Socio-occupational Functioning Research Articles

Cognitive Biases and Socio-Occupational Functioning Mediate the Relationship between Executive Functions and the Severity of Psychopathology among Young Adults with Psychotic-like Experiences: 1-Year Follow-Up Study.

The aim of this study was to investigate whether Trail Making Test (TMT) performance is associated with the severity of psychopathological symptoms related to psychosis among young adults with elevated level of psychotic-like experiences (PLEs), and whether this relationship is mediated by cognitive biases and socio-occupational functioning. A total of 187 subjects from a larger population of 6722 young adults participated in this 1-year follow-up study. The inclusion criteria were an elevated level of PLEs (the highest score of the Prodromal Questionnaire) and a lack of schizophrenia diagnosis. Eventually, 134 subjects (71.6%) completed the TMT, as well as the DACOBS scale (cognitive biases), at baseline and were examined twice using the CAARMS (psychopathology) and SOFAS (socio-occupational functioning) scales. In the first (I) and second (II) measurements, the calculated effects indicate indirect-only mediations, which explained 35 and 38% of the variance of the CAARMS. The TMT B execution time was positively associated with the DACOBS scale (β = 0.19, p = 0.028), which was negatively related to the SOFAS I (β = -0.37, p < 0.001) and SOFAS II (β = -0.20, p = 0.016) measurements. A lower score on the SOFAS I predicted a higher score on the CAARMS I (β = -0.50, p < 0.001), and a lower SOFAS II predicted a higher score on the CAARMS II (β = -0.61, p < 0.001). Subtle EF dysfunctions may, over time, translate into a greater severity of symptoms related to psychosis in people with elevated PLEs, and this is mediated by a deterioration of their metacognition and socio-occupational functioning.

Effect of combining social rhythm therapy to treatment of bipolar disorder versus treatment as usual: a comparative study on a sample of Egyptian patients

BackgroundBipolar disorder (BD) is a common mental illness that is usually associated with significant morbidity causing critical impairment in socio-occupational functioning and even mortality. Social rhythm therapy (SRT) has been suggested as an adjunctive psychotherapy in BD treatment protocols, with its proposed benefits of accelerating recovery from bipolar episodes, delaying relapses, and upgrading patients’ functioning. This study aimed to investigate the outcomes of combining SRT with pharmacological treatment, as compared to pharmacotherapy alone, in a sample of Egyptian BD patients. Sixty eligible bipolar patients were enrolled in this comparative study by convenience sampling and randomly divided into two groups for comparison; group I included 30 BD-I patients treated as usual (TAU) with pharmacological treatment only, while group II included 30 BD patients treated with social rhythm therapy in addition to the traditional psychotropic medications. Manic and depressive symptoms as well as socio-occupational functioning were assessed at baseline and after 3 months of treatment using the Mood Disorder Questionnaire (MDQ), Hamilton Depression Rating Scale (HDRS), and Socio-occupational Functioning Assessment Scale (SOFAS).ResultsPatients treated with SRT therapy showed significant improvement in their manic and depressive symptoms as well as socio-occupational functioning after 3 months of treatment by 65.76%, 55.87%, and 52.5%, respectively. Linear regression analysis showed that the gender and age of the patient could significantly predict improvement of MDQ% in group II, while none of the studied variables could significantly predict the percentage of change in HDRS or SOFAS.ConclusionSRT could be a promising adjunctive therapy promoting early recovery of BD patients compared to standalone pharmacological treatment.

Fronto-temporal cortical grey matter thickness and surface area in the at-risk mental state and recent-onset schizophrenia: a magnetic resonance imaging study

