Is change over time in psychotic symptoms related to social functioning?

2021 ◽  
pp. 002076402110392
Author(s):  
Sascha Kwakernaak ◽  
Wiepke Cahn ◽  
Richard Janssen ◽  
Keyword(s):  
Quality Of Life ◽  
Social Functioning ◽  
Repeated Measures ◽  
Psychotic Disorders ◽  
Medication Use ◽  
Psychotic Symptoms ◽  
Positive Symptoms ◽  
Needs For Care ◽  
Over Time

Objective: In psychosis, treatment often focuses on symptom reduction whereas social functioning is also essential. In this study, we investigate positive psychotic symptoms and medication use in relation to social functioning over a 3-year time-period in 531 patients diagnosed with psychosis. Furthermore, relations of positive symptoms with needs for care and quality of life were also investigated. Method: Using repeated measures analysis, changes were measured over time. Hereafter, mixed model analyses were performed to determine the associations of social functioning, needs for care, and quality of life with psychotic symptoms and patient characteristics. Finally, we assessed differences in symptoms and medication dose between those with an increase and those with a decrease in social functioning. Results: Patients significantly improved in social functioning, while psychotic symptoms increased. Improvement in social functioning was associated with younger age, higher IQ, and lower social functioning at T1, but not with positive symptoms. Also, improvement in social functioning was found to be related to a decrease in the dose of clozapine. Improvement in social functioning occurs despite worsening of positive symptoms. Conclusions: The findings suggest the need to further explore the relation between symptomatology, social functioning, and medication use. In the treatment of psychotic disorders, one should reconsider the strong focus on reducing psychotic symptoms. The current focus needs to shift much more toward improving functional outcome, especially when the patient expresses a desire for change in this respect.

Clinic risk associated with comorbidity of (subclinical) psychosis, anxiety and depressive symptoms: A case for stratified medicine in psychiatry

2016 ◽  
Vol 33 (S1) ◽  
pp. S49-S49 ◽  
Author(s):  
M. van Nierop ◽  
I. Myin-Germeys ◽  
R. van Winkel
Keyword(s):  
Quality Of Life ◽  
Social Functioning ◽  
Childhood Trauma ◽  
Life Stress ◽  
Stress Reactivity ◽  
Daily Life ◽  
Clinical Severity ◽  
Psychotic Symptoms ◽  
The Impact

BackgroundMeta-analyses link childhood trauma to depression, mania, anxiety, and psychosis. It is unclear, however, whether these outcomes truly represent distinct disorders following childhood trauma, or that childhood trauma is associated with admixtures of affective, psychotic, anxiety and manic psychopathology throughout life.AimTo investigate the impact of trauma on psychopathological phenotype, functional outcome, and daily life stress reactivity.MethodsWe used data from a representative general population sample (NEMESIS-2; n = 6646), of whom respectively 1577 and 1120 had a lifetime diagnosis of mood or anxiety disorder, as well as from a sample of patients with a diagnosis of schizophrenia (GROUP; n = 825). Multinomial logistic regression was used to assess whether childhood trauma was more strongly associated with isolated affective/psychotic/anxiety/manic symptoms than with their admixture. Additionally, we examined these groups in terms of social functioning, clinical severity, and quality of life. In a separate sample (n = 621), daily life (emotional and cortisol) stress reactivity was assessed, using ambulatory assessment.ResultsIn all samples, childhood trauma was considerably more strongly associated with an admixture of symptoms of depression, anxiety, psychosis, and mania, rather than with these symptoms in isolation. Individuals exposed to childhood trauma, who also had an admixture of symptoms, had a lower quality of life, more help-seeking behaviour, higher prevalence of substance use disorders, and lower social functioning, compared with individuals not exposed to trauma, without an admixture of symptoms, or neither. Furthermore, trauma-exposed individuals with an admixed psychopathological phenotype show a higher daily emotional stress reactivity.ConclusionChildhood trauma increases the likelihood of a specific admixture of affective, anxiety and psychotic symptoms cutting across traditional diagnostic boundaries. Stratifying according to childhood trauma exposure thus identifies an admixed phenotype, possibly induced by continuous daily life stress reactivity, that has important clinical relevance. Identification of functionally meaningful aetiological subgroups may aid clinical practice.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Personality Compensates for Impaired Quality of Life and Social Functioning in Patients With Psychotic Disorders Who Experienced Traumatic Events

