Gender Differences in Clinical and Psychosocial Features Among Persons With Schizophrenia: A Mini Review

An extensive literature regarding gender differences relevant to several aspects of schizophrenia is nowadays available. It includes some robust findings as well as some inconsistencies. In the present review, we summarize the literature on gender differences in schizophrenia relevant to clinical and social outcome as well as their determinants, focusing on clinical variables, while gender differences on biological factors which may have an impact on the outcome of the disorder were not included herewith. Consistent findings include, in male with respect to female patients, an earlier age of illness onset limited to early- and middle-onset schizophrenia, a worse premorbid functioning, a greater severity of negative symptoms, a lower severity of affective symptoms and a higher rate of comorbid alcohol/substance abuse. Discrepant findings have been reported on gender differences in positive symptoms and in social and non-social cognition, as well as in functional outcome and rates of recovery. In fact, despite the overall finding of a more severe clinical picture in males, this does not seem to translate into a worse outcome. From the recent literature emerges that, although some findings on gender differences in schizophrenia are consistent, there are still aspects of clinical and functional outcome which need clarification by means of further studies taking into account several methodological issues.

Resilience Predicts Self-Stigma and Stigma Resistance in Stabilized Patients With Bipolar I Disorder

The identification of factors that prevent self-stigma and on the other hand promote stigma resistance are of importance in the long-term management of bipolar disorder. Accordingly, the aim of the current study was to investigate the association of factors deemed relevant in this context, i.e., resilience, premorbid functioning, and residual mood symptoms, with self-stigma/stigma resistance. Sixty patients diagnosed with bipolar I disorder were recruited from a specialized outpatient clinic. Self-stigma and stigma resistance were measured by the Internalized Stigma of Mental Illness (ISMI) Scale. The presence and severity of symptoms were assessed by the Montgomery-Asberg Depression Rating Scale (MADRS) and the Young Mania Rating Scale (YMRS). Resilience and premorbid functioning were measured by the Resilience Scale (RS-25) and the Premorbid Adjustment Scale (PAS), respectively. Resilience correlated negatively with self-stigma and positively with stigma resistance and was a predictor for self-stigma/stigma resistance in multiple linear regression analysis. Residual depressive symptoms correlated positively with self-stigma and negatively with stigma resistance. There were no significant correlations between sociodemographic variables, premorbid functioning as well as residual manic symptoms and self-stigma/stigma resistance. The findings of this study implicate that resilience may be considered as an important component of self-stigma reduction interventions.

Test of Premorbid Functioning: You’re Doing It Wrong, but Does It Matter?

Objective Clarify procedures to correctly score Test of Premorbid Functioning (TOPF) and assess the accuracy of TOPF scores in the estimation of premorbid intellectual functioning. Method In this cross-sectional study, post-9/11 veterans (N = 233, 84.12% male) completed the TOPF, the Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV), and performance validity measures. Results All TOPF scores were significantly correlated with WAIS-IV FSIQ scores (range r = 0.56–.73). The degree of discrepancy between TOPF scores and FSIQ varied with 10%–17% of TOPF scores deviating from FSIQ scores by one SD or more. Conclusions Proper TOPF scoring procedures are presented. The TOPF Actual and Predicted scores were related to FSIQ. However, a higher percentage of Actual and Predicted scores were discrepant from FSIQ compared with the other three TOPF estimates, arguing against their use as independent premorbid estimates. Use of the TOPF as was designed is recommended.

T232. PREMORBID SOCIAL FUNTIONING AND AFFECTIVE SYMTPOMS ARE RELATED TO SUBJECTIVE OUTCOME AMONG OUTPATIENTS WITH SCHIZOPHRENIA

Background Improving the subjective outcome of patients should be an important target in the treatment of schizophrenia. Accordingly, the aim of the present study was to examine the influence of determining factors, namely premorbid functioning, residual symptoms, and side effects of antipsychotic medication on subjective outcome. Methods 70 outpatients with schizophrenia (ICD-10) who were clinically stable for a period of at least six months were included into a cross-sectional study. Premorbid functioning, psychopathology, and side effects were assessed by using the Premorbid Adjustment Scale, the Positive and Negative Syndrome Scale, and the Udvalg for Kliniske Undersogelser Side Effect Rating Scale, respectively. Subjective outcome was measured in terms of life satisfaction (Life Satisfaction Questionnaire, LSQ), self-esteem (Index of Self-Esteem, ISE), and needs for care (Berliner Bedürfnisinventar, BeBI). Results Both premorbid social functioning and affective symptoms correlated negatively with most life domains assessed by the LSQ as well as with self-esteem and were associated with less health, social, and functional needs. Concerning side effects, parkinsonism and akathisia showed a significant negative correlation with self-esteem. Discussion Our results highlight the complex nature of subjective outcome in patients suffering from schizophrenia. Evidently, premorbid social functioning plays a prominent role in the experienced subjective outcome in the course of the illness. Furthermore, our findings underscore that constant efforts are essential to reduce depressive symptoms or anxiety in patients. Special attention should also be paid to extrapyramidal motor side effects of medication.

Estimating Premorbid Ability in Rehabilitation Patients Using the Test of Premorbid Functioning and Wide Range Achievement Test–Fourth Edition

Objective: This study examined premorbid ability estimate concordance using Test of Premorbid Functioning predicted Full Scale Intelligent Quotient (TOPF-IQ) and Wide Range Achievement Test–Fourth Edition Word Reading (WRAT4-WR). Method: The sample ( N = 145) was 28% female with average age and education of 40.6 and 13.2 years, respectively. Outpatient neuropsychological evaluations were conducted in a rehabilitation setting. Measures included the TOPF, WRAT4-WR, Wechsler Adult Intelligence Scale–Fourth Edition, and other neuropsychological tests. Non-WAIS measures defined impairment groups. Analyses included t tests, pairwise correlations, concordance correlation coefficients, and root mean square differences. Results: TOPF-IQ, WRAT4-WR, and Full Scale Intelligent Quotient scores were not significantly different but were lower than normative mean. TOPF-IQ and WRAT4-WR showed acceptable agreement (concordance correlation coefficient = .92; root mean square difference = 5.9). Greater premorbid–current ability differences were observed in the impaired group. TOPF-IQ and WRAT4-WR showed lower but similar agreement with Full Scale Intelligence Quotient in the unimpaired group. Conclusions: Findings support the WRAT4-WR in predicting premorbid ability in rehabilitation settings.