Global Assessment Of Functioning Scale Research Articles

Symptomatic, functional and quality of life measures of remission in 194 outpatients with schizophrenia followed naturalistically in a 6-month, non-interventional study of aripiprazole once-monthly

An important goal in the treatment of patients with schizophrenia is remission in various domains, i.e., of symptoms, psychosocial functioning and subjective well-being. We undertook a post hoc analysis of pre-stabilized outpatients with schizophrenia and complete outcome data who had been enrolled in a 6-month non-interventional study of aripiprazole once-monthly (AOM) at 75 German sites. Key outcomes were (i) symptomatic remission (cross-sectional Andreasen et al. criteria (≤mild positive and negative key symptoms on the Brief Psychiatric Rating Scale (BPRS))); (ii) functional remission (Global Assessment of Functioning (GAF) scale score >70), and (iii) subjective well-being remission (WHO-5 scale score ≥13) at week 24. Of 242 enrolled patients, 194 (80.2%) (age = 43.9 ± 15.3 years; 51.5% male, illness duration = 14.0 ± 12.0 years) with complete data were analyzed. While 61.3% of the patients achieved symptomatic remission and 76.8% achieved remission regarding subjective well-being, only 24.7% achieved psychosocial functioning remission at 6 months. Remission rates were similar for men and women and across strata of disease duration with, on average, less remission in patients with longer illness duration. Correlations of improvements on the BPRS and GAF were weak, with the weakest correlation between the BPRS depressive mood item and the GAF scale, but similarly high correlation between BPRS subscales or the BPRS depressive mood item and subjective well-being. These findings suggest that while treatment with AOM can lead to symptomatic remission and remission regarding subjective well-being, additional interventions such as psychosocial therapy or supported employment and education may be necessary to achieve functional remission.

Increased NLRP3 inflammasome expression in peripheral blood mononuclear cells of patients with schizophrenia: a case-control study

Objective This study aimed to evaluate the gene expression of the P2X purinoceptor 7 (P2X7R)- nod-like receptor pyrin domain-containing protein 3 (NLRP3) signal pathway in peripheral blood mononuclear cells (PBMCs) between schizophrenia (SCZ) patients and healthy controls (HC) to reveal its relationship with clinical variables. Methods Thirty-two SCZ patients and 41 healthy controls were included in this study. The Scale for the Assessment of Positive Symptoms (SAPS) and the Scale for the Assessment of Negative Symptoms (SANS), The Global Assessment of Functioning (GAF) scale and the Functioning Assessment Short Test (FAST) scales were applied. P2X7R, NLRP3, IL-1β and IL-18 gene expression levels were evaluated by real-time polymerase chain reaction in PBMCs. Results NLRP3, P2RX7, IL-1β and IL-18 expression levels were significantly higher in PBMCs of SCZ patients than in HC subjects. Negative correlations were found between NLRP3 gene expression levels and GAF and FAST scales scores. There was a negative correlation between IL-18 expression levels and the GAF and FAST scales scores and a positive correlation with the SAPS scale scores. Conclusions Systemic inflammation is implicated in SCZ pathogenesis, according to our findings, which suggest that the NLRP3 pathway may be involved. The NLRP3 inflammasome may serve as a biomarker for SCZ, and its pharmacological regulation may be a promising treatment approach. Key points We hypothesised that the NLRP3 pathway may contribute to the etiopathogenesis of schizophrenia. NLRP3, IL-1β and IL-18 mRNA levels were higher in patients with schizophrenia compared to healthy controls. Negative correlations were found between NLRP3 gene expression levels and GAF and FAST scales scores. There was a negative correlation between IL-18 expression levels and the GAF and FAST scales scores. The SAPS scale scores and IL-18 expression levels had a positive correlation. Given all these findings, it can be stated that NLRP3 inflammasome may play a role in the pathogenesis and symptoms of schizophrenia.

Quality of Life in Patients with Chronic Psychotic Disorders: A Practical Model for Interventions in Romanian Mental Health Centers.

