Social Functioning Outcomes Research Articles

Impact of Irritability and Impulsive Aggressive Behavior on Impairment and Social Functioning in Youth with Cyclothymic Disorder.

Research on adults with cyclothymic disorder (CycD) suggests that irritability and impulsive aggression (IA) are highly prevalent among this population. Less is known about whether these behaviors might also distinguish youth with CycD from youth without CycD. Additionally, little is known about how irritability and IA relate to one another, and whether they are associated with different outcomes. This study aimed to compare irritability and IA across diagnostic subtypes to determine whether CycD is uniquely associated with these behaviors, and to assess how irritability and IA relate to youth social and general functioning. Participants (n = 459), 11-18 years of age, were recruited from an urban community mental health center and an academic outpatient clinic; 25 had a diagnosis of CycD. Youth and caregivers completed measures of IA and irritability. Youth and caregivers also completed an assessment of youth friendship quality. Clinical interviewers assessed youth social, family, and school functioning. Youth with CycD had higher scores on measures of irritability and IA than youth with nonbipolar disorders, but scores were not different from other youth with bipolar spectrum disorders. Measures of irritability and IA were correlated, but represented distinct constructs. Regression analyses indicated that irritability was related to friendship quality (p < 0.005). Both IA and irritability were related to social impairment (ps < 0.05-0.0005) and Child Global Assessment Scale (C-GAS) scores (ps = 0.05-0.005). CycD diagnosis was associated with poorer caregiver-rated friendship quality and social functioning (ps < 0.05). We found that irritability and aggression were more severe among youth with CycD than among youth with nonbipolar diagnoses, but did not differ across bipolar disorder subtypes. Among youth seeking treatment for mental illness, irritability and IA are prevalent and nonspecific. Irritability and IA were uniquely related to our outcomes of social and general functioning, suggesting that it is worthwhile to assess each separately, in order to broaden our understanding of the characteristics and correlates of each.

Paranoid individuals with schizophrenia show greater social cognitive bias and worse social functioning than non-paranoid individuals with schizophrenia

Paranoia is a common symptom of schizophrenia that may be related to how individuals process and respond to social stimuli. Previous investigations support a link between increased paranoia and greater social cognitive impairments, but these studies have been limited to single domains of social cognition, and no studies have examined how paranoia may influence functional outcome. Data from 147 individuals with schizophrenia were used to examine whether actively paranoid and non-paranoid individuals with schizophrenia differ in social cognition and functional outcomes. On measures assessing social cognitive bias, paranoid individuals endorsed more hostile and blaming attributions and identified more faces as untrustworthy; however, paranoid and non-paranoid individuals did not differ on emotion recognition and theory of mind tasks assessing social cognitive ability. Likewise, paranoid individuals showed greater impairments in real-world interpersonal relationships and social acceptability as compared to non-paranoid patients, but these differences did not extend to performance based tasks assessing functional capacity and social competence. These findings isolate specific social cognitive disparities between paranoid and non-paranoid subgroups and suggest that paranoia may exacerbate the social dysfunction that is commonly experienced by individuals with schizophrenia.

Psychological pathways from social integration to health: An examination of different demographic groups in Canada

RationaleThe health effects of social integration have been extensively studied, yet the underlying dynamics of this relationship deserves more exploration. One of the important hypothesized pathways through which social integration affects health is psychological functioning, including a sense of belonging, personal control and generalized trust. ObjectiveUsing a Canadian national survey, this study explored the effect of social integration on different health outcomes via psychological pathways, while incorporating network homophily as a predictor in the model. MethodsFive distinct demographic groups of Canadians (the Native-born Whites, Native-born visible minorities, the Aboriginal people, immigrant Whites and immigrant visible minorities) were compared on their social integration, psychological functioning, and health outcomes. Structural equation models tested the mediation effects of psychological pathways, and group differences were explored by adding interaction terms. ResultsThe study found that visible minority immigrants were least socially integrated, and the Aboriginal people had the poorest self-reported physical and mental health. Although the Aboriginal people had large networks and active network interactions, they showed stronger ethnic and linguistic homophily in their network formation than the two visible minority groups. Structural equation model results supported the mediated relationship between social integration and health via psychological pathways. A positive effect of friendship ethnic homophily on health was identified and explored. ConclusionPolicy makers may seek opportunities to create social environments that facilitate social interactions and formation of social ties and provide support for programs serving ethnic and immigrant groups.

