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Papers by Fatma KİRAS

Kocaeli Üniversitesi Sağlık Bilimleri Dergisi, 2018

Çalışmamızda şizofreni hastalarının öznel iyileşme duygularının klinik şiddet ve bilişsel içgörü ... more Çalışmamızda şizofreni hastalarının öznel iyileşme duygularının klinik şiddet ve bilişsel içgörü ile ilişkisini incelemek amaçlanmıştır. Yöntem: DSM-5 tanı ölçütlerine göre şizofreni ve şizoaffektif bozukluk tanısı alan ve sürdürüm tedavisi devam eden 151 hasta çalışmaya dahil edildi. Hastalar araştırmacılar tarafından hazırlanan sosyodemografik ve klinik veri formu, Pozitif ve Negatif Sendrom Ölçeği, Klinik Global İzlenim, İşlevselliğin Genel Değerlendirmesi, Öznel İyileşmeyi Değerlendirme Ölçeği ve Beck Bilişsel İçgörü Ölçeği ile değerlendirildi. Bulgular: Çalışmaya katılan 151 hastanın yaş ortalaması 37,2, ortalama eğitim süresi 10,4 yıl ve ortalama hastalık süresi 14,2 yıl idi. Grubun %77'sini erkekler oluşturmakta, %71'i bekâr, %68'i ailesi ile birlikte yaşamakta ve %62'si herhangi bir işte çalışmamakta idi. Çalışmamızda öznel iyileşme duygusu klinik durum ve bilişsel içgörü ile ilişkili bulundu. Sonuç: Bu çalışmanın bulguları öznel iyileşme duygusunun klinik durum ve bilişsel içgörü düzeyinden etkilendiğini göstermektedir. İyileştirim çalışmalarında başetme becerileri, umut, özgüven ve bilişsel içgörü geliştirmeye yönelik girişimlere yer verilmesinin hastaların öznel iyileşme duygularının artmasına yardımcı olacağı düşünülmektedir.

Anatolian Journal of Psychiatry, 2018

Objective: To develop a Computerized Adaptive Testing of Social Functioning (Social-CAT) for pati... more Objective: To develop a Computerized Adaptive Testing of Social Functioning (Social-CAT) for patients with stroke. Design: This study contained 2 phases: First, a unidimensional item bank was formed using social-related items with sufficient item fit (i.e., infit and outfit mean square (MNSQ)). The social-related items were selected from 3 commonly used patient-reported quality of life measures. Items with differential item functioning (DIF) of sex were deleted. Second, we performed simulations to determine the best set of stopping rules with both high reliability and efficiency. The participants' responses to the items were extracted from a previous study. Settings: Rehabilitation wards and departments of rehabilitations/neurology of 5 general hospitals. Participants: A total of 263 patients with stroke (47.1% was inpatients).

Schizophrenia Bulletin, 2018

Background: Many people with psychotic disorder experience problems in social functioning, such a... more Background: Many people with psychotic disorder experience problems in social functioning, such as finding and maintaining jobs and relationships, which have been shown to be strongly related to deficits in social cognition. A class of interventions called Social Cognition Training (SCT) aims to improve social cognition through practice and strategy training. SCT has been shown to have positive effects on social cognition. (Social) cognition training, however, is known to optimally translate to functional skills when it is applied to and integrated with different areas of daily life. To promote the transfer of training skills to functional domains, it may therefore be beneficial to provide SCT in virtual reality (VR), since it closely resembles real-life social situations. VR is highly realistic and interactive, allowing for practice of social situations in ecologically valid environments. VR is also controllable, allowing for personalization of situations and difficulty level. In the present study, we tested the acceptance and feasibility of a newly developed VR SCT called 'DiSCoVR' (Dynamic Interactive Social Cognition Training in Virtual Reality). Methods: Twenty-two individuals with a psychotic disorder were recruited from three mental health institutions in the Netherlands. All participants received a VR SCT, which was aimed at three domains: 1) emotion perception (identifying virtual characters' emotions in a virtual street); 2) social perception and theory of mind (understanding social situations and the thoughts, emotions and behavior of virtual characters); and 3) practicing social interactions with a virtual character. The intervention strongly emphasized practice with social situations in VR between, and with, virtual characters. Participants also learned strategies to cope with difficulties they experienced in social situations. Participants were assessed at baseline and post-treatment. Acceptance of the intervention was evaluated at post-treatment using a questionnaire. Social cognition was also assessed (emotion perception, social perception and theory of mind) using video/photo tasks and stories. Finally, psychotic symptoms, social anxiety, paranoia, self-esteem and depression were measured using an interview and questionnaires. Results: The results of this pilot study will be presented, focusing on the findings regarding acceptance and feasibility, but also social cognition and other secondary outcome domains. Discussion: The implications of the findings of the pilot study will be discussed in the context of the preparation of a randomized controlled trial of DiSCoVR (for example, necessary alterations to the protocol and/or VR software). Plans for this randomized controlled trial will be discussed.