Background and Objectives: Current psychiatric care is increasingly focusing on patients’ quality of life (QoL). Research is still trying to determine the main factors which influence QoL. The present study aims to assess the QoL of patients with chronic psychotic-spectrum disorders, as well as its relation to symptomatology, functionality, adaptive behavior, and perceived level of recovery. Materials and Methods: The study included a sample of 78 patients with chronic psychosis. Symptomatology and illness severity were assessed with the Positive and Negative Syndrome Scale (PANSS) and the Clinical Global Impression Scale-Severity (CGI-S) scales, respectively. The Global Assessment of Functioning Scale (GAFS) and the Adaptive Behavior Assessment System II (ABAS-II)-Adult Form were used for the assessment of patients’ functionality, and the Quality-of-Life Inventory (QOLI) scale was applied for the evaluation of QoL. Results: According to the CGI-Severity scale, 20.5% of the patients were borderline mentally ill, and 24.4% were mildly ill. The highest number of patients (34.6%) were moderately ill, while 14.1% and 2.6% were markedly ill and severely ill, respectively. Among the moderately ill patients, more than half (63%) were patients with schizophrenia, 18.5% were patients with delusional disorder, and 18.5% were patients with schizoaffective disorder. Most of the patients (43.6%) presented moderate functioning deficiency, while 38.5% of the patients presented severe deficiency, according to the GAFS score. When assessed with the ABAS, we observed that almost half of the patients (44.9%) showed an average functioning across skill areas in the conceptual, social, and practical domains. A percent of 67.9% of the patients presented an average QoL, while 15.4% and 12.8% showed a very low and low QoL. QoL was not influenced by the patients’ symptomatology, gender, and education level. Having children, family support, better social and conceptual skills, and a higher perceived level of recovery was correlated with an increased QoL, hierarchical multiple regression R2 = 0.379, F(9, 68) = 2.616, and p = 0.012. Conclusions: Psychiatric interventions in psychosis should focus not only on symptoms’ control, but also on improving social and family support, as well as adaptive skills to increase the patients’ QoL.

ДОСВІД ВИКОРИСТАННЯ ШКАЛИ ЗАГАЛЬНОЇ ОЦІНКИ ФУНКЦІОНУВАННЯ ДЛЯ ДІАГНОСТИКИ І ПЛАНУВАННЯ ПСИХОТЕРАПІЇ В НАРКОЛОГІЧНІЙ ПРАКТИЦІ

Significant consequences of alcohol abuse give grounds to classify alcohol dependence as a medical and social pathology that poses a danger to society. The number of patients registered in medical dispensaries in Ukraine reaches 1 million. Recurrences of the disease during the year after treatment are observed in 60-75% of patients with alcohol dependence. The problem is exacerbated by the medical and social consequences of alcohol abuse in the form of increased mental and physical illness, trauma, suicide attempts and aggressive behavior, criminal acts. This renders the search for new therapeutic approaches to the treatment of alcohol dependence relevant. The aim of the study was to examine the feasibility and effectiveness of using the global assessment of functioning scale (GAFS) to diagnose the dynamics of social functioning of patients with alcohol dependence. The study of the dynamics in the level of general functioning with the use of GAFS in the main and control groups yielded the following results. There was a significant increase in psychological, social and professional functioning in 74.0% of patients in whom a system of treatment and prophylactic measures was applied as compared to 46.7% of patients in the comparison group (χ2 = 6.062, p <0.05). A follow-up study showed that the number of persistent remissions was by 2 times higher in the main group than in the comparison group, 54.0% and 23.3%, respectively (p <0.001).

T15. MISMATCH NEGATIVITY INDICES AS A PROGNOSTIC FACTOR FOR REMISSION IN SCHIZOPHRENIA

BackgroundMismatch negativity (MMN) is an event-related potential component when a sequence of relatively standard stimuli is interrupted by the infrequent presentation of deviant stimuli. MMN is known to be associated with neuro-cognition and functional outcomes. Also, abnormally decreased MMN has often been reported in schizophrenia. Remission and recovery rates are related to the neuro-cognition of patients with schizophrenia. The present study explored the relationship of MMN with remission in patients with schizophrenia.MethodsForty patients with schizophrenia were recruited and divided into two groups, with or without remission, according to the Remission in Schizophrenia Working Group criteria (RSWGcr). For assessments of symptom severity, cognitive function and functional outcome, scale such as Positive and Negative Syndrome Scale (PANSS), K-WAIS-IV, and Global Assessment of Functioning (GAF) were measured. MMN of the patients were evaluated at the frontocentral site. A regression analysis was used to identify the factors that significantly predicted symptom improvement and remission including MMN at frontal site assessed at baseline, and anticipated clinical variables as predictive factors.ResultsMMN amplitudes in frontal sites were further decreased in the groups without remission compared to the groups with remission. MMN amplitude was significantly correlated with measures of symptom change and functional outcome measurements in patients with schizophrenia. Regression analysis revealed that symptom severity and MMN significantly predicted remission in patients with schizophrenia. Symptom improvement significantly predicted PANSS at baseline, illness duration, and antipsychotic dose, as did MMN amplitude at frontal site.DiscussionThis study explored the relationship of MMN with remission in patients with schizophrenia. The remitted patients with schizophrenia showed larger MMN amplitude in frontal electrode site than those of non-remitted patients. MMN in frontal sites was correlated with symptom improvement and functional outcomes through PANSS and GAF scales. The present study found that MMN was significantly correlated with variables related to remission such as PANSS and GAF evaluated at 6 months later. MMN indexes appears to be a promising candidate for predicted factor of remission of schizophrenia.

