Idiographic analyses of motivation and related processes in participants with schizophrenia following a therapeutic intervention for negative symptoms

Abstract Background Motivational negative symptoms hinder quality of life and daily functioning of individuals with schizophrenia spectrum disorders. A recently developed intervention, Switch, has shown promising effects on negative symptoms and functional outcomes. Switch targets multiple cognitive, emotional and behavioural processes associated with motivation and goal directed behaviours. We aimed to investigate its effects on motivation and associated processes in a naturalistic setting, and to explore the dynamics between the processes. Methods We used a single case approach (n = 3), with a pre-post and follow-up assessment design, which also included ambulatory assessments (experience sampling method, ESM; and step count). We computed autoregressive lag 1 models to evaluate the effects of the intervention on daily motivation levels and related processes, descriptive pie-charts, and vector autoregressive modelling to reveal the dynamics of the processes over time. Results The intervention was beneficial for each participant according to traditional evaluations of motivational negative symptoms, apathy, daily functioning and quality of life. The effects on the ESM variables revealed distinct outcomes for each individual. The dynamics between the various processes differed between participants, and fluctuated within participants (when comparing baseline, intervention phase, and follow-up). Conclusions This study used an innovative approach to look at the effectiveness of an intervention. The intervention seems to lead to meaningful improvements in motivational negative symptoms and functional outcomes. The mechanisms of change need to be further investigated. Trial registration number ClinicalTrials.gov, NCT04325100. Registered 27 March 27, 2020 -retrospectively registered. Reporting Guidelines from the Transparent Reporting of Evaluations with Non-randomized Designs (TREND) statement were followed.

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Idiographic analyses of motivation and related processes in participants with schizophrenia following a therapeutic intervention for negative symptoms

10.21203/rs.3.rs-21750/v2 ◽

2020 ◽

Author(s):

Bénédicte Thonon ◽

Evelyne Van Aubel ◽

Ginette Lafit ◽

Clara Della Libera ◽

Frank Laroi

Keyword(s):

Quality Of Life ◽

Functional Outcomes ◽

Negative Symptoms ◽

Single Case ◽

Daily Functioning ◽

Schizophrenia Spectrum Disorders ◽

Vector Autoregressive ◽

Assessment Design

Abstract Background : Motivational negative symptoms hinder quality of life and daily functioning of individuals with schizophrenia spectrum disorders. A recently developed intervention, Switch, has shown promising effects on negative symptoms and functional outcomes. Switch targets multiple cognitive, emotional and behavioural processes associated with motivation and goal directed behaviours. We aimed to investigate its effects on motivation and associated processes in a naturalistic setting, and to explore the dynamics between the processes. Methods : We used a single case approach ( n = 3), with a pre-post and follow-up assessment design, which also included ambulatory assessments (experience sampling method, ESM; and step count). We computed autoregressive lag 1 models to evaluate the effects of the intervention on daily motivation levels and related processes, descriptive pie-charts, and vector autoregressive modelling to reveal the dynamics of the processes over time. Results : The intervention was beneficial for each participant according to traditional evaluations of motivational negative symptoms, apathy, daily functioning and quality of life. The effects on the ESM variables revealed distinct outcomes for each individual. The dynamics between the various processes differed between participants, and fluctuated within participants (when comparing baseline, intervention phase, and follow-up). Conclusions : This study used an innovative approach to look at the effectiveness of an intervention. The intervention seems to lead to meaningful improvements in motivational negative symptoms and functional outcomes. The mechanisms of change need to be further investigated.

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Idiographic analyses of motivation and related processes in participants with schizophrenia following a therapeutic intervention for negative symptoms

10.21203/rs.3.rs-21750/v3 ◽

2020 ◽

Author(s):

Bénédicte Thonon ◽

Evelyne Van Aubel ◽

Ginette Lafit ◽

Clara Della Libera ◽

Frank Laroi

Keyword(s):

Quality Of Life ◽

Functional Outcomes ◽

Negative Symptoms ◽

Single Case ◽

Daily Functioning ◽

Schizophrenia Spectrum Disorders ◽

Vector Autoregressive ◽

Assessment Design

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Idiographic analyses of motivation and related processes in participants with schizophrenia following a therapeutic intervention for negative symptoms

10.21203/rs.3.rs-21750/v1 ◽

2020 ◽

Author(s):

Bénédicte Thonon ◽

Evelyne Van Aubel ◽

Ginette Lafit ◽

Clara Della Libera ◽

Frank Laroi

Keyword(s):