Community Mental Health Journal

Subjective recovery is a personally perceived recovery involving other factors beyond clinical re... more Subjective recovery is a personally perceived recovery involving other factors beyond clinical recovery. This study aims at investigating the factors related to subjective recovery in patients with schizophrenia living in Turkey. This study assessed 120 clinically stable outpatients with schizophrenia or schizoaffective disorder using the clinical and psychosocial scales. Gender, type of the diagnosis of disease, and age of the illness onset were found to be correlated with the subjective recovery. Subjective recovery was significantly correlated with CGI-S (r = − 0.25), total PANSS score (r = − 0.29), global assessment of functioning (r = 0.27), social functioning (r = 0.43), internalized stigma (r = − 0.38), self-esteem (r = 0.56), depression (r = − 0.59), and hopelessness (r = − 0.55). Hopelessness and self-esteem were found to be predictive of the subjective recovery explaining 52% of the variance. It can be argued that efforts to promote hope and self-esteem contribute to the subjective recovery.

Archives of Neuropsychiatry

The aim of this study is to investigate the effects of Psychosocial Skills Training (PSST) and Me... more The aim of this study is to investigate the effects of Psychosocial Skills Training (PSST) and Metacognitive Training (MCT) programs on general psychopathology, cognitive functioning, and social functioning in patients with schizophrenia. Methods: Twenty patients with schizophrenia who were treated at the Kocaeli University Psychiatry Department outpatient clinic between January and June 2016, accepted to participate in the study and met inclusion criteria were included in this study. Patients were randomized as two groups of 10 people. The management of each group was carried out by a trainer and a co-trainer. The Positive and Negative Symptom Scale (PANSS) and Clinical Global Impression Scale-Severity (CGI-S) to assess psychopathology, the General Assessment of Functioning (GAF) and the Quality of Life Scale in Schizophrenia (QoLS) to assess social functioning, the Cognitive Assessment Interview (CAI) to assess cognitive functioning were used by the clinicians blinding to groups in the first two weeks before and after the intervention. After the training, first and last test scale scores were compared. Results: All patients who participated in the study completed the study (male: 13, female: 7). There was no significant difference in age, gender, marital status, years of education, duration of illness, the age of onset, and the number of hospitalizations in comparison of individual and clinical characteristics of the groups (p>0.05). When the scores were compared of the groups before and after the intervention, there was a significant difference concerning psychopathology, social and cognitive functioning in both groups (p<0.05). There were no significant differences between the groups in terms of effect size. Conclusion: The study showed that both programs aiming to improve psychopathology and functioning in the treatment of schizophrenia have positive results. Improvement in cognitive functioning should also be tested by neurocognitive tests in the large-scale studies with control groups.

Psychiatry and Clinical Psychopharmacology

OBJECTIVE: It is known that relatives of the patients with schizophrenia tend to hide the illness... more OBJECTIVE: It is known that relatives of the patients with schizophrenia tend to hide the illness from other people, are ashamed of their patients, and feel excluded from society. This situation is referred as self-stigmatization of families, and it may negatively affect the family functioning and therapeutic alliance. Assessing and evaluating the self-stigma of families are essential concerning family therapies and treatment of their patients. The purpose of this study is to develop a culturally sensitive inventory for the assessment of self-stigmatization for families of patients with schizophrenia in Turkey. METHODS: After examining the studies in the related field and conducting a focus group interview with the families of the patients with schizophrenia, a 19-item inventory was formed. One hundred and six relatives of the patients with schizophrenia and schizoaffective disorder were given a sociodemographic form, Self-Stigma Inventory for Families (SSI-F), Beck Depression Inventory (BDI), Beck Hopelessness Scale (BHS), Rosenberg Self-Esteem Scale (RSES), and Zarit Caregiver Burden Scale (ZCBS). Explanatory factor analysis and convergent validity were assessed as validity analysis, and internal consistency coefficient, item-total correlation, and test-retest reliability were calculated for reliability analysis. RESULTS: The sample consisted of 106 relatives whose 52% were female, 77% were married, mean age was 51 years, and level of education was 9 years. In explanatory factor analysis, three factors (social withdrawal, concealment of the illness, and perceived devaluation) with 14 items were detected, and the factors could explain 66.8% of the total variance. SSI-F was significantly correlated with Beck Depression Inventory (r = 0.48, P < 0.01), Beck Hopelessness Scale (r = 0.27, P < 0.01), Zarit Caregiver Burden Scale (r = 0.54, P < 0.01), and Rosenberg Self-Esteem Scale (r = −0.35, P < 0.01). Cronbach's alpha coefficient for SSI-F total score was calculated as 0.88, and test-retest reliability coefficient of SSI-F was 0.93. CONCLUSIONS: This study shows that the SSI-F is a valid and reliable instrument for assessing self-stigmatization in the families of patients with schizophrenia. It can be considered as a valuable instrument to use for research and therapeutic purposes.

