Twenty-seven patients with schizophrenia and thirty patients with bipolar disorder, as well as twenty-five healthy controls, completed measures of social functioning (questionnaire of social functioning), neurocognition (Verbal fluency, Korean-Auditory Verbal Learning Test), and social cognition (basic empathy scale and Social Attribution Task-Multiple Choice), and the childhood trauma questionnaire (CTQ). For neurophysiological measurements, mismatch negativity and heart rate variability (HRV) were recorded from all participants. Multiple hierarchical regression was performed to explore the impact of factors on social functioning. RESULTS:The results showed that CTQ-emotional neglect significantly predicted social functioning in schizophrenia group, while HRV-high frequency significantly predicted social functioning in bipolar disorder patients. Furthermore, emotional neglect and HRV-HF still predicted social functioning in all of the subjects after controlling for the diagnostic criteria. CONCLUSION:Our results implicated that even though each group has different predictors of social functioning, early traumatic events and HRV could be important indicators of functional outcome irrespective of what group they are.
Altered self-report of empathic responding in patients with bipolar disorder.
Cusi Andrée,Macqueen Glenda M,McKinnon Margaret C
Despite evidence of impairments in social cognition in patients with bipolar disorder (BD), systematic investigations of empathic responding in this population have not been conducted. The objectives of the current study were to investigate empathic responding in patients with BD in varying states of illness and to determine whether course of illness variables and symptom severity predicted responding. Twenty well-characterized patients with BD and 20 matched healthy control subjects completed the Interpersonal Reactivity Index (IRI) and the Social Adjustment Scale Self-Report (SAS-SR), self-report measures of cognitive and emotional empathy and of psychosocial functioning, respectively. Patients with BD reported significantly reduced levels of cognitive empathy ('Perspective Taking') and higher levels of personal distress in response to others' negative experiences than did controls. Altered affective empathic abilities correlated significantly with reduced psychosocial functioning in family, social and occupational domains and with increased symptom severity. This study provides preliminary evidence of alterations in empathic responding in patients with BD. Alterations in the ability to adopt the perspective of others may contribute to the difficulties in social communication inherent in this patient population. Additional studies, involving larger samples, are required to determine the contribution of social cognitive performance to impaired social functioning in BD.
The Reciprocal Relationship between Bipolar Disorder and Social Interaction: A Qualitative Investigation.
Owen Rebecca,Gooding Patricia,Dempsey Robert,Jones Steven
Clinical psychology & psychotherapy
BACKGROUND:Evidence suggests that social support can influence relapse rates, functioning and various clinical outcomes in people with bipolar disorder. Yet 'social support' is a poorly defined construct, and the mechanisms by which it affects illness course in bipolar disorder remain largely unknown. Key aims of this study were to ascertain which facets of social interaction affect mood management in bipolar disorder, and how symptoms of bipolar disorder can influence the level of support received. METHOD:Semi-structured qualitative interviews were conducted with 20 individuals with bipolar disorder. Questions were designed to elicit: the effects of social interaction upon the management and course of bipolar disorder; and the impact of bipolar disorder upon social relationships. An inductive thematic analysis was used to analyse the data. RESULTS:Empathy and understanding from another person can make it easier to cope with bipolar disorder. Social interaction can also provide opportunities to challenge negative ruminative thoughts and prevent the onset of a major mood episode. The loss of social support, particularly through bereavement, creates a loss of control and can trigger mania or depression. Hypomanic symptoms can facilitate new social connections, whereas disinhibited and risky behaviour exhibited during mania can cause the breakdown of vital relationships. CONCLUSIONS:An in-depth clinical formulation of an individual's perceptions of how their illness affects and is affected by social interaction is crucial to understanding psychosocial factors which influence mood management. These results have clear application in interventions which aim to promote improved wellbeing and social functioning in bipolar disorder. Copyright © 2016 John Wiley & Sons, Ltd. KEY PRACTITIONERS MESSAGES:The relationship between bipolar-related experiences and social interaction is complex and multi-faceted. Bipolar disorder can damage social relationships and create a loss of social control via extreme mood states, but it can also offer a social advantage through elevated self-confidence during hypomania and enhanced resilience post-recovery. Positive social experiences can facilitate better personal coping and enhanced mood management, whilst negative social experiences can trigger the onset of acute mood episodes. A comprehensive formulation of the reciprocal links between facets of bipolar disorder and characteristics of interpersonal relationships should be used to guide psychosocial interventions that aim to enhance emotion regulation and improve functioning.
