Global health-related quality of life in schizophrenia: systematic review and meta-analysis

Background and aimSigns and symptoms of schizophrenia may have serious impacts on patients’ quality of life leading to concern about different aspects of their lives. This study presents a systematic review and meta-analysis of the studies examining the quality of life among patients with schizophrenia and its relationship with patients’ characteristics.Materials and methodsA total of 40 studies were extracted from searching of relevant databases published between 2000 and 2020. Descriptive data and correlation coefficients between patient’s characteristics and quality of life were extracted and the results were reported according to Preferred Reporting Items for Systematic Reviews and Meta-analyses standards and meta-analysis of pooled studies.ResultsIn total, 8363 patients with schizophrenia participated in 40 studies which used Schizophrenia Quality of Life Scale revision 4. The total score of quality of life (QOL) in the study subjects was reported to be 40.66. Weighted effect size analyses revealed a significant relationship between QOL and variables including patients’ age and duration of the disease. Furthermore, the highest (the worst) score of QOL in schizophrenia patients was observed in Europe 47.04 (95% CI 41.26 to 52.82) and the Euro region 47.05 (95% CI 41.18 to 52.92).ConclusionOverall, the QOL among patients with schizophrenia was in a good status, which could be improved through considering different life aspects of people living in various contexts. In fact, clarifying the determinants of QOL would be a key step in the provision of future treatment efforts.

Measures Matter: A Meta-Analysis of the Effects of Educational Apps on Preschool to Grade 3 Children’s Literacy and Math Skills

Thousands of educational apps are available to students, teachers, and parents, yet research on their effectiveness is limited. This meta-analysis synthesized findings from 36 intervention studies and 285 effect sizes evaluating the effectiveness of educational apps for preschool to Grade 3 children and the moderating role of methodological, participant, and intervention characteristics. Using random effects meta-regression with robust variance estimation, we summarized the overall impact of educational apps and examined potential moderator effects. First, results from rigorous experimental and quasi-experimental studies yielded a mean weighted effect size of +0.31 standard deviations on overall achievement and comparable effects in both math and literacy. Second, the positive overall effect masks substantial variability in app effectiveness, as meta-regression analyses revealed three significant moderators of treatment effects. Treatment effects were larger for studies involving preschool rather than K–3 students, for studies using researcher-developed rather than standardized outcomes, and for studies measuring constrained rather than unconstrained skills.

A-027 Differentiating HIV-Associated Neurocognitive Disorder from Alzheimer’s Disease: A Neuropsychological Profile

Objective This meta-analysis examined the potential for executive function, episodic memory, and motor function to differentiate HIV-associated neurocognitive disorder (HAND) from Alzheimer’s disease (AD), in an attempt to aid in accurate differential diagnosis. Data Selection The literature search identified records investigating neuropsychological test performance associated with HAND and AD. Databases used were: PsycINFO, Academic Search Complete, and Medline with Full Text. Eligibility was assessed using the following inclusion criteria: (a) study examines HAND or AD, (b) diagnosis is determined using standard diagnostic criteria, (c) study contains data regarding executive function, episodic memory, and/or motor function, (d) study published in English, (e) study is quantitative, and (f) study contains statistical information for effect size calculations. A total of 947 relevant studies were initially identified. Twenty studies were included. Data Synthesis Group difference effect sizes were converted/calculated using Cohen’s d and Cohen’s (1998) conventions. Three weighted effect sizes were calculated for constructs of interest for each disorder. Weighted effect size for executive function was large for each group (HAND d = 1.28; AD d = 1.57). A large weighted effect size for episodic memory in AD (AD d = −2.17) and a medium effect size for HAND (HAND d = −0.65) were calculated. A large weighted effect size was determined for motor function in AD (d = 3.60), while a small effect size was calculated for HAND (d = 0.27). Conclusions Level of impairment in episodic memory and motor function can be used to differentiate HAND from AD. Executive function lacked differences needed for diagnostic differentiation. Future research should be done directly comparing neuropsychological performance between HAND and AD.

