Lack of insight as a third variable between subjective appraisal of cognitive impairment and psychotic symptoms

2017 ◽  
Vol 41 (S1) ◽  
pp. S384-S384
Author(s):  
R. Rossi ◽  
V. Santarelli ◽  
C. Marucci ◽  
D. Gianfelice ◽  
F. Pacitti
Keyword(s):  
Cognitive Deficits ◽  
Symptom Severity ◽  
Negative Symptoms ◽  
Psychotic Symptoms ◽  
Subjective Perception ◽  
Mediator Role ◽  
Competing Interest ◽  
The One ◽  
The Relationship ◽  
Mediator Variable

BackgroundThe relationship between subjective appraisal of cognitive deficits and symptom severity in schizophrenia is unclear. Insight reportedly impacts on both factors. Our aim is to further asses the relationship between the subjective perception of cognitive deficits, symptom severity and lack of Insight as a mediator variable.MethodsA total of 109 subject diagnosed with schizophrenia. Positive and Negative Syndrome Scale (PANSS) was modelled as dependent variable; Subjective Scale to Investigate Cognition in Schizophrenia (SSTICS) was modeled as independent variable and “Lack of Insight” (LoI) PANSS Item was tested as a mediator variable. Mediation was assessed using the Sobel Mediation Test.ResultsLoI acts as a suppressor variable (i.e. it enhances the relation between the independent and dependent variable) between SSTICS and negative symptoms, while showing a mediator effect between SSTICS and depressive symptoms.DiscussionLoI has a central role in mediating the relationship between subjective appraisal of cognitive deficits on the one hand and positive and depressed symptoms on the other. Its suppressor role between SSTICS and depression is consistent with several reports of an enhanced risk of depression in patients fully aware of their disability. Its mediator role between STICSS and positive symptoms supports the centrality of LoI as a metacognitive function whose failure may worsen psychotic symptoms.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Can the ‘mediation’ approach help to understand the role of lack of insight in the relationship between symptoms and functioning in schizophrenia?

2017 ◽  
Vol 41 (S1) ◽  
pp. s832-s832
Author(s):  
R. Rossi ◽  
V. Santarelli ◽  
C. Marucci ◽  
G. Pizziconi ◽  
F. Pacitti
Keyword(s):  
Factor Model ◽  
Five Factor Model ◽  
Psychotic Symptoms ◽  
Global Assessment Of Functioning ◽  
Global Functioning ◽  
Mediation Analyses ◽  
Competing Interest ◽  
The One ◽  
The Relationship

IntroductionThe relationship between Lack of insight (LoI) and other symptoms in schizophrenia is complex. LoI could be associated with severity of symptoms at one side and global functioning at the other. For this nature LoI is a candidate ‘mediator’ for the relationship between psychotic symptoms and global functioning.ObjectivesThe aim of this study is to explore the possible role of LoI as a mediator between psychotic symptoms and global functioning in a sample of people with schizophrenia.MethodsSeventy-three patients with a diagnosis of schizophrenia were included. The five-factor model of the PANSS by Wall work was used to assess psychopathology and G12 item as an estimate of LoI. Global assessment of functioning (GAF) was used to measure global disability. Pearson's r correlations and linear regressions for Sobel test for mediation were performed. PANSS factors were modeled as predictors of global functioning and LoI as the mediator.ResultsCorrelations revealed the prerequisite relationships between LoI, positive, negative and disorganized PANSS factors and global functioning. Mediation analyses show that LoI partially mediates the relationship between positive and disorganized factor scores and global functioning. No mediation for negative factor score was observed.ConclusionsLack of insight mediates the relationships between positive and disorganized factors and global functioning. The partial mediation we report suggests that LoI on the one hand is an independent contributor to global function, but further shows an indirect effect of PANSS positive and disorganized factors to GAF total score.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Evaluation of positive and negative symptoms in schizophrenia

1986 ◽  
Vol 1 (2) ◽  
pp. 108-122 ◽  
Author(s):  
Nancy C. Andreasen ◽  
William M. Grove
Keyword(s):  
Negative Symptoms ◽  
The United States ◽  
Psychotic Symptoms ◽  
Positive Symptoms ◽  
University Of Iowa ◽  
Normal Functions ◽  
Subsequent Investigation ◽  
The University ◽  
The Relationship ◽  
Positive And Negative Symptoms