A comparison of psychometric properties of two common measures of caregiving burden: the family burden interview schedule (FBIS-24) and the Zarit caregiver burden interview (ZBI-22)

PurposeThe Family Burden Interview Schedule (FBIS-24) and the Zarit Caregiver Burden Interview (ZBI-22) are among the most widely used measures for assessing caregiving burden, but their psychometric performances have not been compared in the same study of caregivers of people living with schizophrenia (PLS). This is important because the measures assess overlapping constructs- the FBIS-24 assesses objective burden (e.g., completion of manual tasks) and the ZBI-22 assesses subjective burden (e.g., perceived distress, stigma). This study seeks to fill this gap by comparing the reliability and validity of the FBIS-24 and the ZBI-22 in a Chinese community sample of caregivers of PLS.MethodsA Cross-sectional stud was conducted in a community-based mental health service program in Central South part of China. A total of 327 primary family caregivers of PLS completed face-to-face interviews of the FBIS-24, the ZBI-22, the Patient Health Questionnaire (PHQ-9), the Generalized Anxiety Disorder Scale (GAD-7), and the Family Adaptation, Partnership, Growth, Affection and Resolve Index scale (APGAR), and PLS were assessed using the Global Assessment of Function scale (GAF).ResultsOur findings show that both the FBIS-24 and ZBI-22 have comparable psychometric performance in terms of the internal consistency, convergent validity and known group’s validity.ConclusionBoth the FBIS-24 and the ZBI-22 are psychometrically sound measures of caregiving burden but the choice of which measure to use will depend on the research question.

Functional outcome assessment in bipolar disorder: A systematic literature review.

ObjectivesFunctional impairment is an important driver of disability in patients with bipolar disorder (BD) and can persist even when symptomatic remission has been achieved. The objectives of this systematic literature review were to identify studies that assessed functioning in patients with BD and describe the functional scales used and their implementation.MethodsA systematic literature review of English‐language articles published between 2000 and 2017 reporting peer‐reviewed, original research related to functional assessment in patients with BD was conducted.ResultsA total of 40 articles met inclusion criteria. Twenty‐four different functional scales were identified, including 13 clinician‐rated scales, 7 self‐reported scales, and 4 indices based on residential and vocational data. The Global Assessment of Functioning (GAF) and the Functional Assessment Short Test (FAST) were the most commonly used global and domain‐specific scales, respectively. All other scales were used in ≤2 studies. Most studies used ≥1 domain‐specific scale. The most common applications of functional scales in these studies were evaluations of the relationships between global or domain‐specific psychosocial functioning and cognitive functioning (eg, executive function, attention, language, learning, memory) or clinical variables (eg, symptoms, duration of illness, number of hospitalizations, number of episodes).ConclusionsThe results of this review show growing interest in the assessment of functioning in patients with BD, with an emphasis on specific domains such as work/educational, social, family, and cognitive functioning and high utilization of the GAF and FAST scales in published literature.

