Daniel Reinharz

Cognitive predictors of psychosocial functioning outcome in schizophrenia: A follow-up study of subjects participating in a rehabilitation program

The aims of this prospective study were to explore in subjects with psychosis participating in a rehabilitation program whether cognitive performances at baseline predicted (i) psychosocial functioning over a 15-16 month follow-up; (ii) improvement in psychosocial functioning over the rehabilitation program. Visuo-spatial tests from the Cambridge Neuropsychological Test Automated Battery (CANTAB) were administered to assess cognitive performance in 55 subjects with schizophrenia spectrum disorders who completed a rehabilitation program. The Multnomah Community Ability Scale (MCAS) was used to measure dimensions of community functioning. One subscale of the Clients Assessment of Strengths, Interests, and Goals (CASIG) provided a measure of subjective quality of life (QoL). Improvement was defined as a 15% or more increase in psychosocial scores between baseline and follow-up. Worse baseline sustained attention predicted better self-rated quality of life, and better baseline visual memory predicted better community functioning over the rehabilitation follow-up period, in particular, higher autonomy in activities of daily living, and less physical and psychiatric symptoms that could interfere with rehabilitation. Baseline cognitive performances predicted community functioning improvement during the follow-up period: visual memory predicted improvement in daily living autonomy and in social competence; sustained attention predicted improvement in behavioral problems (such as medication compliance, collaboration with treatment providers or impulse control) and social competence; planning performances predicted improvement in social competence. These cognitive functions could be specifically targeted in a rehabilitation program aimed at enhancing functioning in those particular dimensions.

Self-assessed cognitive dysfunction and objective performance in outpatients with schizophrenia participating in a rehabilitation program

OBJECTIVE To explore the pattern of associations between self-assessed and objective neuropsychological performance in a sample of outpatients with schizophrenia participating in a rehabilitation program. METHOD The Subjective Scale to Investigate Cognition in Schizophrenia (SSTICS) [Compr. Psychiatry 44 (2003) 331] was used to assess cognitive complaints in 73 subjects with schizophrenia. Visuo-spatial tests of the Cambridge Neuropsychological Test Automated Battery (CANTAB) [Cogn. Neuropsychiatry 3 (1998) 45] were administered as objective measures. RESULTS Cognitive complaints in several cognitive domains were mainly correlated with a true difficulty in memory. Higher SSTICS attention scores, i.e. increased complaints, were associated with poorer CANTAB explicit visual memory and planning performances. Higher SSTICS executive functioning scores were associated with poorer CANTAB explicit visual memory scores. CONCLUSION These findings suggest that outpatients with schizophrenia express some cognitive difficulties. However, the cognitive nature of these subjective complaints does not strictly correspond with objective performances. These results also suggest that theoretical constructs of cognitive functions do not always have ecological validity. Thus, subjective cognitive complaints should be taken into account in assessment of patient well-being, but cannot be used as a substitute to objective cognitive measures. The simultaneous use of subjective and objective measures of cognitive dysfunction may provide a more complete picture of individual rehabilitation targets in patients with schizophrenia.

Comparison of different strategies in prenatal screening for Down's syndrome: cost effectiveness analysis of computer simulation.

Objectives To assess and compare the cost effectiveness of three different strategies for prenatal screening for Down’s syndrome (integrated test, sequential screening, and contingent screenings) and to determine the most useful cut-off values for risk. Design Computer simulations to study integrated, sequential, and contingent screening strategies with various cut-offs leading to 19 potential screening algorithms. Data sources The computer simulation was populated with data from the Serum Urine and Ultrasound Screening Study (SURUSS), real unit costs for healthcare interventions, and a population of 110 948 pregnancies from the province of Québec for the year 2001. Main outcome measures Cost effectiveness ratios, incremental cost effectiveness ratios, and screening options’ outcomes. Results The contingent screening strategy dominated all other screening options: it had the best cost effectiveness ratio (

Cognitive-Behavioral Treatment for Panic Disorder With Agoraphobia A Randomized, Controlled Trial and Cost-Effectiveness Analysis

C26 833 per case of Down’s syndrome) with fewer procedure related euploid miscarriages and unnecessary terminations (respectively, 6 and 16 per 100 000 pregnancies). It also outperformed serum screening at the second trimester. In terms of the incremental cost effectiveness ratio, contingent screening was still dominant: compared with screening based on maternal age alone, the savings were

A Pan-Canadian Evaluation of Supported Employment Programs Dedicated to People with Severe Mental Disorders

C30 963 per additional birth with Down’s syndrome averted. Contingent screening was the only screening strategy that offered early reassurance to the majority of women (77.81%) in first trimester and minimised costs by limiting retesting during the second trimester (21.05%). For the contingent and sequential screening strategies, the choice of cut-off value for risk in the first trimester test significantly affected the cost effectiveness ratios (respectively, from

Rapid testing versus karyotyping in Down's syndrome screening: cost-effectiveness and detection of clinically significant chromosome abnormalities

C26 833 to

Hereditary hemochromatosis screening: effect of mutation penetrance and prevalence on cost-effectiveness of testing algorithms.

C37 260 and from

A review of best work-absence management and return-to-work practices for workers with musculoskeletal or common mental disorders

C35 215 to

Patient, primary care physician and specialist expectations of primary care physician involvement in cancer care.

C45 314 per case of Down’s syndrome), the number of procedure related euploid miscarriages (from 6 to 46 and from 6 to 45 per 100 000 pregnancies), and the number of unnecessary terminations (from 16 to 26 and from 16 to 25 per 100 000 pregnancies). Conclusions Contingent screening, with a first trimester cut-off value for high risk of 1 in 9, is the preferred option for prenatal screening of women for pregnancies affected by Down’s syndrome.

Family Physician Involvement in Cancer Care Follow-up: The Experience of a Cohort of Patients With Lung Cancer

A randomized, controlled trial was conducted to examine the cost-effectiveness of cognitive-behavioral treatment (CBT) for panic disorder with agoraphobia. A total of 100 participants were randomly assigned to standard (n = 33), group (n = 35), and brief (n = 32) treatment conditions. Results show significant clinical and statistical improvement on standard symptom measures and quality of life from baseline to posttreatment and 3-month follow-up, with no significant differences between treatment conditions. Compared with standard CBT, brief and group CBT incurred lower treatment costs and had a superior cost-effectiveness ratio, suggesting the potential of these alternative treatment conditions in increasing access to effective treatment.