Impaired Role Functioning Research Articles

Functional phenotypes in schizophrenia spectrum disorders: defining the constructs and identifying biopsychosocial correlates using data-driven methods

Functional impairments contribute to poor quality of life in schizophrenia spectrum disorders (SSD). We sought to (Objective I) define the main functional phenotypes in SSD, then (Objective II) identify key biopsychosocial correlates, emphasizing interpretable data-driven methods. Objective I was tested on independent samples: Dataset I (N = 282) and Dataset II (N = 317), with SSD participants who underwent assessment of multiple functioning areas. Participants were clustered based on functioning. Objective II was evaluated in Dataset I by identifying key features for classifying functional phenotype clusters from among 65 sociodemographic, psychological, clinical, cognitive, and brain volume measures. Findings were replicated across latent discriminant analyses (LDA) and one-vs.-rest binomial regularized regressions to identify key predictors. We identified three clusters of participants in each dataset, demonstrating replicable functional phenotypes: Cluster 1—poor functioning across domains; Cluster 2—impaired Role Functioning, but partially preserved Independent and Social Functioning; Cluster 3—good functioning across domains. Key correlates were Avolition, anhedonia, left hippocampal volume, and measures of emotional intelligence and subjective social experience. Avolition appeared more closely tied to role functioning, and anhedonia to independent and social functioning. Thus, we found three replicable functional phenotypes with evidence that recovery may not be uniform across domains. Avolition and anhedonia were both critical but played different roles for different functional domains. It may be important to identify critical functional areas for individual patients and target interventions accordingly.

Unsubstantiated use of Selective serotonin reuptake inhibitors as an alternative for the treatment of depression

Unsubstantiated use of Selective serotonin reuptake inhibitors as an alternative for the treatment of depression

Cancer‐related cognitive impairment in survivors of adolescent and young adult non‐central nervous system cancer: A scoping review

Cancer-related cognitive impairments (CRCI) are common after treatment and can have important impacts on the lives of adolescent and young adult (AYA) cancer survivors-those cancer survivors diagnosed between ages 15 and 39. However, most research focuses on survivors diagnosed under age 15 or over age 39 so we know relatively little about CRCI among AYA survivors of non-central nervous system (CNS) cancers. Here we review the research on CRCI among AYA survivors of non-CNS cancers to determine prevalence, associated factors, and impact on survivors' lives as well as implications for future research. In November 2021 we performed a systematic search of the literature in MEDLINE, Web of Science, PsycInfo, CINAHL, EMBASE, and Cochrane Central Register of Controlled Trials to identify peer-reviewed English language articles describing original research with at least one cognitive outcome and conducted with AYA survivors of non-CNS cancer diagnosed as AYAs. We screened 6003 articles and 21 met eligibility criteria. Guided by the PRISMA-ScR Checklist, we extracted study information to meet review objectives. Most studies employed cross-sectional surveys or interviews, though some employed longitudinal methods, neurocognitive assessments, or brain imaging. From the subset of articles that reported a prevalence we calculated a weighted mean prevalence of 25.75% and weighted median prevalence of 27.8%. The factors associated with CRCI included female gender, higher dose chemotherapy, and comorbidities. CRCI impacted the lives of AYA survivors through impaired role functioning, financial toxicity, and unmet needs. CRCI is highly prevalent among non-CNS cancer survivors diagnosed as AYAs and impacts quality of life and role functioning. This review suggests a need for further longitudinal, imaging, and mixed methods research and provision of resources to help achieve better quality of life and educational and occupational attainment during what is potentially a decades-long survivorship period. However, although interventions might improve cognition and functioning, the review identified only one pilot study. Digital interventions may be a practical and effective option for this age group, but they have yet to be adequately investigated.