Schizophrenia Bulletin

Results: All participants in both groups (n=31) completed the study. Because of such a small samp... more Results: All participants in both groups (n=31) completed the study. Because of such a small sample size (n=28) and a pilot nature of the study we were restricted to use descriptive statistics. The quantitative data suggest that DMT and SC were not equally effective in enhancing primary outcomes. Analysis of the PANSS mean score changes showed a slight increase in the negative symptom in the DMT from 28.33 ± 4.76 to 29.00 ± 4.10, and slight decrease in the SC from 28.92 ± 5.72 to 27.08 ± 5.64. BNSS scores indicate that both groups improved. SC participants reported grater reduction on BNSS overal score from 53.31 ± 11.48 to 47.77 ± 8.10 in comparison to DMT from 53.07 ± 7.27 to 51.93 ± 6.18. However, DMT participants reported reduction of symptoms in distress, antisocial activity, avolition and verbal expression. Analysis of WHO-DAS suggests that DMT was effective in reduction of disability severity compared to SC. DMT participants reported grater improvement in cognition, mobility, self-care, and getting along. Both groups reported reduction of the impact of difficulties on daily functioning on SDS, however DMT participants reported a greater reduction in days during which they were completely unable to perform or had to limit their usual activities or work due to symptoms. In the SC, the results suggest a reduction in the number of days lost and days of lower productivity. Qualitative findings identified participants' experiences and the most important themes related to benefits of the DMT intervention: enhanced activation, motivation, socialization, and self-awareness. Discussion: Results of this study contribute to knowledge about bodybased interventions for schizophrenia and indicate that DMT had an effect on participants psychosocial functioning and coping with negative symptoms. Integration of quantitative and qualitative data provides a wider perspective by gaining a better understanding of the treatment outcomes and explaining inconclusive results. Findings of this study set the stage for larger fully powered research, examining intervention methods and procedures, as well as treatment effects, more thoroughly.

Schizophrenia Bulletin

Background: Schizophrenia is characterized by changes in both ongoing blood oxygenation level dep... more Background: Schizophrenia is characterized by changes in both ongoing blood oxygenation level dependent (BOLD) signal fluctuations of restingstate fMRI and their coherence in terms of functional connectivity. The current study asks the question whether individualized patterns of BOLD fluctuations are able to classify schizophrenia patients from healthy controls. Methods: To investigate this question, 61 schizophrenia (SZ) patients and 73 healthy controls (HC) were obtained from a Mind Research Network COBRE dataset available via COINS (http://coins.mrn.org/dx). The amplitude of low-frequency fluctuations (ALFF) was used as main outcome measure reflecting BOLD fluctuations. Multivariate pattern classification framework based on support-vector machines (SVM) was used to generate and validate ALFF patterns for group separation. Results: ALFF based classifiers were able to distinguish between SZ patients and HC with 76.9% accuracies (balanced accuracy 76.5%, specificity 80.8%, sensitivity 72.1%, Area Under the Curve: 0.78). Decreased ALFF highly predictive for SZ was located in bilateral somatomotor cortex, cuneus and orbitofrontal cortex. Increased ALFF highly predictive for SZ was located in the thalamus, dorsomedial prefrontal cortex, and precuneus. Discussion: Conclusions: Our results provide evidence for BOLDfluctuation pattern could be treated as reliable feature to identify individual patients with schizophrenia from healthy controls. Multivariate pattern analysis such as support vector machine may reliably detect signatures of schizophrenia.