Cognitive and psychological evaluation of a sample of egyptian patients with behcet’s disease without neurological manifestations: a case–control study

Objective Behcet’s disease (BD) is a chronic autoimmune multisystemic vasculitis of unknown cause that affects one case per 170 000 persons in the USA. There are few studies in the literature that targeted BD patient group for cognitive and psychological evaluation and scarce studies that evaluated the patients with BD without neurological manifestations. In this study, we aimed to assess those who have BD without neurological manifestations for cognitive and psychological impairments. Patients and methods A case–control study was conducted. A total of 45 consecutive adult patients, aged 18–60 years, diagnosed with BD without neurological manifestations were evaluated for cognitive and psychological impairments and compared with 30 age-matched and sex-matched healthy control participants. Detailed clinical evaluation was done including disease activity measurement using Behcet’s Disease Current Activity Form. Participants completed a group of neuropsychological assessment including Memory Assessment Scale, Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, Short Form 36 Quality-Of-Life questionnaire, and Global Assessment of Functioning scale. Results Compared with the control group, patients with BD scored lower in Memory Assessment Scale (total and subscores), Short Form 36 Quality-Of-Life questionnaire, and Global Assessment of Functioning scores. BD group showed significantly higher prevalence of depression and anxiety. Conclusion BD without neurological manifestations was associated with cognitive and psychological impairment, and this was not restricted to cases with neuro-BD.

F244. CHILDHOOD PSYCHOTIC EXPERIENCES ARE ASSOCIATED WITH PERSISTENTLY POORER FUNCTIONING INTO YOUNG ADULTHOOD: A 9-YEAR FOLLOW-UP STUDY

BackgroundPsychotic experiences (PEs) are relatively common in childhood and early adolescence, being present in 17% of children aged 9 to 12 (Kelleher et al., 2012). Research suggests that young people who experience PEs are more vulnerable to psychopathology later in life, despite PEs being transient in 78.7% of cases (Zammit et al., 2013). While childhood PEs are associated with poorer functioning (Kelleher et al., 2015), it has not yet been established whether the impact of PEs on functioning persists into later life.Methods52 participants from a prospective cohort study (retention rate: 60.4%) of Irish young people were included on the basis that they had completed a clinical interview at all three data-collection time points (T1 mean age: 11.69; T2: 15.80; T3 18.80). Following each interview, participants were scored on the Global Assessment of Functioning (GAF) scale, and given a Current (C-GAF) score and a Most Severe Past (MSP-GAF) score. Fixed-effects repeated-measures models were used to compare the scores of those with a history of PEs at T1 (n=18) to those without (n=34), accounting for age, gender, and childhood functioning. Secondary analyses investigated whether differences in functioning were evident in those who reported transient PEs (only at T1; n=12).ResultsOverall, participants who had reported childhood PEs (T1) received significantly lower C-GAF scores (F = 31.553, p < .001) and MSP-GAF scores (F = 79.377, p < .001) than those without PEs. Simple effects analysis indicated that deficits in the PE group were evident at each time point for both C-GAF scores (T1: p = .001; T2: p <.001; T3: p = .002) and MSP-GAF scores (T1: p < .001; T2: p = .001; T3: p < .001), indicating poorer functioning from childhood, through adolescence, into early adulthood. There was no significant effect of the co-variates.When the analysis was restricted to a comparison of participants who reported PEs at T1 only (i.e. transient PEs) and those with no history of PEs, the PE group had poorer functioning scoring than their peers across the three time points (C-GAF: F = 17.709, p < .001; MSP-GAF: F= 32.247, p < .001).DiscussionThe analysis provides longitudinal evidence that the presentation of PEs is associated with persistent poor global functioning throughout adolescence and into early adulthood, even when the phenomena are transient. PEs appear to be a marker for vulnerability that extends beyond mental disorder. These results tentatively suggest a causal link between PEs and poorer functioning later in life, as the difference in functioning between the groups in early adulthood was still evident after accounting for childhood functioning. Moreover, the disparity between the groups is clinically relevant, with the PE group scoring one to two categories lower than their peers on the GAF scale even into early adulthood. Childhood PEs are an excellent prognostic marker for future functioning and providing targeted early intervention for these individuals may reduce the likelihood of developing a significant clinical disorder later in life.

Setting up clinical audit in a psychodynamic psychotherapy service: a pilot study