Study protocol for pragmatic trials of Internet-delivered guided and unguided cognitive behavior therapy for treating depression and anxiety in university students of two Latin American countries: the Yo Puedo Sentirme Bien study

BackgroundMajor depressive disorder (MDD) and generalized anxiety disorder (GAD) are highly prevalent among university students and predict impaired college performance and later life role functioning. Yet most students do not receive treatment, especially in low-middle-income countries (LMICs). We aim to evaluate the effects of expanding treatment using scalable and inexpensive Internet-delivered transdiagnostic cognitive behavioral therapy (iCBT) among college students with symptoms of MDD and/or GAD in two LMICs in Latin America (Colombia and Mexico) and to investigate the feasibility of creating a precision treatment rule (PTR) to predict for whom iCBT is most effective.MethodsWe will first carry out a multi-site randomized pragmatic clinical trial (N = 1500) of students seeking treatment at student mental health clinics in participating universities or responding to an email offering services. Students on wait lists for clinic services will be randomized to unguided iCBT (33%), guided iCBT (33%), and treatment as usual (TAU) (33%). iCBT will be provided immediately whereas TAU will be whenever a clinic appointment is available. Short-term aggregate effects will be assessed at 90 days and longer-term effects 12 months after randomization. We will use ensemble machine learning to predict heterogeneity of treatment effects of unguided versus guided iCBT versus TAU and develop a precision treatment rule (PTR) to optimize individual student outcome. We will then conduct a second and third trial with separate samples (n = 500 per arm), but with unequal allocation across two arms: 25% will be assigned to the treatment determined to yield optimal outcomes based on the PTR developed in the first trial (PTR for optimal short-term outcomes for Trial 2 and 12-month outcomes for Trial 3), whereas the remaining 75% will be assigned with equal allocation across all three treatment arms.DiscussionBy collecting comprehensive baseline characteristics to evaluate heterogeneity of treatment effects, we will provide valuable and innovative information to optimize treatment effects and guide university mental health treatment planning. Such an effort could have enormous public-health implications for the region by increasing the reach of treatment, decreasing unmet need and clinic wait times, and serving as a model of evidence-based intervention planning and implementation.Trial statusIRB Approval of Protocol Version 1.0; June 3, 2020. Recruitment began on March 1, 2021. Recruitment is tentatively scheduled to be completed on May 30, 2024.Trial registrationClinicalTrials.govNCT04780542. First submission date: February 28, 2021.

Quality of life impairment in adult Moyamoya patients\u2014preoperative neuropsychological assessment and correlation to MRI and H215O PET findings

Moyamoya angiopathy (MMA) related cerebral perfusion deficits or infarctions might influence quality of life (QoL). This study examines preoperative QoL in adult patients with MMA and correlates these with findings obtained via diagnostic imaging. Sixty-seven adult Moyamoya patients underwent preoperative neuropsychological testing including questionnaires to determine QoL, as well as psychiatric and depressive symptoms. The results were checked for correlation with territorial hypoperfusions seen in H215O PET with acetazolamide (ACZ) challenge (cerebrovascular reserve) and infarction patterns observed in MRI. Each vascular territory was analyzed separately and correlated with QoL. Physical role function was restricted in 41.0% of cases and emotional role function in 34.4% of cases (SF-36). Obsessive–compulsive disorder (39.3%) (SCL-90-R), psychoticism (34.4%) (SCL-90-R), and depression (32.7%) (BDI-II) were also very common. Psychoticism was significantly more frequent in cases where perfusion deficits in PET CT were observed in both MCA territories (left p = 0.0124, right p = 0.0145) and infarctions in MRI were present in the right MCA territory (p = 0.0232). Depression was significantly associated with infarctions in the right MCA territory (SCL-90-R p = 0.0174, BDI-II p = 0.0246). Women were affected more frequently by depression (BDI-II, p = 0.0234). Physical role function impairment was significantly associated with perfusion deficits in the left MCA territory (p = 0.0178) and infarctions in the right MCA territory (p = 0.0428). MMA leads to impairments in different areas of QoL. Approximately one-third of all adult MMA patients suffered from depression, with women being most affected. In addition to depression, presence of executive dysfunctions and mental disorders such as psychoticism, obsessive–compulsive disorder, and impaired physical and emotional role function affected QoL. These patients showed significantly more often infarctions and perfusion deficits in the right MCA territory. Long-term studies with follow-up results are necessary to clarify a possible beneficial impact of early surgical revascularization on QoL and depression in adult MMA patients.

