GAF Scale Research Articles

Long-term effectiveness of aripiprazole once monthly on functioning and quality of life in schizophrenia: results of year 2 of the ReLiAM study.

Aripiprazole once-monthly (AOM) has proven effective in the treatment of schizophrenia, although little is known about its impact on global functioning and quality of life beyond 1year. Here, we investigate the continued impact of AOM on the participants of the ReLiAM study during the second year of follow-up. The participants who were evaluated at ≥ 1 time point during the second year of the ReLiAM study (months 15, 18, 21, and 24; year 1 completers) were assessed via the GAF scale. Secondary outcomes were reported on the SOFAS, CGI-S, and QLS. 109 (86%) completed at least 1 post-12-month visit and 33 (30.3%) patients completed the final assessment at month 24. The improvements observed in the year 1 completers in GAF total score were maintained through to year 2 completers. The improvements in CGI-S and SOFAS that were observed at the end of year 1 were also maintained through the end of the second year. Similar trends of sustained improvement in GAF total score, CGI-S score, and SOFAS were observed in the post-hoc analyses of the year 2 completers. Seventy-four percent (74.3%) of year 1 completers experienced mild treatment-emergent adverse events during the second year, the most frequently reported being weight gain, akathisia, and insomnia. Seventeen percent (17.4%) experienced serious adverse events. Similar findings regarding effectiveness and tolerability were reported in the year 1 completers and in year 2 completers. These findings suggest that the favorable effectiveness, including tolerability observed during the first year following AOM initiation, are maintained and may even continue to improve during the second year of treatment. ClinicalTrials.gov NCT02131415, first posted on May 6, 2014. Overall trial status: Terminated.

Cariprazine in Hospital Treatment of Acute Psychotic Conditions Due to Comorbid Schizophrenia and Chemical Addictions

Background: endogenous psychoses complicated with different addictions have special psychopathological structure including delirious episodes, true hallucinations combined with typical positive symptoms of schizophrenia. These cases are difficult for treatment due to non-compliance of patients and their bad tolerance to drugs. The aim was to study the most effective psychopharmacological treatment using cariprazine for acute psychotic states in paranoid schizophrenia combined with chemical addictions. Patients and Methods: the study was conducted at psychiatric hospitals of Tomsk region, St. Petersburg, Nizhnevartovsk and Noyabrsk from 2018 to 2024. 208 men aged 18 to 45 years suffering from paranoid schizophrenia and dependent on psychoactive substances were examined. The main group made up 104 in-patients, who took cariprazine alone or in combination with haloperidol or chlorpromazine. The control group included 104 in-patients treated with other antipsychotics (aripiprazole, risperidone, olanzapine). Research methods: clinical and psychopathological, psychometric (PANSS, SANS, CGI, GAF), statistical (Python 3.11.0; R version 3.2.4; SPSS Statistics Base 22.0). Results: It was revealed that when comparing the control group with the main group, similar indicators were observed on the CGI and GAF scales on the 2nd week of the study, and on the 4th week of the study, compared with the control group, an improvement in indicators on the PANSS, SANS, CGI, GAF scales was observed. Conclusions: Cariprazine, compared with other atypical antipsychotics (risperidone, olanzapine, aripiprazole), showed a distinct antipsychotic effect in the treatment of acute psychotic states in patients with schizophrenia dependent on psychoactive substances. By the end of the 2nd week after hospitalization, when treating with cariprazine at an average dose of 3 to 6 mg/day in combination with typical neuroleptics (haloperidol, chlorpromazine) or a tranquilizer, the most pronounced antipsychotic effect is achieved. Subsequent isolated use of cariprazine at a therapeutic dose of 3–4.5 mg/day has an effect similar to that of leading atypical antipsychotics by the end of the 4th week of treatment. Unlike other atypical antipsychotics, cariprazine was more effective in the treatment of negative symptoms of schizophrenia, which made it possible to achieve an improvement in overall functioning, increase the duration of remission, and reduce the risk of rehospitalization and the development of hospitalism.

Suicidal thinking and behavior in young people at Clinical High Risk for Psychosis: Psychopathological considerations and treatment response across a 2-year follow-up study.