Psychiatry and Clinical Psychopharmacology

OBJECTIVES: Internalizing the public stigma in patients with schizophrenia leads to selfstigmatiz... more OBJECTIVES: Internalizing the public stigma in patients with schizophrenia leads to selfstigmatization associated with a number of negative consequences such as depression, low self-esteem, hopelessness, impairment of social adaptation, unemployment, and treatment non-adherence. No instruments have been developed to assess the self-stigmatization for patients with schizophrenia living in Turkey. The purpose of this study was to develop a culturally-sensitive and easy-to-use instrument to measure self-stigma of the patients with schizophrenia and schizoaffective disorder. METHODS: After examining the existing stigma and self-stigma scales for people with mental illnesses, a 19-item self-stigma inventory was formed. Focus group interviews were conducted with patients with schizophrenia and the items were reviewed and rephrased into more comprehensible statements for the patients. The pilot study was conducted with a sample of 15 patients with schizophrenia, and the inventory was given its final form, self-stigma inventory for patients (SSI-P). Outpatients with schizophrenia and schizoaffective disorder were given sociodemographic form, SSI-P, Beck Depression Inventory (BDI), Internalized Stigma of Mental Illness (ISMI), Rosenberg Self-Esteem Scale (RSES), Beck Hopelessness Scale (BHS), Positive and Negative Syndrome Scale (PANSS), Clinical Global Impression-Severity (CGI-S), and Global Assessment of Functioning (GAF). For reliability analyses; internal consistency, item-total correlation, and test-retest reliability were assessed. Validity analyses were conducted with Explanatory Factor Analysis and convergent validity. RESULTS: The sample of the study was 162 patients with schizophrenia and schizoaffective disorder of which 77% were males, 70% were single, mean age was 37, and level of education was 10 years. Cronbach's alpha coefficient of the scale was 0.93 ranging among the subscales between 0.60 and 0.91. Kaiser-Meyer-Olkin value was 0.91, and the Barlett test was significant (p < 0.001) for explanatory factor analysis and three factors were found (perceived devaluation, internalized stereotypes and social withdrawal, concealment of the illness) that can explain 63.5% of the total variance. Two items were removed because of their low factor value, and the final form consisted of 17 items. SSI-P was highly correlated with commonly-used stigma scale ISMI (r = 0.73), and moderately correlated with BDI (r = 0.53), BHS (r = 0.40), and RSES (r = −0.59). It also showed low correlation with PANSS negative score (r = 0.19). The test-retest reliability coefficient of the scale was 0.83. CONCLUSION: SSI-P is a reliable and valid instrument for assessing the self-stigmatization of patients with schizophrenia and schizoaffective disorder. The scale is an easy-to-comprehend, user-friendly, and culturally-sensitive tool with its 17 items.

Schizophrenia Bulletin

Background: Social functioning impairment is one of the core features for schizophrenia diagnosis... more Background: Social functioning impairment is one of the core features for schizophrenia diagnosis and are also present in other psychotic spectrum disorders, being determinant for disability. This impairment has multiple domains, which are linked but separate. Previous research has shown that social functioning is multiply determined by neurocognition, social cognition and symptoms, being social cognition the domain that accounts for more of the variance in daily functioning. However, cognitive rigidity in interpersonal perception has received less attention and much variance remains unexplained. The aim of this study was to test the role of interpersonal cognitive rigidity, as measured with the Repertory Grid Technique (RGT) in social functioning in psychosis. Methods: Sample of 40 outpatients with a psychotic spectrum diagnosis from the network of mental health services of Parc Sanitari Sant Joan de Déu (Barcelona, Spain). Cross-sectional study, assessment was carried out by a predoctoral researcher (GMH), using a sociodemographic questionnaire, the Social Functioning Scale (SFS), the Hinting Task (Theory of Mind, ToM), the Beck Cognitive Insight Scale (BCIS), and the RGT (to measure interpersonal cognitive rigidity, two indices were selected: Percentage of Variance Accounted for the First Factor, PVAFF, and Polarization). Pearson correlations and multiple regression analysis were performed. Results: Results showed that social engagement/withdrawal was explained by PVAFF, accounting for 16% of the variance. Independence-competence was explained by polarization, explaining 14.6% of the variance and by sex, which accounted for 11.1% of the variance. Independence-performance was explained by theory of mind, explaining 22.5% of variance. Employment/ occupation was explained by years of illness accounting for 21.6% of variance, and by polarization (beta=-0.318, p=0.026) which explained 10% of variance. Finally, the total score of the SFS was explained by polarization, explaining 14.4% of variance, and sex, which accounted for 12.6% of variance. For prosocial activities and interpersonal communication, none of the variables entered for the linear regression analysis. Discussion: Despite ToM and cognitive insight are common variables reported in the research literature, in our study the cognitive rigidity measures of the RGT, based on the patients' own terms (personal constructs) in rating their significant others, were better predictors of social functioning. These findings support the importance and utility of an idiographic instrument like the RGT to investigate cognitive processes related to social perception and their impact on functioning. Regarding PVAFF, a higher tendency to perceive the interpersonal world from a unidimensional manner predicted a worse outcome in social relationships/withdrawal. Regarding interpersonal polarized thinking, it was the best cognitive predictor of social functioning measures. Our results suggest that a dichotomous thinking style in interpersonal perception might also be relevant for elucidating the dysfunction in social adjustment domains. These findings are still preliminary, and form part of an ongoing study.

