Social outcome in schizophrenia: a 13-year follow-up.

Studies suggest strong links between adverse childhood experiences (ACEs) and poor adult health and social outcomes. However, the use of such studies in non-US populations is relatively scarce. Retrospective cross-sectional survey of 1500 residents and 67 substance users aged 18-70 years in a relatively deprived and ethnically diverse UK population. Increasing ACEs were strongly related to adverse behavioural, health and social outcomes. Compared with those with 0 ACEs, individuals with 4+ ACEs had adjusted odds ratios of the following: 3.96 [95% confidence interval (CI): 2.74-5.73] for smoking; 3.72 (95% CI: 2.37-5.85) for heavy drinking; 8.83 (95% CI: 4.42-17.62) for incarceration and 3.02 (95% CI: 1.38-6.62) for morbid obesity. They also had greater risk of poor educational and employment outcomes; low mental wellbeing and life satisfaction; recent violence involvement; recent inpatient hospital care and chronic health conditions. Higher ACEs were also associated with having caused/been unintentionally pregnant aged <18 years and having been born to a mother aged <20 years. ACEs contribute to poor life-course health and social outcomes in a UK population. That ACEs are linked to involvement in violence, early unplanned pregnancy, incarceration, and unemployment suggests a cyclic effect where those with higher ACE counts have higher risks of exposing their own children to ACEs.

SOCIAL COGNITION AND NEUROCOGNITION AS INDEPENDENT DOMAINS IN PSYCHOSIS

Social and clinical consequences of cognitive deficits in early psychosis: a two-year follow-up study of first-admitted patients

Macro level data indicate that people experiencing mental distress experience poor health, social and economic outcomes. The sociology of mental health has a series of dominant competing explanations of the mechanisms at personal, social and structural levels that generate these poor outcomes. This article explains the limitations of these approaches and takes up the challenge of Hopper (2007) who in this journal proposed the capabilities approach as a means of normatively reconceptualising the experiences of people with mental distress, with a renewed focus on agency, equality and genuine opportunity. Using an innovative methodology to operationalise the capabilities approach, findings from an in-depth qualitative study exploring the lived experiences of twenty-two people with recent inpatient experience of psychiatric units in Scotland are presented. The paper demonstrates that the capabilities approach can be applied to reconceptualise how unjust social outcomes happen for this social group. It distinguishes how the results of using a capabilities approach to analysis are distinct from established dominant analytical frameworks through four added features: a focus on actual lived outcomes; the role of capabilities as well as functionings; being normative; and incorporating agency. The capabilities approach is found to be an operationalisable framework; the findings have implications for professionals and systems in the specific context of mental health; and the capabilities approach offers a fertile basis for normative studies in wider aspects of health and wellbeing.

Many patients with schizophrenia have poor clinical and social outcomes. Some risk alleles closely related to the onset of schizophrenia have been reported to be associated with their clinical phenotypes, but the direct relationship between genetic vulnerability to schizophrenia and clinical/social outcomes of schizophrenia, as evaluated by both practical clinical scales and 'real-world' function, has not been investigated. We evaluated the clinical and social outcomes of 455 Japanese patients with schizophrenia by severity of illness according to the Clinical Global Impression-Severity Scale (CGI-S) and social outcomes by social adjustment/maladjustment at 5 years after the first visit. We examined whether 46 single nucleotide polymorphisms (SNPs) selected from a Japanese genome-wide association study of susceptibility to schizophrenia were associated with clinical and social outcomes. We also investigated the polygenic risk scores of 46 SNPs. Allele-wise association analysis detected three SNPs, including rs2623659 in the CUB and Sushi multiple domains-1 (CSMD1) gene, associated with severity of illness at end point. The severity of illness at end point was associated with treatment response, but not with the severity of illness at baseline. Three SNPs, including rs2294424 in the C6orf105 gene, were associated with social outcomes. Point estimates of odds ratios showed positive relationships between polygenic risk scores and clinical/social outcomes; however, the results were not statistically significant. Because these results are exploratory, we need to replicate them with a larger sample in a future study.

