Fredrik Hjärthag

The Reading the Mind in the Eyes Test: Test–retest reliability of a Swedish version

Introduction. The Reading the Mind in the Eyes Test is a widely used facial affect recognition test. The present study aimed to provide Swedish nonpatient reference values, examine test–retest reliability, and to elucidate strengths and weaknesses of the instrument. Methods. A Swedish version of the test was completed by 158 university students. Fifty-eight participants completed the test twice, 3 weeks apart. The Bland Altman method was used to examine the test–retest reliability. Results. Distribution of responses of the 158 participants is detailed and compared with the English version. The limits of agreement was ±4.3. Conclusions. A test score variation in the range of ±4 (out of 24 possible) is to be expected for the same individual. When the Reading the Mind in the Eyes Test is used, one has to take into account that an obtained test score must be regarded as an approximation.

Illness-related components for the family burden of relatives to patients with psychotic illness

BackgroundPrevious research has shown that symptom severity often implies an increased family burden. Few other illness-related variables have, however, been investigated in this context. This study investigates how family burden is affected by symptom, function, and cognition, as well as how the patient perceives his/her illness and quality of life.MethodA total of 99 relatives, to as many patients diagnosed with psychosis and with their illness at a stable level, participated in this study. The relatives estimated their perceived burden, the patients rated the distress caused by their illness as well as the quality of their lives, and the care staff rated the patients’ symptom and function as well as tested their cognitive abilities.ResultsIncreased family burden can be tied to the patients’ increased symptom severity, to their impaired functioning as well as to the patients’ higher self ratings regarding distress. The family burden is also connected to the patient’s reduced working memory and reduced executive functioning, but this connection is not totally clear and should be further investigated. Of the variables that the patients were rated on, it was the overall functional ability measured with GAF that had the single most impact on perceived family burden.ConclusionsControlling of illness-related variables, such as symptoms, impaired functioning, impaired working memory and executive functioning, as well as the patients’ own experiences of distress, is important in order to lessen the burden for the relatives. All aspects of family burden are, however, not explained by these factors, which is why further research within this realm is required.

Social cognition impairments in Asperger syndrome and schizophrenia

Social cognition impairments are well described in both autism spectrum disorders, including Asperger syndrome (AS), and in schizophrenia spectrum disorders. However, little is known about whether there are differences between the two groups of disorders regarding this ability. The aim of this study was to compare social cognition abilities in AS and schizophrenia. Fifty-three individuals (26 men, 27 women) with a clinical diagnosis of AS, 36 (22 men, 14 women) with a clinical diagnosis of schizophrenic psychosis, and 50 non-clinical controls (19 men, 31 women) participated in the study. Clinical diagnoses were confirmed either by Structured Clinical Interview on DSM-IV diagnosis or the Diagnostic Interview for Social and Communication Disorders. Verbal ability was assessed using the Vocabulary subtest of the WAIS-III. Two social cognition instruments were used: Reading the Mind in the Eyes Test (Eyes Test) and the Animations Task. On the Eyes Test, patients with schizophrenia showed poorer results compared to non-clinical controls; however, no other group differences were seen. Both clinical groups scored significantly lower than the comparison group on the Animations Task. The AS group performed somewhat better than the schizophrenia group. Some differences were accounted for by gender effects. Implicit social cognition impairments appear to be at least as severe in schizophrenia as they are in AS. Possible gender differences have to be taken into account in future research on this topic.

The importance of cross-sectional remission in schizophrenia for long-term outcome: A clinical prospective study

INTRODUCTION This study examines the relationship between having achieved cross-sectional remission and the need for future psychiatric and nursing home care. The study is a prospective long-term follow-up of patients with schizophrenia. MATERIALS AND METHODS Cross-sectional remission was defined by applying the Positive and Negative Syndrome Scale (PANSS) criteria requiring that none of the eight core positive and negative symptom items are scored greater than mild. Patients are followed-up by yearly clinical examinations and medical record review. Information on consumption of healthcare resources and residency status were also gathered. Visits to mental health professionals, number and duration of inpatient psychiatric or nursing home admissions were also recorded. The patients are enrolled in a 12 year prospective study, the Clinical Long-term Investigation of Psychosis in Sweden (the CLIPS study). This report covers the first seven years. RESULTS Those patients who achieved cross-sectional remission at baseline had a lower total consumption of healthcare services than those who were not in remission. The latter group displayed higher values for all measured variables. DISCUSSION Our results show that cross-sectional remission is likely to be an important goal to achieve in order to reduce future treatment needs. Patients in remission live a more independent life and have better preconditions for functioning in society.