Quantfying the disorganization and the core deficit in classical schizophrenia

AimsTo derive scores for mental disorganization and impoverishment from commonly used rating scales, and test the hypothesis that disorganization and impoverishment, along with impaired cognition and role-function reflect a latent variable that is a plausible candidate for the putative core deficit.BackgroundFor more than 100 years, disorganization and impoverishment of mental activity have been recognised as fundamental symptoms of schizophrenia. These symptoms may reflect a core brain process underlying persisting disability. Delusions and hallucinations have been regarded as accessory features. The psychopathological processes predisposing to persisting disability in schizophrenia are poorly understood. The delineation of a core deficit underlying persisting disability would be potentially of great value in predicting outcome and developing improved treatment.MethodPatients aged 18–55 years were included if: they satisfied DSM IV criteria for schizophrenia or schizoaffective disorder. Healthy controls were recruited by public advertisement and selected to match the patient group in age and sex. Study sample included 39 participants with schizophrenia, 1 with schizoaffective disorder and 44 matched healthy controls. We derived disorganization and impoverishment scores from three symptom scales: PANSS, SSPI and CASH. We computed composite scores for disorganization and for impoverishment and employed Confirmatory Factor Analysis to test the hypothesis that a single factor accounts for the relationships between disorganization, impoverishment, cognitive impairment and impaired role function. We assessed the relationship between this latent “core deficit” and diminished Post Movement Beta Rebound (PMBR), an electrophysiological measure from Magnetoencephalography (MEG), associated with persisting brain disorders.ResultFit indices for the single factor model from CFA indicated a good fit: χ2(2) = 1.817, p = .403; RMSEA <.001 GFI = .979. PMBR was significantly reduced in the schizophrenia group compared to healthy controls, t (68) = 3.55, p < .001. Within the patient group, PMBR was significantly and negatively correlated with the CFA factor scores representing the Core Deficit score, r=−.543, p < .01, indicating that high core deficit scores were associated with reduced PMBR. PMBR was significantly correlated with the composite Disorganization score, r=−.521, p < .001.ConclusionOur findings demonstrate that the shared variance between impoverishment (psychomotor poverty); disorganization; cognitive impairment; and impaired role function can be accounted for by a latent variable that can reasonably be described as the core deficit of classical schizophrenia. The demonstration that the severity of the putative core deficit is correlated with the reduction in PMBR provides evidence that the core deficit is associated with an identifiable abnormality of brain dysfunction.

Subjective experience of social cognition in young people at Ultra-High Risk of psychosis: a 2-year longitudinal study

Purpose Impairments in SC have been reported in people at Ultra-High Risk (UHR) of psychosis exclusively using neurocognitive tasks. The aims of this study are (1) to assess subjective experience of SC in adolescent and young adult community help-seekers identified through UHR criteria, (2) to explore significant associations of SC with psychopathology and functioning in UHR individuals; and (3) to monitor longitudinally the SC stability after a 2-year follow-up period. Methods: Participants (97 UHR, 141 First-Episode Psychosis [FEP], and 98 non-UHR/FEP), aged 13-35 years, completed the Comprehensive Assessment of At-Risk Mental States (CAARMS) and the GEOPTE scale of social cognition for psychosis. Within the UHR group, a multiple linear regression analysis (with GEOPTE scores as independent variables and CAARMS dimension subscores and treatment measures as dependent variables) was also performed across the 2-year longitudinal design. Results: In comparison with non-UHR/FEP, both UHR and FEP subjects showed significantly higher GEOPTE scores. Both after 12 and 24 months of follow-up, UHR individuals had a significant decrease in severity on GEOPTE SC subscore. In the UHR group, GEOPTE scores showed significant positive correlations with general psychopathology, positive and negative symptoms. Regression analysis showed a significant contribution of SC in predicting baseline social isolation, impaired role functioning, and general psychopathology. After 1 year of follow-up, improvement in SC was predicted by the number of psychotherapy sessions and lower doses of antipsychotics. Conclusions: SC deficits are prominent in UHR individuals and are similar in severity to those of FEP patients. However, they tend to decrease over time along with the delivery of targeted, specialized interventions for early psychosis.

