Premorbid personality and cognitive function impact on schizophrenia (original) (raw)
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A functional comparison of patients with schizophrenia between the North and South of Europe
European Psychiatry, 2012
Medical trails are today performed worldwide and it is not uncommon that centres of the same study are located in different parts of the world. At the same time, there is a growing demand not only of a defined goal for treatment such as remission but also to demonstrate a distinct improvement in patients' function before the drug will be approved and get reimbursement. To start, it is no longer enough only to show a reduction in symptoms with about 20 points on a rating-scale. The remission criterion by Andreasen et al. [1] is one attempt to construct a qualitative goal for the treatment. Different real life milestones presented independently or in scales such as the Strauss-Carpenter Scale [10] address functional outcome issues. Performance based tests such as the UCSD Performance-Based Skills Assessment-Brief version (UPSA-B) [8] focus on patient's ability to perform without any influence from society that may interfere with outcome. A large number of studies have proved the relationship between cognitive performance and outcome. Achieved remission is also related to a higher level of functional performance and independence [3]. However, patients' cognitive and symptomatic statuses do not seem to solely count for real life milestones. Neither do their performances in a performance-based skills test predict how well they will adapt to normal life. This is shown in a study where patients from United States and Sweden with the same cognitive and functional performance together with the same amount of symptoms control proved to have different outcomes in real life [2]. It is probably differences between societies rather than differences between patient populations that explain these findings. In this study, patients in two areas in Italy, Milan and Naples, compares with one in Sweden, Trollhattan. The purpose is to study similarities in the patients' populations regarding symptomatic status, performance in a performance-based skills assessment and also to compare how these will be matched by achievement of real life milestones. 2. Method 2.1. Design Patients in three different centres, two in Italy and one in Sweden, with schizophrenia or schizoaffective disorder, were included in this study as a part of the EGOFORS initiative.
4th European Conference on Schizophrenia Research: together for better treatment and care
European Archives of Psychiatry and Clinical Neuroscience, 2013
Clinical research over the past several years has increasingly revealed marked heterogeneity and excessive co-morbidity of psychiatric disorders as currently defined. Recent studies have also demonstrated significant overlaps in genetic risk across the spectrum of psychotic disorders, as well as across mood-anxiety disorders. These issues represent barriers to accurate diagnosis and the development of appropriately focused treatments. In response to such concerns, the National Institute of Mental Health (NIMH) developed the Research Domain Criteria project (RDoC), to ''develop, for research purposes, new ways of classifying mental disorders based on dimensions of observable behavior and neurobiological measures.'' This talk will summarize the rationale and current status of RDoC, with an emphasis on how research within the RDoC framework can contribute to new ways of parsing the spectrum of psychotic disorders and to the development of more precisely targeted preventive and treatment interventions.
2014 16 Article-Schizophrenia-Longterm-Followup-SchizRes.pdf
Background: Although the few available studies from LMICs report favorable outcome, the course of schizophrenia is more complex than has been indicated so far. Methods: A sample of 361 people with a standardized clinical diagnosis of schizophrenia were recruited from a predominantly rural community in Ethiopia and followed up regularly for an average of 10 years. Psychiatrists used the Longitudinal Interval Follow-up Evaluation chart to carry out assessment of illness course. Duration of time in clinical remission was the primary outcome. Result: About 61.0% of the patients remained under active follow-up, while 18.1% (n = 65) were deceased. The mean percentage of follow-up time in complete remission was 28.4% (SD = 33.0). Female patients were significantly more likely to have episodic illness course with no inter-episode residual or negative symptoms (χ 2 = 6.28, P = 0.012). Nearly 14.0% had continuous psychotic symptoms for over 75% of their follow-up time. Only 18.1% achieved complete remission for over 75% of their follow-up time. Later onset of illness was the only significant predictor of achieving full remission for over 50% of follow-up time in a fully adjusted model. Conventional antipsychotic medications were fairly well tolerated in 80% of the patients and 4.2% (n = 15) experienced tardive dyskinesia. Conclusion: This population-based study is one of the very few long-term outcome studies of schizophrenia in LMICs. The study demonstrated clearly a differential and more favorable course and outcome for female patients but overall course and outcome of schizophrenia appeared less favorable in this setting than has been reported from other LMICs.