BackgroundStudies to date examining cortical thickness and surface area in young individuals At Risk Mental State (ARMS) of developing psychosis have revealed inconsistent findings, either reporting increased, decreased or no differences compared to mentally healthy individuals. The inconsistencies may be attributed to small sample sizes, varying age ranges, different ARMS identification criteria, lack of control for recreational substance use and antipsychotic pharmacotherapy, as well as different methods for deriving morphological brain measures.MethodsA surfaced-based approach was employed to calculate fronto-temporal cortical grey matter thickness and surface area derived from magnetic resonance imaging (MRI) data collected from 44 young antipsychotic-naïve ARMS individuals, 19 young people with recent onset schizophrenia, and 36 age-matched healthy volunteers. We conducted group comparisons of the morphological measures and explored their association with symptom severity, global and socio-occupational function levels, and the degree of alcohol and cannabis use in the ARMS group.ResultsGrey matter thickness and surface areas in ARMS individuals did not significantly differ from their age-matched healthy counterparts. However, reduced left-frontal grey matter thickness was correlated with greater symptom severity and lower function levels; the latter being also correlated with smaller left-frontal surface areas. ARMS individuals with more severe symptoms showed greater similarities to the recent onset schizophrenia group. The morphological measures in ARMS did not correlate with the lifetime level of alcohol or cannabis use.ConclusionsOur findings suggest that a decline in function levels and worsening mental state are associated with morphological changes in the left frontal cortex in ARMS but to a lesser extent than those seen in recent onset schizophrenia. Alcohol and cannabis use did not confound these findings. However, the cross-sectional nature of our study limits our ability to draw conclusions about the potential progressive nature of these morphological changes in ARMS.

Opioid use disorder and role of yoga as an adjunct in management (OUDARYAM): Study protocol for a randomized controlled trial.

The proposed research aims to test the effects and mechanisms of a six-month yoga-based intervention as an add-on to standard treatment in opioid use disorder (OUD) by conducting a randomized controlled study with the following primary outcome variables: 1) clinical: abstinence (opioid negative urine test), and reductions in pain and craving, and 2) mechanisms: reward circuit activation in response to opioid visual cue craving paradigm, activation in response to a cognitive control task, and resting state functional connectivity through fMRI, and plasma beta-endorphin levels. Secondary outcome variables are perceived stress, anxiety, sleep quality, cognitive performance, pain threshold, buprenorphine dosage and side effects, withdrawal symptoms, socio-occupational functioning, vedic personality traits, heart rate variability, serum cortisol, and brain GABA levels through magnetic resonance spectroscopy (MRS). In this single-blinded, randomized, controlled, parallel-group superiority trial with 1:1 allocation ratio, 164 patients with OUD availing the outpatient/ inpatient clinical services at a tertiary mental healthcare hospital in India will be enrolled after giving informed consent. Consecutive consenting patients will be randomly allotted to one of the two groups - yoga arm (standard treatment + yoga-based intervention), or waitlist group (standard treatment alone). Allocation concealment will be followed, the clinicians, outcome assessors and data analysts will remain blind to subject-group allocation. A validated and standardized yoga program for OUD will be used as an intervention. Participants in the yoga arm will receive 10 supervised in-person sessions of yoga in the initial two weeks followed by tele-yoga sessions thrice a week for the next 22 weeks. The wait-list control group will continue the standard treatment alone for 24 weeks. Assessments will be done at baseline, two weeks, 12 weeks, and 24 weeks. Data from all randomized subjects will be analysed using intent-to-treat analysis and mixed model multivariate analysis. Findings will be disseminated through peer-reviewed publication, conference presentations, and social media. The trial has been registered under Clinical Trials Registry-India with registration number CTRI/2023/03/050737.

Acceptance and Commitment Therapy in Managing Interference of Hallucinations

Abstract Schizophrenia is a disorder of thought and perception characterized by positive, negative, and cognitive symptoms; delusions, hallucinations, and negative symptoms are identified as the most common causes of suffering in schizophrenia. Multiple treatment approaches have aimed to deal with symptoms and disabilities caused by schizophrenia. Acceptance and commitment therapy (ACT) illuminates focusing on valued living without centering on symptoms, and alternately, it changes how an individual relates to his thoughts or feelings through awareness and increased psychological flexibility resulting in treatment outcomes. A 29-year-old graduate male have known schizophrenia since 2011, manifested decreased sleep, suspiciousness, the delusion of reference, thought broadcasting, and second, and third-person auditory hallucinations. A total of 30 sessions were taken in a span of 30–34 months that reduced the impact of hallucinations and resulted in significant improvement in personal and socio occupational functioning. His emotional insight helps him to set his goals and develop a plan to work toward them. ACT dissemination, in this case report, described how maximized attention on valued living elbowed the symptoms, reducing its role in day-to-day information processing and responding to the stimulus.