Low self-compassion in patients with bipolar disorder.
Døssing Marianne,Nilsson Kristine Kahr,Svejstrup Stinna Rzepa,Sørensen Vegard Venås,Straarup Krista Nielsen,Hansen Tia B
BACKGROUND:Emerging research suggests that low self-compassion may be linked to psychopathology and in particular depressive symptoms. To further elucidate this topic, the present study investigated self-compassion in patients with Bipolar Disorder (BD). METHOD:Thirty remitted BD patients were compared to thirty age- and sex matched controls on the Self-Compassion Scale (SCS). The BD patients also completed the Altman Self-Rating Mania Scale (ASRM), the Major Depression Inventory (MDI), the Work and Social Adjustment Scale (WSAS), the Satisfaction With Life Scale (SWLS) and the Internalized Stigma of Mental Illness Scale (ISMI-10) and further reported their illness history on a survey sheet. RESULTS:The BD patients were found to have significantly lower self-compassion than controls. In addition, self-compassion correlated positively and significantly with life-satisfaction but no significant correlations with functional impairment, internalized stigma or frequency of past affective episodes were found. LIMITATIONS:The small sample size entailed reduced statistical power. CONCLUSIONS:By suggesting that self-compassion is reduced and possibly linked to life-satisfaction in BD, the findings highlight a potential vulnerability meriting further investigations.
The Working Alliance Between Patients With Bipolar Disorder and the Nurse: Helpful and Obstructive Elements During a Depressive Episode From the Patients' Perspective.
Stegink Eva E,van der Voort Trijntje Y G Nienke,van der Hooft Truus,Kupka Ralph W,Goossens Peter J J,Beekman Aartjan T F,van Meijel Berno
Archives of psychiatric nursing
Despite treatment, many patients with bipolar disorder experience impaired functioning and a decreased quality of life. Optimal collaboration between patient and mental health care providers could enhance treatment outcomes. The goal of this qualitative study, performed in a trial investigating the effect of collaborative care, was to gain more insight in patients' experiences regarding the helpful and obstructive elements of the working alliance between the patient recovering from a depressive episode and their nurse. Three core themes underpinned the nurses' support during recovery: a safe and supportive environment, assistance in clarifying thoughts and feelings, and support in undertaking physical activities.
Bipolar disorder and self-stigma: A comparison with schizophrenia.
Karidi M V,Vassilopoulou D,Savvidou E,Vitoratou S,Maillis A,Rabavilas A,Stefanis C N
Journal of affective disorders
AIM:Even though numerous studies have focused on the effects of self-stigma on patients with schizophrenia, little is known about self-stigma of patients with bipolar disorder (BD). In this study, a self-administered scale of self-stigmatising attitudes of patients with BD and schizophrenia was used to explore these attitudes, examine the potential differences between the two groups and study the factors that influence stigma within groups. METHODS:Self-stigma of 120 patients with schizophrenia and BD was assessed with the Self-stigma Questionnaire (SSQ) and the Stigma Inventory for Mental Illness (SIMI). Presence of clinical symptoms, overall functioning and level of self-esteem were also evaluated. RESULTS:Self-stigma is present in both groups but differs in its intensity. Patients with BD experience self-stigma in a lesser degree without affecting their social life or overall functioning. Patients with schizophrenia adopt more intense self-stigmatising attitudes leading to social exclusion and lower level of overall functioning. LIMITATIONS:The results are limited by the small sample size, whereas the inclusion of other questionnaires would broaden our insight to self-stigma. CONCLUSIONS:Self-stigma has a direct effect on overall functioning of patients with BD and schizophrenia tampering the clinical outcome of therapeutic interventions. Therefore, it should be incorporated in every treatment plan and be addressed as a clinical symptom of the mental illness.
Positive aspects of mental illness: a review in bipolar disorder.