2014 ◽  
Vol 40 (6) ◽  
pp. 1356-1365 ◽  
Author(s):  
L.-L. Boyette ◽  
D. van Dam ◽  
C. Meijer ◽  
E. Velthorst ◽  
W. Cahn ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Social Functioning ◽  
Psychotic Disorders ◽  
Traumatic Events ◽  
Impaired Quality

scholarly journals Improvements in pain, medication use and quality of life in onabotulinumtoxinA-resistant chronic migraine patients following erenumab treatment – real world outcomes

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
J. Talbot ◽  
R. Stuckey ◽  
L. Crawford ◽  
S. Weatherby ◽  
S. Mullin
Keyword(s):  
Quality Of Life ◽  
Chronic Migraine ◽  
Repeated Measures ◽  
Medication Use ◽  
Pain Medication ◽  
Pain Disability Index ◽  
Pain Disability ◽  
Greater Occipital Nerve ◽  
Patient Health

Abstract Background The CGRP antagonists offer a novel therapeutic approach in migraine. Their utility in patients with severe forms of chronic migraine is a subject of particular interest. We present outcomes of 9 months of erenumab treatment in a cohort of patients with difficult-to-control chronic migraine, all of whom had prior unsatisfactory response to onabotulinumtoxinA. Methods We offered erenumab to 98 patients with a prior unsatisfactory response to onabotulinumtoxinA. Eighty of 98 had trialled greater occipital nerve injections (82%), 32/98 peripheral neurostimulation (33%) and 18/98 intravenous dihydroergotamine (18%). Thirty eight of 98 (39%) met the definition of triptan overuse and 43/98 (44%) analgesic overuse. All patients met the EHF criteria for ‘resistant migraine’. Outcome measures (recorded monthly) included days with headache limiting activities of daily living (“red”), not limiting (“amber”), headache free (“green”), and requiring triptans or other analgesics. Quality of life scores - headache impact test 6 (HIT-6), patient health questionnaire 9 (PHQ-9) and pain disability index (PDI) - were also measured. Results Mean number of red days improved by − 6.4 days (SE 0.67, 95%CI − 7.7 to − 5.1, p=0.001) at 3 months; − 6.8 days (SE 0.96, 95%CI − 8.80 to − 4.9, p=0.001) at 6 months and − 6.5 days (SE 0.86, 95%CI − 8.3 to − 4.8, p=0.001) at 9 months. Repeated measures ANOVA confirmed improvements in the number of red (p=0.001), green (p=0.001), triptan (p=0.001) and painkiller days (p=0.001) as well as scores of the HIT-6 (p=0.001), PHQ-9 (p=0.001), and PDI (p=0.001) across the duration of study. Conclusion We observed improvements in pain, medication use and quality of life in onabotulinumtoxinA-resistant chronic migraine patients following erenumab treatment.

scholarly journals Immunological and Quality-of-Life Profiles in Women with Breast Cancer: Complementary versus Conventional Care

2018 ◽  
Vol 25 (6) ◽  
pp. 391-397
Author(s):  
Elisabeth Hamrin ◽  
Jan Ernerudh ◽  
Anders Rosén
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
T Cells ◽  
Cd8 T Cells ◽  
Repeated Measures ◽  
Group Versus ◽  
Physical Symptoms ◽  
Conventional Care ◽  
Over Time