AIMS AND METHOD Clinical governance implies a need to engage in a demonstrable form of clinical audit. We decided to pilot a pre-post-therapy questionnaire study, involving both therapists and patients, with the aim of assessing its feasibility as a routine measure of outcome in our service. Questionnaires were chosen to reflect both the symptom profile Clinical Outcomes in Routine Evaluation (CORE) and the general level of functioning Global Assessment of Functioning Scale (GAF). The patients were also questioned about their satisfaction with the therapy. RESULTS Of 53 eligible patient-therapist pairs, 26 patients and 19 therapists responded pre-treatment (overall 51% response rate). The mean (s.d.) CORE score per item was 1.93 (0.78), whereas the GAF score was 55 (15.2), somewhat belying the idea that psychotherapists only treat the ‘worried well’. The post-therapy response rate was poorer, rendering statistical analysis of change difficult to perform. The trend, however, was towards an improvement in both symptoms and level of functioning over the course of therapy. CLINICAL IMPLICATIONS Our patient group presents with a considerable degree of impairment. Although the response rates in this pilot study were poor, the data trend suggests that patients do benefit from the treatment offered. The aims of the study were met in that implementation of a clinical audit process within our department is feasible and the data are obtainable. The main interest, however, lies in what we learned from the process. We offer a dynamic and practical assessment of the impediments encountered, with implications for how these might be confronted.

Negative symptoms in first-episode psychosis: Clinical correlates and 1-year follow-up outcomes in London Early Intervention Services.

Negative symptoms (NS) have been associated with poor outcome and remain difficult to treat in patients with psychosis. This study examined the association of NS with clinical features at first presentation to mental health services for psychosis and with outcomes at 1-year follow-up. Clinical data were utilized from five London Early Intervention Services (EIS) included in the MiData audit database. The sample comprised 484 first-episode psychosis patients with complete Positive and Negative Syndrome Scale data at baseline and 1-year follow-up. Multiple imputation (N = 50) was conducted to account for missing follow-up data. Baseline NS were associated with male gender (B = -1.63, P < .05), younger age at onset (B = -.15, P <. 05), a higher level of impairment on the Global Assessment of Functioning (disability) Scale at baseline (B = -.19, P <. 010), an absence of reported substance misuse prior to baseline assessment (B = -3.05, P <. 001) and unemployment at baseline (B = -.93, P <. 01). At 1-year follow-up, NS at presentation were associated with worse Global Assessment of Functioning Scale for symptom (B = -.28, P < .01) and disability (B = -.27, P <. 05) and with hospital admission (OR = 1.06, P < .01). Negative symptoms at presentation to EIS were associated with worse functioning at entry and poorer outcomes 1 year later. Future research is required to better understand the aetiology and trajectories of NS in early psychosis and propose novel targeted interventions.

A retrospective study of expert opinions of a psychosomatic-psychotherapeutic university hospital for public and private customers over a period of 12 years

In a retrospective study design, 285 expert opinions of a psychosomatic-psychotherapeutic university hospital stemming from consecutive, unselected random sampling over a 12-year time period (1990-2011) were analyzed using a predefined list of criteria. Besides client data, the study also noted the type and the objectives of the expertise, the sociodemographic data of the subjects, the biographic data of the subjects, the size of records, the particular psychopathological findings including conflict and structural diagnostics via the Operationalized Psychodynamic Diagnostics (OPD-2, Research Group 2006), syndromic diagnostics according to ICD-10 (WHO) including the related Impairment Scale Score (ISS, Schepank 1995), and the Global Assessment of Functioning-Scale (GAF, Heuft 2016). 54% of the subjects were men. All subjects were 46 years old at the time of examination; on average symptomatology had existed for 7 years, which made assessment of causality difficult. Most assignments referred to the effects of diseases or accidents in private contexts, followed by pension reports. Among the expert opinions related to possible implications of acts of violence, 95% were women. In 43.2% (n = 123) of the cases, the assessment had occurred in the context of legal action. In 65 cases at least one party had requested a supplemental written report during further procedure. In 17.8% (n = 22) of the cases sought by the courts, the expert witness was requested by at least one party to present the assessment verbally. It should be emphasized that OPD conflict and structural diagnostics appear indispensable also for assessing mental health prior to an external event (accident or assault). The use of the two severity ratings (ISS, GAF) is discussed. It is proposed that expert witnesses be requested to name all their clients fromthe last 5 years at the beginning or end of the expert opinion, so that their independence from possible conflicts of interest can be established.