Suicidal ideation has high rates among individuals at Clinical High Risk for Psychosis (CHR-P). CHR-P mental states are currently defined as attenuated psychotic symptoms, brief intermittent psychotic symptoms, or genetic risk and functioning deterioration syndrome. However, the relationship between psychotic experiences and suicidality in CHR-P subjects is still not fully understood. Research emphasizes the need to address suicidality in CHR-P individuals due to its incidence and severe socio-economic impact. This study aimed to assess the baseline prevalence and 2-year incidence rates of suicidal thinking and behaviors in an Italian CHR-P sample, investigate the stability of suicidal ideation over 2 years, and examine its associations with treatment outcomes, sociodemographic characteristics, and clinical factors. CHR-P participants were treated in an "Early Intervention in Psychosis" program and completed the PANSS and the GAF scale at baseline and every 12 months. 180 CHR-P individuals were enrolled (92 with suicidal ideation [SI+]). SI+ subjects had a higher baseline prevalence of past suicide attempts. Over 2 years, a decrease in suicidal ideation severity was observed in the total group. Longitudinal improvement in disorganized symptoms was a key predictor of the decrease in suicidal ideation. Participants with a history of suicide attempts were more likely to attempt again. Addressing disorganization is crucial for suicide prevention in the CHR-P population. Continuous risk monitoring and preventive actions are needed for those with past suicide attempts.

Relationship between changing cognitive domains and atypical antipsychotic treatment in bipolar disorders: a three-year observational study in a psychiatric rehabilitation center during COVID-19 pandemic

IntroductionBipolar Disorders have been consistently associated with cognitive dysfunction across a broad range of cognitive domains (patients, who usually took psychiatric drugs, sometimes presented changes of cognitive disorders). Many studies have focused on improving the illness severity of patients with MDD or BD by combining mood-stabilizing drugs with atypical antipsychotics (AA). However, the results are contradictory and have not confirmed the certain superiority of AA to other therapeutic strategies. Among these, the cognitive remedy has demonstrated important effectiveness on cognitive variations in this group of patients.ObjectivesIn our study, we tried to evaluate some changes in cognitive function in patients with BD treated with antipsychotics related to critical problems with typical cognitive tests.MethodsIn our observational study, we recruited forty-three inpatients (20 females, 23 males) affected by Bipolar Disorder (DSM-5 criteria; particularly 78.5% affected by BD-I), in a psychiatric rehabilitation center. All patients were included in the ordinary rehabilitation treatment. All patients were treated with mood stabilizers (lithium n. 14; valproate n. 29), and at least one AA. The AAs have been the following: quetiapine, aripiprazole, and olanzapine (authorized in Italy)(Table 1). The observation period lasted three years, during three significant waves of the COVID-19 pandemic.All patients at baseline (T0) (March-April 2020), T1 (Maj-June 2021), T2 (April-Maj 2022), and T3 (April – June 2023) were administered the following rating scales: BPRS, YMRS, GAF, and HAM-DThe data were statistically analyzed with the EZAnalyze 3.0 software for the Excel platform.ResultsIn Table 2 and Graphic the results obtained with the rating scales and statistical analysis are shown. In BRPS the data shows a statistically significant reduction in the total score in all periods analyzed. Similar results were found in the GAF and YRMS scales. However, with the HAM-D Scale, there was evidence of an increase in T2, although the differences were not statistically demonstrated. The differences in mean scores are more evident for quetiapine and olanzapine.Image:Image 2:Image 3:ConclusionsOur observational study showed that the atypical antipsychotics used in our work allowed a significant improvement of the symptoms in BD. However, the pandemic waves have no correlation with the treatment performed. New studies are necessary to highlight the relationship of the pharmacological treatment of BD with the progress of the COVID-19 pandemic.Disclosure of InterestNone Declared

Therapeutic advantages of omega-3 fatty acid supplementation in patients with schizophrenia – a systematic review