Background: Previous studies showed that women with breast cancer treated in anthroposophic clinic versus conventional care had increased quality of life (QoL) parameters, fighting spirit, and anxiety coping. We have now analyzed immune and QoL factors in these 2 groups for possible differences during the first 6 months after admission, prompted by anthroposophic studies, including mistletoe extracts, showing beneficial immune system effects. Patients and Methods: Fourteen immunological variables, including leukocyte count, lymphocyte count, activated T cells (CD4+ and CD8+), NK cells, B cells, IL1β, IL6, IL10, and oxytocin, were longitudinally analyzed in both groups (n = 2 × 26). A panel of QoL parameters were analyzed using 3 different instruments. Statistical evaluation included that each patient was its own control. Results: Cytotoxic CD8+ T cell frequency (percent of lymphocytes analyzed by flow-cytometry) significantly decreased over time in the anthroposophic group versus the conventional group (repeated measures ANOVA, p = 0.05). No major differences were observed in other immunological parameters, whereas QoL variables, anxiety decreased and physical symptoms increased/improved significantly in the anthroposophic group (p = 0.04 and p = 0.05, respectively). Conclusion: Overall, women with breast cancer in anthroposophic or conventional therapy did not differ in their immune profiles over time, with exception of decreased cytotoxic T cells in the anthroposophic group. Improvement in physical symptoms along with less anxiety in this group may have influenced the brain-immune axis resulting in lower frequency of CD8+ T cells, a feature associated with less aggressive cancer stages. To evaluate whether this observation is associated with good or bad prognosis, further detailed analyses of memory and naïve CD8+ T cells at tumor site and in blood circulation are essential.

scholarly journals Evaluating the Impact of Music & Memory’s Personalized Music and Tablet Engagement Program in Wisconsin Assisted Living Communities: Pilot Study (Preprint)

2018 ◽  
Author(s):  
James H Ford II ◽  
Debby Dodds ◽  
Julie Hyland ◽  
Michael Potteiger
Keyword(s):  
Quality Of Life ◽  
Assisted Living ◽  
Psychological Symptoms ◽  
Qualitative Interviews ◽  
Medication Use ◽  
Term Care ◽  
The Difference ◽  
The Impact ◽  
Over Time

BACKGROUND Individuals with Alzheimer disease or related dementia represent a significant and growing segment of the older adult (aged 65 years and above) population. In addition to physical health concerns, including comorbid medical conditions, these individuals often exhibit behavioral and psychological symptoms of dementia (BPSD). The presence of BPSD in long-term care residential facilities can disrupt resident’s care and impact staff. Nonpharmacological interventions such as personalized music and tablet engagement maintain cognitive function, improve quality of life (QOL), and mitigate BPSD for older adults with dementia. Evidence of the impact of such interventions in assisted living communities (ALCs) is needed for widespread adoption and sustainment of these technologies. OBJECTIVE The aim of this study was to assess the impact of Music & Memory’s personalized music and tablet engagement (PMATE) program on QOL, agitation, and medication use for residents living in 6 Wisconsin ALCs. METHODS The data collected were on the utilization of iPods and iPads by the residents. Residents’ outcomes were assessed using the Pittsburgh Agitation Scale, the Quality of Life in Late Stage Dementia scale, and self-reported medication use. A mixed-methods approach was utilized to examine the impact of the PMATE program on these outcomes. Descriptive statistics were calculated. A paired t test explored changes in residents’ QOL. A 1-way analysis of variance was utilized to examine changes in resident’s agitation and QOL based on the resident’s utilization of the PMATE program. Qualitative interviews were conducted with the individuals responsible for PMATE implementation in the ALC. Residents excluded from the analysis were those who passed away, were discharged, or refused to participate. RESULTS A total of 5 apps, based on average times used by residents, were identified. In all, 4 of the 5 apps were rated as being useful to promote residents’ engagement. PMATE utilization was not associated with changes in the residents’ agitation levels or antipsychotic medication use over time. Over a 3-month period, the change in residents’ QOL was significant (P=.047), and the differences across ALCs were also significant (F25=3.76, P=.02). High utilizers of the PMATE program (>2500 min over 3 months) showed greater improvements in QOL as compared with low utilizers (a change of −5.90 points vs an increase of 0.43 points). The difference was significant (P=.03). Similar significant findings were found between the high- and midutilizers. CONCLUSIONS The study is one of the first to explore the impact of Music & Memory’s PMATE program on residents living in ALCs. Findings suggest that higher utilization over time improves residents’ QOL. However, a more comprehensive study with improved data collection efforts across multiple ALCs is needed to confirm these preliminary findings.