Efficacy and safety of clozapine in patients with intellectual disability

IntroductionAggression is common and a major behavioral problem in patients with intellectual disability (ID). Antipsychotics are frequently used for psychosis or challenging behavior. There is little literature regarding utilization of clozapine in patients with ID for aggressive behavior.Aims and objectivesThe aims of the study were the evaluation of efficacy and safety of clozapine in treatment of aggression in patients with ID.MethodsA longitudinal naturalistic study including a cohort of 225 consecutive patients with intellectual disability admitted to an acute psychiatric unit between 1 January 2014 and 31 December 2015. Severity of symptoms was assessed at admission with Modified Overt Aggression Scale (MOAS) and Global Assessment of Functioning Scale (GAFS). The data included: demographics, main psychiatric diagnosis, IQ, alcohol/smoking, institutionalization, antipsychotics and another psychotropics, restraint, readiness to discharge (RDQ), side-effects and length of stay.ResultsOf 225 potentially eligible individuals, 205 (92.7%) were treated with antypschotics and 110 male (53.56%) with mean age 32.37 (SD = 9.9). Thirty-seven patients (18%), 18 male (48.65%) were treated with clozapine, mean dose 309.45 mg/day (range 100–450 mg/day). Clozapine reduced need for restraint and duration of hospitalization compared with haloperidol (P &lt; 0.05).ConclusionsClozapine was efficient and safety for treating persistent aggression in patients with intellectual disability. There were no seizures, myocarditis or agranulocytosis during study. Larger and randomized trials are needed to fully explore the anti-aggressive benefit of clozapine.Disclosure of interestThe authors have not supplied their declaration of competing interest.

114.2 Scaling Early Psychosis Treatment in New York State: Challenges and Outcomes

Background: OnTrackNY is a novel coordinated specialty care (CSC) program designed to treat individuals within 2 years of the onset of nonaffective psychosis in New York State. OnTrackNY is funded by New York’s mental health authority, the Office of Mental Health (OMH), which supports service delivery, training and evaluation. Starting with four CSC teams in 2013, OnTrackNY will have 21 teams scattered throughout the state in diverse care settings by 12/16. In order to create an adapting learning health-care system with dynamic real-time improvement cycles, person- and program-level data on care outcomes and processes are collected and reported to teams, while teams offer feedback on their experiences and challenges in program implementation in the context of training activities. This process creates an evolving program model that is anchored in evidence and experience. Little is known about outcomes of CSC programs in the United States. This study describes OnTrackNY program outcomes to 8/16. Methods: The Center for Practice Innovations (CPI), a training and implementation center located at the New York State Psychiatric Institute, oversees training and quality improvement activities for OnTrackNY. CPI works with the Performance Measurement and Evaluation Unit of OMH to monitor referral patterns and enrollment, baseline characteristics and follow-up outcomes, and fidelity. All teams supply quarterly information about team structure and staffing and regarding client status including use of acute services and participation in education and employment. Clinicians are also trained to score client symptom, occupational, and social functioning, using the Mental Illness Research Education and Clinical Center (MIRECC) Global Assessment of Functioning (GAF) scales, adapted for early psychosis. Mechanisms for gathering client self-report and follow-up after discharge are being developed. Results: As of August 2016, a total of 403 individuals have been enrolled in OnTrackNY; 71% male and have a mean age of 21. A total of 15% are less than 18 years old. Forty-two percent are Caucasian, 41% are African American, 10% are Asian, and 23% are Hispanic. Fifty percent are insured by Medicaid, and 40% have private insurance. Client retention in treatment was 82% at 1 year. Mixed model multivariate regression analyses reveal improvements from baseline to 3 months, 9 months, and 1 year (all P < .001) on all MIRECC GAF scales as well as increased odds of participating in work or school and decreased odds of hospitalization. Few differences by individual programs were observed. Being male (all MIRECC GAF scores, education/employment) and having violent ideation or behavior at baseline (all MIRECC GAF scores, hospitalization) was associated with poorer outcomes. Conclusion: OnTrackNY serves as an example of how to scale up early psychosis services across a large state that is supported by resources for services, training, and monitoring of outcomes and fidelity. Limitations include reliance on clinician report. Striving to improve the model and transition and discharge are key future issues that need further exploration.

Concurrent validity of Indian Disability Evaluation and Assessment Scale with sociooccupational functioning scale in patients with schizophrenia.