Introduction and aim. In patients with schizophrenia, omega-3 (n-3) polyunsaturated fatty acids (PUFAs) treatment was found to ameliorate the cardiovascular, metabolic, and inflammatory problems caused by antipsychotic medication and even reduce the need for medication by 20%. In this study, we evaluated the potential therapeutic effects of n-3 PUFA supplementation in patients with schizophrenia. Material and methods. The PRISMA guidelines were followed in conducting this systematic review. The Embase, MEDLINE, Web of Science, and Google Scholar databases were searched electronically. The first search yielded 50 papers in total. Subse quently, 43 publications that did not meet our eligibility requirements were removed, and seven articles were selected. Analysis of the literature. The analysis showed that n-3 PUFA supplementation and the placebo group both decreased their psychotic (PANSS and GAF scales) and Calgary Depression Scale symptomatology and boosted their functional ability (GAF) when used as an adjuvant to antipsychotic medication. When administered as a monotherapy with a metabolic antioxidant, n-3 PUFA supplementation proved beneficial for treating schizophrenia. In patients with schizophrenia, n-3 PUFAs have thera peutic benefits as adjuvant treatments to medications, although not for different variables or patient groups. Conclusion. In many studies, patients with chronic schizophrenia who received n-3 PUFA supplementation showed no improvement in their clinical condition.

Reliability of clinical judgment for evaluation of informed consent in mental health settings and the validation of the Evaluation of Informed Consent to Treatment (EICT) scale.

The competence assessment to give informed consent in the legal and healthcare settings is often performed merely through clinical judgment. Given the acknowledged limited reliability of clinician-based evaluation in the mental health sector, particularly for the assessment of competence to consent, our objective was to ascertain the dependability of clinical judgment when evaluating the ability of schizophrenia patients to make choices about their health. The potential convergence between clinical evaluation and scores from a new standardized assessment (the "Evaluation of Informed Consent to Treatment" - "EICT" scale) was therefore tested. The scale assesses four dimensions of competence, specifically how patients normally understand information relating to care (Understanding); how they evaluate the choice of treatment in terms of risk/benefit ratio (Evaluating); how they reason coherently in the decision-making process (Reasoning); and, finally, their ability to make a choice between treatment alternatives (Expressing a choice). Thirty-four outpatients with schizophrenia were evaluated for their competence to consent by five referring clinicians with different backgrounds (psychiatrist, forensic psychiatrist, geriatrician, anesthetist, and medico-legal doctor). Inter-raters variability was tested through correlation analyses between the scores obtained by the clinicians on a modified version of the Global Assessment of Functioning scale (GAF) designed specifically to subjectively assess functioning in each of the four competence dimensions. Two validated competence scales (Mac-CAT-T, SICIATRI-R), and a neuropsychological battery were also administered along with scales for evaluating neuropsychiatric symptoms severity and side effects of medication. Clinical judgments of the individual specialists showed great inter-rater variability. Likewise, only weak/non-significant correlations were found between the EICT subscales and the respective clinicians-rated GAF scales. Conversely, solid correlations were found between the EICT and MacCAT-T subscales. As expected, healthy controls performed better in the ability to give informed consent to treatment, as measured by the three scales (i.e., EICT, MacCAT-T, and SICIATRI-R), and neuropsychological test performance. In the comparisons between patients who, according to the administered EICT, were able or not able to give informed consent to treatment, significant differences emerged for the Phonemic verbal fluency task (p = 0.038), Verbal judgments (p = 0.048), MacCAT-T subscales, and SICIATRI-R total score. Moreover, EICT exhibited excellent internal consistency (Cronbach's alphas ranging from 0.96 to 0.98 for the four subscales) while the Item Analysis, by measuring the correlation between each item of the EICT and the total score, was excellent for all items of all subscales (alphas ranging from 0.86 to 0.98). In conclusion, our findings highlighted that the assessment of competence exclusively through clinical judgment is not fully reliable and needs the support of standardized tools. The EICT scale could therefore be useful in assessing general competence to consent both in healthcare and legal contexts, where it might be necessary to evaluate the effective competence of patients with psychiatric disorders. Finally, this scale could serve as a valuable tool for decisions regarding whether and to what extent a patient needs support.