T90. QUANTIFYING THE CORE DEFICIT IN CLASSICAL SCHIZOPHRENIA

BackgroundFor more than 100 years, disorganization and impoverishment of mental activity have been recognised as fundamental symptoms of schizophrenia. These symptoms may reflect a core brain process underlying persisting disability. Predisposition to persisting disability is a clinically important aspect of schizophrenia, yet the psychopathological processes predisposing to persisting disability are poorly understood. The delineation of a putative core deficit associated with persisting disability would be of potentially great value in delineating the underlying pathological processes and eventually in enhancing treatment.AimsTo derive scores for mental disorganization and impoverishment from commonly used rating scales, and test the hypothesis that disorganization and impoverishment, along with impaired cognition and role-function reflect a latent variable that is a plausible candidate for the putative core deficit.MethodsIn a group of 40 patients with schizophrenia, we tested the hypothesis that mental disorganization and impoverishment, along with impaired cognition and role-function reflect a latent variable that is a plausible candidate for the core deficit. We derived disorganization and impoverishment factors from three symptom scales: PANSS, SSPI and CASH. For each of the three scales, we demonstrated significant correlation between these factors and impaired role function assessed using the Social and Occupational Functioning Scale (SOFAS) and cognitive impairment measured using the Digit Symbol Substitution Test (DSST). We then assessed the relationship between this latent “core deficit” variable and Post Movement Beta Rebound (PMBR), measured using magnetoencephalography and associated with persisting brain disorders.ResultsA single factor model provided excellent fit for the four features of core deficit, requiring no further modifications. Results were consistently similar for measures from all three scales. χ2 value was non-significant (range: 0.30 to 2.13, df = 2, p > 0.35), GFI met the threshold of greater than 0.9 (range = .976 to .996) and RMSEA was lesser than 0.06 (range = 0.000 to 0.040). PMBR was found to be significantly reduced in the schizophrenia group compared to healthy controls (t (28) =44.2 ± 12.1, p = 0.001). PMBR was strongly correlated with disorganization (r (40) = .600, p=0.001). In the hierarchical regression, neither age nor medication dose were significant predictors, but PMBR did predict the severity of the core deficit (F (1, 23) = 12.6, P=0.002, R² = -.592).DiscussionScores for the two latent variables representing impoverishment and disorganization of mental activity in schizophrenia can be derived from each of three symptom rating scales. A composite measure of impoverishment, disorganization, impaired cognition and impaired role function reflects an underlying psychopathological process that might be described as the core deficit of classical schizophrenia.

Anhedonia in young people with first episode psychosis: a longitudinal study

Aim: Previous research observed deficits in pleasure experience in chronic schizophrenia, but little is known about anhedonia in early psychosis. Aim of this study is: (1) to examine anhedonia in distinct help-seeking subgroups of young people identified through the First Episode Psychosis (FEP) criteria, (2) to investigate its correlations with psychopathology in the FEP sample, and (3) to monitor longitudinally its stability in the FEP group along 1-year follow-up period.Materials and methods: All participants (137 FEP and 95 nonpsychotic psychiatric controls [i.e. non-FEP]), aged 13–35 years, completed the Comprehensive Assessment of At-Risk Mental States (CAARMS), the Schizotypal Personality Questionnaire – Brief version (SPQ-B), the Brief O-LIFE questionnaire (BOL), and the World Health Organization Quality of Life – Brief version (WHOQOL-BREF). We used two different indexes of anhedonia: CAARMS ‘Anhedonia’ item 4.3 and BOL ‘Introvertive Anhedonia’ subscale scores.Results: In comparison with non-FEP, FEP patients showed higher baseline anhedonia scores. After 1-year follow-up period, FEP individuals had a significant decrease in severity of anhedonia scores. In the FEP group, anhedonia showed significant, enduring (over time) correlations with impaired role functioning, negative symptoms, comorbid depression, poorer self-perceived quality of life and specific schizotypal personality traits (i.e. interpersonal deficits).Conclusions: Anhedonia is relevant in the early phase of psychosis and its severity is associated with functioning deterioration and a bad quality of life.

