Deficits In Psychosocial Functioning Research Articles

Influence of clinical and neurocognitive factors in psychosocial functioning after a first episode non-affective psychosis: Differences between males and females.

Deficits in psychosocial functioning are present in the early stages of psychosis. Several factors, such as premorbid adjustment, neurocognitive performance, and cognitive reserve (CR), potentially influence functionality. Sex differences are observed in individuals with psychosis in multiple domains. Nonetheless, few studies have explored the predictive factors of poor functioning according to sex in first-episode psychosis (FEP). This study aimed to explore sex differences, examine changes, and identify predictors of functioning according to sex after onset. The initial sample comprised 588 individuals. However, only adults with non-affective FEP (n = 247, 161 males and 86 females) and healthy controls (n = 224, 142 males and 82 females) were included. A comprehensive assessment including functional, neuropsychological, and clinical scales was performed at baseline and at 2-year follow-up. A linear regression model was used to determine the predictors of functioning at 2-year follow-up. FEP improved their functionality at follow-up (67.4% of both males and females). In males, longer duration of untreated psychosis (β = 0.328, p = 0.003) and worse premorbid adjustment (β = 0.256, p = 0.023) were associated with impaired functioning at 2-year follow-up, while in females processing speed (β = 0.403, p = 0.003), executive function (β = 0.299, p = 0.020) and CR (β = -0.307, p = 0.012) were significantly associated with functioning. Our data indicate that predictors of functioning at 2-year follow-up in the FEP group differ according to sex. Therefore, treatment and preventative efforts may be adjusted taking sex into account. Males may benefit from functional remediation at early stages. Conversely, in females, early interventions centered on CR enhancement and cognitive rehabilitation may be recommended.

Pathological narcissism: An analysis of interpersonal dysfunction within intimate relationships.

Pathological narcissism is marked by deficits in psychosocial functioning. Difficulties in relationships include instances of aggression, devaluation and control; however, few studies have examined these relationships from the perspective of partners and family members. We studied participants who were in relationships with relatives high in narcissistic traits (N = 436; current romantic partners [57.3%]; former romantic partners [21.1%]; family members [15.4%]). Participant responses were analysed thematically, and their underlying mental health problems were also measured. Thematic analysis of participant responses indicated themes of abuse from the relative with narcissism (physical, verbal, emotional and sexual) as well as the relative imposing challenging financial and sexual behaviours. There were complex interpersonal themes of mutual idealization but also devaluation. In response, participants reported high levels of anxiety, depression, self‐aggression, sickness and somatic concerns. Further, participants expressed overt outward hostility towards their relative with narcissism, but also dependency strivings and frustrated dependency themes. Partners and their relative with narcissism appeared locked into interpersonal and intrapersonal dynamic conflicts. Clinical implications include specific attendance to alliance issues, dependency themes, and a focus on limit setting to establish personal safety.

Deficits in low beta desynchronization reflect impaired emotional processing in schizophrenia

Empirical data from previous investigations showed that emotion processing is reflected in beta, and especially in low beta event related desynchronization (ERD) (i.e. a decrease in low beta power). While recognition of social information and emotion processing are impaired in schizophrenia, no previous study analyzed induced and evoked beta oscillations in patients with schizophrenia during emotion processing.Twenty-eight subjects with schizophrenia and twenty-seven healthy controls subjects were enrolled in the study. The two study groups did not differ in age, gender and education. Participants viewed positive, neutral and negative scenes selected from the International Affective Picture System (IAPS) while 128-channel EEG was recorded.A significantly weaker low beta ERD was detected in patients relative to controls for the negative stimulus condition in the right parieto-occipital and temporal regions. Patients with decreased beta ERD showed more prominent negative symptoms and more severe deficits in psychosocial functioning. Only in the control group stronger beta ERD was detected for the negative stimuli relative to positive and neutral stimuli in the same regions.Our major finding is that impaired emotion processing in schizophrenia is reflected in decreased low beta ERD and in the diminished differences between low beta ERD to negative and non-negative emotional stimuli. Furthermore, it was found that patients with decreased beta ERD show more prominent negative symptoms and more severe deficits in psychosocial functioning.

