Anna-Karin Olsson

Psychometric properties of a performance-based measurement of functional capacity, the UCSD Performance-based Skills Assessment - Brief version

The UCSD Performance-based Skills Assessment - Brief version (UPSA-B) describes the functions of patients without negative influences of environmental factors such as unemployment or shortage in housing. The aim of the present study is to further explore the psychometric properties of the UPSA-B as well as to ensure that the Swedish version can be used in clinical practice and for research purposes. Participants were 211 patients, 135 men and 76 women, diagnosed with schizophrenia, schizoaffective disorder, or delusional disorder. Results indicate that the UPSA-B is a reliable instrument with good psychometric properties regarding validity and reliability. The instrument also had a capacity to reveal differences between various patient groups, both diagnostic groups and groups based on remission status. The conclusion drawn is that the UPSA-B is a valuable instrument that could be used in future cross-national studies to describe the level of functioning for patients with schizophrenia and other psychotic illnesses.

Family burden and functional assessment in the Swedish CLIPS-study: do staff and relatives agree on individuals with psychotic disorders' functional status?

PurposeIn this study, the individuals with psychotic disorders’ daily life function was investigated on six dimensions considering their relations to family burden. Functional ratings carried out by relatives and staff were also compared.MethodsTotally 88 relatives, to as many individuals diagnosed with a psychotic disorder, participated in this study. Relatives were to rate their own perceived burden and their ill relatives’ physical functioning, personal care skills, interpersonal relationships, social acceptability, activities, and work skills. The outpatient staff, in all 24 case managers also rated the patients’ functional level on the same assessment tool as did the relatives.ResultsMost dimensions of patients’ everyday functioning were highly correlated to relatives’ burden. The two functional dimensions “interpersonal relationships” and “activities” were best at classifying burden when rated by relatives. Also, comparing independent functional ratings by relatives and staff showed that despite great agreements on most dimensions, they differed significantly on “social acceptability” where relatives rated the function to be poorer and “activities” where relatives rated the function to be better.ConclusionsRelatives, who perceive individuals with a psychotic disorder to be limited in their ability to interpersonal relationships and limited in their ability to activate in everyday life, are more likely to perceive a higher burden. Even though staff and relatives mainly agree on the patients’ functional ability, they often differ in ratings regarding patients’ social acceptability and ability to activate in everyday life. This should be worth considering in clinical practice as well as in future research.

F116. CAN INSIGHT LEAD TO REMISSION - FOR PATIENTS WITH SCHIZOPHRENIA?

Abstract Background It is important to have extensive knowledge of the patients with schizophrenia, to provide the right support in outpatient care to create a good situation for the patient and prevent hospitalization. Lack of insight regarding the illness and symptoms might impair the patient’s ability to understand the illness, the treatment and relapses into psychotic episodes. Symptomatic remission is a well-established goal for treatment. If the core-symptoms do not affect their functions and the status is stable for at least six months, the patient is in remission. Previous research has shown an increased remission status from approximately 30% to more than 50% after using standardized remission criteria for patients with schizophrenia in Sweden. This study aims to investigate the relationship between both insight of symptoms and illness insight with cross-sectional remission. Methods This is a cross-sectional study and the participants consisted of totally 289 patients with schizophrenia diagnosis. Of the participants 111 were women and 178 were men, with a mean age of 47 years (19–83 years old). Using semi-structured interviews and evidence-based assessment scales Remission Scale - Symptom (RS-S) and Psychosis Evaluation Tool for Common use by Caregivers (PECC) the data is collected. Cross tabulations were used to compare the distribution of the variables and the Pearson Chi-Square Tests for examine significant association. Results Insight of symptom: The results show that from the patients who are not in remission, 69.5% are missing insight to symptoms, while 30.5% are having insight of symptoms. When it comes to the patients within remission, 59.0% have an insight of symptoms, while 41.0% are missing this sort of insight. The findings in the analysis with Chi-Square Tests examine independence indicated significant association between insight of symptoms and remission status (1, x2 = 22.17), p = <0,001, phi = -0.28. Insight of illness: During the analysis of insight of illness, the results show that from the patients who are in remission, 61.9% possess insight of illness, compared to 38.1% of the patients lacking insight of illness. Concerning the insight of illness for the patients who are not in remission, 68.2% lack insight of illness, while 31.8% possess insight of illness. The Chi-Square Tests examine independence indicated significant association between insight of illness and remission status (1, x2 = 24.28), p = <0.001, phi = -0.29. Discussion The results show that there is a relationship between insight of symptoms and illness with the cross-sectional symptomatic remission. However, the question is still open if remission is a consequence of insight or if the insight changes over time according to the activity of the illness. By following patients over time and monitoring the activity of symptoms including the state of remission and insight, it will probably be visualized if changes occur related to each other or independently. Also, whether the main focus for success is pharmaceutical treatment aiming for maximal symptom reduction or psychoeducational treatment to develop patients’ ability to understand their illness. Finally, whether insight after being established is a state or a treatment phenomenon? Further research to explore this issue is needed.

Positive and negative affect in schizophrenia spectrum disorders: A forgotten dimension?

Dysfunctional affectivity is common in schizophrenia spectrum disorders (SSD), and may influence quality of life, illness progression and treatment effects. This study describes Positive (PA) and Negative (NA) affect and their relationship to demographic and clinical variables in 135 individuals with SSD. Affect dimensions were assessed by the Positive and Negative Affect Schedule (PANAS). Stepwise regression analyses with affects as dependent variables and demographic and clinical factors as independent variables were performed. Relative to healthy norms, the participants exhibited lower PA and a similar NA level. The PA score was not influenced by demographic or clinical variables. The NA score was predicted by a combination of male gender, single status, and items of general psychopathology from the Positive and Negative Syndrome Scale (PANSS). There was no relation between affects and classical schizophrenia symptoms. In conclusion, the SSD patients exhibited abnormally low PA. The affect level was not influenced by psychosis symptom severity, indicating that the PANAS is a relatively unbiased rating tool of affective responding in SSD. Finally, male gender, single status and general distress were modestly related to NA.

Atypical sensory processing pattern following median or ulnar nerve injury — a case-control study

BackgroundDue to brain plasticity a transection of a median or ulnar nerve results in profound changes in the somatosensory areas in the brain. The permanent sensory deprivation after a peripheral nerve injury might influence the interaction between all senses.The aim of the study was to investigate if a median and/or ulnar nerve injury gives rise to a changed sensory processing pattern. In addition we examined if age at injury, injured nerve or time since injury influence the sensory processing pattern.MethodsFifty patients (40 men and 10 women, median age 43) operated due to a median and/or ulnar nerve injury were included. The patients completed the Adolescent/Adult Sensory Profile questionnaire, which includes a comprehensive characterization on how sensory information is processed and how an individual responds to multiple sensory modalities. AASP categorizes the results into four possible Quadrants of behavioral profiles (Q1-low registration, Q2-sensory seeking, Q3-sensory sensitivity and Q4-sensory avoiding). The results were compared to 209 healthy age and gender matched controls. Anova Matched Design was used for evaluation of differences between the patient group and the control group. Atypical sensory processing behavior was determined in relation to the normative distribution of the control group.ResultsSignificant difference was seen in Q1, low registration. 40% in the patient group scored atypically in this Quadrant compared to 16% of the controls. No correlation between atypical sensory processing pattern and age or time since injury was seen.ConclusionA peripheral nerve injury entails altered sensory processing pattern with increased proportion of patients with low registration to sensory stimulus overall. Our results can guide us into more client centered rehabilitation strategies.