Correlates of severity in a clinical staging model of schizophrenia: a cross-sectional study among 158 subjects

BackgroundClinical staging has been widely used to predict and optimize the treatment of medical disorders. Different models have been proposed to map the development, progression, and extension of psychiatric disorders over time, mainly for schizophrenia. The primary objective of this study was to classify patients with psychosis according to the McGorry staging model and compare factors between the different stages.MethodsThis was a cross-sectional study, collecting data from 158 patients hospitalized for schizophrenia/psychosis. The survey included the Mini International Neuropsychiatric Interview (MINI), Positive and Negative Symptom Scale (PANSS), Montgomery-Asberg Depression Rating Scale (MADRS), Yong Mania Rating Scale (YMRS), Clinical Global Impression (CGI) scale, and the McGorry staging model.ResultsPatients have been classified into three clinical stages: relapse of psychotic disorder (43%), multiple relapses (47.5%), and persistent and severe illness (9.5%). A higher mean duration of hospitalization, psychotic symptoms (PANSS total scale and subscales), chlorpromazine equivalent dose, and number of antipsychotic treatments were found among participants in Stage 4 as compared to the other groups. However, a significantly higher mean GAF scale was found among participants in stage 3b as compared to the other groups.ConclusionEach stage in the McGorry staging model of schizophrenia is associated with well-defined clinical presentations, which help decide the appropriate treatment. Using such models in psychiatry can improve the diagnostic process and potential therapeutic interventions for patients suffering from mental disorders.

Accompanying mental health problems at home: Preliminary data from a crisis resolution and home treatment team in Catalonia.

INTRODUCTION: Crisis resolution and home treatment teams (CRHTTs) provide intensive home care to people in a mental health crisis, becoming an increasingly widespread alternative to hospital admissions. However, there are wide variations in service delivery, organization, and outcomes, and little literature on how these teams work in clinical practice and different settings. To share the organizational functioning, the therapeutic approach, and the outcomes obtained in a CRHTT in Catalonia, Spain. A descriptive analysis of the functioning of a home treatment team, the characteristics of the people served, and the clinical results from November 2017 to December 2019 are presented. One hundred and five people were served, with an average stay of 57 days. And 55.24% were women, and the mean age was 41. Most people could overcome the crisis at home, and 5.71% required hospital admission during home care. A statistically significant improvement was observed in the results of the GAF and HoNOS scales at admission and discharge. Despite reduced staff, home care was an alternative to hospital admission for most people treated. Flexibility, teamwork, and collaboration with the social network are relevant factors when accompanying the recovery process at home.

Latent classes based on clinical symptoms of military recruits with mental health issues and their distinctive clinical responses to treatment over a 6-month duration

IntroductionIn South Korea, all men at the age of 18 or older are required to serve at military for a certain period as an obligation. These recruits should be able to withstand psychological stress and pressures of rapid adaptation of the unique and new environment in military.ObjectivesThe current study attempted to identify distinct subgroups of patients referred for military service suitability and further to investigate whether there is a difference in clinical features such as treatment responsiveness and prognosis among those subgroups.MethodsSubjects were male patients aged 18 to 28 years who visited the department of psychiatry at the University Hospital for evaluating mental health problems related to military service. We conducted a latent profile analysis (LPA) using 10 clinical scales of MMPI-2 as an indicator variable to investigate the subgroups of subjects. The clinical state of subjects was assessed with CGI-S and GAF scale for three time point (0, 3, and 6 month).ResultsThe results showed that the best fitting model corresponded to a three-class model: each class was named ‘Class 1: mild maladjustment’, ‘Class 2: neurotic depression and anxiety’, and ‘Class 3: highly vulnerable and hypervigilant’ respectively. Subsequent analysis was also carried out to identify changes in clinical symptoms and functional level across treatment time of each subgroup identified in LPA. We demonstrated that the three subgroups displayed differential characteristics in treatment responsiveness and clinical course evaluated by CGI-S and GAF over a treatment period of 6 months. Three subgroups indicated significant differences in the number of medications prescribed as well. Class 3 had more antidepressants and anxiolytics on use than Class 1 and 2. Antipsychotic agents and a combination of three antidepressants were prescribed more frequently in Class 3 than in Class 1 and 2.ConclusionsWhile Class 1 and 2 significantly improved over 6 months, Class 3 showed little or no improvement in our clinical parameters even with more medications. This study has a clinical significance that it has classified qualitatively different subgroups within the sample by conducting LPA with clinical profiles of MMPI-2 and provides a basis for comprehensively understanding their differentiated clinical features. This study suggests clinical implications for treatment plan and intervention of each subgroup classified based on MMPI-2 clinical profiles of military recruits who might show maladjustment to serve.Disclosure of InterestNone Declared