Links between autism traits, psychosocial functioning, and cognitive control in Typically developing populations

Autism spectrum disorders (ASDs) are marked by severe deficits in psychosocial functioning (e.g., poor social interaction, difficulty in establishing interpersonal relationships, and lack of social and emotional reciprocity). Some studies have suggested that individuals with ASDs experience difficulties in specific components of cognitive control (e.g., planning, inhibitory control, and cognitive flexibility), and that such impairments may underlie atypical social behaviour. Research has also suggested that features of autism are not restricted to individuals diagnosed with ASDs, and that autism-like traits vary throughout the general population at lower intensities. The present study sought to investigate the relationship between autism traits, psychosocial functioning, and cognitive control in a large sample of typically developing adults. Participants completed an extensive battery of measures relating to trait emotional intelligence, theory of mind, emotion processing, and neurocognitive functioning. Findings are discussed in relation to existing literature, and will conclude by offering directions for future research.

1300 – Depressive symptoms in schizophrenia

Introduction Depressive symptoms in schizophrenia are important not only because they contribute significantly to the suffering caused by the illness but also because they exacerbate deficits in psycho social functioning and commonly precede attempted and completed suicide. Objectives It is important to define and clinically assess such symptoms accurately as there is now increasing evidence that they can be treated successfully. Aims The authors assessed the presence and severity of depressive symptoms, as well as their associations with other clinical and socio-demographic measures, in a group of patients with schizophrenia, who were not in a major depressive episode or diagnosed with schizoaffective disorder. And also possible differences in frequency of depressive symptoms in inpatient and outpatient group. Methods Thirty adult inpatients with schizophrenia and 30 comparison subject with schizophrenia in outpatient treatment were studied. Depressive symptoms were rated primarily with the Hamilton Depression Rating Scale. M.I.N.I. Screen and M.I.N.I were used to screen out other disorders and confirm the diagnosis of schizophrenia. Socio-demographic questionnaire that was used was designed specifically for this study. Results Our results indicate significant presence of depressive symptoms in all study subjects. Mean value of total HAM-D score for the whole sample was 15,63±7,724, corresponding to mild depression. Average total score was significantly higher in the subgroup of inpatients (18.97±6,636) compared with (12,3±7,373) in outpatients. Conclusions The results indicate significant presence of depressive symptoms in patients diagnosed with schizophrenia. This should probably be reflected in guidelines for evaluation and treatment of these patients.

Reduced neural activity of the prefrontal cognitive control circuitry during response inhibition to negative words in people with schizophrenia

Schizophrenia is characterized by deficits in executive control and impairments in emotion processing. This study assessed the nature and extent of potential alterations in the neural substrates supporting the interaction between cognitive control mechanisms and emotion attribution processes in people with schizophrenia. Functional magnetic resonance imaging was performed during a verbal emotional go/no-go task. People with schizophrenia and healthy controls responded to word stimuli of a prespecified emotional valence (positive, negative or neutral) while inhibiting responses to stimuli of a different valence. We enrolled 20 people with schizophrenia and 23 controls in the study. Healthy controls activated an extensive dorsal prefrontal-parietal network while inhibiting responses to negative words compared to neutral words, but showed deactivation of the midcingulate cortex while inhibiting responses to positive words compared to neutral words. People with schizophrenia failed to activate this network during response inhibition to negative words, whereas during response inhibition to positive words they did not deactivate the cingulate, but showed increased responsivity in the frontal cortex. Sample heterogeneity is characteristic of studies of schizophrenia and may have contributed to more variable neural responses in the patient sample despite the care taken to control for potentially confounding variables. Our results showed that schizophrenia is associated with aberrant modulation of neural responses during the interaction between cognitive control and emotion processing. Failure of the frontal circuitry to regulate goal-directed behaviour based on emotion attributions may contribute to deficits in psychosocial functioning in daily life.

The Impact of Psychiatric Comorbidity on Quality of Life in Patients Undergoing Herniated Disc Surgery