A review on the impact of cognitive dysfunction on social, occupational, and general functional outcomes in bipolar disorder.

Bipolar disorder (BD) is associated with significant impairment in cognitive performance across multiple domains of function that often persist after clinical recovery. It remains unclear, however, as to whether this process is related to the clinical status of BD being depressed, manic/hypomanic, or euthymic. In this review, we examine the literature on the cross-sectional and longitudinal relationships between cognitive function and general function depending on the clinical phase of BD. A systematic review of original research that studied both cognitive function and general function in adults (18-60 years), restricted to BD, was conducted in a total of 18 studies meeting inclusion/exclusion criteria. Results show cross-sectional and prospective relationships between cognitive function and general function in patients with BD in both symptomatic and euthymic patients with BD. While studies using general measures of function (e.g., Global Assessment of Function scale) show more inconsistent associations with cognitive function, those employing assessments of domain specific function, suggest a consistent relationship between social and occupational function and cognitive performance. Executive function is commonly affected by cognitive deficits in these patients, but in addition a variety of domains show associations with functional outcomes (e.g., social function, occupational function). Notably, the emerging evidence suggests that cognitive function may be a better predictor of future general function than affective symptom severity. Despite some inconsistencies, in sum the literature on the relationship between cognitive function and general function in BD implicates both cross-sectional and longitudinal associations, both in symptomatic and euthymic patients with BD. And in terms of capturing these changes functional scales in particular domain-specific measures seem superior to general measures.

Randomized controlled trial of computer-based treatment of social cognition in schizophrenia: the TRuSST trial protocol.

BackgroundSchizophrenia is a severe and chronic medical condition, characterized by positive and negative symptoms, as well as pervasive social cognitive deficits. Despite the functional significance of the social cognition deficits affecting many aspects of daily living, such as social relationships, occupational status, and independent living, there is still no effective treatment option for these deficits, which is applied as standard of care. To address this need, we developed a novel, internet-based training program that targets social cognition deficits in schizophrenia (SocialVille). Preliminary studies demonstrate the feasibility and initial efficacy of Socialville in schizophrenia patients (Nahum et al., 2014). The purpose of the current trial (referred to as the TReatment of Social cognition in Schizophrenia Trial or TRuSST) is to compare SocialVille to an active control training condition, include a larger sample of patients, and assess both social cognitive functioning, and functional outcomes.Methods/DesignWe will employ a multi-site, longitudinal, blinded, randomized controlled trial (RCT) design with a target sample of 128 patients with schizophrenia. Patients will perform, at their home or in clinic, 40 sessions of either the SocialVille training program or an active control computer game condition. Each session will last for 40–45 minutes/day, performed 3–5 days a week, over 10–12 weeks, totaling to 30 hours of training. Patients will be assessed on a battery of social cognitive, social functioning and functional outcomes immediately before training, mid-way through training (after 20 training sessions) and at the completion of the 40 training sessions.DiscussionThe strengths of this protocol are that it tests an innovative, internet-based treatment that targets fundamental social cognitive deficits in schizophrenia, employs a highly sensitive and extensive battery of functional outcome measures, and incorporates a large sample size in an RCT design.Trial RegistrationClinicalTrials.gov NCT02246426Registered 16 September 2014

The social functional outcome of being naturalistically treated with paliperidone extended-release in patients with schizophrenia.