3.9 Validating a Diagnostic Interview for Internet Addiction Scale (DIA) for Clinical Samples in Korean Children and Adolescents

This study aimed to develop a semi-structured interview scale to measure internet/game/smartphone addiction. Inspired by the 9-item DSM-5 internet gaming disorder diagnostic criteria, we developed 10-item Diagnostic interview for Internet Addiction (DIA) (ie, cognitive salience, withdrawal, tolerance, difficulty in regulation, decrease in other activities, persistent use despite negative consequences, lying about internet/game/social network software (SNS) use, use of internet/game/SNS for mood modification, significantly impaired role function, and craving).

T248. PSYCHOPATHOLOGY IN F2X.X-UNAFFECTED CO-TWINS AS A VULNERABILITY INDICATOR OF PSYCHOSIS

BackgroundStudies have shown that the risk of developing schizophrenia is associated with an increased risk of most other psychiatric disorders1 and that the familial transmission of risk extends across diagnostic categories.2 In twin studies, unaffected twins may not be completely free of symptomatology even when they do not fulfill diagnostic criteria for a psychiatric illness, but this has not been systematically tested in a twin design.The aim of the study was to investigate subtle psychopathology in unaffected co-twins from proband twin pairs, where one twin had a schizophrenia spectrum disorder diagnosis (ICD-10: F2x.x), and compare the level of psychopathology of F2x.x-unaffected co-twins to that of healthy twins.MethodsWe conducted a multimodal, cross-sectional combined clinical and register-based nation-wide twin study, by including twin pairs where one or both twins had a diagnosis in the schizophrenia spectrum (identified by linking The Danish Twin Register and the Danish Psychiatric Central Research Register). A group of age-and gender matched healthy twin pairs were included. All subjects underwent ratings of psychopathology with Positive and Negative Syndrome Scale (PANSS), Comprehensive Assessment of At Risk Mental State (CAARMS), and Clinical Global Impression (CGI). The current level of functioning was estimated with Global Assessment of Function (GAF).ResultsA total of 219 twins were included; i.e. proband twins (n=65), F2x.x-unaffected co-twins (n=56) and healthy twins n=98). For unaffected co-twins, the mean PANSS total score was 38 (SD 12.6), the CGI score was 1.7 (SD 1.1) and the GAF score was 74 (SD 13.3), which were all significantly higher than in healthy twins (all p<0.02), who had a mean PANSS total score of 32 (SD 5.7), a CGI score of 1 (SD 0.3) and a GAF score of 85 (SD 7.3). For CAARMS, the following items were significantly more severe in the unaffected co-twins compared to healthy twins: anxiety (p=0,021), OCD (p=0.008), stress tolerance (p=0.001), aggression (p=0.01), inappropriate affect (p=0.03), social isolation (p=0.01), and impaired role-function (p=0.001).DiscussionThese preliminary results indicate a subtle but significant level of psychopathology in unaffected co-twins of probands affected with a schizophrenia spectrum disorder compared to healthy twins, measured by PANSS and CGI. Results from CAARMS indicate specific areas of interest, clustered around emotional and behavioral symptoms like anxiety, stress intolerance, social isolation, inappropriate affect/aggression and impaired role-function. This may suggest subtle symptomatology in the f2x.x-unaffected co-twins, which may contribute to the significantly lower level of function in the co-twins compared to healthy twins. The heritability of these measures of psychopathology will be examined using Structural Equation Modelling on the whole cohort of probands, unaffected co-twins and healthy twins.

