Dragutin Ivanec

Temperament, character, and quality of life in patients with schizophrenia and their first-degree relatives

The aim of this study was to investigate the associations between the temperament, character dimensions, and quality of life (QOL) of patients with schizophrenia; their first-degree, nonaffected relatives; and healthy control subjects. One hundred twenty patients, the same number of first-degree relatives, and the same number of control subjects were assessed using the Temperament and Character Inventory and the Quality of Life Enjoyment and Satisfaction Questionnaire. Patients were also assessed using the Positive and Negative Syndrome Scale. Patients and relatives had a significantly lower QOL than control subjects, controlled for temperament and character dimensions. Patients scored significantly higher than control subjects in harm avoidance and self-transcendence and lower in novelty seeking and self-directedness. First-degree relatives had lower results for novelty seeking and scored higher on self-transcendence than control subjects. Harm avoidance, self-directedness, and self-transcendence were the dimensions of Temperament and Character Inventory shown to be the most significant predictors of QOL. Psychopathology and age were also significant predictors of QOL. Our understanding of an individual patients QOL must include personality evaluation.

Perception of Stigmatization in Forensic Patients With Schizophrenia

Background: The literature about perceived stigmatization of forensic patients with schizophrenia is sparse. Aims: To examine relations between the perceived stigmatization of forensic patients with schizophrenia and the intensity of the symptoms, age, regular home visiting, kind of offence, perceived family support and duration of hospitalization. Method: Sixty-two male forensic patients with schizophrenia were included. Perceived stigmatization was measured by the modified questions from the World Health Organization Disability Assessment Schedule II. Symptomatology was assessed with the Positive and Negative Syndrome Scale. Perception of family support was assessed with a visual-analogue scale. Due to different characteristics of offences and possibilities for home visiting, patients were divided into groups of those who had committed violent and non-violent offences, and those with and without the possibility of regular home visiting. Results: Symptoms have an impact on the perception of stigma. The kind of offence committed does not have a significant role in the perception of discrimination. Age was negatively correlated with the perception of stigma. Conclusion: Results might have significance for a better understanding of social relations between forensic patients and their environment and provide us with information about institutionalized forms of stigma. Results might have implications for the treatment and the quality of life of these patients.

Novelty seeking and medication adherence in patients with schizophrenia

The study explored the association between temperament and character and medication adherence in 76 patients with schizophrenia. Patients were assessed with the Temperament and Character Inventory, the Beck Depression Inventory, and the Positive and Negative Syndrome Scale. First-degree relatives were used as informants on adherence. The patients differed in their adherence based on the effect of gender, as males were found to be less adherent than females. Adherence differed based on novelty seeking. The temperament of the patient should be considered during the assessment of adherence.

Current suicidality and previous suicidal attempts in patients with schizophrenia are associated with different dimensions of temperament and character.

Suicide is a major public health problem and the leading cause of premature death in patients with schizophrenia. Information about the patients personality is helpful for assessing the risk of suicide attempts and suicidal ideation. The sample consisted of 120 outpatients with a diagnosis of schizophrenia, 29 of whom had previously attempted suicide. We used the Temperament and Character Inventory to assess personality differences between patients who had previously attempted and had not previously attempted suicide and between patients who had and did not have current suicidal ideation. Current suicidal ideation was assessed using the four-point severity scale, which is item nine from the Beck Depression Inventory. The character dimension Self-transcendence was shown by logistic regression to be a predictor of lifetime suicide attempts. Low Self-directedness was shown to be a predictor of current suicidal ideation. To prevent suicidal behaviour, it is important to better understand the personality traits associated with suicidal ideation and suicide attempts. Suicide attempts and suicidal ideation in schizophrenia may not represent the same phenomenon ranging on a single continuum. The importance of these results suggests that further study is needed.

Temperament and character in patients with schizophrenia with a history of restraint

In order to increase the quality of treatment and improve safety on psychiatric wards, we should learn more about characteristics of patients who are at an increased risk of being mechanically restrained. The aim of the present study, conducted in forensic patients with schizophrenia, was to assess whether there is an association between temperament and character and the patients’ experience of being mechanically restrained. We recruited 56 male forensic patients with schizophrenia, without concomitant substance dependence and antisocial personality disorder, of whom 64% had experienced restraint. Patients were assessed by the Temperament and Character Inventory and the Positive and Negative Syndrome Scale. The analysis has suggested that higher levels of the novelty-seeking and more intensive psychotic symptoms may represent risk factors for the use of restraints. We conclude that certain personality characteristics may enhance the risk for the use of restraints. It is important to better understand the patients’ personality traits associated with such practice.