SummaryMost investigators concur that schizophrenia is probably a heterogeneous group of disorders that share the common features of psychotic symptoms, partial response to neuroleptics, and a relatively poor outcome. The subdivision of schizophrenia into two subtypes, positive versus negative, has achieved wide acceptance throughout the world during recent years. This distinction has heuristic and theoretical appeal because it unites phenomenology, pathophysiology, and etiology into a single comprehensive hypothesis.In spite of its wide appeal, the distinction has a number of problems. These include the failure to distinguish between symptom syndromes and diseases; failure to deal with the mixed patient; failure to take longitudinal course into account; and failure to address conceptually and methodologically the distinction between positive and negative symptoms.This paper focuses primarily on the conceptual basis for two instruments designed to measure positive and negative symptoms, the Scale for the Assessment of Negative Symptoms (SANS) and the Scale for the Assessment of Positive Symptoms (SAPS), originally described in 1982. Since their description, these scales have been used in a variety of other centers. These scales are based on the hypothesis that negative symptoms represent a deficit or diminution in normal psychological functions wliile positive symptoms represent an excess or distortion of normal functions. Reliability data are now available from Italy, Spain, and Japan which suggest that these scales can be used reliably in cultural settings outside the United States. The results of these studies are summarized in this paper. In addition, a replication study involving a new sample of 117 schizophrenics collected at the University of Iowa is described. In this second study of the SANS and SAPS, internal consistency is found to be quite high in the SANS. Thus negative symptoms appear to be more internally correlated with one another than are positive symptoms. The implications of this result are discussed. A principal components analysis is used to explore the relationship between positive and negative symptoms. While the study reported in 1982 suggested that positive and negative symptoms are negatively correlated, in the present study they appear to be uncorrelated. Overall, the results suggest that the SANS and SAPS are useful comprehensive instruments for the evaluation of positive and negative symptoms. The relationship between these symptoms and external validators such as cognitive functioning or CT scan abnormalities will be reported in a subsequent investigation.

Panic Attacks in Chronic Schizophrenia

1990 ◽  
Vol 157 (3) ◽  
pp. 430-433 ◽  
Author(s):  
Nicholas Argyle
Keyword(s):  
Maintenance Therapy ◽  
Social Phobia ◽  
Negative Symptoms ◽  
Chronic Schizophrenia ◽  
Panic Attacks ◽  
Psychotic Symptoms ◽  
Relationship Of ◽  
The Relationship

Of 20 patients attending a clinic for maintenance therapy of schizophrenia, seven had regular panic attacks, and these were often associated with agoraphobia and social phobia. Similar fears and avoidance in other cases were associated with paranoid ideas and negative symptoms. The relationship of panic to psychotic symptoms varied greatly. In two patients neuroleptics were associated with an increase in panic attacks.

Early psychosis in young women

2016 ◽  
Vol 33 (S1) ◽  
pp. S7-S7
Author(s):  
A. Riecher-Rössler
Keyword(s):  
Young Women ◽  
Help Seeking ◽  
Negative Symptoms ◽  
Stress Reactivity ◽  
Psychotic Symptoms ◽  
First Episode ◽  
Seeking Behavior ◽  
Drug Naïve ◽  
Competing Interest ◽  
The University

IntroductionIt is well known that young women are at lower risk for schizophrenic psychoses than young men. However, little is known about the peculiarities of emerging psychosis in young women.ObjectivesTo describe characteristics of emerging psychosis in women.MethodsWithin the FePsy (Früherkennung von Psychosen = early detection of psychosis) study at the University of Basel Psychiatric Clinics we have examined consecutively all patients with a first episode of psychosis (FEP) or an at-risk mental state (ARMS) referred to us between 2000 and 2015.ResultsWomen did not significantly differ from men regarding psychopathology, neither in the ARMS nor in the FEP group. This was true for positive as well as negative symptoms and basic symptoms. Interestingly, women had a higher correlation of self-rating with observer-rating regarding psychotic symptoms. Duration of untreated psychosis was significantly lower in women than in men. Women seek help more quickly than men and their first contact is more often their partner.Regarding neurocognition women showed a slightly better performance in verbal tasks. They also had higher prolactin levels and larger pituitary volumes, even when drug-naive.Transition to psychosis occurred as often and as quickly in women as in men.ConclusionsThere are only few gender differences in patients with emerging psychosis, which resemble mainly those found in the general population, with women showing a better help-seeking behavior, being more partner-oriented, having a better verbal performance and potentially also a higher stress reactivity [1].Disclosure of interestThe author has not supplied his declaration of competing interest.