Cognitive Training in Obsessive-Compulsive Disorder: A Systematic Review.

Cognitive training (CT) for illness-linked neuropsychological deficits has been attempted in psychiatric disorders and, more recently, in obsessive-compulsive disorder (OCD). However, studies are few and far between, with a limited understanding of factors contributing to efficacy. This article aims to provide a comprehensive critical review of studies employing CT in OCD. This systematic review follows the Preferred Reporting of Items for Systematic Review and Meta-Analyses Protocols. Empirical studies that used any form of CT/remediation in individuals with OCD were included. Eight articles met the criteria for inclusion, of which five were randomized controlled trials, two were case series, and one was an open-label trial. The studies have predominantly demonstrated improved trained cognitive functions, with only two showing generalization to untrained domains like clinical symptoms and socio-occupational functioning. There are few controlled trials of CT in OCD, which limits conclusions of efficacy. Given the sparse research in the area, the review summarizes the current status of research and examines important methodological considerations that may inform future studies.

High-definition transcranial direct current stimulation for treating cognitive and negative symptoms in chronic schizophrenia – A sham-controlled proof of concept study

Objectives: Cognitive and negative symptoms are core symptoms of schizophrenia affecting interpersonal and socio-occupational functioning. Impaired dorsolateral prefrontal cortex (DLPFC) function is implicated in negative and cognitive symptoms. Conventional transcranial direct current stimulation (tDCS) to DLPFC has attracted interest as an add-on treatment for these symptoms. High-definition tDCS (HD-tDCS), an optimized form of tDCS, has the potential for more focalized neuromodulation. Studies suggest that an increased number of sessions may increase the effectiveness of stimulation. Hence, we aimed to evaluate the efficacy of 20 sessions of HD-tDCS over the left DLPFC in the improvement of cognitive and negative symptoms in chronic schizophrenia (&gt;2 years continuous illness). Material and Methods: Twenty patients with chronic schizophrenia with predominantly cognitive and negative symptoms were enrolled in this sham-controlled trial. Participants received 20 sessions of HD-tDCS at 2 mA for 20 min, that is, twice daily over 10 days. Montreal cognitive assessment and scale for assessment of negative symptoms were used to assess outcome variables. Assessments were carried out at baseline, 2 weeks, and 6 weeks, respectively. Results: Significant improvement was noted in both active and sham groups across all outcome variables over time. However, a statistically significant decrease in negative symptoms in the active group was noted, which was maintained at the end of 6 weeks, but there was no statistically significant improvement in cognitive symptoms between the active and sham groups at 6 weeks. The stimulation protocol was well tolerated. Conclusion: HD-tDCS has substantial potential in the treatment of negative symptoms; however, its role in cognitive symptoms needs further evaluation.

Life events in obsessive-compulsive disorder: A cross-sectional study

Background: Obsessive compulsive disorder (OCD) is a chronic psychiatric disorder having significant deterioration in patients’ socio-occupational functioning. Stressful life events (SLE) were noted before onset of this disorder. The previous study with Indian population found positive correlation between stressful and traumatic life events and OCD, but was with small sample size and thus result couldn’t be generalized. Aims and Objectives: The aim of the study was to examine the role of life events in patients with OCD and to find out correlation between them, if any. Materials and Methods: Consecutive 30 OPD patients fulfilling ICD-10 DCR criteria for OCD were rated with Yale Brown Obsessive Compulsive Scale (YBOCS), Hamilton Rating Scale for Depression (HAM-D), Hamilton Rating Scale for Anxiety (HAM-A), and Presumptive Stressful Life Events Scale (PSLES). A group of 30 healthy controls from unrelated patient party were also rated on PSLES. Finally, both groups were statistically compared in terms of life events. Results: Two groups were identical in distribution of age and sex. The frequency of life events, 1-year (P=0.000) and lifetime (P=0.000), were significantly higher in OCD group in comparison to healthy controls. There was significant positive correlation between PSLES scores and YBOCS scores. Step-wise linear regression analysis found positively predictability of PSLES score to OCD severity. Conclusion: OCD patients have statistically significant SLE before the onset of their disorder and total number of life events has positive correlation with severity of OCD.