Schizophrenia: from Epidemiology to Rehabilitation
2012
Purpose/Objective: We discuss recent evidences about schizophrenia (frequency, onset, course, risk factors and genetics) and their influences to some epidemiological myths about schizophrenia diffuse between psychiatric and psychopathology clinicians. The scope is to evaluate if the new acquisitions may change the rehabilitation approaches to schizophrenia modifying the balance about the neurodevelopmental hypothesis of schizophrenia accepting that the cognitive deficits are produced by errors during the normal development of the brain (neurodevelopmental hypothesis) that remains stable in the course of illness and the neurodegenerative hypothesis according of which they derived from a degenerative process that goes on inexorably.
RBANS neuropsychological profiles within schizophrenia samples recruited from non-clinical settings
Schizophrenia Research, 2007
This paper examines the potential impact of recruitment source differences in schizophrenia research by comparing the neuropsychological performance of volunteers from the NISAD Schizophrenia Research Register with recently published schizophrenia normative data for the Repeatable Battery for Neuropsychological Status (RBANS).The Register sample comprised 285 volunteers with schizophrenia or schizoaffective disorder. Their RBANS performance was compared with US data from 575 predominantly outpatient-recruited schizophrenia patients.The Register sample displayed impairments in immediate and delayed memory, but near-normal language, attention and visuospatial-constructional performance (mean RBANS total score = 88.72, SD = 16.35). By contrast, health service-recruited schizophrenia patients displayed impairments on all RBANS scales (mean RBANS total score = 70.54, SD = 14.80). Within the Register sample, volunteers with low levels of current functioning had immediate and delayed memory performance comparable to the US schizophrenia sample. Gender and school completion status were also associated with different RBANS profiles.These findings reinforce the notion that a severity/functioning gradient exists across schizophrenia recruitment sources, which has important implications for research design and generalizability. Memory impairments have emerged as a central feature of schizophrenia.
Schizophrenia research, 2012
Psychiatric hospitalization registries are utilized to investigate the incidence and prevalence of schizophrenia for both research and administrative purposes. The assumption behind this is that most individuals with schizophrenia will be hospitalized at least once in their life-time. In an epidemiological survey conducted in the 1980s, a population-based sample (n = 4914) of Israel-born individuals then aged 25-34 were screened in the community, and 29 (0.6%) were subsequently diagnosed by psychiatrists using SADS/RDC criteria. Twenty four years later we linked data from the epidemiological survey with the Israeli National Psychiatric Hospitalization Registry. Twenty seven of the 29 individuals (93%) diagnosed with schizophrenia in the survey were identified in the hospitalization registry with the same diagnosis. Fifty-two (1.0%) participants not diagnosed during the survey with schizophrenia were identified in the psychiatric hospitalization registry 24 years later with schizophr...
Schizophrenia today: epidemiology, diagnosis, course and models of care
2014
Correspondence C. Altamura • E-mail: carlo.altamura@unimi.it; A. Fagiolini • E-mail: andreafagiolini@gmail.com; S. Galderisi • E-mail: silvana.galderisi@gmail. com; P. Rocca • E-mail: paola.rocca@unito.it; A. Rossi • E-mail: alessandro.rossi@cc.univaq.it. Summary Schizophrenia is a serious public health problem: according to WHO it is responsible for 1.1% of total disability adjusted life years (DALYs) and absorbs 1.5-3.0% of all healthcare expenditure in developed countries. In Europe, it is estimated that there are about 5 million persons with schizophrenia, with a prevalence of 0.6-0.8%. In 98% of cases onset occurs before the age of 40 years with a slight male predominance. Several environmental factors have been implicated in the genesis of schizophrenia. Epidemiological data in Italy are less accurate than those in other Western countries. The article presents national and regional epidemiological data on the characteristics of healthcare in patients with schizophrenia. The mo...
The Malaga Schizophrenia Case-Register (Resma): Overview of Methodology and Patient Cohort
International Journal of Social Psychiatry, 2009
Background: Little information has become available after psychiatric reforms regarding outcomes of persons with schizophrenia and related disorders cared for in community-based mental health facilities. Aims: The aim of this study was to determine the consequences of psychiatric services in the users of mental health services in Malaga. Method: We describe the cohort and methods involved in the Schizophrenia Case Register (RESMA) in Malaga, Spain. All cases (n = 1,022) were users of public mental health services provided in the catchment area over one year. The majority were male (65%), single (68%), living with their original family (50%), with primary education (41%) and living on disability benefi ts (52%). Results: Concerning use of services, the majority had out-patient contacts (89%). Results show a substantial overlap in the use of different services during the study period. Conclusion: The Malaga Schizophrenia Case Register provides sociodemographic, clinical and service use information for a large sample of patients with schizophrenia or related disorders. Results obtained from the cohort studied will be instrumental for the follow-up and evaluation of the mental health care reform.