Kocaeli Üniversitesi Sağlık Bilimleri Dergisi, 2018

Çalışmamızda şizofreni hastalarının öznel iyileşme duygularının klinik şiddet ve bilişsel içgörü ... more Çalışmamızda şizofreni hastalarının öznel iyileşme duygularının klinik şiddet ve bilişsel içgörü ile ilişkisini incelemek amaçlanmıştır. Yöntem: DSM-5 tanı ölçütlerine göre şizofreni ve şizoaffektif bozukluk tanısı alan ve sürdürüm tedavisi devam eden 151 hasta çalışmaya dahil edildi. Hastalar araştırmacılar tarafından hazırlanan sosyodemografik ve klinik veri formu, Pozitif ve Negatif Sendrom Ölçeği, Klinik Global İzlenim, İşlevselliğin Genel Değerlendirmesi, Öznel İyileşmeyi Değerlendirme Ölçeği ve Beck Bilişsel İçgörü Ölçeği ile değerlendirildi. Bulgular: Çalışmaya katılan 151 hastanın yaş ortalaması 37,2, ortalama eğitim süresi 10,4 yıl ve ortalama hastalık süresi 14,2 yıl idi. Grubun %77'sini erkekler oluşturmakta, %71'i bekâr, %68'i ailesi ile birlikte yaşamakta ve %62'si herhangi bir işte çalışmamakta idi. Çalışmamızda öznel iyileşme duygusu klinik durum ve bilişsel içgörü ile ilişkili bulundu. Sonuç: Bu çalışmanın bulguları öznel iyileşme duygusunun klinik durum ve bilişsel içgörü düzeyinden etkilendiğini göstermektedir. İyileştirim çalışmalarında başetme becerileri, umut, özgüven ve bilişsel içgörü geliştirmeye yönelik girişimlere yer verilmesinin hastaların öznel iyileşme duygularının artmasına yardımcı olacağı düşünülmektedir.

Anatolian Journal of Psychiatry, 2018

Objective: To develop a Computerized Adaptive Testing of Social Functioning (Social-CAT) for pati... more Objective: To develop a Computerized Adaptive Testing of Social Functioning (Social-CAT) for patients with stroke. Design: This study contained 2 phases: First, a unidimensional item bank was formed using social-related items with sufficient item fit (i.e., infit and outfit mean square (MNSQ)). The social-related items were selected from 3 commonly used patient-reported quality of life measures. Items with differential item functioning (DIF) of sex were deleted. Second, we performed simulations to determine the best set of stopping rules with both high reliability and efficiency. The participants' responses to the items were extracted from a previous study. Settings: Rehabilitation wards and departments of rehabilitations/neurology of 5 general hospitals. Participants: A total of 263 patients with stroke (47.1% was inpatients).

Schizophrenia Bulletin, 2018

Background: Many people with psychotic disorder experience problems in social functioning, such a... more Background: Many people with psychotic disorder experience problems in social functioning, such as finding and maintaining jobs and relationships, which have been shown to be strongly related to deficits in social cognition. A class of interventions called Social Cognition Training (SCT) aims to improve social cognition through practice and strategy training. SCT has been shown to have positive effects on social cognition. (Social) cognition training, however, is known to optimally translate to functional skills when it is applied to and integrated with different areas of daily life. To promote the transfer of training skills to functional domains, it may therefore be beneficial to provide SCT in virtual reality (VR), since it closely resembles real-life social situations. VR is highly realistic and interactive, allowing for practice of social situations in ecologically valid environments. VR is also controllable, allowing for personalization of situations and difficulty level. In the present study, we tested the acceptance and feasibility of a newly developed VR SCT called 'DiSCoVR' (Dynamic Interactive Social Cognition Training in Virtual Reality). Methods: Twenty-two individuals with a psychotic disorder were recruited from three mental health institutions in the Netherlands. All participants received a VR SCT, which was aimed at three domains: 1) emotion perception (identifying virtual characters' emotions in a virtual street); 2) social perception and theory of mind (understanding social situations and the thoughts, emotions and behavior of virtual characters); and 3) practicing social interactions with a virtual character. The intervention strongly emphasized practice with social situations in VR between, and with, virtual characters. Participants also learned strategies to cope with difficulties they experienced in social situations. Participants were assessed at baseline and post-treatment. Acceptance of the intervention was evaluated at post-treatment using a questionnaire. Social cognition was also assessed (emotion perception, social perception and theory of mind) using video/photo tasks and stories. Finally, psychotic symptoms, social anxiety, paranoia, self-esteem and depression were measured using an interview and questionnaires. Results: The results of this pilot study will be presented, focusing on the findings regarding acceptance and feasibility, but also social cognition and other secondary outcome domains. Discussion: The implications of the findings of the pilot study will be discussed in the context of the preparation of a randomized controlled trial of DiSCoVR (for example, necessary alterations to the protocol and/or VR software). Plans for this randomized controlled trial will be discussed.