Emotional scene processing in biotypes of psychosis

Social-emotional deficits in psychosis may be indexed by deviations in emotional scene processing, but event-related potential (ERP) studies indicate such deviations may not map cleanly to diagnostic categories. Neurobiologically defined psychosis subgroups offer an alternative that may better capture neurophysiological correlates of social-emotional deficits. The current study investigates emotional scene-elicited ERPs in Biotypes of psychosis in a large (N = 622), well-characterized sample. Electroencephalography was recorded in healthy persons (N = 129), Biotype-1 (N = 195), Biotype-2 (N = 131), and Biotype-3 (N = 167) psychosis cases. ERPs were measured from posterior and centroparietal scalp locations. Neural responses to emotional scenes were compared between healthy and psychosis groups. Multivariate group discrimination analyses resulted in two composite variates that differentiated groups. The first variate displayed large differences between low-cognition (Biotype-1, Biotype-2) and intact-cognition groups (Biotype-3, healthy persons). The second indicated a small-to-moderate distinction of Biotypes-2 and -3 from Biotype-1 and healthy persons. Two multivariate correlations were identified indicating associations between 1) self-reported emotional experience and generalized cognition and 2) socio-occupational functioning and late-stage emotional processing. Psychosis Biotypes displayed emotional processing deficits not apparent in DSM psychosis subgroups. Future translational research may benefit from exploring emotional scene processing in such neurobiologically-defined psychosis groups.

Psychotic symptoms and neurocognition among patients with major depressive disorder: A chained mediation model of depressive symptoms and socio-occupational functioning

BackgroundDepressive symptom and psychotic symptom have been identified as risk factors for impaired socio-occupational functioning in patients with major depressive disorder (MDD), while neurocognitive functioning is considered to be a potential protective factor against socio-occupational functioning. Nevertheless, little is known about the complex relationship among these factors in patients with MDD. The purpose of this research was to explore whether the relationship between depressive symptom severity and social-occupational functioning is mediated by neurocognitive functioning and psychotic symptom severity in MDD patients. MethodsA total of 659 eligible MDD patients included male and female, and their depressive symptoms and psychotic symptoms at baseline were assessed by the 17-item Hamilton Depression Scale (HAMD-17) and The Brief Psychiatric Rating Scale (BPRS) respectively. Cognitive domains were assessed by the MATRICS Consensus Cognitive Battery (MCCB), and subjective and objective functioning were measured by the Global Assessment of Functioning (GAF). LimitationThe analysis is cross-sectional, which limits causal inference. Result(1) The correlation between depressive symptoms and thought disturbance was positive (r = 0.125, p = 0.001), whereas the correlations with visual learning and memory (r = −0.146, p < 0.001) and socio-occupational functioning (r = −0.175, p < 0.001) were negative. (2) Depressive symptoms mainly affect the socio-occupational functioning of MDD patients via three indirect effects: the single mediating effect of psychotic symptoms and neurocognitive functioning, and the chain mediating effect of psychotic symptoms and neurocognitive functioning. ConclusionsThe results suggest that the relationship between depressive symptom severity and socio-occupational functioning in MDD patients is partially mediated by psychotic symptom severity and neurocognitive functioning.

An update on potential pharmacotherapies for cognitive impairment in bipolar disorder