Psychometric properties of the burden inventory for relatives of persons with psychotic disturbances.

Earlier studies have shown that close relatives are heavily burdened when a family member has schizophrenia. The current purpose was twofold: (1) to examine the psychometric properties for a test of the burden of family members, one used in Swedish clinical practice (the Care Burden Scale for Relatives), and (2) develop a shortened version with the same or better psychometric properties. 99 close relatives, 34 men and 65 women of the same number of patients who had been diagnosed with schizophrenia, schizoaffective disorder, or delusional disorder, completed the Care Burden Scale for Relatives and a visual analog scale measuring perceived global burden on which the total burden was assessed. Patients of the close relatives were assessed on clinical tests often used in psychiatric care to validate the external criteria, such as severity of symptoms and level of functioning. The resulting version, the Burden Inventory for Relatives of persons with psychotic disturbances, showed good psychometric properties which simplifies data collection from relatives of patients with psychotic disturbances. In this study, relatives of those patients not in remission evinced a significantly greater family burden.

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.

Assessment of Distress and Quality of Life: A Comparison of Self-Assessments by Outpatients with a Schizopsychotic Illness and the Clinical Judgment of Nurses

The aim of this study was to investigate how self-assessments of perceived distress and quality of life in patients with schizopsychotic illness are associated with nurse assessments of symptoms, function and life situation. Data were obtained through interviews that used evidence-based rating and visual analogue self-rating scales. Descriptive statistics, correlation and regression analyses were used to process the data. The results demonstrated that the patient self-ratings did not correlate with the nurse assessments, and the perceived distress was not affected by remission status. The findings indicate that patient self-assessments are not a sufficient basis for decisions regarding appropriate treatment interventions.

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.

Cognitive performance, symptom severity, and survival among patients with schizophrenia spectrum disorder: A prospective 15-year study

Patients with schizophrenia have an average lifespan approximately 20 years shorter than the normal population. This study explored if there were any specific common characteristics among patients with schizophrenia spectrum disorder who died prematurely, compared to those who survived or died at a more normative age. The data were obtained from an ongoing twenty-year longitudinal study wherein 67 patients out of 501 participants had died at an average age of 60.5 years. Differences in baseline assessments of symptoms and cognitive ability were compared across patients who died during the time of the study and survivors. Symptom remission was assessed according to the Andreasen remission criteria as presented in 2005. Cognitive performance was assessed with a battery of instruments measuring vigilance, working memory, learning, short-term memory, and executive function. Two patients committed suicide and together they lowered the average lifespan of the study sample by only 0.27 years. The baseline assessments showed no difference in symptoms or remission status between patients who died and those who survived. This finding was in contrast to the cognitive baseline assessments where it was found that those who had died had performed more poorly in multiple domains, especially executive functioning, cognitive flexibility, learning and short-term memory. Survival analysis with Cox models showed that verbal memory and executive functioning were the most substantial independent predictors. Our study shows that although suicide was not a common cause of death, the average age of death is still young for this patient group and cannot be explained by differences in symptom severity. Our findings indicate that cognitive abilities might be of special interest for affective longevity in patients with schizophrenia, either as a marker of special risk or as a target for direct intervention.

What could be learned from a decade with standardized remission criteria in schizophrenia spectrum disorders : An exploratory follow-up study

A decade has passed since the standardized remission criteria of schizophrenia spectrum disorders-the Andreasen Criteria-were defined. Over 2000 studies have been published, but only a few describe symptomatic remission over time. In this prospective study we followed patients for 3 and 5years, respectively. The aim was to investigate how different symptoms affect the occurrence of remission and how the remission cut-off level affects remission sustainability. The participants were patients diagnosed with schizophrenia spectrum disorders (DSM-IV). First, the importance of each core symptom for remission was examined using the Positive and Negative Syndrome Scale (n=274). Second, we investigated which items affect patients to either go in and out of remission or never achieve remission (n=154). Third, we investigated how the sustainability of remission is affected by a cut-off set to 2 (minimal) and 3 (mild) points, respectively (n=154). All core symptoms affected the occurence of remission, to a higher or lesser extent. Delusions and Hallucinatory behavior contributed the strongest to fluctuation between remission and non-remission, while the contribution of Mannerism and posturing was very marginal. Negative symptoms were enhanced when remission was never achieved. Moreover, the study found that remission duration was significantly longer for the cut-off score 2 rather than 3. The study shows that, over time, remission criteria discriminate between being stable, unstable, or never in remission. Patients with only a minimal occurrence of symptom intensity exhibit a significantly longer remission duration compared to patients with mild symptom intensity, indicating that the treatment goal should be minimal symptom intensity.