BackgroundFunctional deficits associated with the Clinical High Risk (CHR) status very often lead to inability to attend school, unemployment, as well as social isolation, thus calling for predictors of individual functional outcomes which may facilitate the identification of people requiring care irrespective of transition to psychosis. Studies have revealed that a pattern of cortical and subcortical gray matter volumes (GMV) anomalies measured at baseline in CHR individuals could predict their functional abilities at follow up. Furthermore, literature is consistent in revealing the crucial role of several environmental adverse events in increasing the risk of developing either transition to psychosis, or a worse overall personal functioning. Therefore, the aim of this study is to employ machine learning to test the individual and combined ability of baseline GMV data and of history of environmental adverse events in predicting good vs. poor social and occupational outcome in CHR individuals at follow up.Methods92 CHR individuals recruited from the 7 discovery PRONIA sites were included in this project. Social and occupational impairment at follow up (9–12 months) were respectively measured through the Global Functioning: Social (GF:S) and Role (GF:R) scale, and CHR with a follow up rating of 7 or below were labeled as having a poor functional outcome. This way, we could separate our cohort in 52 poor outcome CHR and 40 good outcome CHR. GMV data were preprocessed following published procedures which allowed also to correct for site effects. The environmental classifier was built based on Childhood Trauma Questionnaire, Bullying Scale, and Premorbid Adjustment Scale (childhood, early adolescence, late adolescence and adulthood) scores. Raw scores have been normalized according to the psychometric properties of the healthy samples used for validating these questionnaires and scale, in order to obtain individual scores of deviation from the normative occurrence of adverse environmental events. GMV and environmental-based predictive models were independently trained and tested within a leave-site-out cross validation framework using a Support Vector Machine algorithm (LIBSVM) through the NeuroMiner software, and their predictions were subsequently combined through stacked generalization procedures.ResultsOur GMV-based model could predict follow up social outcome with 67.4% Balanced Accuracy (BAC) and significance (p=0.01), while it could not predict occupational outcome (46.6% BAC). On the other hand, our environmental-based model could discriminate both poor vs. good social and occupational outcomes at follow up with, respectively, 71% and 66.4% BACs, and significance (both p=0.0001). Specifically, the most reliable features in the environmental classifier were scores reflecting deviations from the normative values in childhood trauma and adult premorbid adjustment, for social outcome prediction, and in bullying experiences and late adolescence premorbid adjustment, for occupational outcome prediction. Only for social outcome prediction, stacked models outperformed individual classifiers’ predictions (74.3% BAC, p=0.0001).DiscussionEnvironmental features seem to be more accurate than GMV in predicting both social and occupational outcomes in CHR. Interestingly, the predictions of follow up social and occupational outcomes rely on different patterns of occurrence of specific environmental adverse events, thus providing novel insights about how environmental adjustment disabilities, bullying and traumatic premorbid experiences may impact on different bad outcomes associated with the CHR status.

ABSTRACTObjective: To present an overview of studies that investigated associations between social cognition functions (social cue perception, empathy, understanding intentions) and social behaviour or social outcome following traumatic brain injury (TBI).Methods: The literature search was conducted in the Medline, PsycInfo, Cochrane Library and Web of Science databases. Main criteria for selection were that the participants were adult persons with TBI, social cognition as well as social behaviour or social outcome post-TBI was assessed and correlations between social cognition and social behaviour or outcome were reported. Average correlations were calculated based on weighted summation of the correlations from the individual studies.Results: Of the 511 publications identified in the search, 13 were selected. Ten of these assessed emotion recognition, six assessed understanding of intentions and two assessed empathy. Average correlations between social cognition performance and post-injury social behaviour or outcome were significant for each of the three social cognition functions; poorer performance was associated with poorer outcome. Effect sizes varied from small to moderate (understanding intentions) to moderate (emotion recognition) to large (empathy).Conclusions: The associations were in line with models of social cognition and proposals that impairments in social cognition may underlie social behaviour difficulties and poor social outcome following TBI.