BackgroundSocial functioning is an important outcome for patients with schizophrenia. To evaluate the effects of paliperidone extended-release (PAL-ER) on social function, symptomatology, and safety in the routine clinical practice, we conducted a 1-year post-marketing surveillance study of PAL-ER. We also explored relationships between symptomatic improvement and socially functional outcome in patients with schizophrenia.Patients and methodsPatients with an established diagnosis of schizophrenia were allowed flexible 3–12 mg/day dosing during the surveillance. Patients were assessed on social functioning using the Social and Occupational Functioning Assessment Scale (SOFAS) and on symptomatology using the Clinical Global Impression–Schizophrenia scale. All adverse events (AEs) were also collected.ResultsA total of 1,429 patients were enrolled in the surveillance study, of whom 1,405 were evaluable for safety and 1,142 were evaluable for efficacy. The treatment discontinuation rate for any reason during the observation period was 34.66%. Significant improvements were observed on both Social and Occupational Functioning Assessment Scale and Clinical Global Impression–Schizophrenia scale during the observation period. The percentage of patients with socially functional remission (SOFAS ≥61) also increased significantly. A significant association between early improvements in positive symptoms, sex, severity of negative symptoms at baseline, and socially functional remission was observed. A total of 33.52% of patients had AEs and 8.75% of patients had serious AEs. Despite the recommendation of monotherapy with PAL-ER, 65.84% of patients were given additional antipsychotics (polypharmacy). Post hoc comparisons of monotherapy versus polypharmacy revealed that the monotherapy group had better outcomes and fewer AEs than the polypharmacy treated group. The improvement in social functioning and the rate of socially functional remission did not differ between groups.ConclusionPAL-ER treatment showed effective symptom control and improvement in social functioning. The data suggest that early response to antipsychotic treatment should be important for functional outcomes.

The Relationship Between Social Cognition and Functional Outcomes in Schizophrenia

Social cognition, an area of interest in schizophrenia research, has been related to functional outcomes. In this paper, we intended to determine if social cognition is impaired in individuals with schizophrenia (N=15), compared to controls (N=15) and to investigate the correlation between social cognition (measured with Narrative of Emotions Task), neurocognition (Montreal Cognitive Assessment) and functional outcomes (Role Functioning Scale, Independent Living Skills Survey). Our results suggest that higher levels of social cognition are related to better functioning in schizophrenia and that social cognition might have a specific influence, irrespective of the common processes it shares with neurocognition.

Improvement in Social Cognition and Functional Outcome After Group Cognitive Remediation Treatment (rehacop Program): a Randomized Controlled Trial

Deficits in social cognition are related to functional disability in schizophrenia. Therefore, new treatment programs should address these deficits in schizophrenia. The goal of this study was to test if neurocognition, social cognitive deficits and functional disability improve after group cognitive remediation with a neuropsychological tool: the REHACOP program. One hundred and one patients with schizophrenia were randomly allocated into experimental or control groups. The patients allocated on the experimental group (N= 52) received a group cognitive rehabilitation treatment using REHACOP. They attended 36 sessions of 90 minutes during three months. During the same time and frequency, patients under control condition (N=49) received Occupational activities. Both groups received treatment as usual (TAU). Patients underwent clinical, neuropsychological, social cognitive (Theory of mind, emotional perception, attributional style and social perception) and functional outcome (UPSA) pre- and post treatment assessments. Repeated measures of MANOVA showed that Group (REHACOP vs occupational therapy) x Time (pre vs post-treatment) interactions were significant for neurocognition total score (F=16.54, p<0.001), social perception (F=8.05, p<0.01), theory of mind (F=14.19, p<0.001) and UPSA (F=12.14, p<0.001) showing that experimental group obtained significant improvement when compared to controls. Attributional style did not show significant improvements. Our results suggest that REHACOP is an effective group cognitive remediation program for minimizing existing cognitive, social cognitive and functional disability.