STUDY OF LIFE EVENTS AND PREMORBID FUNCTION IN RECENT ONSET SCHIZOPHRENIA

Background and Objectives: Stressful life events preceded onset of psychosis like schizophrenia. Factors which help to identify disease at an earlier stage enable to seek early medical care. This study aims to compare occurrence of life events in subjects presenting 1st time with schizophrenia in the preceding year and to assess premorbid function of individuals. Methods: This was a case–control study with subjects attending psychiatry outpatient department for the 1st time with schizophrenia and controls from general population. After obtaining informed consent, sociodemographic data were collected along with premorbid functioning using premorbid adjustment scale (PAS), presumptive stressful life events scale (PSLES), positive and negative syndrome scale, premorbid schizoid and schizotypal assessment scale, and global assessment functioning scale (GAF). Data analysis was done using SPSS 22 software. p<0.05 was considered significant. Results: Sixty cases and 60 controls were compared. Mean age was 30.45±9.21 years, 55% were male, 56.66% were married, 68.33% were from rural background, and 81.66% were from low socioeconomic status. Mean number of stressful life events in the preceding year, PSLES score, PAS scale, Premorbid schizoid and schizotypal traits scale, and GAF scale were all significantly higher in cases. Married men showed higher stress and life events score. Conclusion: Subjects with schizophrenia experience severe stress before onset of illness and showed more premorbid social dysfunction. Married subjects experience severe stress than others. Duration of untreated illness was less in urban subjects and those with positive family history but had no correlation with severity.

Validity of the Functioning Assessment Short Tests (FAST), in patients with schizophrenia

IntroductionFunctional impairment in schizophrenia is one of the main features of the disorder and implies a great impact on the patient's quality of life. The Brief Functioning Assessment Scale (FAST), originally validated in bipolar disorder, has also been validated for its application in other mental disorders. However, we only found one study on the reliability and validity of the Brazilian version in schizophrenia. The purpose of this study was to analyze the psychometric properties of the Spanish version of the FAST in patients diagnosed with schizophrenia. Material and methodsA total of 226 patients with a diagnosis of schizophrenia were evaluated by mean the FAST, the GAF and the self-care requirements scale (ERA). Scale properties were analyzed in terms of internal consistency, inter-observer agreement and test-retest reliability. Convergent validity with the GAF and ERA scales was also analyzed, as well as construct validity by means of a Confirmatory Factor Analysis (CFA). ResultsFor the total scale, the results showed high internal consistency (Cronbach's Alpha of, 87), as well as good inter-observer (ICC=,86) and test-retest (ICC=,77) agreement. Concurrent validity with the GAF scale was discrete (r=−,32; P<,001) and with the ERA scale was moderate (r=,50; P<,001). CFA showed an internal structure that matched the six factors proposed by the original scale, with a good level of item saturation for each factor. ConclusionsThe FAST scale showed good psychometric properties in terms of reliability and validity in its Spanish version for its application in patients with schizophrenia. It can be considered as a good tool to assess different areas of functional impairment in clinical practice and research.

Personal Health Budget: a new rehabilitation approach for severe mental illness within a caring community

IntroductionPersonal Health Budget (PHB) has been provided to consumers with severe mental illness within a policy shift toward a person-tailored mental healthcare treatment based on individual unmet needs. PHB is an amount of money to support patient’s health and wellbeing needs, which is planned and agreed between patients and their local NHS team. It is not new money, but it may mean spending money differently so that patients can get the care that they need. However, evidence of beneficial effects of PHB is still scarce.ObjectivesThe aim of this study was to provide preliminary data on clinical and social benefits of adding PHB to a standard pharmacotherapy in patients with severe mental illness across a 24-month follow-up period.Methods137 individuals with severe mental illness (aged 18–50 years) were recruited in one of the adult mental health services of an Italian Department of Mental Health. They completed the Global Assessment of Functioning scale, the Health of the Nation Outcome Scale and the Brief Psychiatric Rating Scale. Friedman’s test for repeated measure was used to assess the longitudinal stability of functioning and clinical parameters. A linear regression analysis was also performed.ResultsA significant decrease in all GAF scale, HoNOS and BPRS scores along the 24 months of follow-up was observed. Regression analysis results specifically showed a relevant association between a PHB multiaxial intervention and the longitudinal reduction in BPRS ‘Negative Symptoms’ and HoNOS ‘Social Problems’ subscores.ConclusionsOur findings support the useful implementation of a PHB approach for severe mental illness patients within the Italian mental health service network.DisclosureNo significant relationships.