Background:The Government of India (GOI) has recommended the use of Indian Disability Evaluation and Assessment Scale (IDEAS) for the assessment and certification of disability in patients with mental illness. Although data are available in terms of internal consistency and construct validity of IDEAS, concurrent validity of IDEAS has rarely been evaluated.Aim:The aim was to study the concurrent validity of IDEAS with Global Assessment of Functioning (GAF) and Social and Occupational Functioning Scale (SOFS) in patients with schizophrenia.Materials and Methods:One hundred and seventy-eight consenting patients with schizophrenia in remission were assessed for disability, functioning, and psychopathology using the IDEAS, SOFS, GAF, and Positive and Negative symptom scale (PANSS) respectively.Results:Mean total PANSS score was 51.3 (standard deviation SD −11.19). Disability (>40%) was present in 84.8% of the sample. All the component scores of IDEAS (self-care, interpersonal activities, communication, and work), total IDEAS score, and Global IDEAS score correlated significantly (P < 0.001) with the three domains of SOFS (adaptive life skills, social appropriateness and communication, and interpersonal relationships) along with the total SOFS score. GAF total score had significant negative correlation (P < 0.001) with all the components of IDEAS, total IDEAS score and global IDEAS score. Higher residual psychopathology was also associated with overall higher disability as assessed by total IDEAS score and Global IDEAS score.Conclusions:This study shows that the GOI-modified IDEAS had good concurrent validity with global and sociooccupational functioning as assessed by GAF and SOFS respectively.

A Qualitative Study of Clinicians Experience with Rating of the Global Assessment of Functioning (GAF) Scale.

The severity of illness in psychiatry is rated using the Global Assessment of Functioning (GAF) scale. The GAF scale is often used in both research settings and in the clinic. The scale ranges from 1 to 100 and is subdivided into ten 10-point intervals, each with verbal rating instructions called anchor points and examples. GAF is an instrument that needs improvement. Studying clinicians' experiences with this rating system may be important for developing improvements. The aim of this study was to collect information from clinicians about their experiences with the GAF instrument, and to collect their ideas on how the GAF scale can be improved, particularly in the area of verbal instructions (i.e., anchor points and examples). Qualitative interviews were performed with 25 clinicians. Through this interview process, several weaknesses of the GAF scale were revealed. We found that clinicians have unique experiences that can be important for the development of a better GAF scale. Rating with the GAF scale also requires sufficient collection of patient information.

Fundamental Role of Methylenetetrahydrofolate Reductase 677 C → T Genotype and Flavin Compounds in Biochemical Phenotypes for Schizophrenia and Schizoaffective Psychosis.

The Mental Health Biomarker Project (2010–2016) explored variables for psychosis in schizophrenia and schizoaffective disorder. Blood samples from 67, highly characterized symptomatic cases and 67 gender and age matched control participants were analyzed for methyl tetrahydrofolate reductase (MTHFR) 677C → T gene variants and for vitamin B6, B12 and D, folate, unbound copper, zinc cofactors for enzymes in the methylation cycle, and related catecholamine pathways. Urine samples were analyzed for indole-catecholamines, their metabolites, and oxidative-stress marker, hydroxylpyrolline-2-one (HPL). Rating scales were Brief Psychiatric Rating Scale, Positive and Negative Syndrome Scale, Global Assessment of Function scale, Clinical Global Impression (CGI) score, and Social and Occupational Functioning Assessment Scale (SOFAS). Analysis used Spearman’s correlates, receiver operating characteristics and structural equation modeling (SEM). The correlative pattern of variables in the overall participant sample strongly implicated monoamine oxidase (MAO) enzyme inactivity so the significant role of MAO’s cofactor flavin adenine nucleotide and its precursor flavin adenine mononucleotide (FMN) within the biochemical pathways was investigated and confirmed as 71% on SEM of the total sample. Splitting the data sets for MTHFR 677C → T polymorphism variants coding for the MTHFR enzyme, discovered that biochemistry variables relating to the wild-type enzyme differed markedly in pattern from those coded by the homozygous variant and that the hereozygous-variant pattern resembled the wild-type-coded pattern. The MTHFR 677C → T-wild and -heterozygous gene variants have a pattern of depleted vitamin cofactors characteristic of flavin insufficiency with under-methylation and severe oxidative stress. The second homozygous MTHFR 677TT pattern related to elevated copper:zinc ratio and a vitamin pattern related to flavin sufficiency and risk of over-methylation. The two gene variants and their different biochemical phenotypes govern findings in relationship to case-identification, illness severity, duration of illness, and functional disability in schizophrenia and schizoaffective psychosis, and establish a basis for trials of gene-guided precision treatment for the management of psychosis.