Quality Of Life ◽

Negative Symptoms ◽

Single Case ◽

Daily Functioning ◽

Schizophrenia Spectrum Disorders ◽

Vector Autoregressive ◽

Assessment Design ◽

Registration Number

Abstract Background Motivational negative symptoms hinder quality of life and daily functioning of individuals with schizophrenia spectrum disorders. A recently developed intervention, Switch, has shown promising effects on negative symptoms and functional outcomes. Switch targets multiple cognitive, emotional and behavioural processes associated with motivation and goal directed behaviours. We aimed to investigate its effects on motivation and associated processes and explore the dynamics between the processes. Methods We used a single case approach (n = 3), with a pre-post and follow-up assessment design, which also included ambulatory assessments (experience sampling method, ESM; and step count). We computed autoregressive lag 1 models to evaluate the effects of the intervention on daily motivation levels and related processes, descriptive pie-charts, and vector autoregressive modelling to reveal the dynamics of the processes over time. Results The intervention was beneficial for each participant according to traditional evaluations of motivational negative symptoms, apathy, daily functioning and quality of life. The effects on the ESM variables revealed distinct outcomes for each individual. The dynamics between the various processes differed between participants, and fluctuated within participants (when comparing baseline, intervention phase, and follow-up). Conclusions This study used an innovative approach to look at the efficacy of an intervention. The intervention seems to lead to significant improvements. The mechanisms of change need to be further investigated. Trial registration number: ClinicalTrials.gov, NCT04325100. Registered 27 March 27, 2020 -retrospectively registered, https://www.clinicaltrials.gov/ct2/show/NCT04325100 Reporting: Guidelines from the Transparent Reporting of Evaluations with Non-randomized Designs (TREND) statement [1] were followed.

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Antidepressant Controlled Trial For Negative Symptoms In Schizophrenia (ACTIONS): a double-blind, placebo-controlled, randomised clinical trial

Health Technology Assessment ◽

10.3310/hta20290 ◽

2016 ◽

Vol 20 (29) ◽

pp. 1-46 ◽

Cited By ~ 8

Author(s):

Thomas RE Barnes ◽

Verity C Leeson ◽

Carol Paton ◽

Céire Costelloe ◽

Judit Simon ◽

...

Keyword(s):

Quality Of Life ◽

Negative Symptom ◽

Antipsychotic Medication ◽

Functional Outcomes ◽

Negative Symptoms ◽

Controlled Trial ◽

Health Technology ◽

Double Blind

BackgroundNegative symptoms of schizophrenia represent deficiencies in emotional responsiveness, motivation, socialisation, speech and movement. When persistent, they are held to account for much of the poor functional outcomes associated with schizophrenia. There are currently no approved pharmacological treatments. While the available evidence suggests that a combination of antipsychotic and antidepressant medication may be effective in treating negative symptoms, it is too limited to allow any firm conclusions.ObjectiveTo establish the clinical effectiveness and cost-effectiveness of augmentation of antipsychotic medication with the antidepressant citalopram for the management of negative symptoms in schizophrenia.DesignA multicentre, double-blind, individually randomised, placebo-controlled trial with 12-month follow-up.SettingAdult psychiatric services, treating people with schizophrenia.ParticipantsInpatients or outpatients with schizophrenia, on continuing, stable antipsychotic medication, with persistent negative symptoms at a criterion level of severity.InterventionsEligible participants were randomised 1 : 1 to treatment with either placebo (one capsule) or 20 mg of citalopram per day for 48 weeks, with the clinical option at 4 weeks to increase the daily dosage to 40 mg of citalopram or two placebo capsules for the remainder of the study.Main outcome measuresThe primary outcomes were quality of life measured at 12 and 48 weeks assessed using the Heinrich’s Quality of Life Scale, and negative symptoms at 12 weeks measured on the negative symptom subscale of the Positive and Negative Syndrome Scale.ResultsNo therapeutic benefit in terms of improvement in quality of life or negative symptoms was detected for citalopram over 12 weeks or at 48 weeks, but secondary analysis suggested modest improvement in the negative symptom domain, avolition/amotivation, at 12 weeks (mean difference –1.3, 95% confidence interval –2.5 to –0.09). There were no statistically significant differences between the two treatment arms over 48-week follow-up in either the health economics outcomes or costs, and no differences in the frequency or severity of adverse effects, including corrected QT interval prolongation.LimitationsThe trial under-recruited, partly because cardiac safety concerns about citalopram were raised, with the 62 participants recruited falling well short of the target recruitment of 358. Although this was the largest sample randomised to citalopram in a randomised controlled trial of antidepressant augmentation for negative symptoms of schizophrenia and had the longest follow-up, the power of statistical analysis to detect significant differences between the active and placebo groups was limited.ConclusionAlthough adjunctive citalopram did not improve negative symptoms overall, there was evidence of some positive effect on avolition/amotivation, recognised as a critical barrier to psychosocial rehabilitation and achieving better social and community functional outcomes. Comprehensive assessment of side-effect burden did not identify any serious safety or tolerability issues. The addition of citalopram as a long-term prescribing strategy for the treatment of negative symptoms may merit further investigation in larger studies.Future workFurther studies of the viability of adjunctive antidepressant treatment for negative symptoms in schizophrenia should include appropriate safety monitoring and use rating scales that allow for evaluation of avolition/amotivation as a discrete negative symptom domain. Overcoming the barriers to recruiting an adequate sample size will remain a challenge.Trial registrationEuropean Union Drug Regulating Authorities Clinical Trials (EudraCT) number 2009-009235-30 and Current Controlled Trials ISRCTN42305247.FundingThis project was funded by the NIHR Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 20, No. 29. See the NIHR Journals Library website for further project information.