Evolutive Pattern of Major Depressive Disorder among Young Patients

Abstract Background: Major depressive disorder (MDD) in young patients represents a real public health problem, with a concerning increase in its prevalence. Aim of the study: To observe and to document relevant information regarding the particularities and the evolutive clinical patterns of MDD in young patients (18–50 years). Material and methods: We conducted a retrospective cross-sectional descriptive study on 68 patients diagnosed with MDD, aged 18–50 years, admitted to the First Department of Psychiatry of the Clinical County Hospital of Târgu Mureș, Romania between January 1, 2019 and September 30, 2020. Data regarding the patients’ psychiatric evaluation (primary and secondary diagnosis, relapses, associated personality disorders, autolytic attempts, treatment options, evolution, comorbidities) and psychological evaluation (HAM-D, HAM-A, GAF) were analyzed. Results: The highest prevalence of MDD was found in the 41–50 years age group (66%), followed by the 31–40 years age group (24%). Regarding the GAF and HAM-D scales, 90% of patients had scores in the range of 41–50 and &gt;20 respectively. We found a high prevalence of personality disorders (75%), the most common being borderline personality disorder (27%). Younger patients (18–35 years) tended to recover quicker, with an average of 8.15 hospitalization days compared to older patients (36–50 years) who had an average of 12 days. Relapses were present in 55% of cases, being more frequent in women, and there was a 50% rate of relapse in subjects with no social support network. Autolytic attempts were present in 25% of cases and insomnia in 92%. Conclusions: MDD has a major impact on the patients’ global functionality and their quality of life. In our study, women were more vulnerable to develop MDD, while younger adults were less prone to develop MDD and they recovered more quickly.

Predicting discharge from long-term forensic treatment: patients characteristics, protective factors, needs and treatment-related factors study in the Czechia

ABSTRACT One of the challenges in forensic psychiatry is determining when an inpatient is ready to be discharged and return to the community. The comprehension of factors that predict extended treatment or discharge is relatively limited. We assessed the treatment progress of a cohort of forensic inpatients (N=80) divided into two groups: discharged patients and patients who remain detained. We derived socio-demographic and clinical variables from each patient’s medical records and scores on the HoNOS-Secure, GAF, and SAPROF scales. The dataset was subjected to logistic regression and Chi-square analysis to determine the relevant factors. We gained insights into illness as a strong predictor of discharge, which is also associated with the patient’s general compliance with the facility program and participation in occupational therapy. The majority of our sample has moderate or severe functional impairment according to GAF. The instruments used can capture dynamic factors related to discharge or continuing hospitalization, namely the SAPROF total or external factors score, the HoNOS-Secure subscale, and significant items from the HCR-20 clinical and risk subscales.

Antipsychotic selection strategies: the need for a holistic approach

To describe the connections between strategies for antipsychotic prescribing and clinical, socio-psychological factors of treatment adherence in patients with psychotic disorders. The study included 83 inpatients with schizophrenic spectrum disorders (F2x) - 67%, affective disorders (F3x) - 15%, neurotic and personality (F4x + F6x) - 9%, organic diseases of the central nervous system (F0x) - 9%. We used a visual analog scale for patients' subjective severity of their condition, locus control test, Internalized stigma of mental disorder scale (ISMI), Treatment motivation assessment questionnaire (TMAQ), and Medication Compliance Scale (MCS), which also includes BPRS, SANS, GAF scales. Dispersion analysis (p≤0.05), effect sizes calculation (Cohen's d/Cramer's V) were performed (ES). The options for prescribed antipsychotics did not depend on positive and negative symptoms, social maladjustment, suicidality, disease recurrence. The outpatient use of more than one antipsychotic was associated with socio-demographic differences in patients, high internality in life failures (ES=0.98), self-stigmatization (ES=0.94) due to the psychiatric stereotypes endorsement (ES=1.03), and social self-isolation (ES=1.08). Prescription of atypical antipsychotics during hospitalization was associated with subjectively less severe condition in patients (ES=0.7), their position of active cooperation with a doctor (ES=1.08), high internality of achievements (ES=0.99), lower psychiatric stereotypes endorsement (ES=1.19), social self-isolation (ES=1.58). Depot antipsychotic was predominantly an option for patients with secondary education (ES=0.34). Types and forms of antipsychotic treatment were associated not with clinical but with social and psychological patients' characteristics. The prescription of atypical antipsychotics, including depot forms, is specifically associated with not only treatment adherence, but with a favorable profile of patients' motivation for treatment.