The impact of prostate cancer diagnosis and treatment decision-making on health-related quality of life before treatment onset

ObjectiveThe objective of this study is to test if patients’ health-related quality of life (HRQoL) declines after prostate biopsy to detect Pca, and after subsequent treatment decision-making in case Pca is confirmed, and to test whether personality state and traits are associated with these potential changes in HRQoL.MethodsPatients who were scheduled for prostate biopsy to detect Pca (N = 377) filled out a baseline questionnaire about HRQoL (EORTC QLQ-C30 and PR25), “big five” personality traits (BFI-10), optimism (LOT-r), and self-efficacy (Decision Self-efficacy Scale) (t0). Patients with confirmed Pca (N = 126) filled out a follow-up questionnaire on HRQoL within 2 weeks after treatment was chosen but had not yet started (t1).ResultsHRQoL declined between t0 and t1, reflected in impaired role and cognitive functioning, and elevated fatigue, constipation, and prostate-specific symptoms. Sexual activity and functioning improved. Baseline HRQoL scores were unrelated to the selection of a particular treatment, but for patients who chose a curative treatment, post-decision HRQoL showed a greater decline compared to patients who chose active surveillance. Optimism was associated with HRQoL at baseline; decisional self-efficacy was positively associated with HRQoL at follow-up. No associations between HRQoL and the “big five” personality traits were found.ConclusionPatients who have undergone prostate biopsy and treatment decision-making for Pca experience a decline in HRQoL. Choosing treatment with a curative intent was associated with greater decline in HRQoL. Interventions aimed at optimism and decision self-efficacy could be helpful to reduce HRQoL impairment around the time of prostate biopsy and treatment decision-making.

Predictors of transition to psychosis in individuals at clinical high-risk for psychosis

ObjectiveClinical high risk (CHR) for psychosis state is characterized by presence of potentially prodromal for schizophrenia symptoms. The aim of this study was to assess the predictors of transition to first psychotic episode.MethodsThe study included 123 CHR subjects. All the subjects were characterized by the presence of one of the group of criteria: (1) UHR criteria, (2) basic symptoms criteria and (3) negative symptoms and formal thought disorders (FTD). The presence of FTD in clinical high-risk individuals was assessed with methods of experimental pathopsychology. The mean length of follow-up was 26 months (SD 18). All subjects were males, mean age = 20.2 (SD: 2.1). We examined the subjects’ performance using the Cambridge automated neuropsychological test battery. We applied survival analyses to determine associations between a transition to psychosis and sociodemographic, clinical and neurocognitive parameters. To determine which items are the best predictors, Cox regression analyses were applied.ResultsThe psychosis developed in 39 subjects (31.7%). Global assessment of functioning, positive symptoms, blunted affect, social isolation, impaired role function, disorganizing/stigmatizing behavior, basic symptoms (thought pressure, unstable ideas of reference), neurocognitive parameters (visual memory and new learning, decision making, executive function) significantly influenced the transition to psychosis. A prediction model was developed and included unusual thought content (Wald = 12.386, P &lt; 0.0001, HR = 2.996), perceptual abnormalities (Wald = 4.777, P = 0.029, HR = 1.43) and impaired role function (Wald = 1.425, P &lt; 0.028, HR = 4.157).ConclusionClinical measures are important predictors for transition to psychosis in high-risk individuals.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Chronic multimorbidity impairs role functioning in middle-aged and older individuals mostly when non-partnered or living alone.