The Role of Substance Abuse in Prediction of Long-term Outcome of Schizophrenia – Systematic Review and Meta-analysis

Background Alcohol and other substance use problems are common among individuals with schizophrenia. Objectives Many of the previous studies have focused on clinical comorbidity, not on longitudinal design. Aims The aim of this study was to investigate if premorbid or early substance use predicts long-term clinical and social course in schizophrenia. Methods A systematic review to identify potentially relevant studies was conducted. Studies with a follow-up period of at least two years were included. Following outcomes were studied: negative, positive and total symptoms, clinical remission, hospitalizations, social functioning, employment, and global outcome. Spearman's correlations were used to summarize results, negative correlations indicating poorer outcome with substance use. Results The search identified 10776 unique potentially relevant articles of which 25 studies met our inclusion criteria. The meta-analysis included 5 to 13 studies in each outcome category. Moderate to high heterogeneity was found between studies in each outcome group. In meta-analysis, substance use associated modestly with outcome. All the associations were non-significant and correlations between −0.06 and 0.09. Non-significant findings are explained by the fact that the original studies found often opposite results, indicating both worse and better long-term outcome for early substance users. Conclusions Although comorbid substance use associates with poorer outcome in schizophrenia, the early substance use has only a modest effect on long-term outcome. This difference to studies on current comorbidity may indicate that those who continue substance abuse have poor outcome, e.g. due to poor treatment adherence, whereas those who stop the abuse may have relatively good outcome.

Effect of treatment modality on long-term outcomes in attention-deficit/hyperactivity disorder: a systematic review.

BackgroundEvaluation of treatments for attention-deficit/hyperactivity disorder (ADHD) previously focused on symptom control, but attention has shifted to functional outcomes. The effect of different ADHD treatment periods and modalities (pharmacological, non-pharmacological, and combination) on long-term outcomes needs to be more comprehensively understood.MethodsA systematic search of 12 literature databases using Cochrane’s guidelines yielded 403 English-language peer-reviewed, primary studies reporting long-term outcomes (≥2 years). We evaluated relative effects of treatment modalities and durations and effect sizes of outcomes reported as statistically significantly improved with treatment.ResultsThe highest proportion of improved outcomes was reported with combination treatment (83% of outcomes). Among significantly improved outcomes, the largest effect sizes were found for combination treatment. The greatest improvements were associated with academic, self-esteem, or social function outcomes. A majority of outcomes improved regardless of age of treatment initiation (60%–75%) or treatment duration (62%–72%). Studies with short treatment duration had shorter follow-up times (mean 3.2 years total study length) than those with longer treatment durations (mean 7.1 years total study length). Studies with follow-up times <3 years reported benefit with treatment for 93% of outcomes, whereas those with follow-up times ≥3 years reported treatment benefit for 57% of outcomes. Post-hoc analysis indicated that this result was related to the measurement of outcomes at longer periods (3.2 versus 0.4 years) after treatment cessation in studies with longer total study length.ConclusionsWhile the majority of long-term outcomes of ADHD improve with all treatment modalities, the combination of pharmacological and non-pharmacological treatment was most consistently associated with improved long-term outcomes and large effect sizes. Older treatment initiation age or longer durations did not markedly affect proportion of improved outcomes reported, but measurement of outcomes long periods after treatment cessation may attenuate results.

Interventions for Attention-Deficit Hyperactivity Disorder: A Year in Review

Children diagnosed with attention-deficit/hyperactivity disorder (ADHD) experience core symptoms of inattention, hyperactivity, and/or impulsivity, which often result in difficulties in social and psychological functioning and poor outcomes. A wide variety of interventions exist to treat these symptoms and improve associated impairments; some better established than others. Compared to treatments used in isolation, the combination of psychosocial treatment and medication may yield incremental benefits and is highly recommended. Pharmacological interventions are often selected as one component of treatment for ADHD due to convincing evidence of their efficacy in reducing core ADHD symptoms. Psychosocial interventions, such as behavioral parent training (BPT), behavioral classroom interventions, and skills training also have shown benefit for children with ADHD, particularly with regard to improvements in overall functioning. Within the past year, many new studies and reviews have appeared proposing and evaluating new treatments or updates to existing treatments for ADHD. New developments include studies on gene response variability for medication treatment, parent friendship coaching, and cognitive training. This paper provides an up-to-date summary and critical analysis of both new and well-established ADHD interventions.