A prospective comparison of the FACT-e and EORTC-QLQC30 and OG25 questionnaires for evaluating changes in health-related quality of life in patients with esophageal cancer.

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 130-130
Author(s):  
Gail Darling
Keyword(s):  
Quality Of Life ◽  
Esophageal Cancer ◽  
Repeated Measures ◽  
Disease Free Survival ◽  
Well Being ◽  
Symptom Improvement ◽  
Life Questionnaire ◽  
European Organization ◽  
Over Time

130 Background: The FACT-E (Functional Assessment of Cancer Therapy– Esophageal) and the EORTC QLQ-C30 (European Organization for Research on Treatment of Cancer Quality of Life Questionnaire) and its cancer-specific module (OG25) are two validated instruments used to assess quality-of-life (QOL) in patients with esophageal cancer. This study investigates the differences between these two instruments. Methods: This is a prospective study of 22 consecutive patients treated with chemoradiation followed by surgery. Questionnaires were self-administered at each of the following: baseline (prior to treatment), 6-8 weeks and 12-14 weeks following start of chemoradiation, and 1, 3, 6, 9, 12, and 18 months following esophagectomy. Mixed model regression was applied to model the repeated measures of the two questionnaires to compare slopes. Results: Of the 22 patients, 20 proceeded to surgery. Overall survival and disease-free survival at 18 months were 59% and 55% respectively. Comparison of the QOL domains over time showed good correlation for physical and functional well-being, with an apparent variation in the magnitude of the changes over time for the latter. The questionnaires were discordant with respect to social and total well-being. Social well-being showed a return to baseline by 1 month post-op using the FACT, but never recovered to baseline for the EORTC. FACT Total well-being recovered to baseline by 9 months, while the EORTC only approached baseline values by 18 months. The disease-specific modules showed post-operative symptom improvement with the FACT and a deterioration with the EORTC. There was also discordance in emotional well being. Conclusions: Domain comparisons of the EORTC and FACT questionnaires showed differing results. Discordance was seen for emotional, social and overall QOL, as well as symptomatology. The EORTC total and physical well-being domains showed a similar pattern of change over time. These findings might result from the overall tendency of the EORTC to emphasize physical aspects of QOL. Thus these two instruments appear to measure different aspects of QOL, which may affect their clinical utility.

Evaluation of cognitive function and quality of life in breast cancer patients receiving adjuvant dose dense chemotherapy.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e19519-e19519
Author(s):  
Michael B. Dabrow ◽  
Christine E. Szarka ◽  
Joanne Moore ◽  
Michael R Chernick
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
Adjuvant Chemotherapy ◽  
Repeated Measures ◽  
Early Stage ◽  
Well Being ◽  
Cancer Center ◽  
Dose Dense ◽  
Over Time