Fifteen-month follow-up of an assertive community treatment program for chronic patients with mental illness

ObjectiveThis study was to evaluate the effect of an assertive community treatment (ACT) program on psychiatric symptoms, global functioning, life satisfaction, and recovery-promoting relationships among individuals with mental illness.MethodsThirty-two patients were part of the ACT program and 32 patients matched for age, sex, and mental illness were in a standard case-management program and served as a control group. Follow-up with patients occurred every 3 months during the 15 months after a baseline interview. Participants completed the Brief Psychiatric Rating Scale (BPRS), Global Assessment of Functioning (GAF) Scale, Life Satisfaction Scale, and Recovery-Promoting Relationship Scale (RPRS).ResultsAccording to the BPRS, the ACT group showed a significant reduction in symptom severity, but the ACT program was not significantly more effective at reducing psychiatric symptoms from baseline to the 15-month follow-up compared to the case-management approach. The ACT group showed more significant improvement than the control group in terms of the GAF Scale. Both groups showed no significant differences in the change of life satisfaction and in the change of recovery-promoting relationships. We observed a significant increase in recovery-promoting relationships in the control group, but the group × time interactions between groups were not statistically significant.ConclusionsIn this study, we observed that ACT was significantly better at improving the GAF than case management. However, ACT did not demonstrate an absolute superiority over the standard case-management approach in terms of the BPRS and the measures of life satisfaction and recovery-promoting relationships. ACT, however, may have some advantages over a standard-case management approach.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Religious delusions in bipolar and schizoaffective patients: A Romanian sample

Introduction Religious delusions have regularly been reported throughout history in patients with schizophrenia, affective psychoses, complex partial seizure disorders and drug-induced psychoses. Objectives The purpose of the study was to identify potential differences regarding demographic and clinical features of bipolar and schizoaffective patients presenting religious delusions. Method Thirty-five inpatients diagnosed with bipolar disorder and 32 inpatients diagnosed with schizoaffective disorder, according to ICD 10 diagnostic criteria, were selected for this study. The assessment of the subjects took place between 2012 and 2015. We divided the subjects into two samples: with and without religious delusions. Socio-demographic (age, sex, education, marital status) and clinical data were analysed. The Brief Psychiatric Rating Scale (BPRS) and the Global Assessment of Functioning Scale (GAF) were used to assess current psychopathology and global functioning. Results Among the schizoaffective patients, 17.8% and 16.9% of bipolar patients presented religious delusions. Similarly, in both samples, patients with religious delusion were older, more frequently unmarried women, had graduated high school, had higher BPRS total scores and higher BPRS psychotic cluster scores and had lesser global functioning. Conclusions Religious delusions were not related to any of the two diagnostic groups but were associated, in both bipolar and schizoaffective patients, with an increased severity of psychotic positive symptoms and had worse global functioning.

Is clinical global impression associated with intelligence in schizophrenia

Introduction The findings of studies examining the association of cognition with symptoms or functioning in schizophrenia are contradictory. Aim To investigate the clinical and functional correlates of general intelligence in schizophrenia. Method Forty-nine stabilized individuals with schizophrenia were recruited in a cross-sectional study. Intelligence was assessed using the Wechsler Adult Intelligence Scale III (WAIS). Clinical symptoms were measured with the Positive and Negative Syndrome Scale (PANSS) and the Clinical Global Impression Scale (CGI). Functioning was assessed with the Global Assessment of Functioning Scale (GAF) and the Strauss-Carpenter Scale (SCS). Separate linear regression analyses were conducted using WAIS full scale as the dependent variable and the following predictors: PANSS total or PANSS positive or PANSS negative scores or CGI or GAF or SCS scores. Significant predictors were entered in one final overall model. Age and gender were entered as covariates in all analyses. Results ANOVA models for PANSS total, positive and negative psychopathology scores and SCS scores were not significant. However, negative symptoms were inversely associated with intelligence (B=−0.61, 95% CI=−1.012, −0.209, t =−3.06, df=45, P =0.004). CGI scores inversely correlated with WAIS total scores (B=−6.078, 95% CI=−9.029, −3.128, t =−4.151, df=44, P t =2.679, df=45, P =0.01). In the final (overall) model, only CGI remained significant. One unit increase in CGI (e.g. mildly versus moderately ill) was associated with 5.2 units decrease in full IQ scores (B=−5.168, 95% CI=−9.257, −1.078, t =−2.550, df=0.002, P =0.015). Conclusions Clinical global impression of stabilized individuals with schizophrenia predicts their level of general intelligence.