New dopaminergic and non-dopaminergic theories in schizophrenia and their therapeutic impact

1997 ◽  
Vol 9 (2) ◽  
pp. 64-67
Author(s):  
R.S. Kahn
Keyword(s):  
Cognitive Deficits ◽  
Negative Symptoms ◽  
Dopamine Neurons ◽  
Psychotic Symptoms ◽  
Positive Symptoms ◽  
The Core ◽  
Schizophrenic Patients ◽  
Core Symptoms ◽  
Influential Theory

The dopamine (DA) hypothesis of schizophrenia, postulating that schizophrenia is characterized by increased dopamine function, has been the most influential theory on the pathogenesis of schizophrenia. It has recently been revised based on the appreciation that the core symptoms of schizophrenia may not be the positive (psychotic) symptoms, but rather the negative symptoms and the cognitive deficits found in schizophrenic patients. This revision has prompted the hypothesis that schizophrenia is characterized by both decreased prefrontal dopamine activity (causing deficit symptoms) and increased dopamine activity in mesolimbic dopamine neurons (causing positive symptoms).Notwithstanding this revision of a role for dopamine in schizophrenia, it has become increasingly evident that dysfunction of other monoaminergic systems may be as important in contributing to the pathophysiology of schizophrenia. Specifically, the putative role of serotonin (5-hydroxytryptamine, 5-HT) in schizophrenia is gaining considerable attention. Several observations, such as the ability of the 5-HT antagonist, ritanserin, to alleviate schizophrenic symptoms and, when added to haloperidol (Haldol®), to decrease its extrapyramidal side-effects (EPS), have stimulated studies into a role of 5-HT in schizophrenia. The finding that clozapine (Leponex®), clinically superior to conventional neuroleptics, is a weak DA2 antagonist but a potent 5-HT1c and 5-HT2 antagonist has further stimulated 5-HT-related research in schizophrenia.

An Approach to Comorbidity Between Obsessive-Compulsive Disorder and Schizophrenia

2016 ◽  
Vol 33 (S1) ◽  
pp. S495-S495
Author(s):  
A. Gomez Peinado ◽  
S. Cañas Fraile ◽  
P. Cano Ruiz
Keyword(s):  
Mental Health ◽  
Obsessive Compulsive Disorder ◽  
Negative Symptoms ◽  
Behavioral Therapy ◽  
Psychotic Symptoms ◽  
Simultaneous Presence ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Salud Mental ◽  
Competing Interest

IntroductionAn association has been observed between obsessive symptoms in Obsessive Compulsive Disorder (OCD) and psychotic symptoms in schizophrenia, being sometimes difficult to establish a clear limit between them. The term “schizo-obsessive disorder” was proposed to describe the resulting disorder of comorbidity of OCD and schizophrenia, although it has not been definitely settled.ObjectiveTo analyze the incidence of coexistence of OCD and schizophrenia symptoms and the way it modifies the treatment and prognosis of the illness.MethodReview of some articles published in Mental Health journals such as “Salud Mental” and “Actas Españolas de Psiquiatría”.ResultsSome studies about psychotic patients have determined 15% as the average of comorbidity of OCD and schizophrenia. The probability of having OCD is six times bigger if there is psychotic pathology associated.The fact that obsessive and psychotic symptoms get together in some patients shades the prognosis bringing more negative symptoms, more depressive humor, a larger cognitive impairment, more resistance to treatment and more relapses than we can observe in OCD and schizophrenia isolated.The pharmacological treatment usually consists in neuroleptic plus anti-obsessive drugs, together with cognitive-behavioral therapy. Sometimes, when there is a very bad evolution, it is required to consider psychosurgery as one necessary option, even though its use in this context is not much widespread.ConclusionsThe simultaneous presence of OCD and schizophrenia is more common than we could expect only by chance and makes the prognosis worse, being difficult to find a truly effective treatment.Disclosure of interestThe authors have not supplied their declaration of competing interest.

The Co-occurrence Of Eating Disorders And Psychosis

2016 ◽  
Vol 33 (S1) ◽  
pp. S425-S425 ◽  
Author(s):  
C. Alves Pereira ◽  
J.R. Silva ◽  
R. Cajão ◽  
J.P. Lourenço ◽  
T. Casanova
Keyword(s):  
Eating Disorders ◽  
Critical Reflection ◽  
Literature Search ◽  
Case Series ◽  
The Other ◽  
Psychotic Symptoms ◽  
Psychotic Illness ◽  
Other Hand ◽  
Competing Interest ◽  
The Relationship