Bicultural Straddling Among Immigrant Adolescents: A Concept Analysis.

Increasing population diversity in the United States creates challenges for providing culturally responsive health care to immigrant adolescents. Nursing providers have few effective concepts to guide their understanding of how culturally diverse adolescents handle different cultural influences (between family and society) and how straddling two cultures may influence adolescents' decision making about health. Bicultural straddling is defined as an ongoing process of adaptation resulting from living within two different cultural influences. A concept analysis of bicultural straddling is important to nursing professionals in caring for culturally diverse adolescents. Walker and Avant's methodology was used to guide our understanding about how immigrant adolescents straddle cultural influences between their homes and society. Straddling two different cultures influences adolescents' health-related beliefs, attitudes, perceptions, and behaviors as they navigate everyday struggles to make informed health decisions. Adolescents' ability to achieve active straddling will allow them to experience positive social functioning, psychological development, and health outcomes. By understanding the ongoing process of "bicultural straddling" as a balancing act, nurse professionals can develop effective interventions to alleviate stress derived from acculturation among immigrant families and ultimately help adolescents achieve biculturalism.

Mismatch negativity, social cognition, and functional outcomes in patients after traumatic brain injury.

Mismatch negativity is generated automatically, and is an early monitoring indicator of neuronal integrity impairment and functional abnormality in patients with brain injury, leading to decline of cognitive function. Antipsychotic medication cannot affect mismatch negativity. The present study aimed to explore the relationships of mismatch negativity with neurocognition, daily life and social functional outcomes in patients after brain injury. Twelve patients with traumatic brain injury and 12 healthy controls were recruited in this study. We examined neurocognition with the Wechsler Adult Intelligence Scale-Revised China, and daily and social functional outcomes with the Activity of Daily Living Scale and Social Disability Screening Schedule, respectively. Mismatch negativity was analyzed from electroencephalogram recording. The results showed that mismatch negativity amplitudes decreased in patients with traumatic brain injury compared with healthy controls. Mismatch negativity amplitude was negatively correlated with measurements of neurocognition and positively correlated with functional outcomes in patients after traumatic brain injury. Further, the most significant positive correlations were found between mismatch negativity in the fronto-central region and measures of functional outcomes. The most significant positive correlations were also found between mismatch negativity at the FCz electrode and daily living function. Mismatch negativity amplitudes were extremely positively associated with Social Disability Screening Schedule scores at the Fz electrode in brain injury patients. These experimental findings suggest that mismatch negativity might efficiently reflect functional outcomes in patients after traumatic brain injury.

Future orientation and health quality of life in primary care: vitality as a mediator.

Temporal perspective, including views about future goals, may influence motivational processes related to health. An adaptive sense of future orientation is linked to better health, but little research has examined potential underlying factors, such as vitality. In a sample of 101 primary care patients, we examined whether belief in the changeability of the future was related to mental and physical energization and, in turn, to health-related quality of life. Participants were working, uninsured primary care patients, who completed self-report measures of future orientation, vitality, and health-related quality of life. Mediation models, covarying age, sex, and race/ethnicity indicated that vitality significantly mediated the association between future orientation and the outcomes of general health, mental health, social functioning, bodily pain, and role limitations due to emotional and physical reasons. Vitality exerted an indirect-only effect on the relation between future orientation and physical functioning. Our findings suggest that adaptive beliefs about the future may promote, or allow access to, physical and mental energy and, in turn, may result in better mental and physical health functioning. Individual-level and public health interventions designed to promote future orientation and vitality may beneficially influence quality of life and well-being.

Social cognition and functional outcome in schizophrenia: The moderating role of cardiac vagal tone.