The relationship between intolerance of uncertainty and anxiety in autism: A systematic literature review and meta-analysis

The association between intolerance of uncertainty and anxiety has proved robust in neurotypical populations and has led to effective interventions targeting intolerance of uncertainty. The aim of this systematic review and meta-analysis was to investigate this association in autistic people, given the high prevalence of anxiety in this population and the limited effectiveness of therapies used currently to treat anxiety in autism. A protocol was published on the Prospero database (CRD42019125315), and electronic databases were searched using terms related to intolerance of uncertainty, anxiety and autism. Included in the systematic review were 12 studies, of which 10 were included in a meta-analysis. Results showed that anxiety and intolerance of uncertainty were consistently elevated in autistic participants. Examining the correlation between these two constructs, the meta-analysis revealed a large sample-weighted effect size, r = 0.62, 95% confidence interval = [0.52, 0.71], p < 0.001. The strength of this association was comparable to meta-analyses conducted on neurotypical populations, and therefore, it was concluded intolerance of uncertainty may be an appropriate target for intervention for autistic individuals. However, conclusions were limited due to the small number of relevant studies that were available and due to issues with methodological quality. Lay abstract People who find it especially hard to cope with the unexpected or unknown are said to have an intolerance of uncertainty. Autistic individuals often report a preference for certainty and experience levels of anxiety that can interfere with their daily life. Understanding more about the link between the intolerance of uncertainty and anxiety in autistic people might lead to better treatments for anxiety being developed. Therefore, this work aimed to review previous research in order to explore this link. Twelve studies were found and their results were compared and contrasted. The autistic people who participated in the studies completed questionnaires that suggested a large number of them experienced very high levels of anxiety and intolerance of uncertainty. Of 10 studies that used relevant statistics, nine found a statistically significant link between anxiety and the intolerance of uncertainty. In general, the strength of the link was about the same as previous research found in people who did not have a diagnosis of autism. This might mean that interventions that aim to help people who are intolerant of uncertainty could be effective for autistic individuals.

An update on the efficacy of anti-inflammatory agents for patients with schizophrenia: a meta-analysis

BackgroundAccumulating evidence shows that a propensity towards a pro-inflammatory status in the brain plays an important role in schizophrenia. Anti-inflammatory drugs might compensate this propensity. This study provides an update regarding the efficacy of agents with some anti-inflammatory actions for schizophrenia symptoms tested in randomized controlled trials (RCTs).MethodsPubMed, Embase, the National Institutes of Health website (http://www.clinicaltrials.gov), and the Cochrane Database of Systematic Reviews were systematically searched for RCTs that investigated clinical outcomes.ResultsOur search yielded 56 studies that provided information on the efficacy of the following components on symptom severity: aspirin, bexarotene, celecoxib, davunetide, dextromethorphan, estrogens, fatty acids, melatonin, minocycline, N-acetylcysteine (NAC), pioglitazone, piracetam, pregnenolone, statins, varenicline, and withania somnifera extract. The results of aspirin [mean weighted effect size (ES): 0.30; n = 270; 95% CI (CI) 0.06–0.54], estrogens (ES: 0.78; n = 723; CI 0.36–1.19), minocycline (ES: 0.40; n = 946; CI 0.11–0.68), and NAC (ES: 1.00; n = 442; CI 0.60–1.41) were significant in meta-analysis of at least two studies. Subgroup analysis yielded larger positive effects for first-episode psychosis (FEP) or early-phase schizophrenia studies. Bexarotene, celecoxib, davunetide, dextromethorphan, fatty acids, pregnenolone, statins, and varenicline showed no significant effect.ConclusionsSome, but not all agents with anti-inflammatory properties showed efficacy. Effective agents were aspirin, estrogens, minocycline, and NAC. We observed greater beneficial results on symptom severity in FEP or early-phase schizophrenia.

Promoting Treatment Credibility

Patients’ perception of treatment credibility represents their belief about a treatment’s personal logicality, suitability, and efficaciousness. Although long considered an important common factor bearing on clinical outcome, there have been no systematic reviews of the credibility–outcome association. In this chapter, the authors first discuss the definitions of credibility and similar constructs, common measures of credibility, clinical examples of treatment credibility perception, and several landmark studies. The chapter then presents a meta-analysis of the association between patients’ credibility perception and their posttreatment outcomes. The meta-analysis was conducted on 24 independent samples with 1,504 patients. The overall weighted effect size was r = .12, or d = .24. Next, the authors present moderators and mediators of the treatment credibility–outcome link (the former in the context of the meta-analysis), evidence supporting causality in the association, patient factors contributing to their treatment credibility perception, and limitations of the research base. Finally, the chapter reviews diversity considerations, training implications, and therapeutic practices with regard to patient-perceived treatment credibility and its association with therapy outcome.

Cultivating Positive Outcome Expectation

Patients’ outcome expectation (OE) represents their belief about the mental health consequences of participating in psychotherapy. In this chapter, the authors first discuss the definitions of OE and similar constructs, common OE measures, clinical examples of OE, several landmark studies, and results of a previous meta-analysis of the OE-outcome association. The chapter then presents an updated meta-analysis of 81 independent samples with 12,722 patients. The overall weighted effect size was r = .18, or d = .36. Next, the authors present moderators and mediators of the OE–outcome link (the former in the context of the meta-analysis), evidence supporting causality in the association, patient factors related to OE, and limitations of the research base. Finally, the chapter reviews diversity considerations, training implications, and therapeutic practices with regard to OE and its robust association with therapy outcome.