BackgroundDue to the aging of the population, society includes a growing proportion of older individuals prone to chronic morbidity. This study aimed to investigate the adverse effects of single and multiple chronic morbidity on psychosocial health and whether these effects are more pronounced in individuals who are non-partnered or living alone.Materials and methodsBaseline data from the ‘Lifelines Cohort Study’ collected between 2006 and 2013 in the Netherlands were used. Individuals aged 50+ (n = 25,214) were categorized according to their health status (healthy, single chronic morbidity, multiple chronic morbidity), relationship status (partnered, non-partnered), and living arrangement (living with someone, living alone). Analyses of covariance (ANCOVA) were performed to study the main- and the interaction-effects on mental health and role functioning as assessed with the RAND-36.ResultsIrrespective of having chronic morbidity, having a partner was associated with better mental health when partners shared a home. Individuals with single and especially multiple chronic morbidity had impaired role functioning. Having a partner mitigated the adverse effects of multimorbidity on role functioning, but only in individuals who shared a home with their partner. Non-partnered individuals with multimorbidity and those not sharing a home with their partner demonstrated impaired role functioning.ConclusionsThe results demonstrate that multimorbidity negatively affects role functioning, but not the mental health, of middle-aged and older individuals. Sharing a home with a partner can mitigate these adverse effects, while other combinations of relationship status and living arrangement do not. Offering intervention to those individuals most vulnerable to impaired functioning may relieve some of the increasing pressure on the health care system. An individual’s relationship status along with one’s living arrangement could foster the identification of a target group for such interventions attempting to sustain physical functioning or to adapt daily goals.

Clinical Practice Guidelines for the management of Depression.

Depression is a common disorder, which often leads to poor quality of life and impaired role functioning. It is known to be a major contributor to the global burden of diseases and according to World Health Organization (WHO), depression is the fourth leading cause of disability worldwide and it is projected that by 2020, it will be the second most common leading cause of disability. Depression is also associated with high rates of suicidal behaviour and mortality. When depression occurs in the context of medical morbidity, it is associated with increased health care cost, longer duration of hospitalization, poor cooperation in treatment, poor treatment compliance and high rates of morbidity. Depression is also known to be associated with difficulties in role transitions (e.g., low education, high teen child-bearing, marital disruption, unstable employment) and poor role functioning (e.g., low marital quality, low work performance, low earnings). It is also reported to be a risk factor for the onset and persistence of a wide range of secondary disorders. Available data also suggests that between one-third and one-half of patients also experience recurrence of depressive episodes.

Évaluation des états mentaux à risque de transition psychotique : validation de la version française de la CAARMS

This article aims to present the validation study of the French version of the Comprehensive Assessment of at risk mental states (CAARMS), an interview that seeks to determine whether young adults criteria for at-risk (AR) mental states, or psychosis. We assessed 40 young subjects, 15 were considered as "prodromal" (Prd) and 10 as experiencing a first episode of psychosis (PEP) by our expert clinician at the center - centre d'évaluation des jeunes adultes et adolescents, University Hospital Centre, Paris - and 15 were healthy controls matched for age and sex. When assessed with the CAARMS, 73 % (n=11) of the prodromal subjects reached the criteria for AR mental state, four subjects did not reach the criteria for AR, nor psychosis (P) and 100 % of the PEP reached the criteria for P. The three groups were significantly different on CAARMS total score (P<0.001) and subscores ; Prd subjects had intermediate scores between PEP (P<0.001) and controls (P<0.001) scores, PEP showing the highest scores. Post-hoc analysis showed that Prd significantly differed from Controls on each subscale (P<0.001) and that Prd differed from PEP on the "positive symptoms" subscale (P<0.001), as well as on "behavioural change" (P=0.021), owing to difference on the item "impaired role function". We used the brief psychiatric rating scale 24 items with anchor (BPRS24-EA) in addition to with the CAARMS, the AR group showed intermediate scores between controls and P subjects. Total scores of both scales were correlated (r=0.408 ; P=0.043) and the BPRS24-EA "positive symptoms" score was correlated with CAARMS' scores on the "Positive symptoms" subscale (r=0.456, P=0.022), "emotional disturbance" (r=0.506, P=0.01), and "behavioural change" (r=0.666 P=0.001). We found no correlation between BPRS negative and depression subscales and any of the CAARMS' subscales. When looking at its reliability, reliability coefficients (Cronbach's alpha) showed excellent reliability for "positive symptoms", "emotional disturbance", "behavioural change" and "general psychopathology" (respectively r=0.82, 0.75, 0.78, 0.84, 0.83) and moderate reliability for "cognitive change", "negative symptoms" and "motor/physical change" (respectively r=0.39, 0.59, 0.43). Overall, analysis of the results of construct validity, concurrent validity and reliability of the CAARMS indicates that the French version is valid and reliable. It is now available to develop and implement early detection programs in French speaking countries.