e19519 Background: Breast cancer therapy related neurocognitive dysfunction, such as memory impairment and “chemo-brain”, has been reported by many women during and after receiving adjuvant chemotherapy. Studies evaluating this effect have had mixed results regarding its validity. No study has evaluated a specific regimen and none have examined dose dense therapy. We have serially evaluated the cognitive and quality of life changes in patients receiving dose dense adjuvant adriamycin/cyclophosphamide followed by pactitaxel (DD AT-P) chemotherapy. Methods: Patients with early stage breast cancer (Stages I, II) who were treated at a single community hospital cancer center and were given dose dense AC-P adjuvant chemotherapy were asked to participate in this trial. 45 patients were enrolled and 43 were eligible for evaluation with the following instruments: FACT-F, FAS test, MMSE, MNA and BDI. Tests were administered at the start of chemotherapy, at the completion of chemotherapy, at 6 months and 12 months after completing chemotherapy. The tests were administered by oncology nurses. Scores were evaluated using repeated measures analysis of variance testing whether or not the change from baseline test scores had a trend over time. Results: 43 patients were evaluated. Age range was 34-72 years with a median age of 52. 34 patients completed 4 evaluations, 6 completed 3 evaluations, 3 completed 2 evaluations. The only measures demonstrating significant trends were the FAS test (p=0.022) and the Functional Well-Being (p=0.002) and Physical Well-Being (p<0.0001) portions of the FACT-F. The changes over time for these measures all indicated improved performance over baseline at the completion of the trial. The remainder of the tests showed no significant change over time. Conclusions: Dose dense adjuvant chemotherapy with AC-P for breast cancer does not result in decreased cognitive or quality of life measures over time. Patients can be reassured that this specific program of therapy will not lead to long term decreases in mental function and quality of life.

scholarly journals Longitudinal analysis of quality of life outcomes in children during treatment for acute lymphoblastic leukemia: A report from the Children’s Oncology Group (COG) AALL0932.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 10522-10522
Author(s):  
Daniel Zheng ◽  
Xiaomin Lu ◽  
Wilhelmenia L. Ross ◽  
Anne L. Angiolillo ◽  
Reuven Schore ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Acute Lymphoblastic Leukemia ◽  
Family Functioning ◽  
Repeated Measures ◽  
Emotional Functioning ◽  
Lymphoblastic Leukemia ◽  
Average Risk ◽  
Emotional Impairment ◽  
Over Time

10522 Background: 5-year event-free survival for average-risk acute lymphoblastic leukemia (AR-ALL) in children is ~95%. However, therapy involves multi-agent chemotherapy, frequent hospital visits (duration of therapy is 26 months for girls and 38 months for boys) and painful procedures that can adversely affect quality of life (QOL). Methods: AR-ALL patients enrolled on COG AALL0932 were offered participation if ≥4 years old at diagnosis with an English-speaking parent. At ~2, 8, 17, 26, and 38 (boys only) months after diagnosis, parents completed the PedsQL4.0 and the Family Assessment Device instruments for QOL (assessing physical and emotional functioning) and family functioning, respectively. The proportions of individuals scoring in the impaired range (i.e. 2 SD below population mean) were calculated at each timepoint. Patterns of impairment over time and potential predictors were examined. Results: 594 participants with AR-ALL (48% female, 68% white) were diagnosed at a median age of 5.6 (IQR: 4.6–7.1) years. At 2 months, a significant percentage of participants had impaired scores compared to population norms for physical (36.5 vs. 2.3; 95% CI 32.3-40.8) and emotional functioning (26.2 vs. 2.3; 95% CI 22.5-30.2). Although scores improved over time, elevations persisted at 26 months for physical (11.9 vs. 2.3; 95% CI 8.4-16.1) and emotional (9.8 vs. 2.3; 95% CI 2.0-6.7) functioning. In repeated measures analysis with multivariate modeling, emotional impairment at 2 months (OR 3.7; 95% CI 1.5-7.7) and abnormal family functioning (OR 1.5; 95% CI 1.1-2.1) significantly predicted emotional impairment. QOL outcomes were similar for girls at 26 months and boys at 38 months. Conclusions: Many children with AR-ALL experience severe impairment in both physical and emotional functioning that begins early in treatment and persists. Family functioning is a modifiable risk factor that may be targeted for early screening and intervention.

scholarly journals Creating Live Interactions to Mitigate Barriers (CLIMB): A Mobile Intervention to Improve Social Functioning in People With Chronic Psychotic Disorders

2016 ◽  
Vol 3 (4) ◽  
pp. e52 ◽  
Author(s):  
Bruno Biagianti ◽  
Danielle Schlosser ◽  
Mor Nahum ◽  
Josh Woolley ◽  
Sophia Vinogradov
Keyword(s):  
Quality Of Life ◽  
Social Cognition ◽  
Group Therapy ◽  
Social Functioning ◽  
Mobile Devices ◽  
Psychotic Disorders ◽  
Positive Effects ◽  
Randomized Controlled Studies ◽  
Therapy Sessions