Recent studies examined the role of psychiatric comorbidity in the process of rehabilitation in patients undergoing herniated disc surgery. These patients suffer from physical and psychosocial complaints or symptoms, which impact their everyday life negatively and the success of rehabilitation potentially. The objectives of this study are (1) to examine the quality of life (QoL) in disc surgery patients and to compare the findings with reference data from the general German population, and (2) to investigate the impact of psychiatric comorbidity on QoL of patients undergoing herniated disc surgery. This study consists of 305 patients aged between 18 and 55 years who took part in face-to-face interviews during their hospital stay. Psychiatric comorbidity was assessed with the Composite International Diagnostic Interview (CIDI-DIA-X). By means of the 36-Item Short-Form Health Survey (SF-36), QoL was assessed in patients undergoing herniated disc surgery with and without psychiatric comorbidity. These findings were compared with the QoL of a representative sample of the general German population. Compared with the general population, QoL in patients with herniated disc surgery was lower in all domains of the SF-36. Psychiatric comorbidity impacts the QoL in patients with herniated disc surgery in all SF-36 domains except "physical function". The patients with psychiatric comorbidity showed significantly lower levels of QoL in the domains "bodily pain", "vitality", "social function", "role emotional", and "mental health". Psychiatric comorbidity has a substantial adverse effect on QoL in patients undergoing disc surgery. Therefore, it will be necessary to diagnose psychiatric comorbidities at an early stage and to include psychosocial interventions in the treatment of herniated disc patients aimed at improving deficits in psychosocial functioning and QoL.

Subtle deficits of cognitive theory of mind in unaffected first-degree relatives of schizophrenia patients

Alterations of theory of mind (ToM) and empathy were implicated in the formation of psychotic experiences, and deficits in psychosocial functioning of schizophrenia patients. Inspired by concepts of neurocognitive endophenotypes, the existence of a distinct, potentially neurobiologically based social-cognitive vulnerability marker for schizophrenia is a matter of ongoing debate. The fact that previous research on social-cognitive deficits in individuals at risk yielded contradictory results may partly be due to an insufficient differentiation between qualitative aspects of ToM. Thirty-four unaffected first-degree relatives of schizophrenia patients (21 parents, 8 siblings, 5 children; f/m: 30/4; mean age: 48.1 ± 12.7 years) and 34 controls subjects (f/m: 25/9; mean age: 45.9 ± 10.9 years) completed the 'Movie for the Assessment of Social Cognition'-a video-based ToM test-and an empathy questionnaire (Interpersonal Reactivity Index, IRI). Outcome parameters comprised (1) 'cognitive' versus 'emotional' ToM, (2) error counts representing 'undermentalizing' versus 'overmentalizing', (3) empathic abilities and (4) non-social neurocognition. MANCOVA showed impairments in cognitive but not emotional ToM in the relatives' group, when age, gender and neurocognition were controlled for. Relatives showed elevated error counts for 'undermentalizing' but not for 'overmentalizing'. No alterations were detected in self-rated dimensions of empathy. Of all measures of ToM and empathy, only the IRI subscale 'fantasy' was associated with measures of psychotic risk, i.e. a history of subclinical delusional ideation. The present study confirmed subtle deficits in cognitive, but not emotional ToM in first-degree relatives of schizophrenia patients, which were not explained by global cognitive deficits. Findings corroborate the assumption of distinct social-cognitive abilities as an intermediate phenotype for schizophrenia.

Abnormal movements are associated with poor psychosocial functioning in adolescents at high risk for psychosis

The period immediately preceding the onset of overt psychosis is characterized by a range of symptoms and behaviors including emerging attenuated psychosis, spontaneous movement abnormalities, and a broad decline in role and social functioning. Recent evidence suggests that basal ganglia dysfunction, which is implicated in the development of psychotic symptomatology, may manifest in the form of both movement abnormalities and deficits in processes integral to psychosocial functioning. However, little is known about the relationship between abnormal movement function and the observed psychosocial deficits. In the present study, 40 clinical high-risk participants meeting criteria for a prodromal syndrome were assessed for movement abnormalities and global role and social functioning at baseline. Role and social functioning were then followed up after a one-year period. At baseline, the severity of spontaneous movement abnormalities was associated with poor role functioning. Further, when controlling for baseline functioning, movement abnormalities predicted changes in social functioning one-year later, with a trend in the same direction for role functioning. Exploratory analyses also indicated that elevated baseline movement abnormalities distinguished those at-risk participants who eventually converted to psychosis and that this was also the case for poorer baseline global role functioning (at the trend level). Taken together, the results suggest that movement abnormalities are closely associated with deficits in psychosocial functioning. Elucidating the link between these phenomena may serve to refine etiological models of frontal-subcortical circuit dysfunction and inform understanding of functioning and outcome of these affected youth.

Do comorbid anxiety disorders impact treatment planning for outpatients with major depressive disorder?