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The long-term impact of preoperative psychological distress on functional outcomes, quality of life, and patient satisfaction after total knee arthroplasty

The Bone & Joint Journal ◽

10.1302/0301-620x.102b7.bjj-2019-1562.r2 ◽

2020 ◽

Vol 102-B (7) ◽

pp. 845-851 ◽

Cited By ~ 2

Author(s):

Graham S. Goh ◽

Ming Han Lincoln Liow ◽

You Wei Adriel Tay ◽

Jerry Yongqiang Chen ◽

Sheng Xu ◽

...

Keyword(s):

Quality Of Life ◽

Mental Health ◽

Psychological Distress ◽

Functional Outcomes ◽

Knee Score ◽

Sf 36 ◽

Total Knee

Aims While patients with psychological distress have poorer short-term outcomes after total knee arthroplasty (TKA), their longer-term function is unknown. We aimed to 1) assess the influence of preoperative mental health status on long-term functional outcomes, quality of life, and patient satisfaction; and 2) analyze the change in mental health after TKA, in a cohort of patients with no history of mental health disorder, with a minimum of ten years’ follow-up. Methods Prospectively collected data of 122 patients undergoing primary unilateral TKA in 2006 were reviewed. Patients were assessed pre- and postoperatively at two and ten years using the Knee Society Knee Score (KSKS) and Function Score (KSFS); Oxford Knee Score (OKS); and the Mental (MCS) and Physical Component Summary (PCS) which were derived from the 36-Item Short-Form Health Survey questionnaire (SF-36). Patients were stratified into those with psychological distress (MCS < 50, n = 51) and those without (MCS ≥ 50, n = 71). Multiple regression was used to control for age, sex, BMI, Charlson Comorbidity Index (CCI), and baseline scores. The rate of expectation fulfilment and satisfaction was compared between patients with low and high MCS. Results There was no difference in the mean KSKS, KSFS, OKS, and SF-36 PCS at two years or ten years after TKA. Equal proportions of patients in each group attained the minimal clinically important difference for each score. Psychologically distressed patients had a comparable rate of satisfaction (91.8% (47/51) vs 97.1% (69/71); p = 0.193) and fulfilment of expectations (89.8% vs 97.1%; p = 0.094). The proportion of distressed patients declined from 41.8% preoperatively to 29.8% at final follow-up (p = 0.021), and their mean SF-36 MCS improved by 10.4 points (p < 0.001). Conclusion Patients with poor mental health undergoing TKA may experience long-term improvements in function and quality of life that are comparable to those experienced by their non-distressed counterparts. These patients also achieved a similar rate of satisfaction and expectation fulfilment. Undergoing TKA was associated with improvements in mental health in distressed patients, although this effect may be due to residual confounding. Cite this article: Bone Joint J 2020;102-B(7):845–851.