Individuals with schizophrenia face significant challenges in daily functioning, and although social cognition predicts how well patients respond to these challenges, associated physiological mechanisms remain unspecified. The present study draws from polyvagal theory and tested the hypothesis that respiratory sinus arrhythmia (RSA), an established indicator of the capacity to self-regulate and adapt to environmental demands, combines with social cognition to predict functional outcome. Using data from 41 schizophrenia patients and 36 healthy comparison subjects, we replicated group differences in RSA and social cognition and also demonstrated that RSA and social cognition interact to predict how effectively patients manage work and independent living activities. Specifically, RSA did not enhance functional outcomes when social cognition was already strong, but higher levels of RSA enabled effective role functioning when social-cognitive performance was impaired. Jointly, RSA and social cognition accounted for 40% of the variance in outcome success, compared with 21% when evaluating social cognition alone. As polyvagal theory suggests, physiological flexibility and self-regulatory capacity may compensate for poorer social-cognitive skills among schizophrenia patients.

Social cognition and its relationship to functional outcomes in patients with sustained acquired brain injury.

Deficits in social cognition are common after traumatic brain injury (TBI). However, little is known about how such deficits affect functional outcomes. The purpose of this study was to investigate the relationship between social cognition and functional outcomes in patients with TBI. We studied this relationship in 20 patients with TBI over the course of 1 year post-injury. Patients completed neurocognitive assessments and social cognition tasks. The social cognition tasks included an emotion-perception task and three theory of mind tasks: the Faux Pas test, Reading the Mind in the Eyes (Eyes) test, and the Moving-Shapes paradigm. The Craig Handicap Assessment and Reporting Technique was used to assess functional outcomes. Compared with our database of normal subjects, patients showed impairments in all social cognition tasks. Multiple regression analysis revealed that theory of mind ability as measured by the Eyes test was the best predictor of the cognitive aspects of functional outcomes. The findings of this pilot study suggest that the degree to which a patient can predict what others are thinking is an important measure that can estimate functional outcomes over 1 year following TBI.

Randomized, controlled trial of Interpersonal and Social Rhythm Therapy for young people with bipolar disorder.

This randomized, controlled clinical trial compared the effect of interpersonal and social rhythm therapy (IPSRT) to that of specialist supportive care (SSC) on depressive outcomes (primary), social functioning, and mania outcomes over 26-78weeks in young people with bipolar disorder receiving psychopharmacological treatment. Subjects were aged 15-36years, recruited from a range of sources, and the patient groups included bipolar I disorder, bipolar II disorder, and bipolar disorder not otherwise specified. Exclusion criteria were minimal. Outcome measures were the Longitudinal Interval Follow-up Evaluation and the Social Adjustment Scale. Paired-sample t-tests were used to determine the significance of change from baseline to outcome period. Analyses of covariance were used to determine the impact of therapy, impact of lifetime and current comorbidity, interaction between comorbidity and therapy, and impact of age at study entry on depression. A group of 100 participants were randomized to IPSRT (n=49) or SSC (n=51). The majority had bipolar I disorder (78%) and were female (76%), with high levels of comorbidity. After treatment, both groups had improved depressive symptoms, social functioning, and manic symptoms. Contrary to our hypothesis, there was no significant difference between therapies. There was no impact of lifetime or current Axis I comorbidity or age at study entry. There was a relative impact of SSC for patients with current substance use disorder. IPSRT and SSC used as an adjunct to pharmacotherapy appear to be effective in reducing depressive and manic symptoms and improving social functioning in adolescents and young adults with bipolar disorder and high rates of comorbidity. Identifying effective treatments that particularly address depressive symptoms is important in reducing the burden of bipolar disorder.