ABSTRACT Introduction Cognitive impairment is a core feature of bipolar disorder (BD) that impedes recovery by preventing the return to optimal socio-occupational functioning and reducing quality of life. Presently, there are no efficacious treatments for cognitive impairment in BD, but many pharmacological interventions are being considered as they have the potential to target the underlying pathophysiology of the disorder. Areas covered This review summarizes the available evidence for pharmacological interventions for cognitive impairment in bipolar disorder. We searched PubMed, MedLine, and PsycInfo from inception to December 1st, 2022. Traditional treatments, such as lithium, anticonvulsants (lamotrigine), antipsychotics (aripiprazole, asenapine, cariprazine, lurasidone, and olanzapine), antidepressants (vortioxetine, fluoxetine, and tianeptine) and psychostimulants (modafinil), and emerging interventions, such as acetylcholinesterase inhibitors (galantamine and donepezil), dopamine agonists (pramipexole), erythropoietin, glucocorticoid receptor antagonists (mifepristone), immune modulators (infliximab, minocycline and doxycycline), ketamine, metabolic agents (insulin, metformin, and liraglutide), probiotic supplements, and Withania somnifera are discussed. Expert opinion The investigation of interventions for cognitive impairment in BD is a relatively under-researched area. In the past, methodological pitfalls in BD cognition trials have also been a critical limiting factor. Expanding on the existing literature and identifying novel pharmacological and non-pharmacological treatments for cognitive impairment in BD should be a priority.

Correlation between Negative Life Experiences and Auditory Hallucinations in Schizophrenia

IntroductionAuditory Hallucination(AH) is a core &amp; one of the most common symptom seen in schizophrenia. A prevalence study found that 1yr prevalence of AHs is 70% among patients of schizophrenia. Most theories of AHs discuss biological &amp; psychological factors in phenomenology of voices. There definitely is a role of biological &amp; neuroanatomical basis for occurrence of psychotic phenomenon &amp; AHs, however environment &amp; sociocultural background play important role in their genesis. It has been observed that theme of AHs is usually same, repetitive &amp; associated with past life experiences of patients. The Negative Life Experience(NLE) though not always have significant impact on patient’s psyche, may manifest sooner or later in mental illness. Although AHs may be comforting, helping to cope up with unacceptable unconscious conflict, most patients report them to be negative, distressing &amp; affecting socio-occupational functioning, thus making it important to understand &amp; treat them effectively. Often, AHs stays as a residual symptom with which patient has to deal throughout life. This study is an effort to bridge existing gaps for better understanding of AHs &amp; hence, Schizophrenia. It aims to understand effect of NLE on AHs, &amp; thereby contribute to aetiology &amp; therapeutic services to reduce distress of patients.ObjectivesThis study aims to find presence of history of past NLE in patients with schizophrenia having AHs, find a correlation between NLE &amp; the content of AHs &amp; hence to establish the role of sociocultural factors in phenomenology of AH in patients with schizophrenia.MethodsA longitudinal study of 30 patients diagnosed with Schizophrenia as per DSM-5 having AHs visiting Psychiatry Department of Government Hospital was carried out over a period of 2yrs. A quantitative study to find correlation between presence of NLE &amp; AH in patients and a qualitative study by in-depth interview of 10 patients with help of semi-structured questionnaire to understand phenomenology by procedures of interpretative phenomenological analysis was carried out.ResultsA positive statistically significant correlation between NLE &amp; content of AH was found. Majority of patients experienced AHs based on NLE in past &amp; heard voices related to it. Various themes such as Guilt, Fear, Inadequacy, Anger, Frustration surfaced during the qualitative study.ConclusionsThis study thus strengthens the holistic model where sociocultural factors with biological &amp; psychological factors play a role in pathogenesis of AHs. Treatment weighing on addressing NLE &amp; emotions attached to it may help in foreshortening recovery &amp; deal with residual AHs. This can help in therapeutic management of distress in patients, relieve internal conflict within their psyche, where they would feel more understood and learn to live with persistent AHs.Disclosure of InterestNone Declared

A cross-sectional study of sociodemographic profile, availability, pattern of use, and service utilization by opioid users in a tertiary care hospital