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P101 The leeds paediatric brain arteriovenous malformation (BAVM) outcomes

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2019-abn.158 ◽

2019 ◽

Vol 90 (3) ◽

pp. e49.1-e49

Author(s):

N Kalra ◽

SP Solanki ◽

AK Tyagi

Keyword(s):

Quality Of Life ◽

Functional Outcomes ◽

Cohort Analysis ◽

Paediatric Population ◽

Healthy Children ◽

Hrqol Score ◽

Related Quality ◽

The Mean

ObjectivesThe commonest cause of stroke in a paediatric population is a ruptured brain ateriovenous malformation (bAVM). We aim to assess the functional outcomes of patients who have undergone operative intervention at our unit for ruptured and non-ruptured bAVMs.DesignA single centre retrospective cohort analysis of paediatric bAVM patients.Subjects10 paediatric patients at time of surgery between January 2007 – December 2017 mean age at follow up 15.9 years, range 2–26 years, mean time to follow up 6.3 years, range 1.5–11.2 years.MethodsPatients with bAVMs were identified via the paediatric neurovascular database. They were contacted via telephone and the Paediatric Quality of Life (PedsQL) questionnaire administered via parent proxy if the patient was under 18, and by the patient if above 18. Functional outcomes were assessed using the PedsQL questionnaire score and converted in to a health-related quality of life (HRQOL) score.Results10 patients underwent resection of their bAVMS, 9 survived and 7 were contactable. The mean HRQOL score 88.9 points, range 65.2–100. Only one patient had a HRQOL score below the mean of a child with chronic disease.ConclusionsThe mean HRQOL outcome score of operated paediatric bAVM was similar to that of healthy children. Patients having bAVM surgery within our unit have had a good functional outcome. Although there are small numbers in this series, there is a low incidence of operated paediatric bAVMs. Our findings suggests that such operations should be undertaken in units with expertise.

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A Systematic Review: Outcomes in Adult Recurrent Respiratory Papillomatosis Treated with Intralesional Cidofovir or Bevacizumab

Otolaryngology ◽

10.1177/0194599816683384 ◽

2017 ◽

Vol 156 (3) ◽

pp. 435-441 ◽

Cited By ~ 9

Author(s):

Sarah Drejet ◽

Stacey Halum ◽

Matthew Brigger ◽

Elaine Skopelja ◽

Noah P. Parker

Keyword(s):

Quality Of Life ◽

Disease Severity ◽

Functional Outcomes ◽

Remission Rate ◽

A Priori ◽

Poor Quality ◽

Recurrent Respiratory Papillomatosis ◽

Related Quality

Objectives (1) To systematically identify studies evaluating the use of intralesional cidofovir or bevacizumab as an adjunct in adult recurrent respiratory papillomatosis, determine disease severity and functional outcomes, and assess study quality. (2) To compare outcomes between the 2 adjuncts. Data Sources Ovid Medline, EMBASE, Scopus, and Clinical-Trials.gov . Review Methods Data sources were systematically searched. A priori inclusion and exclusion criteria were instituted. Quality was evaluated with the Newcastle-Ottawa Quality Assessment Scale. A priori criteria were instituted to select studies suitable for comparison. Results A total of 254 identified studies led to 16 for full-text review, including 14 for cidofovir and 2 for bevacizumab. Disease severity outcomes were reported in all studies, including remission rate, Derkay scores, time interval between operations, and/or lesion volume reduction. Remission rate was the most commonly reported (14 studies). Functional outcomes were reported in 5 studies (36%), including quality-of-life questionnaires, acoustic/aerodynamic analysis, and perceptual voice analysis. Voice-related quality of life was the most commonly reported (2 studies). Of 16 studies, 12 (75%) were rated poor quality. Reports almost invariably showed improved disease severity and functional outcomes following treatment; however, variable outcome measures and inadequate follow-up disallowed direct comparison of adjuncts. Conclusion Remission rate was the most commonly reported disease severity outcome, and voice-related quality of life was the most commonly reported functional outcome. Most studies were of poor quality. No studies met criteria for comparative analysis between adjuncts. Future research would be improved by reporting consistent and comparable disease severity and functional outcomes, treatment protocols, and follow-up.

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Patient-Physician Communication About Health-Related Quality-of-Life Problems: Are Non-Hodgkin Lymphoma Survivors Willing to Talk?

Journal of Clinical Oncology ◽

10.1200/jco.2012.47.6705 ◽

2013 ◽

Vol 31 (31) ◽

pp. 3964-3970 ◽

Cited By ~ 13

Author(s):

Neeraj K. Arora ◽

Roxanne E. Jensen ◽

Nadiyah Sulayman ◽

Ann S. Hamilton ◽

Arnold L. Potosky

Keyword(s):