Management of Patients With Refractory Angina: Canadian Cardiovascular Society/Canadian Pain Society Joint Guidelines

Refractory angina (RFA) is a debilitating disease characterized by cardiac pain resistant to conventional treatments for coronary artery disease including nitrates, calcium-channel and β-adrenoceptor blockade, vasculoprotective agents, percutaneous coronary interventions, and coronary artery bypass grafting. The mortality rate of patients living with RFA is not known but is thought to be in the range of approximately 3%. These individuals suffer severely impaired health-related quality of life with recurrent and sustained pain, poor general health status, psychological distress, impaired role functioning, and activity restriction. Effective care for RFA sufferers in Canada is critically underdeveloped. These guidelines are predicated upon a 2009 Canadian Cardiovascular Society (CCS) Position Statement which identified that underlying the problem of RFA management is the lack of a formalized, coordinated, interprofessional strategy between the cardiovascular and pain science/clinical communities. The guidelines are therefore a joint initiative of the CCS and the Canadian Pain Society (CPS) and make practice recommendations about treatment options for RFA that are based on the best available evidence. Concluding summary recommendations are also made, giving direction to future clinical practice and research on RFA management in Canada.

Most people with mental disorders are happy: A 3-year follow-up in the Dutch general population

Three questions are addressed: (1) How (un)happy are people with and without mental disorders? (2) What are the clinical characteristics associated with happiness among people with a mental disorder? (3) Does happiness predict recovery from mental disorders? A representative sample (N = 7076) of the Dutch population was interviewed at baseline and 1 and 3 years later. Mental disorders were assessed using the Composite International Diagnostic Interview. Happiness was measured using a single question on how often respondents had felt happy during the past 4 weeks. Of the respondents with a mental disorder 68.4% reported they had felt often happy, compared to 89.1% without a disorder. The unhappiness of people with mental disorders is associated with having a mood disorder and impaired emotional and social role functioning. Happiness enhances the changes of recovery from a mental disorder at follow-up. The implications are discussed.

Understanding the Burden of Depression

Major depressive disorder is a highly prevalent, chronic, and disabling disease affecting millions of individuals worldwide. The burden of major depressive disorder includes impaired role functioning, decreased quality of life, the development of medical conditions, and increased morbidity and mortality. The long-term, recurrent nature of depression and its frequent resistance to available therapies lead to increased utilization of health services, which represents a large financial burden in health care costs. Major depressive disorder is often undertreated; however, even when treatment is adequate, remission rates are low and partial response is common.

S21-02 - The structure of the ultra high risk mental state for psychosis. A latent class cluster analysis study

IntroductionIndividuals at Ultra High Risk (UHR) for psychosis typically present with attenuated psychotic symptoms. However it is difficult to predict which individuals will later develop frank psychosis when their mental state is rated in terms of individual symptoms.The objective of the study was to examine the phenomenological structure of the UHR mental state and identify symptom profiles that predict later transition to psychosis.MethodPsychopathological data from a large sample of UHR subjects were analysed using latent class cluster analysis.A total of 318 individuals with a UHR for psychosis. Data were collected from two specialised community mental health services for people at UHR for psychosis: OASIS in London and PACE, in Melbourne.ResultsLatent class cluster analysis produced 4 classes: Class 1 - Mild was characterized by lower scores on all the CAARMS items. Subjects in Class 2 - Moderate scored moderately on all CAARMS items and was more likely to be in employment. Those in Class 3 - Moderate-Severe scored moderately-severe on negative symptoms, social isolation and impaired role functioning. Class 4 - Severe was the smallest group and was associated with the most impairment: subjects in this class scored highest on all items of the CAARMS, had the lowest GAF score and were more likely to be unemployed. This group was also characterized by the highest transition rate (41%).ConclusionsDifferent constellations of symptomatology are associates with varying levels of risk to of transition to psychosis.