Psychological Inflexibility in People with Chronic Psychosis: The Mediating Role of Self-Stigma and Social Functioning

Psychosis is associated with self-stigmatization and loss of social functioning that increase the severity of the disorder. Psychological inflexibility (PI)—an individual’s tendency to suppress undesirable private events—plays a fundamental role in the emergence and worst prognosis of psychosis. The main objective of this study was to analyze whether self-stigma and social functioning mediate the association of PI with the severity of psychosis in adults with chronic schizophrenia. The study was carried out with a sample of 103 outpatients. The Acceptance and Action Questionnaire, the Internalized Stigma of Mental Illness Scale, and the Social Functioning Scale were used for clinical assessments. Data analyses were performed by using the PROCESS macro for SPSS. Results showed that the link between PI and the severity of psychosis is not direct, but is better explained by mediation of the self-stigma and social functioning of those assessed. PI also predicts worse social functioning without the need to take self-stigma into account. Moreover, self-stigma alone does not predict the severity of psychotic symptoms; this relationship has to be mediated by social functioning. These findings suggest that interventions designed to increase psychological flexibility, such as Acceptance and Commitment Therapy (ACT), may offer an alternative to attenuate the negative impact of self-stigma and to improve the social functioning.

The assessment of capacity limitations in psychiatric work disability evaluations by the social functioning scale Mini-ICF-APP

Objective Insurers frequently commission medical experts to estimate the degree of the remaining work capacity (RWC) in claimants for disability benefits. The social functioning scale Mini-ICF-APP allows for a rating of activity and participation limitations in thirteen capacity domains, considered as particularly relevant for work ability. The current study sought to evaluate the role of the Mini-ICF-APP ratings in psychiatric work disability evaluations, by examining how the capacity limitation ratings varied with the claimants’ primary psychiatric diagnoses and how the ratings were related to RWC estimates. Methods Medical experts estimated the RWC of 946 claimants with mental disorders and rated their activity and participation limitations using the Mini-ICF-APP, with higher ratings reflecting more severe limitations. The ratings were compared between claimants with different psychiatric diagnoses by analyses of variance. The mean Mini-ICF-APP rating across all capacity domains as well as all capacity-specific ratings were entered in simple or multiple regression models to predict the RWC in an alternative job. Results The Mini-ICF-APP capacity limitation ratings in all domains but mobility were higher for claimants with personality and behavior disorders as compared to those with mood disorders or with neurotic, stress-related and somatoform disorders. The largest differences were observed in social capacities (e.g. group integration: F 2, 847 = 78.300, P < 0.001). In claimants with depression, all ratings increased with the severity of the diagnosis (all Fs 2, 203 > 16.393, all Ps < 0.001). In the overall sample, the mean Mini-ICF-APP rating showed a strong negative correlation with the estimated RWC (r = −.720, P < 0.001). Adding the capacity-specific ratings to the prediction model improved this prediction only marginally. Discussion The Mini-ICF-APP allows for documenting claimants’ activity and participation limitations, which is likely to increase the transparency of medical experts’ RWC estimates and enables them to check the plausibility of such estimates. However, our study showed that despite the strong association between RWC and Mini-ICF-APP ratings, half of the RWC variance was unrelated to the capacity limitations documented in the Mini-ICF-APP.

Social cognition and social functioning in people with borderline personality disorder and their first-degree relatives

Background A few papers studying healthy, first-degree relatives of people with borderline personality disorder (BPD) have found that this group presents attention and memory problems. However, current research has not analyzed their social cognition. Materials and Methods We designed an age-, gender- and education-level matched case-control study involving 57 people with BPD, 32 of their first-degree relatives, and 57 healthy controls in Spain in 2018–2019. All were assessed for social cognition and functioning using the Movie for Assessment of Social Cognition and the Social Functioning Scale; other potential confounders were also collected (marital status, occupation and household variables). Results There were differences in the social cognition domain of overmentalizing errors, with the BPD group scoring significantly higher than controls; however, there was no significant difference with relatives; in the social functioning domain of family relationships, with the controls showing the highest scores. Social engagement/withdrawal, interpersonal behavior, independence-competence, prosocial activities, full scale and categorization domains showed the same pattern: the BPD group had lower scores than their relatives and the controls. Relatives were significantly different from BPD patients in family relationships, social engagement/withdrawal and interpersonal behavior, as well as on the full Social Functioning Scale (both as a linear and categorical variable). However, only controls showed differences with relatives in family relationships. Conclusions All in all, relatives show similar levels of social cognition and functioning compared with controls, and people with BPD show some alterations in different domains of both social cognition and functioning.