Paediatric stroke (PS) is a heterogeneous, acute neurological condition that occurs in approximately 7 per 100 000 children. Associated sequelae, including intellectual impairment, specific cognitive deficits, and functional and emotional problems, have the potential to impact on social and psychiatric outcomes. However there has been limited research into psychosocial outcomes following focal brain insult such as PS. Considering the heterogeneous neuropathology and developmental timing of stroke, studies in this emerging area have the potential to inform the relationship between age at brain injury, lesion location and plasticity/vulnerability for psychosocial function. Findings may be clinically relevant to non-brain injured populations, considering the emerging neural understanding for social function. To clarify the nature of recovery in these ‘psychosocial’ domains after PS, a series of empirical papers were utilised to examine various aspects of social and behavioural adjustment as well as investigate the influence of brain insult-related factors and non-insult factors, including attention and family function. Firstly, a review paper examined the existing literature in psychosocial outcomes following PS. The paper highlighted the variability in outcomes, the potential impact of brain-related and non-insult factors and the dearth of theoretical research in the area. A series of studies was conducted, involving parent, child and teacher questionnaires, neurobehavioural assessment and brain imaging. A pilot study aimed to describe attention and social functioning in children with two types of early brain insult: malformations of cortical development (MCD) and stroke. Children with pre-natal MCD experienced more generalised, numerous and clinical levels of impairment than children with acquired stroke, though impairment was present in both groups. A strong association between everyday attention and social functioning was observed. Complex attention processes were also associated with social functioning. The next empirical paper examined PS specifically and aimed to describe attention and social adjustment and their inter-relationships. The stroke cohort was found to have significantly poorer outcomes in attention compared to normative expectations. Frontal and more diffuse lesions were associated with poorer attention skills. Impairment in shifting attention was predictive of social problems in the PS group. The third empirical paper investigated the impact of stroke pathology, including timing of insult, lesion location, lesion volume and functional outcome on measures of social adjustment, social participation and psychiatric functioning. There was a high frequency of psychosocial impairments following paediatric stroke. Generally, insult related characteristics, (lesion volume and broad lesion location) did not impact on social and behavioural outcomes. Findings regarding age at insult were inconclusive. Functional outcome was predictive of social participation. The final empirical paper examined the impact of non-insult factors, such as family function, on social outcomes in PS compared to a control group with a chronic illness not involving the central nervous system. The study also investigated the influences of the child's social environment, i.e. peer relationships on psychiatric outcomes. Notably, there were largely no differences between the stroke and control groups in social and psychiatric outcomes. Family function was found to be predictive of social problems in the entire cohort of children. In the PS group, level of peer group integration was found to be predictive of externalizing problems. Together, results of these papers indicate that the presence of a brain injury in early life such as PS is associated with an elevated risk of social and attentional dysfunction, with heterogeneous social and behavioural outcomes. Early insults prior to 12 months of age are associated with poorer outcomes. It appears that the injury-related risk factors (lesion volume, lesion location), established as predictors of cognitive and physical outcomes, are unable to predict social outcomes in isolation. Rather, findings suggest that environmental factors, such as family function, play a key role. Complex attention processes also appear to play a critical role in efficient social functioning. Findings emphasise the reciprocity between cognitive, behavioural and social outcomes, and highlight the prevalence of social problems in children with stroke. The similarities in social and behavioural outcomes across PS and chronic illness control groups further highlight the role of having a chronic illness and the importance of a child's adjustment to illness in determining social and behavioural outcomes.

Because early illness course and outcome may affect the long-term outcome of schizophrenia-spectrum disorders, it is especially important to address poor outcome in this early critical period. To evaluate whether integrated treatment compared with standard treatment reduced the proportion of patients with poor clinical and social outcome after 1 year. A total of 547 patients with first-episode psychosis were included in the study, 275 randomly assigned to integrated treatment and 272 to standard treatment. Measures assessed psychotic symptoms and social functioning. There was a significant beneficial effect of integrated treatment v. standard treatment on "any poor outcome". Integrated treatment had a significantly better effect on "any poor outcome" in patients with schizophrenia compared with patients in standard treatment. The integrated treatment significantly reduced the proportion of patients with poor clinical and social outcome compared with standard treatment.

