Clozapine-related obsessive–compulsive symptoms and their impact on wellbeing: a naturalistic longitudinal study

Background Obsessive–compulsive symptoms (OCS) are commonly associated with clozapine treatment but are frequently overlooked by clinicians despite their potential impact on patients' quality of life. In this study, we explored whether OCS severity impacted subjective wellbeing and general functioning, independently of depressive and psychotic symptoms. Methods We used anonymised electronic healthcare records from a large cohort of patients who were treated with clozapine and assessed annually for OCS, wellbeing, general functioning, and psychopathology using standardised scales as part of routine clinical practice. We used statistical mixed linear model techniques to evaluate the longitudinal influence of OCS severity on wellbeing and general functioning. Results A total of 184 patients were included, with 527 face-to-face assessments and 64.7% evaluated three or more times. Different linear mixed models demonstrated that OCS in patients treated with clozapine were associated with significantly worse wellbeing scores, independently of depression and psychotic symptoms, but OCS did not impair general functioning. Obsessional thinking and hoarding behaviour, but not compulsions, were significantly associated with the impact on wellbeing, which may be attributable to the ego-syntonic nature of the compulsions. Conclusions Given the frequent occurrence of OCS and their negative impact on wellbeing, we encourage clinicians to routinely assess and treat OCS in patients who are taking clozapine.

ДОСВІД ВИКОРИСТАННЯ ШКАЛИ ЗАГАЛЬНОЇ ОЦІНКИ ФУНКЦІОНУВАННЯ ДЛЯ ДІАГНОСТИКИ І ПЛАНУВАННЯ ПСИХОТЕРАПІЇ В НАРКОЛОГІЧНІЙ ПРАКТИЦІ

Significant consequences of alcohol abuse give grounds to classify alcohol dependence as a medical and social pathology that poses a danger to society. The number of patients registered in medical dispensaries in Ukraine reaches 1 million. Recurrences of the disease during the year after treatment are observed in 60-75% of patients with alcohol dependence. The problem is exacerbated by the medical and social consequences of alcohol abuse in the form of increased mental and physical illness, trauma, suicide attempts and aggressive behavior, criminal acts. This renders the search for new therapeutic approaches to the treatment of alcohol dependence relevant. The aim of the study was to examine the feasibility and effectiveness of using the global assessment of functioning scale (GAFS) to diagnose the dynamics of social functioning of patients with alcohol dependence. The study of the dynamics in the level of general functioning with the use of GAFS in the main and control groups yielded the following results. There was a significant increase in psychological, social and professional functioning in 74.0% of patients in whom a system of treatment and prophylactic measures was applied as compared to 46.7% of patients in the comparison group (χ2 = 6.062, p <0.05). A follow-up study showed that the number of persistent remissions was by 2 times higher in the main group than in the comparison group, 54.0% and 23.3%, respectively (p <0.001).

Predictors of quality of life and functioning in schizophrenia

Background: In order to pursue recovery, Quality of life (QoL) and general functioning in patients with schizophrenia are milestones that need to be addressed in the treatment of the disease. The major aim of the present study was to examine the relationship between QoL, functionality and symptoms, and clinical characteristics of the disease, and to identify whether the two domains of negative symptoms, avolition/apathy and diminished expression, are predictive factors for the quality of life and functionality in patients diagnosed with schizophrenia. In the present cross-sectional study, 87 patients diagnosed with schizophrenia completed a thorough battery of instruments evaluating: clinical symptoms, stigma, QoL, functionality, socio-demographic and clinical variables. Multiple regression analyses were performed to test the significance of predictor variables for QoL and functionality. Multiple regression analyses revealed that internalized stigma, depression, and excitement were significant predictors for the variability of QoL, and experiential deficit and cognitive symptoms were significant predictors of the variability of functioning. In patients with schizophrenia, functioning and quality of life are two related but different constructs. Even though they are strongly associated, they have different predictive factors. The clinical implication of these results is that both of these constructs should be assessed and that the strategies for improving them should be different.