Background: The menace of substance abuse is not only socially unacceptable but also emerging as a major public health challenge in many States of India, including Rajasthan. Aims: The aim of this study is to study the sociodemographic profile, pattern of use, availability of opioids, and process of seeking treatment services for opioid dependence. Subjects and Methods: After ethical clearance, a cross-sectional observational study was carried out among those who fulfilled the screening criteria at a tertiary care hospital. A self-designed pro forma was used, which included a sociodemographic profile, drug use profile and pattern, behaviors and practices, service access, and the World Health Organization Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST). Results were analyzed using SPSS version 22. Results: The mean age of the participants was 41.25 (±12.4) years. The majority (98.3%) were males, married (91.7%), illiterate (33.3%), farmers (61.7%), 45.7% lived in Bikaner District, and 83.3% lived in rural areas. Crude opium was the most common drug used in the lifetime of 98% of users. The most common comorbid substance used was tobacco, used by 75% of them. In 85% of cases, opioid drugs were purchased with their own legal earnings. The major reasons for starting opioid drugs were peer pressure (38.3%), to relieve pain/stress (25%), and to increase physical stamina for work (33.3%). The majority (73.3%) of them had utilized services for deaddiction purposes earlier. Conclusion: The rural population in Western Rajasthan was highly affected by opium dependence. Participants were mainly low-potency opioid users without significant impairment in socio-occupational functioning, and their use was mainly to relieve stress and pain and to increase work capacity.

Attention Deficit Hyperactivity Disorder: What The Eyes Don’t See!!

Attention deficit hyperactivity disorder (ADHD) is the most common neuro-behavioral disorder characterized by a classical triad of hyperactivity-impulsivity and inattention prevalent in 5% of school-going children, mostly in boys. It is a chronic disorder with persistent of symptoms in a significant proportion of children diagnosed in childhood and impairing in most domains of socio-occupational functioning. Challenges in diagnosis occur due to symptoms domains of ADHD representing extremes of developmental processes of hyperactivity and inattention. Temperament is another construct that is important while evaluating a child with ADHD to avoid misdiagnosis and/or overdiagnosis. There is literature to support that the presentation of ADHD is not just limited to the triad of symptoms described in DSM 5, but it manifests a plethora of symptoms which, in the majority of cases, often go unnoticed. These symptoms may be a result of executive function deficits, emotion dysregulation, the presence of comorbid disorders, and/or psychosocial issues. Impairments of ADHD continue into adolescence and adulthood. However, ADHD in adults is still an under-researched area. The article aims to provide a bird’s eye view of the various hidden difficulties inherent in ADHD but which often is missed in clinical practice.

Feasibility of an Intervention Targeting Health through Exergaming as an Alternative to Routine Treatment (FIT HEART): protocol for a non-randomised two-armed pilot study

BackgroundDespite elevated risk of cardiometabolic disease among those with serious mental illness, and widespread recognition that physical activity interventions are required, there are multiple barriers to implementing typically recommended physical activity programmes in secure inpatient settings. Due to low mood, negative symptoms and poor socio-occupational functioning, psychiatric inpatients often lack motivation to engage in physical activity programmes. Moreover, regular access to outdoor spaces and exercise equipment is limited. As such, there is a need for novel physical activity interventions that are suitable for secure settings. This study aims to investigate the feasibility, acceptability and potential effectiveness of an intervention (exergaming) to promote physical activity among patients in a secure mental health setting.MethodsThis non-randomised, two-arm pilot study will employ a pre-test/post-test parallel group design, comparing the exergaming intervention with a “routine treatment” control. Two high-secure, sub-acute wards in the Long Bay Hospital Mental Health Unit will be non-randomly allocated to either the exergaming intervention or the “routine treatment” control group.The intervention group will receive a 12-week programme comprising three 30-min exergaming sessions per week using various Xbox KinectTM activity-based games designed to simulate moderate intensity exercise. The “routine treatment” group will continue to receive the standard model of care delivered by the Justice Health and Forensic Mental Health Network. Accelerometers will be distributed to all participants to collect daily energy expenditure, number of steps taken, intensity of physical activity and heart rate data throughout the study.The primary outcomes are (1) intervention feasibility and acceptability, and (2) baseline to post-intervention changes in physical health outcomes (levels of physical activity; cardiovascular fitness; clinical measures of cardiometabolic risk). Secondary outcomes are baseline to post-intervention changes in mental health outcomes (depression, anxiety, stress, positive psychiatric symptoms). Outcomes will be assessed at baseline, mid-intervention, and post-intervention.DiscussionThis research will contribute to evidence-based practice in the care of patients with serious mental illness: a vulnerable population with complex physical and mental health needs and a markedly elevated risk of cardiovascular disease. The findings will inform cardiovascular health promotion strategies and the implementation of physical activity interventions in secure inpatient settings.Trial registrationANZCTR, ACTRN12619000202167. Registered on 12 February 2019, https://www.anzctr.org.au. ANZCTR mandatory data items comply with the minimum dataset requirements of the World Health Organisation (WHO). The ANZCTR contributes trial registration data to the WHO International Clinical Trials Registry Platform (WHO ICTRP).