Community Mental Health Journal

Subjective recovery is a personally perceived recovery involving other factors beyond clinical re... more Subjective recovery is a personally perceived recovery involving other factors beyond clinical recovery. This study aims at investigating the factors related to subjective recovery in patients with schizophrenia living in Turkey. This study assessed 120 clinically stable outpatients with schizophrenia or schizoaffective disorder using the clinical and psychosocial scales. Gender, type of the diagnosis of disease, and age of the illness onset were found to be correlated with the subjective recovery. Subjective recovery was significantly correlated with CGI-S (r = − 0.25), total PANSS score (r = − 0.29), global assessment of functioning (r = 0.27), social functioning (r = 0.43), internalized stigma (r = − 0.38), self-esteem (r = 0.56), depression (r = − 0.59), and hopelessness (r = − 0.55). Hopelessness and self-esteem were found to be predictive of the subjective recovery explaining 52% of the variance. It can be argued that efforts to promote hope and self-esteem contribute to the subjective recovery.

Archives of Neuropsychiatry

The aim of this study is to investigate the effects of Psychosocial Skills Training (PSST) and Me... more The aim of this study is to investigate the effects of Psychosocial Skills Training (PSST) and Metacognitive Training (MCT) programs on general psychopathology, cognitive functioning, and social functioning in patients with schizophrenia. Methods: Twenty patients with schizophrenia who were treated at the Kocaeli University Psychiatry Department outpatient clinic between January and June 2016, accepted to participate in the study and met inclusion criteria were included in this study. Patients were randomized as two groups of 10 people. The management of each group was carried out by a trainer and a co-trainer. The Positive and Negative Symptom Scale (PANSS) and Clinical Global Impression Scale-Severity (CGI-S) to assess psychopathology, the General Assessment of Functioning (GAF) and the Quality of Life Scale in Schizophrenia (QoLS) to assess social functioning, the Cognitive Assessment Interview (CAI) to assess cognitive functioning were used by the clinicians blinding to groups in the first two weeks before and after the intervention. After the training, first and last test scale scores were compared. Results: All patients who participated in the study completed the study (male: 13, female: 7). There was no significant difference in age, gender, marital status, years of education, duration of illness, the age of onset, and the number of hospitalizations in comparison of individual and clinical characteristics of the groups (p>0.05). When the scores were compared of the groups before and after the intervention, there was a significant difference concerning psychopathology, social and cognitive functioning in both groups (p<0.05). There were no significant differences between the groups in terms of effect size. Conclusion: The study showed that both programs aiming to improve psychopathology and functioning in the treatment of schizophrenia have positive results. Improvement in cognitive functioning should also be tested by neurocognitive tests in the large-scale studies with control groups.

Psychiatry and Clinical Psychopharmacology

OBJECTIVE: It is known that relatives of the patients with schizophrenia tend to hide the illness... more OBJECTIVE: It is known that relatives of the patients with schizophrenia tend to hide the illness from other people, are ashamed of their patients, and feel excluded from society. This situation is referred as self-stigmatization of families, and it may negatively affect the family functioning and therapeutic alliance. Assessing and evaluating the self-stigma of families are essential concerning family therapies and treatment of their patients. The purpose of this study is to develop a culturally sensitive inventory for the assessment of self-stigmatization for families of patients with schizophrenia in Turkey. METHODS: After examining the studies in the related field and conducting a focus group interview with the families of the patients with schizophrenia, a 19-item inventory was formed. One hundred and six relatives of the patients with schizophrenia and schizoaffective disorder were given a sociodemographic form, Self-Stigma Inventory for Families (SSI-F), Beck Depression Inventory (BDI), Beck Hopelessness Scale (BHS), Rosenberg Self-Esteem Scale (RSES), and Zarit Caregiver Burden Scale (ZCBS). Explanatory factor analysis and convergent validity were assessed as validity analysis, and internal consistency coefficient, item-total correlation, and test-retest reliability were calculated for reliability analysis. RESULTS: The sample consisted of 106 relatives whose 52% were female, 77% were married, mean age was 51 years, and level of education was 9 years. In explanatory factor analysis, three factors (social withdrawal, concealment of the illness, and perceived devaluation) with 14 items were detected, and the factors could explain 66.8% of the total variance. SSI-F was significantly correlated with Beck Depression Inventory (r = 0.48, P < 0.01), Beck Hopelessness Scale (r = 0.27, P < 0.01), Zarit Caregiver Burden Scale (r = 0.54, P < 0.01), and Rosenberg Self-Esteem Scale (r = −0.35, P < 0.01). Cronbach's alpha coefficient for SSI-F total score was calculated as 0.88, and test-retest reliability coefficient of SSI-F was 0.93. CONCLUSIONS: This study shows that the SSI-F is a valid and reliable instrument for assessing self-stigmatization in the families of patients with schizophrenia. It can be considered as a valuable instrument to use for research and therapeutic purposes.

