Anne-Kari Torgalsbøen

Neurocognitive predictors of remission of symptoms and social and role functioning in the early course of first-episode schizophrenia

In a Norwegian ongoing longitudinal study, we investigate the neurocognitive development in first-episode schizophrenia patients, and the influence of neurocognition on remission and real life functioning. In the present study, results from the early course of illness are reported. The sample includes 28 schizophrenia spectrum patients and 28 pairwise matched healthy controls. The patients were recruited from mental health service institutions and data on psychosocial functioning, remission and neurocognition were obtained through a clinical interview, an inventory on social and role functioning, operational criteria of remission, and a standardized neurocognitive test battery, the MATRICS Consensus Cognitive Battery (MCCB). Large effect size differences between patients and controls were observed at baseline on every cognitive domain, as well as statistically significant improvements on overall cognitive function at follow-up for the patient group. A remission rate of 61% was found. The neurocognitive baseline measure of Attention significantly predicted remission status at follow-up, whereas Attention and Working Memory at baseline predicted levels of social and role functioning. In the early course of the illness, more than half of the group of first-episode patients were in remission, and neurocognitive functions are significantly associated with both remission of symptoms and social and role functioning.

Sustaining full recovery in schizophrenia after 15 years: does resilience matter?

The main purpose of this study was to follow up a group of persons who, fifteen years ago were considered to be fully recovered from schizophrenia, in order to examine how many have sustained their recovery and to investigate the role of resilience in recovery. A semi-structured interview was designed for this 15-year follow-up study based on previous research related to the course and prognosis of schizophrenia. In addition to the interview, measures of psychosocial functioning and the degree of positive and negative symptoms were used. Remission and recovery were evaluated by consensus-based criteria. The Connor-Davidson Resilience Scale was chosen to assess resilience. The results show a significant correlation between resilience and present psychosocial functioning. There is also a significant difference between fully recovered subjects and those in remission regarding their resilience score. These results show that the majority of the subjects had maintained their recovery, and that subjects who are still fully recovered have not used medication for seventeen years and are more resilient. Thus, a sustained, full recovery without medication seems possible for a subgroup of schizophrenia patients characterized by high resilience.

“Full Recovery” from Schizophrenia in the Long Term: A Ten-Year Follow-Up of Eight Former Schizophrenic Patients

The present study reports longitudinal data on individuals who ten years ago were fully recovered from a previously diagnosed schizophrenia. Seven out of ten subjects consented and were reexamined at the present follow-up, and data on an eighth subject was secured elsewhere. A semistructured interview was used to examine psychosocial functioning of the subjects in the follow-up period. Out of the six subjects with a confirmed diagnosis of schizophrenia, only three subjects were still fully recovered; one had a deteriorating course and two had a fluctuating course of illness. The results from the study indicate that recovery from schizophrenia may take the form of time-limited remissions for half of the reexamined subjects when strict criteria for full recovery are used. Protective factors such as willpower, a (partly) intact capacity for object attachment, and a supportive family may be important prerequisites for recovery. Two different courses of schizophrenia are illustrated by cases.

Maintenance of recovery from schizophrenia at 20-year follow-up: what happened?

The present study reports longitudinal data on individuals who 20-years ago were fully recovered from previously diagnosed schizophrenia. Four subjects from the original sample consented and were interviewed at the present follow-up; data on two more subjects were secured elsewhere. A semistructured interview, the Positive and Negative Symptom Scale (PANSS) and Connor and Davidsons Resilience Scale (CD-RISC) were used to examine the psychosocial functioning and resilience of the subjects in the follow-up period. Out of the six subjects with a confirmed diagnosis of schizophrenia, two subjects were still fully recovered, one was recovered, one was in remission, one had a deteriorating course of illness, and one was deceased. The results indicate that full recovery was maintained for nearly half of the reexamined subjects when a criterion-based definition of full recovery is used. Good personality and attitudinal approaches (resilience) seem to play a role in sustaining recovery.

Passive/apathetic social withdrawal and active social avoidance in schizophrenia: difference in underlying psychological processes.

Objective: Social withdrawal, a core feature of negative symptoms, is differentiated into passive social withdrawal (PSW) and active social avoidance (ASA). We examined whether this differentiation was related to differences in underlying psychological processes of object relations and reality testing. Method: Two hundred seventy-two outpatients with schizophrenia and schizoaffective disorders from VA Connecticut Healthcare System/Connecticut Mental Health Center were evaluated using the Bell Object Relations and Reality Testing Inventory (BORRTI) and the Positive And Negative Symptoms Scale. Results: Distinct patterns were found; PSW was associated with object relation subscales explaining 5% of the variance, ASA was associated with object relations and all reality testing subscales explaining 12% of the variance. Conclusions: Findings suggest differences in the underlying mechanisms behind PSW and ASA, confirming that PSW is a primary negative symptom, while ASA is related more to positive symptoms.