Research indicates that depressed patients with comorbid anxiety disorders have a poorer long-term course of illness, are less responsive to treatment, and may experience greater deficits in psychosocial functioning, when compared with depressed patients without comorbid anxiety disorders. The objective of this study was to examine, through use of a large, well-characterized clinical database, how clinicians may modify treatment recommendations in depressed outpatients when anxiety disorders are present. A group of 346 case records, derived from the Methods to Improve Diagnostic Assessment and Services (MIDAS) project at Rhode Island Hospital, were examined to determine what treatment recommendations were made immediately after diagnosis. Psychopharmacological and psychotherapeutic treatments were classified to capture differences in recommendations between groups. Demographic and clinical characteristics were compared for patients with ( n = 248) and without ( n = 98) comorbid anxiety disorders. Utilizing logistic regression models, we found patients with anxiety disorders had a greater number of psychopharmacological therapies included as part of their initial treatment plan, but no differences were found in initial psychotherapeutic interventions. Our results indicate that practitioners are making unique recommendations based on comorbid anxiety diagnoses, but outcome studies are now needed to determine the most effective treatment methods for this patient population.

Subjektive Lebensqualität von Patienten mit Zwangserkrankungen im Vergleich mit der Allgemeinbevölkerung

Patients with obsessive-compulsive disorder (OCD) not only suffer from obsessive-compulsive symptoms, but also the disorder is associated with impaired social functioning, which impact their everyday life negatively. Subjective quality of life (QoL) in patients with OCD was examined and compared to the general German population. 75 patients with OCD (ICD-10 F42.0-F42.2) were recruited from the outpatient clinic for anxiety disorders at the Department of Psychiatry of the University of Leipzig. Patients showing psychiatric co-morbidity were excluded. By means of the WHOQOL-BREF, QoL was assessed in patients with OCD and in a sample of the general population of Saxony/Germany. Compared with the general population, QoL in patients with obsessive-compulsive disorders was lower in all domains of the WHOQOL-BREF. OCD has a substantial adverse effect on patients' subjective QoL. Therefore, it will be necessary to include interventions in the treatment of OCD aimed at improving residual deficits in psychosocial functioning and QoL.

Subjective quality of life of patients with obsessive–compulsive disorder

Obsessive-compulsive disorder (OCD) is the fourth most frequent diagnosis in psychiatry. Patients with OCD suffer from obsessive thinking and compulsive behavior, which impact their everyday life negatively. Subjective quality of life (QoL) in patients with OCD was examined and compared to the general German population and to patients with schizophrenia. Seventy-five patients, aged 21-72, with OCD (ICD 10 F42.0-F42.2) were recruited from the outpatient clinic for anxiety disorders at the Department of Psychiatry of the University of Leipzig. By means of the WHOQOL-BREF, QoL was assessed in patients with OCD in a representative sample of patients with schizophrenia and in a sample of the general population of Saxony/Germany. Compared with the general population, QoL in patients with OCDs was lower in all domains of the WHOQOL-BREF. Unexpectedly, QoL in patients with OCDs was lower in the domains "psychological well-being" and "social relationships" when compared with schizophrenia patients. OCD has a substantial adverse effect on patients' subjective QoL, which may be even greater than the adverse effect of schizophrenia. Therefore, it will be necessary to include interventions in the treatment of OCD aimed at improving residual deficits in psychosocial functioning and QoL.

A controlled longitudinal 5-year follow-up study of children at high and low risk for panic disorder and major depression

To evaluate the longitudinal course of psychiatric disorders in children of parents with panic disorder (PD) and major depression (MD) as they transition through the period of risk from childhood into adolescence. Over a 5-year follow-up, we compared psychiatric disorders in four groups of children: (1) offspring of parents with PD plus MD (n=136); (2) offspring of parents with PD without MD (n=27); (3) offspring of parents with MD but without PD (n=53); and (4) offspring of non-PD non-MD parents (n=103). Parental PD was significantly associated with increased risk for anxiety disorders, irrespective of parental MD. Parental MD was associated with increased risk for MD, disruptive behavior disorders, and deficits in psychosocial functioning, irrespective of parental PD. These longitudinal findings confirm and extend previous cross-sectional results documenting significant associations between PD and MD in parents and patterns of psychopathology and dysfunction in their offspring.