Schizophrenia Bulletin

Results: All participants in both groups (n=31) completed the study. Because of such a small samp... more Results: All participants in both groups (n=31) completed the study. Because of such a small sample size (n=28) and a pilot nature of the study we were restricted to use descriptive statistics. The quantitative data suggest that DMT and SC were not equally effective in enhancing primary outcomes. Analysis of the PANSS mean score changes showed a slight increase in the negative symptom in the DMT from 28.33 ± 4.76 to 29.00 ± 4.10, and slight decrease in the SC from 28.92 ± 5.72 to 27.08 ± 5.64. BNSS scores indicate that both groups improved. SC participants reported grater reduction on BNSS overal score from 53.31 ± 11.48 to 47.77 ± 8.10 in comparison to DMT from 53.07 ± 7.27 to 51.93 ± 6.18. However, DMT participants reported reduction of symptoms in distress, antisocial activity, avolition and verbal expression. Analysis of WHO-DAS suggests that DMT was effective in reduction of disability severity compared to SC. DMT participants reported grater improvement in cognition, mobility, self-care, and getting along. Both groups reported reduction of the impact of difficulties on daily functioning on SDS, however DMT participants reported a greater reduction in days during which they were completely unable to perform or had to limit their usual activities or work due to symptoms. In the SC, the results suggest a reduction in the number of days lost and days of lower productivity. Qualitative findings identified participants' experiences and the most important themes related to benefits of the DMT intervention: enhanced activation, motivation, socialization, and self-awareness. Discussion: Results of this study contribute to knowledge about bodybased interventions for schizophrenia and indicate that DMT had an effect on participants psychosocial functioning and coping with negative symptoms. Integration of quantitative and qualitative data provides a wider perspective by gaining a better understanding of the treatment outcomes and explaining inconclusive results. Findings of this study set the stage for larger fully powered research, examining intervention methods and procedures, as well as treatment effects, more thoroughly.

Schizophrenia Bulletin

Background: Schizophrenia is characterized by changes in both ongoing blood oxygenation level dep... more Background: Schizophrenia is characterized by changes in both ongoing blood oxygenation level dependent (BOLD) signal fluctuations of restingstate fMRI and their coherence in terms of functional connectivity. The current study asks the question whether individualized patterns of BOLD fluctuations are able to classify schizophrenia patients from healthy controls. Methods: To investigate this question, 61 schizophrenia (SZ) patients and 73 healthy controls (HC) were obtained from a Mind Research Network COBRE dataset available via COINS (http://coins.mrn.org/dx). The amplitude of low-frequency fluctuations (ALFF) was used as main outcome measure reflecting BOLD fluctuations. Multivariate pattern classification framework based on support-vector machines (SVM) was used to generate and validate ALFF patterns for group separation. Results: ALFF based classifiers were able to distinguish between SZ patients and HC with 76.9% accuracies (balanced accuracy 76.5%, specificity 80.8%, sensitivity 72.1%, Area Under the Curve: 0.78). Decreased ALFF highly predictive for SZ was located in bilateral somatomotor cortex, cuneus and orbitofrontal cortex. Increased ALFF highly predictive for SZ was located in the thalamus, dorsomedial prefrontal cortex, and precuneus. Discussion: Conclusions: Our results provide evidence for BOLDfluctuation pattern could be treated as reliable feature to identify individual patients with schizophrenia from healthy controls. Multivariate pattern analysis such as support vector machine may reliably detect signatures of schizophrenia.