S106. MONITORING SOCIAL FUNCTIONING THROUGH A MOBILE-BASED APPLICATION FOR YOUTH AT-RISK OF PSYCHOSIS: 2-MONTH FEASIBILITY STUDY

Background Youth at clinical high-risk (CHR) for developing psychosis are characterized by long-standing social deficits and isolation compared to healthy youth. Because poor social functioning is predictive of transition to psychosis, it is important to monitor its fluctuations. Objectives: 1) To test initial usability of an app (SOMO); and 2) to confirm that SOMO is acceptable, feasible, and safe to monitor daily social functioning among youth at clinical high-risk (CHR) for developing psychosis. Methods Participants: 24 CHR participants (12–30 years old) used SOMO for 2 months to test its initial feasibility to monitor social functioning. Measures: 1) SOMO comprises 13 daily questions regarding social interactions in-person or online covering: type of relationship, time spent together, quality of the interaction, activities done, conflict and resolution, meaningfulness of the interaction, subjective opinion of the socialization, and level of loneliness. 2) Social functioning was assessed with the Social Functioning Scale (GF:S), which assesses peer relationships, peer conflict, age-appropriate intimate relationships, and involvement with family members. 3) Qualitative data of the SOMO was gathered through the 23-item Mobile Application Rating Scale (MARS) covering questions about engagement, functionality, aesthetics, information provided, and subjective quality of SOMO. Analyses. a) Descriptive information of 1) usability data (i.e., loggings, social relationships, ad meaningfulness) and 2) the app quality ratings (i.e., engagement, functionality, aesthetics, and information) was collected. Results There were 750 loggings over the 2-month testing period, with 50% of participants logging in at least every other day. Participants had 690 in-person interactions and 497 online interactions. The most meaningful interactions were considered the ones with their partner, followed by interactions with friends, casual friends, family, others and strangers in-person respectively. Participants reported conflict in 18.2% of their interactions. SOMO obtained a high overall score on the MARS (M=4.38). Ratings for engagement (M=3.91), functionality (M=4.54), aesthetics (M=4.56), information (M=4.51), subjective score (M=3.89), and perceived impact in behavior (M=3.52) were higher than other relevant mHealth apps. All participants rated SOMO as safe. Social functioning did not change significantly after using SOMO. Discussion SOMO demonstrated initial acceptability, feasibility, and safety among CHR participants.

Autistic traits in psychotic disorders: prevalence, familial risk, and impact on social functioning

Background Prevalence estimates of autistic traits in individuals with psychotic disorders (PD) vary greatly and it is unclear whether individuals with a familial risk (FR) for psychosis have an increased propensity to display autistic traits. Furthermore, it is unknown whether the presence of comorbid autism traits disproportionally affects the cognitive and behavioral aspects of social functioning in PD. Methods In total, 504 individuals with PD, 587 unaffected siblings with FR, and 337 typical comparison (TC) individuals (16–50 years) were included. Autistic and psychotic traits were measured with the Autism Spectrum Quotient (AQ) and the Community Assessment of Psychic Experiences (CAPE). Social cognition was assessed with the Picture Sequencing Task (PST) and social behavior with the Social Functioning Scale (SFS). Results For PD 6.5% scored above AQ clinical cut-off (⩾32), 1.0% for FR, and 1.2% for TC. After accounting for age, sex, and IQ, the PD group showed significantly more autistic traits and alterations in social behavior and cognition, while FR and TC only displayed marginal differences. Within the PD group autistic traits were a robust predictor of social behavior and there were no interactions with positive psychotic symptoms. Conclusions Levels of autistic traits are substantially elevated in PD and have a profoundly negative association with social functioning. In contrast, autistic traits above the clinical cut-off are not elevated in those with FR, and only marginally on a dimensional level. These findings warrant specific clinical guidelines for psychotic patients who present themselves with autistic comorbidity to help address their social needs.

Features of psychological status in women with functional ovarian cysts

Aim. To analyze the psychological status indices in women with functional cysts of the ovaries. Materials and methods. The group of observation (group I) included 35 women with functional ovarian cysts (follicular and yellow body cysts), the group of comparison (group II) 34 patients with no cysts available and normal ovarian volume. The mean age of the patients examined was 28.7 5.2 and 29.3 4.8 years, respectively. The methods used included registration of complaints and anamnesis data, standard general clinical and gynecological studies, ultrasound scanning of pelvic organs using apparatus Sonoscape 6000, survey with Beck Depression Inventory, Spielberger-HaninScale, MOS SF-36. Results. Health status of women with functional cysts of the ovaries is characterized by abdominal pain syndrome (91.3 % and 14.7 6.0%; p 0.001), mastodynia in the second phase of cycle (37.1 % and 8.8 4.9 %; p 0.01), dysmenorrhea (37.1 % and 14.7 6.0 %; p 0.05) that undoubtedly influences the indices of psychoemotional status. It is worth noting that the prevalence of smoking among women of group I is high (26.5 % and 2.9 % respectively; p 0.01). The characteristic features of psychological status of group I patients are the following: high level of reactive anxiety (Spielberger-Hanin Anxiety Scale 45.7 1.9 and 35.8 0.9 scores; p 0.001), elevated level of depression (Beck scale 18.9 3.4 and 9.5 5.3 scores; p 0.01) and, as a result, decrease in the quality of life, especially with the Role Functioning Scale (25.71, 61.79 scores, p 0.01) and Social Functioning Scale (26.60 and 62.93 scores, p 0.05). Conclusions. Improvement of health among women with functional ovarian cysts should be complex and include modification of the way of life (refusal from smoking), anti-inflammatory therapy, correction of hypothalamic-pituitary dysfunction and psychological status.