Data Refute Belief About Schizophrenia Outcomes

Association of Family History of Psychosis with Long-term Outcome in Schizophrenia – the Northern Finland Birth Cohort 1966 Study

Outcome and its predictors in schizophrenia within the Northern Finland 1966 Birth Cohort

The duration of untreated psychosis (DUP) influences treatment outcome in schizophrenia but its relevance in untreated patients, ill for a very long duration, is not known. This study examined outcome and factors related to it after one year of treatment of schizophrenia patients who were ill for many years and not previously treated. Among 75 never-treated patients with schizophrenia detected in a community survey in Chennai, India, 49 took treatment and were followed up prospectively for one year. Evaluation at intake and outcome was carried out using standardized methods. A good clinical outcome in 29%, social outcome in 35%, occupational outcome in 51% and global outcome in 31% was observed at the end of one year. Patients with poor global outcome did not significantly differ from those with good outcome on demographic and clinical variables at intake but for the presence of delusions and formal thought disorder. The proportion with good outcome in clinical, work and global measures fell steadily with increasing DUP. This difference was significant for clinical and global outcomes after a DUP of 5 years. The relationship between DUP and response to treatment held good even in chronic stages of schizophrenia with longer DUP associated with poorer outcome.

A major public health concern associated with schizophrenia and psychotic disorders is the long-term disability that involves impaired cognition, lack of social support, and an inability to function independently in the community. A critical goal of early detection and intervention studies in psychosis is therefore to understand the factors leading to this often profound impairment. To develop a predictive model of functional (social and role) outcome in a clinical high-risk sample for psychosis. Prospective, naturalistic, longitudinal 3- to 5-year follow-up study. The Recognition and Prevention Program in New York, a research clinic located in the Zucker Hillside Hospital in New York. One hundred one treatment-seeking patients at clinical high risk for psychosis. Ninety-two (91%) were followed up prospectively for a mean (SD) of 3 (1.6) years. Neurocognitive and clinical assessment. The primary outcome variables were social and role functioning at the last follow-up visit. Poor social outcome was predicted by reduced processing speed (odds ratio [OR], 1.38; 95% CI, 1.050-1.823; P = .02), impaired social functioning at baseline (OR, 1.85; 95% CI, 1.258-2.732; P = .002), and total disorganized symptoms (OR, 5.06; 95% CI, 1.548-16.527; P = .007). Reduced performance on tests for verbal memory (OR, 1.74; 95% CI, 1.169-2.594; P = .006), role functioning at baseline (OR, 1.34; 95% CI, 1.053-1.711; P = .02), and motor disturbances (OR, 1.77; 95% CI, 1.060-2.969; P = .03) predicted role outcome. The areas under the curve for the social and role prediction models were 0.824 (95% CI, 0.736-0.913; P < .001) and 0.77 (95% CI, 0.68-0.87; P < .001), respectively, demonstrating a high discriminative ability. In addition, poor functional outcomes were not entirely dependent on the development of psychosis, because 40.3% and 45.5% of nonconverters at clinical high risk had poor social and role outcomes, respectively. Results from this study support the increasing emphasis on functional decline as a critically important outcome that parallels conversion to psychosis and suggest that both psychosis and long-term functional disability are equally important targets for prevention. Reduced neurocognitive performance, functional impairments, and nonpositive attenuated symptoms at baseline were associated with an increased risk of poor functional outcomes in our sample. Poor functional outcomes were not entirely dependent on positive symptoms and the development of psychosis, further highlighting the need for intervention at this early stage of development for those who do and do not convert to a full-blown psychotic disorder.