Comorbid impulsivity after one year of epilepsy surgery

BackgroundPsychiatric comorbidities in patients with drug-resistant epilepsy (DRE) are frequently observed before and after epilepsy surgery. Impulsivity, defined as behaviors that are poorly conceived, are also frequent among patients with epilepsy. The aim of this study was to determine the presence of comorbid impulsivity in patients with DRE after one year of epilepsy surgery. MethodsPatients who underwent epilepsy surgery for DRE and completed the postsurgical assessment protocol one year after surgery were included. All patients underwent a presurgical protocol comprising of neurological, psychiatric, neuropsychological, video-EEG and MRI assessments. The psychiatric evaluation was performed before and one year after surgery using SCID-I, SCID-II, GAF scale of DSM IV, and Beck Depression Inventory II. One year after surgery, Barratt Impulsiveness Scale 11, and Engel classification of seizures, were administered. ResultsA total of 38 patients were included in this study, 21 women (55.3%) and 17 men (44.7%), mean age 36 years (SD = 9.4). Higher impulsivity was associated with a worse epilepsy seizure outcome (p < 0.05), one year after surgery. According to the multiple linear regression analysis, a worse epilepsy seizure outcome was associated with higher levels of nonplanning impulsivity (p < 0.05) (p < 0.05, β −0.5, r2 0.25). The GAF score was negatively associated with motor score (p < 0.05, β −0.584, r2 0.42) and with the total BIS-11 score (p < 0.05, β −0.557, r2 0.39). ConclusionsImpulsivity has been associated with a worse post-surgical seizure outcome. Larger studies about impulsivity might confirm these preliminary findings.

Profile of Chronic Mental Disorder Patients with or without Suicide Ideation in the Psychiatric Ward of Dr. Soetomo General Hospital, Surabaya

Introduction: Risk factors for suicide ideation or suicide are the history of mental illness, family history with suicide or depression, and having suicide attempts. This study aimed to determine patients with mental disorder profiles that had suicide ideation and never had suicide ideation. This study also aimed to identify the intensity of suicide idea and history of suicide attempts at a subject that had suicide ideation.Methods: This was a descriptive observational study. This study was conducted using C-SSRS questionnaires and some additional interviews with chronic mental disorder patients in the Psychiatric Ward, Dr. Soetomo General Hospital, Surabaya.Results: Total patients that had suicide ideation were 11 patients, consisted of 8 patients with schizophrenia, and 2 patients with bipolar disorder. The mean length of illness was 16.55 years, GAF Scale when suicide ideation appeared was at range 40-31 until 60-51. GAF Scale got better in range 60-51 until 80-71, mostly in teenagers and adults when suicide ideation appeared, primarily women. Many of them were unemployed, had lower income, did not have income, and were non-college graduates. The total subjects that never had suicidal ideation were 23 patients, 2 of them with depression, mean age of illness onset was 12.04 years old, the balance between women and men, some of them were sellers and worked in a private field, with income range between 2 until 5-6 million, and few of them were college graduates.Conclusion: Suicide ideation was mostly found in some subjects with younger age, had longer length of illness, had lower GAF Scale, primarily women, unemployed, had lower income, and had lower education.