Advance Directives for Persons With Serious Mental Illness

Back to table of contents Previous article Next article LettersFull AccessAdvance Directives for Persons With Serious Mental IllnessAnjali Varma, M.D.Anjali VarmaSearch for more papers by this author, M.D.Published Online:1 Jul 2005https://doi.org/10.1176/appi.ps.56.7.874-aAboutSectionsView EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: The May issue of Psychiatric Services includes three articles focusing on the clinical utility of medical and psychiatric advance directives for persons with serious mental illness (1,2,3). In the absence of nationally accepted clear guidelines, the topic is complex and intriguing. The onset of two major psychiatric illnesses—bipolar disorder and schizophrenia—occurs in late adolescence and early adulthood. It is important to discuss advance directives with patients who have these illnesses soon after the onset of illness, at an earlier age than people in the general population typically begin to think about advance directives.The need to discuss this topic early after illness onset has become clearer in light of recent research findings showing that each psychotic exacerbation among patients with schizophrenia and each mood episode among patients with bipolar disorder lead to subtle brain damage, as evidenced by periventricular white matter opacities that can be seen with magnetic resonance imaging and cognitive deficits in executive functions and deficits in psychosocial functioning that are revealed by neurocognitive testing and other assessments. Frontal lobe deficits have been found to persist even in states of relative stability among patients with schizophrenia and in euthymic states of patients with bipolar disorder (4,5). It has been difficult to disentangle the role and contribution of stabilizing psychotropic medications with regard to cognitive difficulties. Furthermore, subtle subsyndromal mood symptoms of depression or hypomania may not be gauged by primary care doctors but may affect the decision-making capacity of some patients. Therefore, use of one or more screening instruments, such as the Hamilton Rating Scale for Depression, the Hamilton Rating Scale for Anxiety, and Young's Mania Rating Scale, may be advisable before conclusions are made about whether a psychiatric patient is able to complete an advance directive.Although the authors of the articles in the May issue mention the concept of "fluctuating capacity," many individuals who are in a seemingly stable and competent phase may not really be so because of the above-mentioned factors. As our knowledge about medical and psychiatric advance directives among patients with severe mental illness gradually improves, we as clinicians need to be aware of the possible confounding factors.Finally, children with severe mental retardation or autism will never be able to give advance directives.In the future even if use of both psychiatric and medical advance directives becomes routine clinical practice, the role of surrogate decision makers for persons with mental illness should not be undermined.Dr. Varma is a psychiatry resident at the University of Virginia-Roanoke Salem.

Developmental Pathways in Youth Sexual Aggression and Delinquency: Risk Factors and Mediators

Childhood exposure to violence against females and male-modeled antisocial behavior were examined as risk factors for sexual aggression, and nonsexual aggression and delinquency, in a sample of 182 adolescent male sex offenders using structural equation modeling. Both risk factors produced direct and indirect effects on nonsexual aggression and delinquency with Psychosocial Deficits and Egotistical–Antagonistic Masculinity playing important mediating roles. Exposure to violence against females helped explain sexual aggression through the mediating role of Psychosocial Deficits. As hypothesized, youth who sexually offended against prepubescent children manifested greater deficits in psychosocial functioning, committed fewer offenses against strangers, and demonstrated less violence in their sexual offending than offenders against pubescent females. Findings are discussed within the context of two major evolutionary psychological concepts for explaining human sexual behavior: intrasexual selection and intersexual selection.

Juvenile sex offenders: toward the development of a typology.

Adolescent males who sexually offended against prepubescent children were contrasted with those who targeted pubescent and postpubescent females. As hypothesized, path analyses revealed that the former group had greater deficits in psychosocial functioning, used less aggression in their sexual offending, and were more likely to offend against relatives. Theorized relationships between developmental risk factors, personality mediators, and sexual and nonsexual offense characteristics were assessed in both groups of juvenile sex offenders. Deficits in psychosocial functioning were found to mediate the influence of childhood exposure to violence against females on adolescent perpetration of sexual and nonsexual offenses. Additional univariate analyses were conducted to further explore some associations among early risk factors, personality mediators, and outcomes. Childhood physical abuse by a father or stepfather and exposure to violence against females were found to be associated with higher levels of comorbid anxiety and depression. Noncoercive childhood sexual victimization by a male nonrelative was found to be associated with sexual offending against a male child. Clinical and theoretical implications of the findings are discussed.