Predictive physiological anticipatory activity preceding seemingly unpredictable stimuli: An update of Mossbridge et al’s meta-analysis

Background: This is an update of the Mossbridge et al’s meta-analysis related to the physiological anticipation preceding seemingly unpredictable stimuli which overall effect size was 0.21; 95% Confidence Intervals: 0.13 - 0.29 Methods: Nineteen new peer and non-peer reviewed studies completed from January 2008 to June 2018 were retrieved describing a total of 27 experiments and 36 associated effect sizes. Results: The overall weighted effect size, estimated with a frequentist multilevel random model, was: 0.28; 95% Confidence Intervals: 0.18-0.38; the overall weighted effect size, estimated with a multilevel Bayesian model, was: 0.28; 95% Credible Intervals: 0.18-0.38. The weighted mean estimate of the effect size of peer reviewed studies was higher than that of non-peer reviewed studies, but with overlapped confidence intervals: Peer reviewed: 0.36; 95% Confidence Intervals: 0.26-0.47; Non-Peer reviewed: 0.22; 95% Confidence Intervals: 0.05-0.39. Similarly, the weighted mean estimate of the effect size of Preregistered studies was higher than that of Non-Preregistered studies: Preregistered: 0.31; 95% Confidence Intervals: 0.18-0.45; No-Preregistered: 0.24; 95% Confidence Intervals: 0.08-0.41. The statistical estimation of the publication bias by using the Copas selection model suggest that the main findings are not contaminated by publication bias. Conclusions: In summary, with this update, the main findings reported in Mossbridge et al’s meta-analysis, are confirmed.

Predictive physiological anticipation preceding seemingly unpredictable stimuli: An update of Mossbridge et al’s meta-analysis

Background: This is an update of the Mossbridge et al’s meta-analysis related to the physiological anticipation preceding seemingly unpredictable stimuli. The overall effect size observed was 0.21; 95% Confidence Intervals: 0.13 - 0.29 Methods: Eighteen new peer and non-peer reviewed studies completed from January 2008 to October 2017 were retrieved describing a total of 26 experiments and 34 associated effect sizes. Results: The overall weighted effect size, estimated with a frequentist multilevel random model, was: 0.29; 95% Confidence Intervals: 0.19-0.38; the overall weighted effect size, estimated with a multilevel Bayesian model, was: 0.29; 95% Credible Intervals: 0.18-0.39. Effect sizes of peer reviewed studies were slightly higher: 0.38; Confidence Intervals: 0.27-0.48 than non-peer reviewed articles: 0.22; Confidence Intervals: 0.05-0.39. The statistical estimation of the publication bias by using the Copas model suggest that the main findings are not contaminated by publication bias. Conclusions: In summary, with this update, the main findings reported in Mossbridge et al’s meta-analysis, are confirmed.

Predictive physiological anticipation preceding seemingly unpredictable stimuli: an update of Mossbridge’s et al. meta-analysis

Background: This is an update of the Mossbridge et al’s meta-analysis related to the physiological anticipation preceding seemingly unpredictable stimuli which overall effect size was 0.21; 95% Confidence Intervals: 0.13 - 0.29Methods: Nineteen new peer and non-peer reviewed studies completed from January 2008 to June 2018 were retrieved describing a total of 27 experiments and 36 associated effect sizes.Results: The overall weighted effect size, estimated with a frequentist multilevel random model, was: 0.28; 95% Confidence Intervals: 0.18-0.38; the overall weighted effect size, estimated with a multilevel Bayesian model, was: 0.28; 95% Credible Intervals: 0.18-0.38. The weighted mean estimate of the effect size of peer reviewed studies was higher than that of non peer reviewed studies, but with overlapped confidence intervals: Peer reviewed: 0.36; 95% Confidence Intervals: 0.26-0.47; Non peer reviewed: 0.22; 95% Confidence Intervals: 0.05-0.39. Similarly, the weighted mean estimate of the effect size of Preregistered studies was higher than that of Non-Preregistered studies: Preregistered: 0.31; 95% Confidence Intervals: 0.18-0.45; No-Preregistered: 0.24; 95% Confidence Intervals: 0.08-0.41.The statistical estimation of the publication bias by using the Copas selection model suggest that the main findings are not contaminated by publication bias.Conclusions: In summary, with this update, the main findings reported in Mossbridge et al’s meta-analysis, are confirmed.