Traumatic brain injury (TBI) is a leading cause of death and disability in youth under the age of 15, and therefore represents a major public health problem (Bruns & Hauser, 2003; Centers for Disease Control and Prevention, 1999). In the United States, for instance, more than 1 million children and adolescents sustain TBI annually, resulting in approximately 150,000 hospitalizations and 5,000 deaths (Kraus, 1995; Langlois, Rutland-Brown, & Thomas, 2005). Similar rates are reported in other industrialized nations (O’Connor, 2002). Injury severity is strongly related to the outcomes associated with TBI, so that moderate and severe injuries account for most of the mortality and morbidity associated with pediatric TBI, despite representing only about 15% of all cases (Kraus, 1995). As improved medical treatment has led to more frequent survival, concern has increasingly focused on the subsequent cognitive, emotional, and behavioral morbidity,especially among children with more severe injuries (Yeates, 2000), leading to significant economic and social burden for the community. Despite the growing interest in postacute sequelae, the social outcomes of child-hood TBI remain largely uncharacterized and poorly understood. Although social competence is an important predictor of numerous other outcomes, including psychological adjustment, academic performance, and health status (Cacioppo et al., 2002; Rubin, Bukowski, & Parker, 2006), we know little about social outcomes among children with TBI. Nevertheless, because of its critical developmental implications, poor social functioning is likely to play a major role in the reductions in quality of life reported following childhood TBI (Stancin et al., 2002). Several different lines of research suggest that children with TBI are vulnerableto poor social outcomes. First, children with developmental disabilities and chronic health conditions affecting the central nervous system, such as epilepsy and cerebral palsy, are rated as less socially accepted and less socially competent than peers (Nassau & Drotar, 1997). Second, neuroimaging research has revealed an anterior-posterior gradient in the focal lesions associated with TBI. Larger and more numerous lesions are found in frontal and anterior temporal regions (Levin et al., 1989; Mendelsohn et al., 1992; Wilde et al., 2005), which are the same regions that have been implicated as the neural substrates of social information processing and the regulation of social behavior (Adolphs, 2001; Grady & Keightley, 2002). Third, the few previous studies of social outcomes in childhood TBI have shown that children with severe TBI are less skilled at social problem solving and are rated as less socially competent and lonelier than healthy children or children with injuries not involving the brain and that their poor social outcomes persist over time (Andrews, Rose, & Johnson, 1998; Bohnert, Parker, & Warschausky, 1997; Dennis, Guger, Roncadin, Barnes, & Schachar, 2001; Janusz, Kirkwood, Yeates, & Taylor, 2002; Max et al., 1998; McGuire & Rothenberg, 1986; Papero, Prigatano, Snyder, & Johnson, 1993; Yeates et al., 2004). Nevertheless, previous research on the social outcomes of childhood TBI is limitedin quantity and has not made use of state-of-the-art measures and models of social function, thereby precluding a comprehensive portrayal of social consequences following childhood TBI. Now is an excellent time to consider social outcomes in children with TBI. The emerging field of social cognitive neuroscience provides a critical perspective on the social impact of childhood TBI. Social neuroscience not only supplies research tools needed to better understand the neural substrates and social cognitive processes associated with social functioning, but also provides a foundation for a multilevel, integrative analysis of the social difficulties arising from brain insults (Brothers, 1990; Cacioppo, Berntson, Sheridan, & McClintock, 2000; Moss & Damasio, 2001; Ochsner & Lieberman, 2001; Posner, Rothbart, & Gerardi-Caulton, 2001), and in particular the role of the frontal lobes and executive functions in these processes. The methods and models derived from social neuroscience will be particularlypowerful when combined with those associated with the study of social competence in developmental psychology and developmental psychopathology (Parker et al., 2006; Rubin et al., 2006). The latter approaches reflect a developmental perspective that can enhance the field of social neuroscience. In short, we now have the toolsExecutive functions andand models to begin to understand how children’s abilities to identify, think about, produce, and regulate emotions; to consider other people’s perspectives, beliefs, and intentions; and to solve interpersonal problems are associated with their daily functioning in the social world. Furthermore, we can model this association in terms of developmental processes and brain pathology. The goal of this chapter is to describe the relationship between childhood TBI andsocial outcomes. The chapter begins with a description of the major elements of social development as currently conceptualized by developmental psychologists, and continues with a description of how social cognitive neuroscience informs our understanding of the neural substrates of social behavior. The chapter next summarizes developmental issues that arise in the study of social outcomes in childhood TBI. This methodological and conceptual knowledge base is then applied to childhood TBI, by showing how it affects the frontal lobes, executive functions, social information processing, and social behavior, as well as their respective linkages. It concludes with the presentation of an integrative model of social outcomes of TBI and with a discussion of future research needs and possible clinical implications.