Psychiatry and Clinical Psychopharmacology

OBJECTIVES: Internalizing the public stigma in patients with schizophrenia leads to selfstigmatiz... more OBJECTIVES: Internalizing the public stigma in patients with schizophrenia leads to selfstigmatization associated with a number of negative consequences such as depression, low self-esteem, hopelessness, impairment of social adaptation, unemployment, and treatment non-adherence. No instruments have been developed to assess the self-stigmatization for patients with schizophrenia living in Turkey. The purpose of this study was to develop a culturally-sensitive and easy-to-use instrument to measure self-stigma of the patients with schizophrenia and schizoaffective disorder. METHODS: After examining the existing stigma and self-stigma scales for people with mental illnesses, a 19-item self-stigma inventory was formed. Focus group interviews were conducted with patients with schizophrenia and the items were reviewed and rephrased into more comprehensible statements for the patients. The pilot study was conducted with a sample of 15 patients with schizophrenia, and the inventory was given its final form, self-stigma inventory for patients (SSI-P). Outpatients with schizophrenia and schizoaffective disorder were given sociodemographic form, SSI-P, Beck Depression Inventory (BDI), Internalized Stigma of Mental Illness (ISMI), Rosenberg Self-Esteem Scale (RSES), Beck Hopelessness Scale (BHS), Positive and Negative Syndrome Scale (PANSS), Clinical Global Impression-Severity (CGI-S), and Global Assessment of Functioning (GAF). For reliability analyses; internal consistency, item-total correlation, and test-retest reliability were assessed. Validity analyses were conducted with Explanatory Factor Analysis and convergent validity. RESULTS: The sample of the study was 162 patients with schizophrenia and schizoaffective disorder of which 77% were males, 70% were single, mean age was 37, and level of education was 10 years. Cronbach's alpha coefficient of the scale was 0.93 ranging among the subscales between 0.60 and 0.91. Kaiser-Meyer-Olkin value was 0.91, and the Barlett test was significant (p < 0.001) for explanatory factor analysis and three factors were found (perceived devaluation, internalized stereotypes and social withdrawal, concealment of the illness) that can explain 63.5% of the total variance. Two items were removed because of their low factor value, and the final form consisted of 17 items. SSI-P was highly correlated with commonly-used stigma scale ISMI (r = 0.73), and moderately correlated with BDI (r = 0.53), BHS (r = 0.40), and RSES (r = −0.59). It also showed low correlation with PANSS negative score (r = 0.19). The test-retest reliability coefficient of the scale was 0.83. CONCLUSION: SSI-P is a reliable and valid instrument for assessing the self-stigmatization of patients with schizophrenia and schizoaffective disorder. The scale is an easy-to-comprehend, user-friendly, and culturally-sensitive tool with its 17 items.

Schizophrenia Bulletin

Background: Social functioning impairment is one of the core features for schizophrenia diagnosis... more Background: Social functioning impairment is one of the core features for schizophrenia diagnosis and are also present in other psychotic spectrum disorders, being determinant for disability. This impairment has multiple domains, which are linked but separate. Previous research has shown that social functioning is multiply determined by neurocognition, social cognition and symptoms, being social cognition the domain that accounts for more of the variance in daily functioning. However, cognitive rigidity in interpersonal perception has received less attention and much variance remains unexplained. The aim of this study was to test the role of interpersonal cognitive rigidity, as measured with the Repertory Grid Technique (RGT) in social functioning in psychosis. Methods: Sample of 40 outpatients with a psychotic spectrum diagnosis from the network of mental health services of Parc Sanitari Sant Joan de Déu (Barcelona, Spain). Cross-sectional study, assessment was carried out by a predoctoral researcher (GMH), using a sociodemographic questionnaire, the Social Functioning Scale (SFS), the Hinting Task (Theory of Mind, ToM), the Beck Cognitive Insight Scale (BCIS), and the RGT (to measure interpersonal cognitive rigidity, two indices were selected: Percentage of Variance Accounted for the First Factor, PVAFF, and Polarization). Pearson correlations and multiple regression analysis were performed. Results: Results showed that social engagement/withdrawal was explained by PVAFF, accounting for 16% of the variance. Independence-competence was explained by polarization, explaining 14.6% of the variance and by sex, which accounted for 11.1% of the variance. Independence-performance was explained by theory of mind, explaining 22.5% of variance. Employment/ occupation was explained by years of illness accounting for 21.6% of variance, and by polarization (beta=-0.318, p=0.026) which explained 10% of variance. Finally, the total score of the SFS was explained by polarization, explaining 14.4% of variance, and sex, which accounted for 12.6% of variance. For prosocial activities and interpersonal communication, none of the variables entered for the linear regression analysis. Discussion: Despite ToM and cognitive insight are common variables reported in the research literature, in our study the cognitive rigidity measures of the RGT, based on the patients' own terms (personal constructs) in rating their significant others, were better predictors of social functioning. These findings support the importance and utility of an idiographic instrument like the RGT to investigate cognitive processes related to social perception and their impact on functioning. Regarding PVAFF, a higher tendency to perceive the interpersonal world from a unidimensional manner predicted a worse outcome in social relationships/withdrawal. Regarding interpersonal polarized thinking, it was the best cognitive predictor of social functioning measures. Our results suggest that a dichotomous thinking style in interpersonal perception might also be relevant for elucidating the dysfunction in social adjustment domains. These findings are still preliminary, and form part of an ongoing study.