IntroductionSeveral reviews have reported the incidence of schizophrenia in patients with eating disorders (ED) to be between 3–10% and the incidence of transient psychotic episodes to be 10–15%. On the other hand, anorexia nervosa appears to affect 1 to 4% of schizophrenia patients. Reports of psychosis and ED occurring in the same patient have led to various views as to the nature of the relationship between the two.ObjectiveAnalysis of the literature illustrated by different clinical cases in which appears to be a relationship between ED and psychosis.AimsCritical reflection about the hypothesis that could underlie the comorbidity of psychotic illness and ED.MethodsNon-systematic review of a literature search using the keywords: eating disorders; psychosis; comorbidity.ResultsThere is no consistent sequence in the co-occurrence of the two conditions – ED sometimes precede and sometimes follows the onset of psychosis. ED patients can develop psychotic symptoms, most frequently transient in the course of the disorder, while others are subsequently diagnosed with a chronic psychotic disorder. On the other hand, patients with a primary psychotic illness can develop an eating disorder. The connection between the two, however, remains speculative, considering the hypothesis that ED and psychosis can be entirely separate disorders that can, by chance, occur in the same person.ConclusionsThe area of comorbidity and overlapping symptoms in psychiatry requires more deep research. Despite evidence from case series, the comorbidity between ED and psychosis is poorly understood, and firm conclusions cannot be drawn from this analysis.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals The role of perceived discrimination in mediating the relationship between minority status and psychotic symptoms in a community sample

Konselor ◽  
2020 ◽  
Vol 8 (4) ◽  
Author(s):  
Eko Hermanto ◽  
Sali Rahadi Asih ◽  
Edo Sebastian Jaya
Keyword(s):  
Negative Symptoms ◽  
Minority Groups ◽  
Perceived Discrimination ◽  
Community Sample ◽  
Underlying Mechanism ◽  
Psychotic Symptoms ◽  
Minority Status ◽  
Social Stressors ◽  
The Relationship

Minority groups have been found to be at higher risk of developing psychotic symptoms, but the underlying mechanism is yet to be established. This study aims to determine the mechanism that underlies the relationship between minority status and psychotic symptoms, investigating the role of perceived discrimination as a mediator. We assessed 387 participants from a community sample in Indonesia using the Community Assessment of Psychotic Experiences for psychotic symptoms, surveys adapted from the NEMESIS study for minority status and perceived discrimination, and controlled for depression with the Patient Health Questionnaire-9. Mediation analysis was conducted, which showed that perceived discrimination fully mediated the relationship between minority status and positive psychotic symptoms, but not negative psychotic symptoms. This finding supports the social defeat hypothesis, which states that social stressors lead to positive psychotic symptoms due to dopamine dysregulation. However, further research is required to illustrate the association between social stressors and negative symptoms.

scholarly journals Cognitive impairment as a risk factor for psychosis

2005 ◽  
Vol 7 (1) ◽  
pp. 31-38 ◽  
Keyword(s):  
Risk Factor ◽  
Cognitive Impairment ◽  
Cognitive Functioning ◽  
Brain Function ◽  
Negative Symptoms ◽  
Psychotic Disorders ◽  
Epidemiological Studies ◽  
Psychotic Symptoms ◽  
Future Research ◽  
The Relationship

Since the time of Kraepelin and Bleuler, it has been recognized that schizophrenia is associated with a profound and persistent cognitive impairment. This paper reviews the major clinical and epidemiological studies of cognitive functioning in schizophrenia and other psychotic disorders, and presents several possible models to explain the association between cognitive impairment and psychosis. Cognitive impairment is present in the majority of patients with schizophrenia, and, in some, it is already evident in the premorbid stages of the disorder. This cognitive impairment is not secondary to psychotic symptoms, negative symptoms, or socioeconomic status. Cognitive impairment can also be observed in nonpsychotic family members of psychotic patients. On the basis of this evidence, it has been proposed that abnormal cognitive functioning can be considered as a possible causal risk factor for psychosis. Recent studies assessing the relationship between genetic background, cognition, brain function, and schizophrenia are presented here as an outline for future research.

Communication, Trust, and Loyalty in the Hotel Sector: The Mediator Role of Consumer's Complaints

2020 ◽  
Vol 25 (1) ◽  
pp. 183-187
Author(s):  
Beatriz Palacios Florencio ◽  
Luna Santos Roldán ◽  
Juan Manuel Berbel Pineda
Keyword(s):  
Customer Loyalty ◽  
Structural Equations ◽  
Structural Equations Modeling ◽  
Mediator Role ◽  
Hotel Sector ◽  
The Relationship ◽  
Mediator Variable

The purpose of this study was to analyze how the relationship between communication with customers, loyalty, and trust are mediated by a correct handling of customers' complaints. A survey of 629 customers of the hotel sector, and using structural equations modeling, was used. The results demonstrated that good customer communication and information when handling claims positively and significantly influences customer loyalty and trust. Loyal and trusting customers is one of the aims of companies. These are generally determined by the communication carried out by the firm. Nevertheless, it is understandable that there is a mediator variable: the firm's handling of customers' complaints.

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