Effects of mental health self-efficacy on outcomes of a mobile phone and web intervention for mild-to-moderate depression, anxiety and stress: secondary analysis of a randomised controlled trial

BackgroundOnline psychotherapy is clinically effective yet why, how, and for whom the effects are greatest remain largely unknown. In the present study, we examined whether mental health self-efficacy (MHSE), a construct derived from Bandura’s Social Learning Theory (SLT), influenced symptom and functional outcomes of a new mobile phone and web-based psychotherapy intervention for people with mild-to-moderate depression, anxiety and stress.MethodsSTUDY I: Data from 49 people with symptoms of depression, anxiety and/or stress in the mild-to-moderate range were used to examine the reliability and construct validity of a new measure of MHSE, the Mental Health Self-efficacy Scale (MHSES). STUDY II: We conducted a secondary analysis of data from a recently completed randomised controlled trial (N = 720) to evaluate whether MHSE effected post-intervention outcomes, as measured by the Depression, Anxiety and Stress Scales (DASS) and Work and Social Adjustment Scale (WSAS), for people with symptoms in the mild-to-moderate range.ResultsSTUDY I: The data established that the MHSES comprised a unitary factor, with acceptable internal reliability (Cronbach’s alpha = .89) and construct validity. STUDY II: The intervention group showed significantly greater improvement in MHSE at post-intervention relative to the control conditions (p’s < = .000). MHSE mediated the effects of the intervention on anxiety and stress symptoms. Furthermore, people with low pre-treatment MHSE reported the greatest post-intervention gains in depression, anxiety and overall distress. No effects were found for MHSE on work and social functioning.ConclusionMental health self-efficacy influences symptom outcomes of a self-guided mobile phone and web-based psychotherapeutic intervention and may itself be a worthwhile target to increase the effectiveness and efficiency of online treatment programs.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12610000625077.

Duration of untreated psychosis as predictor of long-term outcome in schizophrenia: systematic review and meta-analysis.

Duration of untreated psychosis (DUP) is one of the few potentially modifiable predictors of outcomes of schizophrenia. Long DUP as a predictor of poor short-term outcome has been addressed in previous meta-analyses, but the long-term effects of DUP remain unclear. To analyse the associations between DUP and long-term outcomes of schizophrenia. A systematic literature search was performed using seven electronic databases and manual searches. Random effects weighted meta-analysis with correlation coefficients was used to pool the results. We identified 3493 unique publications, from which 33 samples met our predefined selection criteria. Long DUP correlated statistically significantly with poor general symptomatic outcome, more severe positive and negative symptoms, lesser likelihood of remission and poor social functioning and global outcome (correlations 0.13-0.18). Long DUP was not associated with employment, quality of life or hospital treatment. The small but mostly consistent correlation between long DUP and poor outcome indicates that early intervention in psychosis may have at least subtle positive effects on the long-term course of illness.

Repetitive transcranial magnetic stimulation (rTMS) improves facial affect recognition in schizophrenia.

Facial affect recognition, a basic building block of social cognition, is often impaired in schizophrenia. Poor facial affect recognition is closely related to poor functional outcome; however, neither social cognitive impairments nor functional outcome are sufficiently improved by antipsychotic drug treatment alone. Adjunctive repetitive transcranial magnetic stimulation (rTMS) has been shown to enhance cognitive functioning in both healthy individuals and in people with neuropsychiatric disorders and to ameliorate clinical symptoms in psychiatric disorders, but its effects on social cognitive impairments in schizophrenia have not yet been studied. Therefore, we evaluated the effects of sham-controlled rTMS on facial affect recognition in patients with chronic schizophrenia. Inpatients (N = 36) on stable antipsychotic treatment were randomly assigned to double-blind high-frequency (10 Hz) rTMS or sham stimulation for a total of ten sessions over two weeks. In the verum group, each session consisted of 10 000 stimuli (20 trains of 5 s) applied over the left dorsolateral prefrontal cortex at 110% of motor threshold. Facial affect recognition was assessed before (T0) and after (T1) the ten sessions. Facial affect recognition improved significantly more after rTMS (accuracy change: mean = 8.9%, SD = 6.0%) than after sham stimulation (mean = 1.6%, SD = 3.5; Cohen's d = 1.45). There was no correlation with clinical improvement. Our results indicate that prefrontal 10 Hz rTMS stimulation may help to ameliorate impaired facial affect recognition in schizophrenia.