Quality Of Life ◽

Sexual Functioning ◽

Daily Functioning ◽

Health Related Quality ◽

Non Hodgkin Lymphoma ◽

Follow Up Care ◽

Related Quality ◽

Health Related

Purpose To investigate non-Hodgkin lymphoma (NHL) survivors' willingness to discuss health-related quality-of-life (HRQOL) problems with their follow-up care physician. Patients and Methods Willingness to discuss HRQOL problems (physical, daily, emotional, social, and sexual functioning) was examined among 374 NHL survivors, 2 to 5 years postdiagnosis. Survivors were asked if they would bring up HRQOL problems with their physician and indicate reasons why not. Logistic regression models examined the association of patient sociodemographics, clinical characteristics, follow-up care variables, and current HRQOL scores with willingness to discuss HRQOL problems. Results Overall, 94%, 82%, 76%, 43%, and 49% of survivors would initiate discussions of physical, daily, emotional, social, and sexual functioning, respectively. Survivors who indicated their physician “always” spent enough time with them or rated their care as “excellent” were more willing to discuss HRQOL problems (P < .05). Survivors reporting poorer physical health were less willing to discuss their daily functioning problems (P < .001). Men were more willing to discuss sexual problems than women (P < .001). One in three survivors cited “nothing can be done” as a reason for not discussing daily functioning problems, and at least one in four cited “this was not their doctor's job” and a preference to “talk to another clinician” as reasons for not discussing emotional, social, and sexual functioning. Conclusion NHL survivors' willingness to raise HRQOL problems with their physician varied by HRQOL domain. For some domains, even when survivors were experiencing problems, they may not discuss them. To deliver cancer care for the whole patient, interventions that facilitate survivor-clinician communication about survivors' HRQOL are needed.

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Duloxetine for Chemotherapy-Induced Peripheral Neuropathy (DRAFT)

10.1093/med/9780190658618.003.0015 ◽

2018 ◽

Author(s):

Rebecca Burke ◽

Akhila Reddy

Keyword(s):

Quality Of Life ◽

Peripheral Neuropathy ◽

Crossover Trial ◽

Daily Functioning ◽

Double Blind ◽

Study Intervention ◽

Pain Improvement ◽

Daily Function

This chapter discusses the Smith et al. randomized, double-blind, placebo-controlled crossover trial determining the effectiveness of duloxetine compared to placebo in reducing painful chemotherapy-induced peripheral neuropathy. Patients were divided into the duloxetine-first or placebo-first group, then subsequently crossed over to the alternate group. The study particularly examined changes in pain severity, quality of life, interference with daily function, and adverse events. The study demonstrated that patients receiving duloxetine first reported a statistically significant decrease in pain, improvement in quality of life, and decreased pain interference with daily functioning. This chapter describes the basics of the study, including funding, year study began, year study was published, study location, who was studied, who was excluded, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, gives a summary and discusses implications, and concludes with a relevant clinical case.

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Modeling the Longitudinal Effects of Insight on Depression, Quality of Life and Suicidality in Schizophrenia Spectrum Disorders: Results from the FACE-SZ Cohort

Journal of Clinical Medicine ◽

10.3390/jcm8081196 ◽

2019 ◽

Vol 8 (8) ◽

pp. 1196 ◽

Cited By ~ 3

Author(s):

Mickaël Ehrminger ◽

Mathieu Urbach ◽

Christine Passerieux ◽

Bruno Aouizerate ◽

Fabrice Berna ◽

...

Keyword(s):

Quality Of Life ◽

Structural Equation ◽

Negative Symptoms ◽

Equation Modeling ◽

Schizophrenia Spectrum Disorders ◽

Targeted Interventions ◽

Schizophrenia Spectrum ◽

Baseline Levels ◽

Spectrum Disorders

Background: Up to half of the patients with schizophrenia attempt suicide during their lifetime. Better insight is associated with better functioning but also with increased suicidality. The direction of the relationship between insight and suicidality is not clear, hence we aimed to provide new elements using structural equation modeling. Methods: Insight, quality of life (QoL), depression, and suicidality were measured at baseline and at 12 months in individuals with schizophrenia spectrum disorders. The relationships between these variables were investigated by latent difference score models, controlling for chlorpromazine doses, positive and negative symptoms, and general psychopathology. Results: 738 patients were included, and 370 completed the study. Baseline levels of insight predicted changes in suicidality, whereas baseline levels of suicidality did not predict changes in insight, suggesting that better insight underlies suicidality and predicts its worsening. Our results suggest this temporal sequence: better insight → worse QoL → increased depression → increased suicidality, while insight also affects the three variables in parallel. Conclusion: Better insight predicts a worsening of QoL, depression and suicidality. These findings contribute to our global understanding of the longitudinal influence of insight on suicidality. We advocate that insight-targeted interventions should not be proposed without the monitoring of depression and suicide prevention.

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