Background Numerous psychosocial interventions for individuals with chronic psychotic disorders (CPD) have shown positive effects on social cognitive and functional outcome measures. However, access to and engagement with these interventions remains limited. This is partly because these interventions require specially trained therapists, are not available in all clinical settings, and have a high scheduling burden for participants, usually requiring a commitment of several weeks. Delivering interventions remotely via mobile devices may facilitate access, improve scheduling flexibility, and decrease participant burden, thus improving adherence to intervention requirements. To address these needs, we designed the Creating Live Interactions to Mitigate Barriers (CLIMB) digital intervention, which aims to enhance social functioning in people with CPD. CLIMB consists of two treatment components: a computerized social cognition training (SCT) program and optimized remote group therapy (ORGT). ORGT is an innovative treatment that combines remote group therapy with group texting (short message service, SMS). Objectives The objectives of this single-arm study were to investigate the feasibility of delivering 6 weeks of CLIMB to people with CPD and explore the initial effects on outcomes. Methods Participants were recruited, screened and enrolled via the Internet, and delivered assessments and interventions remotely using provided tablets (iPads). Participants were asked to complete 18 hours of SCT and to attend 6 remote group therapy sessions. To assess feasibility, adherence to study procedures, attrition rates, engagement metrics, and acceptability of the intervention were evaluated. Changes on measures of social cognition, quality of life, and symptoms were also explored. Results In total, 27 participants were enrolled over 12 months. Remote assessments were completed successfully on 96% (26/27) of the enrolled participants. Retention in the 6-week trial was 78% (21/27). Of all the iPads used, 95% (22/23) were returned undamaged at the end of the intervention. Participants on average attended 84% of the group therapy sessions, completed a median of 9.5 hours of SCT, and posted a median of 5.2 messages per week on the group text chat. Participants rated CLIMB in the medium range in usability, acceptability, enjoyment, and perceived benefit. Participants showed significant improvements in emotion identification abilities for prosodic happiness (P=.001), prosodic happiness intensity (P=.04), and facial anger (P=.04), with large within-group effect sizes (d=.60 to d=.86). Trend-level improvements were observed on aspects of quality of life (P values less than .09). No improvements were observed for symptoms. Conclusions It is feasible and acceptable to remotely deliver an intervention aimed at enhancing social functioning in people with CPD using mobile devices. This approach may represent a scalable method to increase treatment access and adherence. Our pilot data also demonstrate within-group gains in some aspects of social cognition after 6 weeks of CLIMB. Future randomized controlled studies in larger samples should evaluate the extent to which CLIMB significantly improves social cognition, symptoms, and quality of life in CPD.

Psychological and Cognitive Aspects of Borderline Intellectual Functioning

2017 ◽  
Vol 22 (3) ◽  
pp. 159-166 ◽  
Author(s):  
Bastianina Contena ◽  
Stefano Taddei
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Intellectual Functioning ◽  
Clinical Impact ◽  
Review Of The Literature ◽  
Borderline Intellectual Functioning ◽  
General Quality ◽  
Meta Analyses ◽  
Over Time

Abstract. Borderline Intellectual Functioning (BIF) refers to a global IQ ranging from 71 to 84, and it represents a condition of clinical attention for its association with other disorders and its influence on the outcomes of treatments and, in general, quality of life and adaptation. Furthermore, its definition has changed over time causing a relevant clinical impact. For this reason, a systematic review of the literature on this topic can promote an understanding of what has been studied, and can differentiate what is currently attributable to BIF from that which cannot be associated with this kind of intellectual functioning. Using Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) criteria, we have conducted a review of the literature about BIF. The results suggest that this condition is still associated with mental retardation, and only a few studies have focused specifically on this condition.

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