Psychometric Validation of the Athens Insomnia Scale Among Nurses: A Robust Approach Using Both Classical Theory and Rating Scale Model Parameters.

PurposeFew studies have investigated the validity of the Athens insomnia scale (AIS) using a robust approach of both classical theory and the rating scale model. Therefore, in this study, we investigated psychometric validation of the AIS using both of these approaches in nurses.MethodsNurses (n= 563, age= 33.2±7.1 years) working in health facilities in Saudi Arabia participated in a cross-sectional study. Participants completed the AIS, socio-demographics tool, and sleep health-related questions.ResultsConfirmatory factor analysis (CFA) favored a 2-factor structure with both comparative fit index (CFI), and incremental fit index (IFI) having values above 0.95. The 2-factor model had the lowest values of Akaike information criterion (AIC), root mean square error of approximation (RMSEA), χ2, and χ2/df. This 2-factor structure showed configural invariance (CFI more than 0.95, RMSEA less than 0.08, and Χ2/df less than 3), and metric, scalar, and strict invariance (based on Δ CFI ≤-0.01, and Δ RMSEA ≥ 0.015 criteria). No ceiling/floor effects were seen for the AIS total scores. Infit and outfit mean square values for all the items were within the acceptable range (<1.4, >0.6). The threshold estimates for each item were ordered as expected. Cronbach’s α for the AIS tool, factor-1 score, factor-2 score was 0.86, 0.82, and 0.72, respectively. AIS factor scores-1/2 were significantly associated with a habitual feeling of tiredness after usual night sleep (p<0.001), Impairment of daytime socio-occupational functioning (p<0.05), and with a feeling of daytime fatigue, irritability, and restlessness (p<0.05).ConclusionThe findings favor the validity of a 2-factor structure of the AIS with adequate item properties, convergent validity, and reliability in nurses.

Psychosocial functioning among current noninjecting opioid users: Is there any difference between methadone maintenance treatment and treatment as usual?

Background:Patients with opioid use disorder (OUD) have a significant problem in psychosocial functioning domains, which are not systematically studied in India. This study aimed to evaluate the psychosocial functioning in current noninjecting opioid users on Methadone Maintenance Treatment (MMT) versus Treatment as Usual (TaU: Chlordiazepoxide, Zolpidem, Trazodone, Tramadol, Tapentadol, and Buprenorphine).Materials and Methods:It is a cross-sectional study on patients of current noninjecting OUD on MMT or TaU for at least in the past month. Comorbidities and illness severity were assessed with the help of Mini-International Neuropsychiatric Interview 7.0.2 and World Health Organization-The Alcohol, Smoking, and Substance Involvement Screening Test 3.0, respectively. Social and occupational functioning assessment scale (SOFAS), WHO Quality of Life (WHOQoL-BREF), and Client Satisfaction Questionnaire (CSQ-8) assessed the sociooccupational functioning and QoL and client satisfaction. A total of 67 participants (37 on MMT and 30 on TaU) were included in the study.Results:A significant difference between the two groups (MMT better than TaU) was based on SOFAS scores, CSQ-8, and WHOQoL-BREF. In the TaU group, there was a significant negative correlation between risk of addiction severity with sociooccupational functioning (r = −0.5; P = 0.0046), physical health (r = −0.48; P = 0.0087) and social relationship (r = −0.47; P = 0.0087) domain of QoL. In the MMT group, the association between risk of addiction severity with sociooccupational functioning, domains of QoL, and client satisfaction were insignificant.Conclusion:Sociooccupational Functioning, Client Satisfaction, and QoL of patients maintained on MMT are better than those on TaU.