Relationship between neurocognition and functional recovery in first-episode schizophrenia: Results from the second year of the Oslo multi-follow-up study

Lack of control of confounding variables, high attrition rate, and too few neurocognitive domains completed at each assessment point are some of the limitations identified in studies of the relationship between cognition and functional outcome in schizophrenia. In the ongoing Oslo multi-follow-up study 28 first episode schizophrenia patients and a pairwise matched control group (N=28) are assessed with the MATRICS Consensus Cognitive Battery (MCCB), a clinical interview, an inventory on social and role functioning and criteria of remission and recovery at several follow-up points. The current paper describes the rate of remission and full recovery, and investigates the relationship between neurocognition and functional outcome. At 2-year follow-up, 80.0% of the patients were in remission and 16.0% of them fulfilled the criteria for full recovery. The attrition rate was very low. In the follow-up period, there was a statistically significant decline in Verbal Learning and a significant improvement on Reasoning/Problem Solving and Social Cognition in the schizophrenia group, but not in the control group. This indicates a differentiated neurocognitive course. In the schizophrenia group, Attention/Vigilance and years of education at baseline were significant predictors of social and role functioning 2 years later.

Comorbidity in schizophrenia: a prognostic study of personality disorders in recovered and non-recovered schizophrenia patients.

Symptoms and outcome in schizophrenia are heterogeneous. Part of the variation in outcome might be due to the coexistence of other forms of psychopathology. In the present study the prevalence of personality disorders in a group of recovered and non-recovered schizophrenia patients was focused to examine the prognostic implications of comorbidity for the outcome of the disorder. The results showed no significant differences in prevalence of personality disorders in the two groups at first admission to the hospital, but the difference at the time of interview was close to significance. Emotional and conduct difficulties in adolescence were significantly more prevalent in the non-recovered group. Schizoid features and emotional and conduct disorders in childhood were also more often reported among the non-recovered subjects. The results confirm that comorbidity contributes to the variation in outcome for schizophrenia patients, but does not confirm its prognostic significance.

The relationship between level of cognitive impairments and functional outcome trajectories in first-episode schizophrenia

Although cognitive impairments are consistently linked to functional outcome in chronic schizophrenia, the relationship remains unclear for patients with first-episode schizophrenia. The objective of this present study was to determine whether there are distinct developmental trajectories for functional outcome in patients with different levels of baseline cognition. The present study has a multi-follow-up design, and includes data from six follow-ups over four years. Assessments were conducted yearly, apart from the first year where assessments were conducted every six months. A total of 28 patients with first-episode schizophrenia participated in the study, with 79% of patients retained at the 4-year follow-up. Cognition was assessed with MATRICS Consensus Cognitive Battery. Functional outcomes were obtained through Global functioning: Social and Global functioning: Role. Data were analyzed with linear multilevel models. Results suggest steady improvements in social and role functioning among the patients across the four year period. Baseline attention, verbal learning, and verbal working memory were significantly associated with social outcome. Role functioning was significantly associated with attention, verbal working memory, and reasoning/problem solving. Furthermore, the rate of change in social outcome varies among patients depending on their baseline level of attention and verbal working memory, with the lowest scoring group showing the least improvement over the years. The subgroup of patients with the largest cognitive impairments at the onset of the disorder shows limited improvements in social functioning compared to higher functioning groups.

Object Relations, Reality Testing, and Social Withdrawal in Schizophrenia and Bipolar Disorder

Abstract In this study, we investigated the relationships between observed social withdrawal (Positive and Negative Syndrome Scale [PANSS] Passive Social Withdrawal and PANSS Active Social Avoidance), subjectively experienced social withdrawal (Social Functioning Scale [SFS] Withdrawal and SFS Interpersonal Behavior), and their associations to the underlying psychological patterns of Object Relations and Reality Testing. Patients with schizophrenia (n = 55) and bipolar disorder (n = 51) from the ongoing Thematically Organized Psychosis project, Oslo University Hospital, Norway, were evaluated using the Bell Object Relations and Reality Testing Inventory, the PANSS, and the SFS. Object relations and reality testing subscales related differentially to PANSS Passive Social Withdrawal and PANSS Active Social Avoidance. These two measures, together with the level of alienation, explained a significant amount of variance in self-experienced social dysfunction. Findings reveal the multidimensional nature of social dysfunction in severe mental disorders.

Object relations and reality testing in schizophrenia, bipolar disorders, and healthy controls: differences in profiles and clinical correlates.

OBJECTIVE Deficits in object relations (OR) and reality testing (RT) functions are found in schizophrenia but have never been investigated in bipolar disorder. In the current study, we examine if there are OR and RT differences in schizophrenia and bipolar disorder compared to healthy controls and to what extent differences in clinical characteristics mediates the putative effect of diagnosis. METHODS We used the Bell Object Relation and Reality Testing Inventory (BORRTI) to measure OR and RT in schizophrenia (n = 55), bipolar disorder (n = 51) and healthy controls (n = 158). Diagnoses and the life time presence of psychotic symptoms were evaluated based on the Structured Clinical Interview for DSM-IV. We used the Positive And Negative Symptom Scale to measure current symptoms. RESULTS Analyses of variance with post hoc tests showed statistically significant differences in OR and RT between the Schizophrenia (SCZ), Bipolar Disorder (BD), and Healthy Control (HC) groups. Multiple regression analyses indicated that a lifetime history of psychotic symptoms contributed significantly to the variance in one BORRTI subscale (Social Incompetence) while Positive And Negative Symptom Scale components (either the positive component and emotional discomfort component) contributed significantly to the variance in all BORRTI subscales except one (Uncertainty of Perception). CONCLUSIONS OR and RT deficits are present both in SCZ and BD, but differences appears to be mediated by differences in current positive and depressive symptoms.