Retinal function and preclinical risk traits in children and adolescents at genetic risk of schizophrenia and bipolar disorder

BackgroundThe millions of children having a parent affected by a major psychiatric disorder may carry, as vulnerability indicators, electroretinographic (ERG) anomalies resembling those seen in adult patients. Our goal was to determine whether ERG anomalies in high-risk youths are related to clinical precursors of a later transition to illness such as the presence of childhood DSM-IV diagnoses, bouts of psychotic like experiences, lower global IQ and social functioning deterioration. MethodsThe 99 youths (53% males) aged 5–27 years had one parent affected by schizophrenia, bipolar disorder or major depressive disorder. They were assessed with a best-estimate DSM-IV diagnoses based on review of medical charts and a structured interview (K-SADS or SCID), global IQ (WISC-V and WAIS-IV), global functioning (GAF scale) and psychotic-like experiences using interviews and a review of medical records. The electroretinogram of rods and cones was recorded. ResultsCone Vmax latency was longer in offspring having psychotic-like experiences, respective adjusted mean [SE] ms of 31.59 [0.27] and of 30.96 [0.14]; P = 0.018). The cone Vmax delayed latency was associated with a lower global IQ (R = −0.18; P = 0.045) and with deteriorated global functioning (GAF; R = −0.25; P = 0.008). In contrast, rods had decreased b-wave amplitude only in offspring with a non-psychotic non-affective DSM diagnoses, respective means [SE] μV of 170.18 [4.90] and of 184.01 [6.12]; P = 0.044). ConclusionsERG may mark neurodevelopmental pathways leading to adult illness and have an effect on early pre-clinical traits, giving clues to clinicians for the surveillance of sibling differences in high-risk families.

Evaluation of IGF-1 as a novel theranostic biomarker for schizophrenia

ObjectiveIn the current study, we aimed to investigate fasting plasma levels of glucose, insulin, growth hormone, IGF-1, and lipid profile in remission schizophrenia patients, treatment resistant schizophrenia patients and healthy controls and to determine whether IGF-1 levels can be used as a theranostic biomarker in schizophrenia. MethodsSixty-two patients under remission from schizophrenia, sixty-five treatment-resistant patients with schizophrenia and sixty-two healthy controls were included in the study. All patients were recruited and evaluated over 11 months. Symptoms at the time of evaluation were assessed twice using BPRS, PANSS, CGI, and GAF scales by an experienced psychiatrist in accordance with Andreaseen's remission criteria and TRIPS group resistance criteria. Blood samples were collected from all participants to determine fasting glucose, LDL, HDL, Triglyceride, Total Cholesterol, fasting, insulin, GH and IGF-1 levels. ResultsFasting blood glucose levels were found to be higher in patients with schizophrenia than in healthy controls. Moreover, LDL levels of the treatment sensitive group were higher than that of the treatment resistant group while they were not significantly different from the healthy controls. IGF-1 levels were lower in the treatment sensitive group than in both treatment resistant and healthy control groups. IGF-1, LDL and age of disease onset were found to be significantly associated with treatment resistance in a regression model. DiscussionIn the present study, remitted patients with schizophrenia could be distinguished from treatment-resistant patients and healthy controls with serum IGF-1, fasting glucose and LDL levels. In addition, we found that smoking and age of disease onset together with IGF-1 levels could significantly predict resistance to treatment.

Do we really listen?

IntroductionThe improvement perceived by the patients is a subjective measure of the psychic state, while the clinical evaluation corresponds to an objective evaluation of the psychopathological improvement performed by a psychiatrist. It is therefore relevant to evaluate whether these parameters evolve in a common way after patients have undergone an intervention in Day Hospital focusing on first psychotic episodes.ObjectivesStudy the relationship between subjective improvement and clinical evaluation.MethodsThis is a prospective study, which includes consecutive patients admitted to the Day Hospital during 2018. Their objective clinical improvement was assessed by means of the PANSS and GAF scales at admission and discharge. Subjective clinical improvement was assessed using an anonymous Likert scale with a score between 1 and 7. Sociodemographic data and other satisfaction parameters were also collected. A statistical analysis was performed using Pearson’s correlation.ResultsA total of 73 patients were included. The perception of improvement on the part of the patients is very high presenting average values close to the maximum in almost all the evaluated items. The correlation between subjective improvement and PANSS variation presented a Pearson value 0.008; p = .957 and with the GAF variation presented a Pearson correlation of -0.066; p = .578 which indicates that there is no significant correlation between the variables.Diagnostic groupsFrequencyPercentageDrugs11,4Psychosis3750.7Affective2128.8Neurosis1013.7Personality34.1Total72ConclusionsClinical evaluation and subjective perception of improvement are independent parameters.