Association of clinical factors with socio-occupational functioning among individuals with schizophrenia.

Schizophrenia is assumed to be developing into a marked disability affecting performances in educational and vocational fields for both males and females. It is a psychiatric disorder that has been proven to be associated with poor occupational skills and functioning. This research aimed at studying the clinical correlates of socio-occupational functioning skills of persons with schizophrenia as per the ICD-10, DCR criteria. The is a cross-sectional descriptive study that included 200 participants diagnosed with schizophrenia, in which sociode mographic and clinical data sheet and Socio-occupational Functioning Scale (SOFS) by Saraswat et al. were used. Mean age of the participants was 34 years, with onset of illness being 24 years of age. The results indicated significant correlation at 0.05 level between the total score of SOFS and age of onset and duration of illness. It can be concluded that for a better treatment outcome in a disorder like schizophrenia, bio-psychosocial model of treatment is necessary.

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Introduction:Theory of mind (ToM) is the ability of a person to understand his and others’ mental states. It is part of social cognition and is known to affect patients of schizophrenia by declining their socio-occupational functioning. There continues a debate whether it is state dependent or a trait of schizophrenia and by far the results have been mixed.Aim:To assess ToM deficits in patients of schizophrenia and compare with their first-degree relatives (FDR) and healthy controls. Additionally, to identify the factors affecting the ToM in patients of schizophrenia.Methods:A cross-sectional comparative study to assess ToM deficits in 30 patients of schizophrenia in remission and their FDRs and compare them with healthy controls. Social Cognition Rating Tools in Indian Setting (SOCRATIS) was used to assess ToM. Positive and Negative Syndrome Scale (PANSS) was applied for assessment of severity of schizophrenia. The probable factors affecting ToM were also assessed.Results:43.33% cases had first order ToM deficit, 77.33% had second order ToM deficit and 93.33% cases had deficit in faux pas. FDRs performed poorly as compared to controls but not as poor as cases.Conclusion:The study shows that patients with schizophrenia have ToM deficits. These deficits are present even during remission, which could mean that ToM is not state dependent and is a trait marker of schizophrenia. FDRs also performed poorly on ToM tasks than healthy controls, which could mean that ToM is a possible endophenotype of schizophrenia.

Naturalistic study of “Adherence to Follow-Up” in the initial 1st year cohort of patients utilizing a tertiary hospital-based geriatric mental health-care service using the “Service Evaluation Framework”

Background: There are very few specialised hospital with quality assurance services catering to the needs of the elderly with mental illness. The concept of 'Appointment adherence' has received little attention in the field of geriatric mental health from India. There is a need to study the pattern of 'drop-out' amongst geriatric patients. Method: An initial cohort of first 105 cases presenting to the clinic were followed up to explore their socio-demographic and clinical variables, overall functioning and satisfaction with the services. Adopting a 'naturalistic approach,' and using the 'service evaluation framework', at the assessment period of about 36 months, tools like socio-clinical profile, Hindi Mental State Examination (HMSE), Everyday Abilities Scale for India (EASI), Global Assessment of Function (GAF) scale, WHOQOL-BREF-Hindi version, Patient Satisfaction Scale (PAT-SAT) and 'Service Evaluation (SSS-16 and SSS-10 Practitioner Versions)' were administered. Result: 68 cases were available for assessment of functional outcome and satisfaction parameters were assessed for 78 of the cases. 75% had functional disorders and medical morbidity was present in more than 50% of cases. The mean score for WHOQOL-BREF and GAF were 44.4 (poor quality of life) and 72.91 (slight impairment in socio-occupational functioning) respectively. PAT-SAT score in all the sub-categories were above average. 'Organic' diagnosis patients had lower QoL on certain domains compared to 'functional' patients. Only 30.47% patients were coming for follow-up with 25.71% having died. Of the 32/68 (34.29%) cases who had dropped out, 50% were adherent to treatment in different ways. Additionally, GAF scores were lower in 'drop-out' group. Conclusions: There is a relatively high rate of 'drop-out' over a 3-year period. However, if patients keep coming for follow-up (i.e. do not 'drop-out'), they are more likely to show improvement in their level of social and occupational functioning.