Galvez Juan Francisco,Thommi Sairah,Ghaemi S Nassir
Journal of affective disorders
INTRODUCTION:There is growing interest to understand the role of positive psychological features on the outcomes of medical illnesses. Unfortunately this topic is less studied in relation to mental health, and almost completely neglected in relation to one of the most common severe psychiatric illnesses, bipolar disorder. Certain specific psychological characteristics, that are generally viewed as valuable and beneficial morally or socially, may grow out of the experience of having this affective disorder. OBJECTIVE:We describe the sources, research and impact of these positive psychological traits in the lives of persons with bipolar disorder based on the few published literature available to date. These include, but are not limited to: spirituality, empathy, creativity, realism, and resilience. METHODS:After an extensive search in the literature, we found 81 articles that involve descriptions of positive psychological characteristics of bipolar disorder. RESULTS:We found evidence for enhancement of the five above positive psychological traits in persons with bipolar disorder. CONCLUSIONS:Bipolar disorder is associated with the positive psychological traits of spirituality, empathy, creativity, realism, and resilience. Clinical and research attention to preserving and enhancing these traits may improve outcomes in bipolar disorder.
Social and nonsocial cognition in bipolar disorder and schizophrenia: relative levels of impairment.
Lee Junghee,Altshuler Lori,Glahn David C,Miklowitz David J,Ochsner Kevin,Green Michael F
The American journal of psychiatry
OBJECTIVE:This study aimed to determine the relative extent of impairment in social and nonsocial cognitive domains in patients with bipolar disorder compared with schizophrenia patients and healthy comparison subjects. METHODS:Sixty-eight clinically stable outpatients with bipolar disorder, 38 clinically stable outpatients with schizophrenia, and 36 healthy comparison subjects completed a range of social (facial affect perception, emotional regulation, empathic accuracy, mental state attribution, and self-referential memory) and nonsocial (speed of processing, attention/vigilance, working memory, verbal memory, visual memory, and reasoning/problem solving) cognitive tasks. RESULTS:For each social cognitive task, patients with bipolar disorder did not differ significantly from comparison subjects, and both groups performed better than schizophrenia patients. Within the bipolar group, clinical features and medication status were not related to social cognitive performance. Bipolar patients showed performance patterns across tasks (i.e., profiles) that were similar to those of comparison subjects on both social and nonsocial cognitive domains, whereas both groups differed from schizophrenia patients for both domains. Regarding relative impairment across the two cognitive domains, results revealed a significant group-by-domain interaction in which bipolar patients showed less impaired social than nonsocial cognition, while schizophrenia patients showed the opposite pattern. CONCLUSIONS:Bipolar patients showed less impairment on social relative to nonsocial cognitive performance, whereas schizophrenia patients showed more impairment on social relative to nonsocial cognitive performance. These results suggest that these two cognitive domains play different roles in bipolar disorder compared with in schizophrenia.
Risk or resilience? Empathic abilities in patients with bipolar disorders and their first-degree relatives.
Seidel Eva-Maria,Habel Ute,Finkelmeyer Andreas,Hasmann Alexander,Dobmeier Matthias,Derntl Birgit
Journal of psychiatric research
Endophenotypes are intermediate phenotypes which are considered a more promising marker of genetic risk than illness itself. While previous research mostly used cognitive deficits, emotional functions are of greater relevance for bipolar disorder regarding the characteristic emotional hyper-reactability and deficient social-emotional competence. Hence, the aim of the present study was to clarify whether empathic abilities can serve as a possible endophenotype of bipolar disorder by applying a newly developed task in bipolar patients and their first-degree relatives. Three components of empathy (emotion recognition, perspective taking and affective responsiveness) have been assessed in a sample of 21 bipolar patients, 21 first-degree relatives and 21 healthy controls. Data analysis indicated significant differences between controls and patients for emotion recognition and affective responsiveness but not for perspective taking. This shows that in addition to difficulties in recognizing facial emotional expressions, bipolar patients have difficulties in identifying emotions they would experience in a given situation. However, the ability to take the perspective of another person in an emotional situation was intact but decreased with increasing severity of residual hypomanic and depressive symptoms. Relatives performed comparably bad on emotion recognition but did not differ from controls or patients in affective responsiveness. This study is the first to show that deficient emotion recognition is the only component of empathy which forms a possible endophenotype of bipolar disorder. This has important implications for prevention strategies. Furthermore, changes in affective responsiveness in first-degree relatives show a potential resilience marker.