Dark Tetrad and psychological distress among male violent offenders and male community adults

The first aim of this study was to explore differences between male violent offenders and male community adults in Dark Tetrad traits and psychological distress. The second aim was to investigate moderation effects of dark traits in the prediction of psychological distress based on the membership of violent offenders or community adults. The sample included 142 male violent offenders (M = 40.73, SD = 11.43) convicted of murder, severe murder, or rape, and 573 men from the community population in Serbia without a history of criminal convictions (M = 41.71, SD = 15.11). Serbian adaptations of the Short Dark Triad (SD3), Comprehensive Assessment of Sadistic Tendencies (CAST), and Clinical Outcomes in Routine Evaluation - Outcome Measure (CORE-OM) were used. Results showed that violent offenders had higher scores on psychopathy and problems in social and general functioning, while community adults had higher scores on narcissism. Furthermore, moderation analyses showed that physical sadism was significantly correlated with risk behaviors in the community adults, but not in violent offenders.

Die Erfassung des allgemeinen familiären Funktionsniveaus: Psychometrische Evaluation der deutschen Version der Brief Assessment of Family Functioning Scale

ZusammenfassungDie Funktionalität des Systems Familie spielt nicht nur in der Entwicklungspsychologie und Familienforschung, sondern auch bei vielen körperlichen Erkrankungen und psychischen Störungen eine zentrale Rolle. Trotz dieser hohen Relevanz existieren nur sehr wenige ultra-kurze, d. h. anwendungsökonomische Selbstbeurteilungsverfahren, die das allgemeine familiäre Funktionsniveau abbilden. Diese Lücke schließt die Brief Assessment of Family Functioning Scale (BAFFS), die aus drei Items der General Functioning Scale des international weit verbreiteten Family Assessment Device besteht. In dieser Studie wurde die deutsche Version der BAFFS erstmals an einer großen und repräsentativen Allgemeinbevölkerungsstichprobe (n=2463) psychometrisch evaluiert. Mittels Multigruppen-konfirmatorischen Faktorenanalysen konnte starke Messinvarianz für relevante Teilstichproben (Frauen vs. Männer; Probanden in Partnerschaften mit vs. ohne Kinder) bei guter Modellpassung gezeigt werden. Obwohl eines der drei Items, welches als einziges negativ formuliert ist, ungenügende psychometrische Itemkennwerte aufwies, lag die interne Konsistenz bei Cronbachs α=0,71. Als Hinweis auf eine adäquate Konstruktvalidität fanden sich hypothesenkonform Assoziationen des familiären Funktionsniveaus mit dem sozioökonomischen Status sowie mit aktueller Depressivität und Ängstlichkeit. Trotz ausstehender Anwendungserfahrungen und psychometrischer Analysen der Kurzskala Allgemeines Familiäres Funktionsniveau (KSAFF) als der deutschen Version der BAFFS in relevanten Zielgruppen und bei Patienten in Klinik und Forschung, kann das mit drei Items sehr anwendungsökonomische Verfahren zur orientierenden Erfassung des allgemeinen familiären Funktionsniveaus empfohlen werden, zumal es in der Allgemeinbevölkerung mit einigen Einschränkungen akzeptable bis gute psychometrische Kennwerte zeigte.

Investigation of the Effects of Home-Based Exercise and Cognitive Training on Cognitive and Physical Functions in Cardiac Patients: The COVEPICARDIO Study Protocol of a Randomized Clinical Trial

Introduction: During the COVID-19 pandemic, confinement measures are likely to produce collateral damage to health (stress, confusion, anxiety), especially in frail individuals and those living with cardiovascular disease (CVD). In cardiac patients in particular, these measures dramatically increase the level of physical inactivity and sedentary lifestyle, which can decrease cardiorespiratory capacity and increase the risk of acute events, rehospitalization, and depressive syndromes. Maintaining a minimum level of physical activity and cognitive stimulation during the COVID-19 crisis is essential for cardiac patients. This study is designed to document the effects of 6 months of home-based physical exercise alone or combined with cognitive training on cognitive and physical functions in patients with CVD over 50 years old.Methods and Analysis: 122 patients (&gt;50 years old) with stable CVD and no contraindication to perform physical exercise training will be recruited and randomly assigned to one of the 2 following arms: (1) Home-based physical exercise alone, (2) Home-based physical exercise combined with cognitive training. The intervention lasts 6 months, with remote assessments performed prior to, mid and post-training. A follow-up 6 months after the end of the intervention (12 month) is also proposed. The primary outcome is cognition, including general functioning (Montreal Cognitive Assessment (MoCA) score), as well as performances on measures of executive functions, processing speed, and episodic memory. The secondary outcome is physical performance, including balance, gait and mobility, leg muscle strength and estimated cardiorespiratory fitness. Tertiary outcomes include mood, anxiety, and health-related quality of life as assessed by self-reported online questionnaires.Discussion: With the COVID-19 crisis, there is a critical need for remote exercise and cognitive training, and to further investigate this topic, in particular for cardiac patients. The present context can be viewed as an opportunity to perform a major shift from center-based programs to home-based physical exercise. This is especially important to reach out to older adults living in remote areas, where access to such interventions is limited.ClinicalTrials.gov: [https://clinicaltrials.gov/ct2/show/NCT04661189], NCT04661189.