Effect of expectation on pain assessment of lower- and higher-intensity stimuli

Abstract Background and aims Pain modulation via expectation is a well-documented phenomenon. So far it has been shown that expectations about effectiveness of a certain treatment enhance the effectiveness of different analgesics and of drug-free pain treatments. Also, studies demonstrate that people assess same-intensity stimuli differently, depending on the experimentally induced expectations regarding the characteristics of the stimuli. Prolonged effect of expectation on pain perception and possible symmetry in conditions of lower- and higher-intensity stimuli is yet to be studied. Aim of this study is to determine the effect of expectation on the perception of pain experimentally induced by the series of higher- and lower-intensity stimuli. Methods 192 healthy participants were assigned to four experimental groups differing by expectations regarding the intensity of painful stimuli series. Expectations of two groups were congruent with actual stimuli; one group expected and received lower-intensity stimuli and the other expected and received higher-intensity stimuli. Expectations of the remaining two groups were not congruent with actual stimuli; one group expected higher-intensity stimuli, but actually received lower-intensity stimuli while the other group expected lower-intensity stimuli, but in fact received higher-intensity ones. Each group received a series of 24 varied-intensity electrical stimuli rated by the participants on a 30° intensity scale. Results Expectation manipulation had statistically significant effect on pain intensity assessment. When expecting lower-intensity stimuli, the participants underestimated pain intensity and when expecting higher-intensity stimuli, they overestimated pain intensity. The effect size of expectations upon pain intensity assessment was equal for both lower- and higher-intensity stimuli. Conclusion The obtained results imply that expectation manipulation can achieve the desired effect of decreasing or increasing both slight and more severe pain for a longer period of time. Manipulation via expectation before the stimuli series was proven to be effective for pain modulation in the entire series of stimuli which lasted around 10 min. The results suggest a potential benefit of manipulating expectations to alleviate emerging pain, since the obtained effects are moderate to large. Implications It seems that expectation effect is strong enough to “overcome” even the direct effect of stimulus intensity (at least in the low to moderate intensity range), which suggests potential benefits of verbal instructions even in rather painful stimuli.

Effects of Psychological Distance and Need for Cognitive Closure on Impression Formation

ABSTRACT Based on theoretical and empirical similarities between Construal level theory of psychological distance and the Need for cognitive closure (NFC) theory, it could be hypothesized that psychological distance and NFC represent constructs that overlap to some degree. Since both theories describe judgmental behavior in terms of schematic processing, we hypothesized that primacy effect, a schema-driven phenomenon, is strengthened under the heightened NFC and psychological distance. We tested this hypothesis in an impression formation experiment while manipulating psychological distance and measuring NFC. Low NFC and psychological closeness reflect preference for situationally specific, contextually rich information, and therefore their joint effect resulted in reliance on all available information regardless of their position in a sequence. High NFC and psychological distance produced a preference for clear, schematic, stable knowledge, and therefore weighed first information more, which resulted in the primacy effect.

P03-530 - Religious coping in psychiatric patinets and their first-degree relatives

Objective The aim of the study was to examine the prevalence of religious coping among persons with schizophrenia, their first-degree relatives and control subjects and to gain a preliminary understanding of the relationship between religious coping, symptom severity, QOL, level of functioning, internalized stigma and depression. We also examine associations between psychopathology and religiosity in the group of patients. Methods A total of 120 outpatinets with diagnosis of schizophrenia, 120 their first-degree relatives who also were key caregivers, and 120 control subjects completed a survey consisting of the Religious Coping Index, Quality of Life Enjoyment and Satisfaction Questionnaire-Short Form, Beck Depression Inventory, Internalized Stigma of Mental Illness scale, Positive and Negative Symptom Scale and Global Assessment of Functioning scale. Results The results showed that patients and their relatives were more religious than controls but patients went to church less. Positive religious coping was not associated with illness outcomes, but negative religious coping was associated with worse quality of life, more depression, worse functioning and more internalized stigma. Higher religiosity was associated with higher values of altogether PANSS and positive and general subscales. Conclusions Our results suggest that religious activities and beliefs are particularly important for the persons with schizophrenia and their caring relatives. Negative religious coping is associated with worse illness outcomes.

767 ASSESSMENT OF PAIN IN OTHERS – SEARCHING FOR WHAT MATTERS

Background and Aims: The diagnosis of neuropathic pain is challenging and has therapeutic relevance. The Thai short-form McGill Pain Questionnaire is not specific for this pain type. The Thai DN4 needed physical examination. The ID Pain scale is brief, simple and valid for diagnosis of neuropathic pain. Aim of this study is to translate the ID Pain scale into Thai and validate this scale. Methods: The 6-item ID Pain scale was translated into Thai. Some wording was revised after a pilot study. The final version was tested in patients who have any type of pain including neuropathic. Sensitivity and specificity were calculated. The overall predictive accuracy was estimated using ROC curves. Results: One hundred patients participated in this study; 24 were neuropathic, 49 were nociceptive and 27 were mixed pain. Forty-six patients have chronic pain. Mean age of patient with neuropathic, nociceptive and mixed pain were 51.3±15.5, 51.3±15.2 and 53.9±13.7 years, respectively. Seventy-five were female. Sensitivity and specificity for diagnosis of neuropathic pain if total score ≥ 2 were 83% and 80%. Area under the ROC curve of the neuropathic, mixed and nociceptive pain groups were 0.890 (95% CI 0.824–0.955), 0.587 (95% CI 0.464–0.709) and 0.147 (95% CI 0.071–0.224), respectively. Conclusions: The Thai ID Pain is simple, valid, sensitive and accurate for diagnosis of neuropathic pain. The ID pain scale translation with permission from Professor Russell Portenoy, Department of Pain Medicine and Palliative Care, Beth Israel Medical Center, New York, NY, USA.