Multi-center nationwide study on pediatric psychiatric inpatients 2000–2018: length of stay, recurrent hospitalization, functioning level, suicidality, violence and diagnostic profiles

Inpatient treatment is an important part of child and adolescent psychiatric (CAP) care. This nationwide study explores the changes in length of stay, recurrent hospitalization, functioning level, suicidality, violence and diagnoses of CAP inpatients in Finland in 2000, 2011 and 2018. We obtained comprehensive questionnaire data on each study year from 93 to 95% of all CAP wards in Finland. We split the 1276 inpatients into two age groups in each study year: under 13 and 13–18. The median length of stay in inpatient treatment decreased from 82.0 days in 2000 to 20.5 days in 2018 (p < 0.001) and recurrent hospitalization increased from 38 to 46%. General functioning, which was evaluated by the Children’s Global Assessment Scale, deteriorated by an average of six points between 2000 and 2018. Violent threats decreased from 21.5 to 16.6% and violent acts decreased from 26.9 to 20.3%. Suicidal threats decreased from 42.6 to 23.3% in those aged under 13 and remained stable among those aged 13–18. In the 13–18 group, there was an increase in the diagnoses of ADHD, from 5.0 to 16.9% and depression, from 25.1 to 41.7%. However, psychosis decreased from 23.2 to 12.6% in the older age group. In the whole cohort, anxiety disorders increased from 7.6 to 15.6%. The overall picture does not show that CAP inpatients have become more disturbed. While the general functioning of CAP inpatients deteriorated somewhat over the 2000–2018 study period, symptoms of suicidality and violence remained stable or decreased. There was also a continuous increase in short-term treatment.

Gender Differences in Peer Influence on Autistic Traits in Special Needs Schools—Evidence From Staff Reports

Children and adolescents with an intellectual disability (ID) and autistic traits often attend special needs schools where they are surrounded by peers with diverse characteristics. Given the role that peers can play in social development, we examined whether autistic traits development in students with ID and high levels of such characteristics are influenced by the level of autistic traits among the schoolmates they like most. Furthermore, we investigated the degree to which this peer influence susceptibility depends on students’ gender. A longitudinal design, with data collection points at the beginning and the end of a school year, was used. Staff reported on 330 students with high levels of autistic traits (20.6% girls; age 10.17 years, SD = 3.74) who attended 142 classrooms in 16 Swiss special needs schools. Results showed that students’ future individual level of autistic traits (T2) was not predicted by the autistic traits level of preferred peers (T1), controlling for individual autistic traits at T1, level of general functioning, gender, and age. However, the peer effect was significantly moderated by students’ gender, indicating that girls but not boys were susceptible to peer influence. These findings are discussed in terms of implications for understanding autistic traits development and directions of support for children and adolescents in their peer context.

Phenomenon of Urban Agriculture and Its Role in Shaping Sustainable Cities

The rapid growth and development of the world have lead to significant changes in the expansion of urban sprawl, land distribution, and the general functioning model of modern cities. The problems connected to ecology, economy, human physical and mental well-being become more urgent with every day under the influence of arising deficiency of open green spaces, nutritional security, and sustainable financial models for small-scale businesses within the cities; and not only affect regular citizens but also general tendencies of urban and landscape planning that are supposed to deal with those issues. One of the tools aimed at combating them for the past decades has been an increasingly popular urban agriculture, particularly chosen as a studying object of interest for this publication. The following paper represents complex research conducted in an integrated manner by reviewing the overall phenomenon of urban agriculture and its pioneering practices; determining the key components of their successful functioning and positive ways of affecting surroundings; and consequently forming the list of concluding recommendations for planning and management of such structures. As the main methods of research, the selective case study, describing principal features of such initiatives, and relevant literature analysis for the fundamental information gathering were applied by the author. The results of the research were composed into the summarizing table highlighting core data and supporting developed conclusion based on examination and designing suggestion for interested parties.